Lords amendment: No. 46, in page 41, line 9, after "54" insert
"(Amendments of certain controls in relation to the provision of pharmaceutical services)"
§ Mr. John MacKay
I beg to move, That this House doth disagree with the Lords in the said amendment.
§ Mr. Deputy Speaker
With this, we may take the following Lords amendments: No. 61, in the Title, line 5, leave out "and".
No. 62, in the Title, line 5, after "stocks" insert
and the control of pharmaceutical services".
§ Mr. MacKay
The amendments were consequential to a new clause on pharmaceutical services which was inserted in another place and subsequently deleted. The amendments therefore no longer serve any purpose and should also be deleted.
§ Mr. Ewing
I expected a much better and more extensive explanation from the Minister. Perhaps he had to drop his children off at school today and did not have time to get properly briefed on the background to this matter.
My hon. Friend the Member for Glasgow, Garscadden (Mr. Dewar) thanked the Minister for something that had been inserted on Report in another place, and I am grateful to the other place for deleting on Report something that was inserted during the Committee stage there. This is a much more important matter than the Minister conveyed with his few brief and curt remarks. The background must be explained for the benefit of the House and, particularly, the public.
The Government have been negotiating a new contract with the pharmaceutical societies in England and Wales and in Scotland. As part of that, a deal has been struck that pharmacies that dispense fewer than 1,300 prescriptions a month will be subject to a buy-out arrangement which is to be jointly financed by the pharmaceutical societies and the Government. Such an arrangement would have had far-reaching effects in many parts of Scotland and may yet have such effects if the Government introduce primary legislation to implement a contract whose terms we have not yet seen in writing. There are 290 pharmacies in Scotland that dispense fewer than 1,300 prescriptions a month, and most of them are in rural areas.
The hon. Member for Stirling (Mr. Forsyth) is not present. I do not make a point of that, but it was interesting to note that the day after the Government suffered the defeat that led to the House being recommended to reject these amendments, the hon. Member tabled an early-day motion — which still stands on the Order Paper, supported by a fair number of Tory Members — congratulating the other place on the defeat that it had inflicted on the Govenment and the removal from the Bill of the provisions to which the Ministry briefly referred.
725 I must make it clear to the Minister that what happened in this case is not acceptable. The Department of Health and Social Security in England and Wales backed away from this proposal, on legal advice. The DHSS had intended to pursue the proposal, but it took legal advice and announced that it would deal with the matter through primary legislation. I took that to mean legislation in the next Session, though that was not stated specifically. The Scottish Office knows full well that the Department of Health and Social Security in England and Wales has been given legal advice against going ahead with it at this stage, and that the matter should be dealt with in primary legislation. Once again, the Scottish Office is prepared to subject the people of Scotland to something from which the Government have backed away in England and Wales. In passing, may I say that this seems to be revaluation all over again.
I have made inquiries and tried to obtain a copy of the negotiated contract, but I understand that it is not yet in written form. I am trying to be as gentle as I can with the Minister. But it is important that, as soon as the contract is in written form, copies are placed in the Library so that hon. Members on both sides of the House can see in detail what the contract means for pharmacists in their constituencies. The loss of 290 pharmacies in Scotland is not acceptable.
I am not saying that if and when the legislation is introduced Opposition Members will oppose it root and branch. Although I cannot speak for Conservative Members, I suspect that sonic will share our view that the legislation will be judged not with regard to the interests of the pharmacists, and even less the interests of the Government's spending programmes, but on its benefit or damage to patients or consumers.
For the past three years Scottish Members—this does not apply to English Members— have been receiving letters from constituents about proposals to close the school of pharmacy at Heriott Watt university. We have sent those letters to Ministers and received the standard reply—that it is part of the Government's attempt to cut public expenditure. I accept that answer, but what makes me so angry is the attempt to bring the measure in through the back door. There is a conspiracy between the Pharmaceutical Society of Great Britain and the Government to limit the number of students entering pharmacy school. That conspiracy has led to proposals for the closure of the school of pharmacy at Heriott Watt university. The contract extends throughout the United Kingdom.
There is a provision to set up pharmacy committees for each area health board in Scotland and for the equivalent in England and Wales. The pharmacy committees are to have extensive powers. The committee will consist of three local pharmacists, three members of the area health board and an independent chairman. How independent is independent? It is difficult to understand who could be an independent chairman in those circumstances. The committees will he all-powerful. The pharmacy committee will decide whether an application to receive a National Health Service contract is granted. The committee will also have the right to lay down conditions and standards that the pharmacist and, I suspect, his premises must meet before the contract is granted. There would be no appeal against the decision of the pharmacy committee.
I appreciate that you have been very tolerant with me. Mr. Deputy Speaker. This issue is far too important to be 726 allowed merely to slip past tonight without any comment on the background to the reasons why the Government have urged the House to disagree with the Lords amendments.
I am grateful for the opportunity to alert hon. Members on both sides of the House to what is going on. The legislation will not only affect Labour constituencies. I do not wish to be political about this, which will surprise the Minister, but the strong balance of probability is that it will have a greater and more devastating effect in Conservative constituencies—although it will affect my constituency. I wish to give a warning and fire a shot across the bows of the Minister and his colleagues. By the time this legislation is introduced, the Government will have been forgiven for dragging it in through the back door. It will be judged not on the back-door methods, but en the advantages or disadvantages to the patients who have their prescriptions dispensed at pharmacies.
§ Mr. Roger Gale (Thanet, North)
The hon. Member for Falkirk, East (Mr. Ewing) is right about the amendments having greater significance than might appear at first, but he is wrong in many other respects.
The amendments have a profound effect on the pharmaceutical business in the whole of the United Kingdom, not only in Scotland. The defeat last week in the other place is a defeat not for the Government but. sadly, for the community and the rural pharmacies. For the past two years the national pharmaceutical negotiating committee in England and Wales and its Scottish equivalent have been negotiating jointly with the Department of Health and Social Security, the Minister for Health and my hon. Friend the Under-Secretary of State for Scotland.
I am sure you will recall, Mr. Deputy Speaker, that in the small hours of a winter morning, I raised the future of the community and rural pharmacists on an Adjournment debate. I am sorry that the hon. Member for Falkirk, East was not present to hear it. At that time, there was grave concern, as there still is, for the future of the community and rural pharmacists. Pharmacists felt that the negotiations for their future contract were unduly prolonged, that no end was in sight, and that as a result many association members were likely to suffer severe financial hardship and, in some cases, bankruptcy. The negotiations continue. Before the summer recess an agreement was reached between the two negotiating committees in Scotland and in ngland and Wales with the respective Ministers. A new contract was drawn up that was endorsed overwhelmingly by pharmacists. The contract covered not only remuneration but the service that pharmacists wish to provide to the community. It is absolutely correct to say that the provisions of the new contract would have had an effect on some pharmacists who issued fewer than 16,000 scrips a year. As the hon. Member for Falkirk, East rightly said, 300 pharmacists would undoubtedly have suffered severely financially. As I understand it, there was no suggestion of an enforced buy-out——.
§ 6 pm
§ Mr. Ewing
The hon. Gentleman covered the point that I wanted to raise in an intervention. It relates to a difference of opinion between us. He speaks of "compensation" while I speak of a "buy-out". The documents from the Scottish Office and other sources make it clear that the buy-out was to be financed jointly by the Government and the Pharmaceutical Society. The Pharmaceutical Society would not have made the contribution expected of it unless its remaining members would receive substantial improvements in their remuneration and income.
§ Mr. Gale
Like the hon. Gentleman, I, too, must confess that I have not seen the contracts and, therefore, we are both working a little in the dark. However, the representatives of the negotiating committee have assured me that its members were satisfied with the options offered, and that there was to be no compulsion of any kind, but an offer of compensation for those who wished to take it. Nevertheless, I take the hon. Gentleman's point.
In addition to that arrangement, provision was made to deal with a problem which was and still is escalating—the leapfrogging of pharmacists closer to doctors' surgeries. That mitigates heavily against rural pharmacists —exactly those to whom the hon. Gentleman referred. When a pharmacist opens a shop he takes business from another pharmacist half a mile from the surgery, who in turn has a choice either to move closer to the surgery or to go to the wall. The poor rural pharmacist and genuine community pharmacist who provide extremely valuable service—as I serve a partly rural constituency I am well aware of this—are in dire trouble. They came to me mid-winter last year seeking assistance because their foreseeable future, if not destroyed, had been severely threatened by the failure to pass the legislation.
In addition to the agreements, the Department and the Scottish Office decided to introduce through the family practitioner committee and the pharmaceutical services negotiating committee in Scotland regulations to allow those respective committees to license, not existing, but new pharmacies, to put an end to leapfrogging and to prevent the further extension of what is rapidly becoming nonsense for the Health Service and those who seek to practise. This clause would have dealt with that.
A relevant side issue is that the result of the negotiations would have meant a £4 million a year saving for the Health Service. That sum was to be ploughed back into exactly the kind of further benefits which pharmacists wished, and still wish, to provide —counselling services, assistant pharmacists, and other benefits for the entire community, rural and otherwise. That agreement was reached for Scotland, England and Wales prior to the summer recess, and pharmacists confidently expected that those regulations would be in force by now.
My hon. Friend the Minister for Health took further legal advice and decided that he did not have the power to introduce the regulations. My hon. Friend the Scottish Minister with responsibility for health took advantage of the legislation before the House to have introduced in the other place a clause which would at least have given the Scottish Office the power to allow Scottish pharmacists to take the lead, as Scotland so often does. In that way the new contract would at least have been introduced in Scotland. However, because of the machinations of Lord Ross and others the baby has been thrown out with the bath 728 water, and Scottish pharmacists will not only not get their new contract, which has been under negotiation for two years, as has the English and Welsh one, but will not even be brought into line with United Kingdom legislation. As I said, that is a defeat not for the Government, but for pharmacists and, therefore, the communities that they serve.
If my hon. Friend the Minister bumps into the Secretary of State for Social Services, will he mention that hon. Members who represent English and Welsh constituencies are worried at the outcome of the matter, and wait with bated breath to know what new moves will be taken to resolve the negotiating difficulties that pharmacists face? Will my hon. Friend be kind enough to tell the House tonight how he and his Department propose to resolve the problem for the Scottish pharmacists who have been badly let down in another place?.
§ Mr. James Wallace (Orkney and Shetland)
In the narrow issue before the House I agree with the Minister that we should disagree with the Lords amendment. This is merely a tidying up matter, consequential on the main vote of the other place last week. I am informed that, apart from the Lord Advocate, no one was prepared to speak in favour of the clause.
The hon. Members for Thanet, North (Mr. Gale) and for Falkirk, East (Mr. Ewing) told the House why the step taken in the other place was correct. It appears that the Department decided that the matter could not be dealt with during the present Session, and probably required primary legislation, and that Scotland would be bounced into accepting the measure through a late amendment tabled in the other place. Although the matter is being debated this evening, it is not subject to the scrutiny that would have occurred if it had been part of the original Bill. It would have been extensively debated on Second Reading, in Committee—members of the Committee will agree that on the whole our debates were constructive—and on Report before reaching the other place.
The hon. Member for Thanet, North made it clear that the measures were important and wide-ranging. He accepted the principal criticism of the hon. Member for Falkirk, East that the proposals would hit hard pharmacists in sparsely populated rural areas such as the one I represent. In Orkney and Shetland, where there are no pharmacists for many miles, doctors must already dispense prescriptions. I continue to receive letters from those doctors. The limited list has put them in an invidious position, and they find that they must prescribe privately for patients when the drug that a patient requires is not on the list. Many doctors find that wholly unacceptable, and it goes against the grain. That serves to illustrate the important consequences which would have followed had the amendment not been defeated in another place. I believe that it is incumbent on the Minister to tell us what the Government's intentions are and not to leave us with his brief but correct opening remarks.
§ Mr. John Hannam (Exeter)
I shall be brief in speaking in support of my hon. Friend the Member for Thanet, North (Mr. Gale). The decision that was taken in another place will have far-reaching implications. I shall not deal with Scottish matters because I know that the problems are different there.
If the contract applied to the issuing of new NHS pharmacy contracts, the many small pharmacists who it is 729 thought might lose their pharmacies would be reduced considerably. I know that in England and Wales the numbers are low—they amount to 30 or 40—but the figures that have been quoted for Scotland are extremely high. I accept that there may be special considerations when dealing with Scotland.
It would seem that the problem is acute. The negotiations that have taken place to try to secure agreement on the contracts were approved unanimously by the general council of the Pharmaceutical Society, which included Scottish interests. It is important that we achieve some resolution of what will be an ongoing problem throughout Scotland, England and Wales.
I hope that my hon. Friend the Under-Secretary of State will give us some inkling of the Government's intentions. The objectives are to secure a better use of NHS resources and a properly controlled network of pharmacies throughout the country, and to overcome the difficulties which have developed over the years, especially with rural pharmacies. I hope that my hon. Friend will give a fuller explanation of the Government's legislative plans.
§ Mr. John MacKay
As the hon. Member for Orkney and Shetland (Mr. Wallace) said, I did not say too much in my remarks when asking the House to disagree with the Lords in the amendment. The amendments that we are discussing are extremely small or limited and arise because I am not asking the House to agree with the amendments which were made in another place. Their Lordships chose not to accept the Government's invitation to amend these provisions in a certain way when the Bill was before them.
As there has been a discussion this evening, I shall say a few words about the amendments. My hon. Friends the Members for Thanet, North (Mr. Gale) and for Exeter (Mr. Hannam) have a greater grasp of the issue than the hon. Member for Orkney and Shetland. The hon. Member for Falkirk, East (Mr. Ewing) has decided to keep his options open by telling the House that he was not exactly asking the Opposition to vote against any legislation that will be forthcoming.
The principle of the clause, which was defeated in another place, was to provide the Secretary of State for Scotland with the power to make regulations modifying the health boards' obligation to admit to their pharmaceutical lists every qualified person who asks for admission. That was what the clause provided. If that clause had been passed in another place, any regulations made under it would have been subject to the negative resolution procedure and thus the House would have been able to debate the regulations. I do not think that we were rushing through Parliament a proposal that would have prevented the regulations from being discussed. The regulations were the all-important factor.
I think that all Scottish Members received a letter from the Pharmaceutical General Council of Scotland dated 18 October. Colin Virden, the secretary, wrotethe proposals in the Minister's new contract package have the unanimous support of the Pharmaceutical General Council, which represents retail pharmacists throughout Scotland".Equally, the Pharmaceutical Society of Great Britain, Scottish Department, has confirmed support for the proposed legislation, which it considers would be greatly to the benefit of both the public and the profession in Scotland.
730 The new contract provides for compensation to small pharmacies which are uneconomical from the point of view of the contractor and from that of the Health Service which are run by pharmacists who wish to terminate their NHS contracts. There would have been provision for compensation. That could have been done, but in the absence of the clause that we invited those in another place to insert there was a danger that someone could have taken compensation and then applied for automatic readmission to the lists. I do not think that hon. Members, especially those on the Opposition Benches, who are for ever telling us how important the Health Service is, would want to see NHS resources used in that wasteful manner.
The Government and the profession have a shared commitment to providing an NHS pharmaceutical service where it best meets the needs of the patients. We believe that the proposed new contract arrangements would have done that. We contend that they would have ensured a network of pharmacies where necessary and in a way that would be desirable for patient care without extravagant use of NHS resources.
The greatest misconception was voiced by the hon. Member for Orkney and Shetland, who said that all rural pharmacies would suffer. That is not so. There would be safeguards covering the financing of essential small pharmacies, which are mainly but not exclusively in rural areas, by means of special funding arrangements. As my hon. Friend the Member for Thanet, North said, the idea of making admission to the lists non-automatic was to prevent leapfrogging, which can affect adversely the small pharmacies about which many hon. Members are worried.
§ Mr. Ewing
I am sure that the Minister would not want to mislead the House. However, he is giving the impression that the arrangements for essential pharmacies. are contained in the new contract without explaining that for a considerable time there have been arrangements to finance essential pharmacies through the essential pharmacy allowance. Those arrangements are to continue and they are not part of the new contract. No one should be under any misapprehension about that.
§ Mr. MacKay
I am not denying that. I did not imply that those arrangements did not exist. However, the accusation has been made that if the new contract came into being the protection of and help for small rural pharmacies would no longer exist. I am saying that that is not true. The financing of essential rural services would be continued by means of special funding arrangements.
My hon. Friends the Members for Thanet, North and for Exeter want to know what the Government intend to do in the situation in which my right hon. Friend the Secretary of State for Social Services and I find ourselves. We remain fully committed to the recent agreements on a new NHS contract for community pharmacists. We intend to introduce at the earliest possible opportunity the legislation that is necessary to control entry to the pharmaceutical list. Any new legislation will cover the agreements reached in England and Wales and those in Scotland and Northern Ireland. I cannot predict when it will be possible to introduce such legislation.
§ Question put and disagreed to.
§ Lords amendment: No. 47, in page 41, line 9, after "28" insert "and 28B".731
§ The Solicitor-General for Scotland
I beg to move, That this House doth agree with the Lords in the said amendment.
§ Mr. Speaker
With this it will. be convenient to discuss Lords amendment No. 56, in page 48, line 32, at end insert—