15 Apr 2013 : Column 129

Simon Hughes (Bermondsey and Old Southwark) (LD): Let me say to my hon. Friend and to those on the Treasury Bench that his announcement about a general anti-tax avoidance provision is hugely welcome, particularly in London, where people have seen companies get away with not paying taxes for many years—something that no previous Government have adequately dealt with. It is very welcome and we look forward to it becoming law as soon as possible.

Sajid Javid: I welcome my right hon. Friend’s support for the measure.

This Finance Bill includes measures to close 15 loopholes that have been used to avoid tax. Nine of these provisions have immediate effect from Budget day, and one—on tackling stamp duty avoidance—is backdated to the previous Budget, following the Chancellor's clear warning in 2012. This demonstrates the Government’s continuing commitment to fast, effective and targeted action to tackle avoidance. In addition, we are strengthening the successful disclosure of the tax avoidance schemes regime to increase the information that promoters of tax avoidance schemes have to provide about the users of their schemes. Together with the GAAR, these measures will increase tax revenues by almost £l billion by 2017-18, as well as protecting future revenues. In addition, the Government are investing almost £1 billion in HMRC’s compliance activities in order to raise additional revenues of £22 billion per annum by the end of 2014-15. This represents £9 billion more in compliance revenues—a 70% per cent increase since 2010-11.

This Finance Bill introduces a package of measures to ensure that owners of high-value properties cannot avoid paying their fair share of tax by placing their property in a corporate envelope. From April, residential properties held by certain non-natural persons that are worth more than £2 million will be subject to a new annual tax on enveloped dwellings. The Bill also introduces a new capital gains tax charge on these non-natural persons disposing of such high-value properties from April 2013.

Allow me, Mr Speaker, to draw my remarks to a close. [Hon. Members: “Hear, hear!”] I thought that that would bring a cheer. Finance Bill 2013 is a Bill for growth and fairness. It encourages investment, it supports innovation and entrepreneurs, it provides real help to families and working people, it tackles avoidance, and it asks those who are better off to pay more. I commend it to the House.

Question put, That the Bill be now read a Second time.

The House divided:

Ayes 321, Noes 249.

Division No. 201]


10.13 pm


Adams, Nigel

Afriyie, Adam

Aldous, Peter

Alexander, rh Danny

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, rh Gregory

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Bingham, Andrew

Binley, Mr Brian

Birtwistle, Gordon

Blackman, Bob

Blunt, Mr Crispin

Boles, Nick

Bone, Mr Peter

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brokenshire, James

Brooke, Annette

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Burstow, rh Paul

Burt, Lorely

Byles, Dan

Cable, rh Vince

Cairns, Alun

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Chishti, Rehman

Clappison, Mr James

Clark, rh Greg

Clarke, rh Mr Kenneth

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crabb, Stephen

Crockart, Mike

Crouch, Tracey

Davey, rh Mr Edward

Davies, David T. C.


Davies, Glyn

Davies, Philip

Davis, rh Mr David

de Bois, Nick

Dinenage, Caroline

Djanogly, Mr Jonathan

Dorrell, rh Mr Stephen

Dorries, Nadine

Doyle-Price, Jackie

Drax, Richard

Duddridge, James

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Ellis, Michael

Ellison, Jane

Elphicke, Charlie

Eustice, George

Evans, Graham

Evans, Jonathan

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Featherstone, Lynne

Field, Mark

Foster, rh Mr Don

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fuller, Richard

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

Gibb, Mr Nick

Gilbert, Stephen

Gillan, rh Mrs Cheryl

Glen, John

Goldsmith, Zac

Goodwill, Mr Robert

Gove, rh Michael

Graham, Richard

Grant, Mrs Helen

Gray, Mr James

Grayling, rh Chris

Green, rh Damian

Greening, rh Justine

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Halfon, Robert

Hammond, rh Mr Philip

Hammond, Stephen

Hancock, Matthew

Hands, Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Oliver

Heath, Mr David

Hemming, John

Henderson, Gordon

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Horwood, Martin

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunt, rh Mr Jeremy

Huppert, Dr Julian

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Javid, Sajid

Jenkin, Mr Bernard

Johnson, Gareth

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kirby, Simon

Knight, rh Mr Greg

Kwarteng, Kwasi

Laing, Mrs Eleanor

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Leech, Mr John

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Lewis, Dr Julian

Liddell-Grainger, Mr Ian

Lidington, rh Mr David

Lilley, rh Mr Peter

Lloyd, Stephen

Lopresti, Jack

Lord, Jonathan

Loughton, Tim

Luff, Peter

Lumley, Karen

Macleod, Mary

Main, Mrs Anne

Maude, rh Mr Francis

May, rh Mrs Theresa

Maynard, Paul

McCartney, Jason

McCartney, Karl

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McPartland, Stephen

McVey, Esther

Menzies, Mark

Mercer, Patrick

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Moore, rh Michael

Mordaunt, Penny

Morgan, Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Mundell, rh David

Munt, Tessa

Murray, Sheryll

Murrison, Dr Andrew

Neill, Robert

Newmark, Mr Brooks

Newton, Sarah

Nokes, Caroline

Nuttall, Mr David

O'Brien, Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Osborne, rh Mr George

Ottaway, Richard

Paice, rh Sir James

Parish, Neil

Patel, Priti

Pawsey, Mark

Penning, Mike

Penrose, John

Percy, Andrew

Phillips, Stephen

Pickles, rh Mr Eric

Pincher, Christopher

Poulter, Dr Daniel

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Raab, Mr Dominic

Randall, rh Mr John

Reckless, Mark

Redwood, rh Mr John

Rees-Mogg, Jacob

Reevell, Simon

Reid, Mr Alan

Rifkind, rh Sir Malcolm

Robathan, rh Mr Andrew

Robertson, rh Hugh

Robertson, Mr Laurence

Rosindell, Andrew

Rudd, Amber

Ruffley, Mr David

Russell, Sir Bob

Rutley, David

Sanders, Mr Adrian

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shapps, rh Grant

Sharma, Alok

Shelbrooke, Alec

Shepherd, Sir Richard

Simpson, Mr Keith

Skidmore, Chris

Smith, Miss Chloe

Smith, Henry

Smith, Julian

Smith, Sir Robert

Soames, rh Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stunell, rh Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Syms, Mr Robert

Tapsell, rh Sir Peter

Teather, Sarah

Thornton, Mike

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Turner, Mr Andrew

Tyrie, Mr Andrew

Uppal, Paul

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Villiers, rh Mrs Theresa

Walker, Mr Charles

Walker, Mr Robin

Wallace, Mr Ben

Ward, Mr David

Watkinson, Dame Angela

Weatherley, Mike

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Roger

Williams, Stephen

Williamson, Gavin

Wilson, Mr Rob

Wollaston, Dr Sarah

Wright, Jeremy

Wright, Simon

Yeo, Mr Tim

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Ayes:

Mark Hunter


Joseph Johnson


Abbott, Ms Diane

Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Ali, Rushanara

Allen, Mr Graham

Anderson, Mr David

Ashworth, Jonathan

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Banks, Gordon

Barron, rh Mr Kevin

Bayley, Hugh

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Benton, Mr Joe

Berger, Luciana

Betts, Mr Clive

Blackman-Woods, Roberta

Blears, rh Hazel

Blenkinsop, Tom

Blomfield, Paul

Blunkett, rh Mr David

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Campbell, Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Chapman, Jenny

Clark, Katy

Clarke, rh Mr Tom

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Connarty, Michael

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Dakin, Nic

Danczuk, Simon

David, Wayne

Davidson, Mr Ian

Davies, Geraint

De Piero, Gloria

Denham, rh Mr John

Dobbin, Jim

Dobson, rh Frank

Docherty, Thomas

Dodds, rh Mr Nigel

Donaldson, rh Mr Jeffrey M.

Donohoe, Mr Brian H.

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Farrelly, Paul

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Fovargue, Yvonne

Francis, Dr Hywel

Galloway, George

Gapes, Mike

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goggins, rh Paul

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hamilton, Mr David

Hamilton, Fabian

Hanson, rh Mr David

Harman, rh Ms Harriet

Harris, Mr Tom

Havard, Mr Dai

Healey, rh John

Hendrick, Mark

Hepburn, Mr Stephen

Hillier, Meg

Hilling, Julie

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hopkins, Kelvin

Hosie, Stewart

Howarth, rh Mr George

Hunt, Tristram

Irranca-Davies, Huw

Jackson, Glenda

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Helen

Jones, Mr Kevan

Jones, Susan Elan

Jowell, rh Dame Tessa

Joyce, Eric

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lammy, rh Mr David

Lavery, Ian

Lazarowicz, Mark

Leslie, Chris

Lewis, Mr Ivan

Llwyd, rh Mr Elfyn

Long, Naomi

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

MacNeil, Mr Angus Brendan

Mactaggart, Fiona

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Mann, John

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McClymont, Gregg

McCrea, Dr William

McDonagh, Siobhain

McDonald, Andy

McDonnell, John

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

Meacher, rh Mr Michael

Mearns, Ian

Miller, Andrew

Mitchell, Austin

Moon, Mrs Madeleine

Morden, Jessica

Morrice, Graeme


Morris, Grahame M.


Mudie, Mr George

Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Pearce, Teresa

Perkins, Toby

Pound, Stephen

Powell, Lucy

Qureshi, Yasmin

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reed, Steve

Reynolds, Emma

Riordan, Mrs Linda

Ritchie, Ms Margaret

Robertson, Angus

Robertson, John

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, rh Mr Andrew

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Thornberry, Emily

Trickett, Jon

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watson, Mr Tom

Watts, Mr Dave

Weir, Mr Mike

Whiteford, Dr Eilidh

Whitehead, Dr Alan

Williams, Hywel

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Winterton, rh Ms Rosie

Wishart, Pete

Woodcock, John

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Noes:

Lyn Brown


Heidi Alexander

Question accordingly agreed to.

15 Apr 2013 : Column 130

15 Apr 2013 : Column 131

15 Apr 2013 : Column 132

15 Apr 2013 : Column 133

Bill read a Second time.

15 Apr 2013 : Column 134

Finance (No.2) Bill (Programme)

Motion made, and Question put forthwith (Standing Order No. 83A(7)).

That the following provisions shall apply to the Finance (No. 2) Bill:


1. The following shall be committed to a Committee of the whole House—

(a) Clauses 1, 3, 16, 183, 184 and 200 to 212;

(b) Schedules 3 and 41;

(c) any new Clauses, and any new Schedules, first appearing on the Order Paper not later than Tuesday 16 April 2013 and relating to tax measures concerning housing; and

(d) any new Clauses, and any new Schedules, relating to value added tax or the bank levy or air passenger duty or the subject matter of Clauses 1 and 16 and Schedule 3 or the subject matter of Clause 3 or the subject matter of Clauses 203 to 212 and Schedule 41.

2. The remainder of the Bill shall be committed to a Public Bill Committee.

Proceedings in Committee

3.–(1) Proceedings in Committee of the whole House shall be completed in two days.

(2) Those proceedings shall be taken on each of those days as shown in the first column of the following table and in the order so shown.

(3) Each part of the proceedings shall (so far as not previously concluded) be brought to a conclusion at the time specified in relation to it in the second column of the Table.

(4) Standing Order No. 83B (programming committees) shall not apply to proceedings in Committee of the whole House.



Time for conclusion of proceedings

First day


New Clauses and new Schedules relating to tax measures concerning housing.

Two hours after the commencement of proceedings on the Bill.

New Clauses and new Schedules relating to the bank levy; Clauses 200 to 202.

Four and a half hours after the commencement of proceedings on the Bill.

New Clauses and new Schedules relating to the subject matter of Clauses 203 to 212 and Schedule 41; Clauses 203 to 212; Schedule 41.

Seven hours after the commencement of proceedings on the Bill.

Second day


New Clauses and new Schedules relating to the subject matter of Clauses 1 and 16 and Schedule 3; Clauses 1 and 16; Schedule 3.

Two hours after the commencement of proceedings on the Bill.

New Clauses and new Schedules relating to value added tax or the subject matter of Clause 3; Clause 3.

Four and a half hours after the commencement of proceedings on the Bill.

New Clauses and new Schedules relating to air passenger duty; Clauses 183 and 184.

Six and a half hours after the commencement of proceedings on the Bill.

4.–(1) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 20 June 2013.

(2) The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

15 Apr 2013 : Column 135

5. When the provisions of the Bill considered, respectively, by the Committee of the whole House and by the Public Bill Committee have been reported to the House, the Bill shall be proceeded with as if it had been reported as a whole to the House from the Public Bill Committee.

Consideration and Third Reading

6. Proceedings on Consideration and on Third Reading shall be completed in two days.

7. Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading. —(Anne Milton.)

Question agreed to.

finance (no. 2) bill (Carry-over)

Motion made, and Question put forthwith (Standing Order No. 80B(1)(a)),

That if, at the conclusion of this Session of Parliament, proceedings on the Finance (No. 2) Bill have not been completed, they shall be resumed in the next Session.—(Anne Milton.)

Question agreed to.

Children and Families Bill (Programme) (No. 2)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the Order of 25 February 2013 (Children and Families Bill (Programme)) be varied as follows:

In paragraph 2 of the Order (conclusion of proceedings in Public Bill Committee) for ‘Tuesday 23 April 2013’ substitute ‘Thursday 25 April 2013’.—(Anne Milton.)

Question agreed to.

Financial Assistance to Industry


That the Motion in the name of Secretary Vince Cable relating to Financial Assistance to Industry shall be treated as if it related to an instrument subject to the provisions of Standing Order

15 Apr 2013 : Column 136

No. 118 (Delegated Legislation Committees) in respect of which notice has been given that the instrument be approved.—

(Anne Milton.)

Section 5 of the European Communities (Amendment) Act 1993

Motion made,

That, for the purposes of its approval under section 5 of the European Communities (Amendment) Act 1993, the Government’s assessment as set out in the Budget Report shall be treated as if it were an instrument subject to the provisions of Standing Order No. 118 (Delegated Legislation Committees).—(Anne Milton.)

Hon. Members: Object.

Sittings of the House

Motion made,

That, on Wednesday 17 April—

(1) the House shall meet at 2.30 pm and the moment of interruption shall be at 10.00 pm;

(2) notwithstanding the provisions of Standing Order No. 21 (Time for taking questions), no questions shall be taken other than questions which are in the Speaker’s opinion of an urgent character and relate either to matters of public importance or to the arrangement of business;

(3) the sitting in Westminster Hall shall begin at 2.30 pm and continue for up to four and a half hours; and

(4) in calculating the period of four and a half hours in paragraph (3) no account shall be taken of any period during which the sitting in Westminster Hall may be suspended owing to a division being called in the House or in a committee of the whole House.—(Anne Milton.)

Hon. Members: Object.

15 Apr 2013 : Column 137

Community Pharmacies

Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)

Mr Speaker: Perhaps after waiting a moment for a suitably attentive and perhaps even respectful audience, the hon. Member for Ealing North (Stephen Pound) can rise from his seat to offer the House the benefit of his eloquence.

10.31 pm

Stephen Pound (Ealing and North) (Lab) : I am extremely grateful, Mr Speaker, for your generosity and for the way in which you slowed down through the gears. It is greatly appreciated. I am strangely gratified to see such a well attended House tonight, and delighted on behalf of both myself and the Minister that all our colleagues will be staying here rather than miss a word of this Adjournment debate.

There are many reasons why a humble, insignificant Back Bencher should raise an item on the Adjournment. One can seek the ventilation of an issue; one can seek the investigation of an issue. One can seek adumbration or agitation, and possibly even instigation. In my case, it is with some trepidation that I approach a subject that is originally to do with celebration, but that then moves into the dark world of prognostication and, in the case of the Minister, implication.

There has been a quiet but dramatic and extraordinary revolution in the world of the community pharmacist. The traditional model of the dispensing chemist is as outdated as the mediaeval apothecary. I urge all right hon. and hon. Members to visit the new world of the community pharmacist, which will exist in their constituencies as surely as it does in mine.

It would be invidious to mention individuals in the context of the miracle that is occurring in north-west London, but if I were so tempted, the names of Nilesh Morjaria of the Church pharmacy, of Mahendra Gokani of Mandeville road and of C.K. Nathwani of the Ravenor pharmacy would feature strongly, as would Usha and Dilip Shah of the Alpha pharmacy in Northolt. It was at a visit to that estimable emporium, kindly facilitated by the Royal Pharmaceutical Society in the person of the passionate Charles Willis, once an ornament of this House, that the full range of services now available from what we once called our “local chemist” became apparent.

The Minister will be well aware that the core role of the pharmacist—the dispensing of medicines—has grown from 556 million medicines in 2002 to 885 million medicines in 2011, an increase of 56%. I will return to the current figures. The patient or the customer will find the community pharmacist offering services such as home delivery of medicines and medicines use reviews, which ensure that patients gain optimal use from prescribed medicines—2.4 million people took advantage of such a review in the last year and the outcomes were staggering. Forty per cent. of asthma sufferers showed better asthma management and 55% of patients with chronic obstructive pulmonary disease demonstrated a reduction in symptoms following a medicines use review.

The consequential reduction in emergency visits to accident and emergency departments will bring a warm glow to the Minister’s heart and to the hearts of his

15 Apr 2013 : Column 138

Treasury colleagues, as will the new medicine service, which advises patients on the therapeutic use of newly prescribed medicines. Evidence already exists that shows that 31% of those who make use of this new medicines service adhere more fully to prescribed medicines, minimising waste and increasing their effectiveness.

Smoking cessation is one of the supreme achievements of the community pharmacists in my part of the world, and Usha and Dilip Shah have not only improved quality of life by their efforts, but actually saved lives, as theirs is one of the most successful smoking cessation services offered. As one who had his last gasper in February 2006, I can speak of the effectiveness of this service from a position of breathless authority.

There are more than 20 different services cited by the health and social care information centre, including the monitoring of anti-coagulant medicines, minor ailment schemes and supplementary prescribing services, but countless additional services are available, from flu vaccine provision to travel clinics. In the case of C.K. Nathwani, the Ravenor pharmacist, a mobility clinic supplies wheelchairs and dispenses walking frames and commodes, all in a friendly and familiar environment close to the patients’ homes and with no queuing up.

Oliver Colvile (Plymouth, Sutton and Devonport) (Con): I recognise that the hon. Gentleman is saying that pharmacists do an incredibly good job, and I agree, but does he agree that we should seek to decriminalise any dispensing errors that pharmacists might make? They can go to prison for such errors, but GPs are merely struck off.

Stephen Pound: Not for the first time, the hon. Gentleman raises an extraordinarily interesting point. I will discuss later the issue of the level playing field for pharmacists. Far be it from me to suggest that he might wish to seek his own Adjournment debate on that subject as it is one of great significance, but I do not disagree with the points that he makes. I look to the Minister for a similar statement.

The Minister will conclude that I have certainly ventilated the approbation and celebration I referred to earlier, but all is not well—all is not sweetness and light in the well-lit and warm world of the community pharmacy. I hope that the Minister and I can agree that the community pharmacist is the third pillar of the NHS and, just as general practice and hospital care defined the early days of the NHS and were labelled as the two great pillars on which the new creation stood, the changing role of the community pharmacist can come to define a third pillar.

The cruel tyranny of time prevents me from fully detailing this proposition, but I refer the Minister and the House to the excellent 2013 UCL school of pharmacy lecture “From making medicines to optimising health”, given by the chief executive of the Pharmaceutical Services Negotiating Committee, Sue Sharpe. Dr Sharpe identifies the intentions of the 2008 White Paper “Pharmacy in England”, while rightly deducing that even in the short time since then the nature of the community pharmacist has changed over and over again. She should also be credited with allowing me to remind the House of the marvellous quote from Auden to which she refers in her lecture:

“Health is the state about which medicine has nothing to say”.

15 Apr 2013 : Column 139

At one level, the picture is one of rosy growth and rude good health. Diversification in over the counter sales has increased the profitability of the pharmacist, and a new form of health care and preventive medicine has emerged almost without notice and certainly without fanfare. The NHS is so effusively documented at every level that I am sure I could find the evidence of my birth in the first week of the NHS in Hammersmith in July 1948, when I was one of the first of what Aneurin Bevan identified as “bundles for Britain’s future”—I like to think that he looked down on me swinging in my white-painted metal bassinet in Queen Charlotte’s hospital and identified me as a class warrior of the future, although I would sadly disappoint him in that area. The fact that I am still alive, however, is a credit to the NHS. In such a system, it is extraordinary that there is a real paucity of documentation relating to the range of services and extent of outcomes of community pharmacy. Hopefully, this will not remain uncorrected, but I freely admit to my concerns about the place of the community pharmacist in the new NHS structures. I very much hope that the Minister will allow me to share these concerns with him tonight, and also allow me to look in gentle supplication to him for some positive suggestions.

The Minister is all too well aware that the Health and Social Care Act 2012 empowers clinical commissioning groups, led by GPs, and health and wellbeing boards to play the key role in shaping local health care services. I contend that commissioning public services on a localised basis may lead to variations in availability, quality and outcomes. I realise that we have discussed this at length, and I do not want to rehash the arguments that wracked the House during the passage of the Health and Social Care Act 2012, but one way in which this apparent deficit could be addressed is through pharmacy representation. There is currently no pharmacy representation on health and wellbeing boards. Such representation could be a catalyst for constructive change in primary care. Even the pharmaceutical needs assessments drawn up by the health and wellbeing boards may lack any input from pharmacists.

The sheer complexity of the arrangements under which the new commissioning arrangements operate can be a barrier to the provision of services. I am indebted to Benjamin Wheatley of Boots for confirmation that individual contracts now require pharmacy contractors to invoice either local authorities or clinical commissioning groups via the NHS shared business services. I have to say that my head aches when I try to contemplate the mechanism whereby one invoices through all these various groups and all the choices concerned. I am all in favour of choice, but sometimes it is ridiculous. In cases such as this, we are actually preventing good people from doing good work. The effect of this additional work load can be catastrophic.

I do not often praise, without reservation, coalition Ministers, with the obvious exception of the hon. Gentleman who adorns the Dispatch Box this evening, but I pray in evidence the words of the noble Lord the Earl Howe, speaking at the pharmacy business awards dinner in 2011—what a night that was—when he said:

“The Government sees pharmacy as integral to every aspect of our plans to modernise the NHS.”

He went on to say:

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“there is still some way to go before our reforms are in place. This transition period is an opportunity for pharmacy to make its presence felt.”

I profoundly hope that the transition period does not follow distant historical, if not to say Trotskyist, precedent and aspire to a state of permanent revolution. I sincerely hope that the Government can allow the community pharmacists to do what they do best.

At the present time the playing field is not level, but opportunities there are aplenty. One of the five domains in the NHS outcomes framework—I have to say, Mr Speaker, that the Minister is a good and decent and honourable man, and I have had the pleasure of his company and his acquaintance for many years. I cannot believe that he would ever talk about the “five domains of the NHS outcomes framework.” There are those around us who do and it is to them that we must give credit tonight, but let them come out with this peculiar, strangulated syntax. I hope that the Minister will reply in honest, Norfolk talk.

The NHS outcomes framework refers directly to the quality of life for people with long-term conditions, and this is an excellent opportunity for the community pharmacy, in addition to other qualified health care practitioners, to deliver a key aspect of the Government’s new health care system in England. The pharmacist, as is so obvious when one comes to think of it, may often be the first person to spot a development in a patient’s condition. An early identification can be therapeutically priceless. It is often the community pharmacist who notes that someone has not come in for their medication or, when they are delivering to their home, that the person does not open the door, is looking more tired and pale, or occasionally has something more dramatic such as a nosebleed. This early identification is absolutely priceless, and this is where the role of the community pharmacist has changed beyond almost all recognition. I am seriously worried that such best practice, as recommended by Earl Howe, is threatened by the impact of changing priorities as commissioners change.

The funding passed to CCGs and local authorities is already being used to commission services from community pharmacies, so that for every new service there is a very real possibility that an existing one will be ended. Local authorities will, quite rightly, look to address their own priorities. I referred earlier to the additional pharmacy-led services in England and the huge growth in recent years, but 2012 actually saw a decrease of 5%. It is reasonable to assume that the transition period between commissioners in 2013 and 2014 will see that decline continue. It must be recorded that any diversion from existing services will have an immediate effect on patients. If there is one thing we can all agree on, it is how the community pharmacist has earned the trust of patients and the patient community. It has been so remarkable and beneficial that it cannot be threatened. If there is one thing that patients in long-term care plans in particular are terrified of, it is a change in the structure that could affect their medication and the ability of a community pharmacist to provide for their needs.

The General Pharmaceutical Council is the regulator of pharmacists, and as such pharmacists are not required to register with Monitor or even the Care Quality Commission. This lack of a registration number actually inhibits many pharmacists from applying to provide services under the “any qualified provider” scheme. I do

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not know why, but they cannot register. I have tried myself to operate the system for registering online. If someone wishes to provide a service, they have to give their registration number, and if they are not entitled to be allocated a number, the whole process stops. I hope that this small but significant and far-reaching improvement is one that, yet again, can be laid at the Minister’s feet, with the gratitude of the people, and that we can be delighted by another Lamb amendment.

Allied with the codification of a requirement for community pharmacist representation within NHS England and the resuscitation of the roles previously identified in SHAs and PCTs, a new model of integrated health care could relieve pressure on general practice, provide local and accessible services, manage long-term conditions and deliver healthy living advice. In my part of the world, we have a huge number of singlehanded GP practices. They are typically elderly men—occasionally women, but usually men—operating in terraced houses. It is most unlikely that they can be sacked—I am not altogether sure they should be sacked—but they need a complementary service, because the singlehanded GP model is simply not appropriate to the dizzying variety of illnesses and conditions that apply particularly in the urban environment at this the beginning of the 21st century. I would like to see a synergy between community pharmacists and general practitioners working together to the benefit of all patients.

Above all, pharmacies can work with the new health bodies, GPs and other health care professions to support a modernised, caring health care system that delivers high standards of patient care. The Minister blanched earlier when I referred to him as a good and decent man. I meant that sincerely. I think that everyone in the House holds the Minister in the same esteem. He is a good and decent man, and I hope that he will consider some, if not all, of the points I have raised tonight and agree with me that a fair following wind from the Government would be greeted with delight and relief by our greatly valued community pharmacists and would go a long way towards ensuring a happy, hale and hearty nation and safeguarding our future.

I have received three messages from parliamentary colleagues inquiring whether this debate is a tribute to that distinguished former chemist, the late Baroness Thatcher. She achieved a great deal in the world of chemistry, and certainly as a woman she was an extraordinary achiever, but community pharmacists perform great miracles every day. Let us hope that the Minister is as convinced of their good will and good work as I am and that tonight he will put his shoulder to that wheel and advance the cause of integrated health care and the role of the community pharmacist.

10.48 pm

The Minister of State, Department of Health (Norman Lamb): I congratulate the hon. Member for Ealing North (Stephen Pound) not only on securing this debate on community pharmacies, but on entertaining us. At the end of a long day, it has been appreciated by the gathering before me, small though it might be. I can assure him that I am not often found talking about domains and the outcomes framework. He and I are at one on that. He talked about the quiet revolution he has witnessed in his constituency and the several fine pharmacies there. They do incredibly valuable work, and I can assure him absolutely that I see a critical role for community

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pharmacies. He talked about integrated care. They can play a central role in an integrated service for patients, particularly those with the long-term, chronic conditions he referred to, so I am completely at one with him on that.

Today, more NHS community pharmacies than ever offer health care treatment and healthy lifestyle advice and support in England. As I think the hon. Gentleman said, they dispensed 885 million prescription items last year—up 56% from 10 years ago, with nine in every 10 items prescribed. Pharmacies are also involving accessible. Research has shown that 99% of people can get to a pharmacy with relative ease, especially in more deprived communities, perhaps including parts of his constituency. Because of that, many people use their local pharmacy team as the first port of call for all sorts of health problems, both minor and major. Indeed, that might be the first point at which a serious condition is identified. For that reason, pharmacies are incredibly important. For example, many pharmacies now offer services that help patients to get the best from their medicines or provide support for patients with long-term conditions such as asthma who are starting a new medicine.

However, this goes beyond mere statistics. A graph or chart cannot represent the relief of an elderly person who gets help with a niggling cold or cough, the comfort that a pharmacist can provide a young mother worried about her child’s health or the benefits that people with diabetes or heart disease get from good lifestyle advice. This is all because people trust the community pharmacist. That trust is a vital commodity that should be very much valued. As the hon. Gentleman said, community pharmacies help people to live healthier day-to-day lives. I know he saw that for himself when he visited a pharmacy in his constituency recently. Indeed, I visited a pharmacy in my constituency in Sheringham recently. For a photo opportunity, I had a blood pressure test done on my arm. It came out that I had high blood pressure, so I was immediately referred to my GP. It happens that my blood pressure is all right, but that kind of reminder or shock to the system—in this case experienced by me—is of enormous value to many people, and he was right to highlight that.

The pharmacy that the hon. Gentleman visited has, like many others, helped thousands of people to quit smoking. He talked about his own experience. I am not sure whether he got help from a pharmacy, but I remember as his next-door neighbour over in Norman Shaw North that he used to smoke like a chimney and he has now stopped. That is an admirable achievement. Nearly three quarters of all pharmacies in England gave out quit kits last year, many as part of the Stoptober campaign, which was an enormous success.

Our pharmacies show how they can be proactive, not reactive places, genuinely improving people’s health and well-being on a daily basis, so I welcome the endorsement that the hon. Gentleman gave to the pharmacy’s history of good service. Demand for health care will increase. An increasing population, with people living longer and needing more treatment, means that we must harness every available resource to meet those needs. We want to see pharmacy’s contribution flourish in the future, very much as a central part of local health provision.

Only a fortnight ago, far-reaching changes to transform commissioning health care in England came into effect. Clinicians, not managers, are now in the driving seat.

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The NHS Commissioning Board—now NHS England—has responsibility for commissioning all NHS primary care services, including pharmaceutical services. We expect NHS England to involve clinical commissioning groups where appropriate, because they know the needs of their local populations best. To meet those needs, CCGs are free to commission further services over and above what NHS England commissions. If they want to, and if it is appropriate, CCGs can commission those services from pharmacies. Local authorities now have the powers and funding to commission public health services, such as stopping smoking or sexual health services, and are free to commission from pharmacies. That provides an enormous opportunity to pharmacies. There is an increase in the public health budget this year and next. It is important for pharmacies to get stuck in and make their case to local authorities about the service they can provide—accessible to all, on the high street and trusted, as we have agreed.

These are far-reaching and necessary developments. It is therefore important that new commissioners are fully aware of pharmacy’s potential. That is why the pharmacy and public health forum, chaired by Professor Richard Parish, has been working on how pharmacy can best enhance its role in public health, with more research into pharmacy’s contribution.

Our goal is to allow the new commissioning arrangements to make people healthier. The hon. Gentleman referred to integrated care, which I also mentioned earlier. The Government intend to focus on trying to achieve an integrated care model across the country, moving away from the fragmented nature of health care delivery towards a much more integrated model, and pharmacies can play an absolutely central role in that approach. Pharmacy has an excellent reputation when it comes to integration. I know that pharmacies have a track record of providing quality services that people value, and that patients and consumers hold pharmacy in high regard, so all commissioners should recognise the potential of community pharmacies. It is also clear that the relationship should work the other way, too. Just as commissioners support pharmacies, pharmacies should also be ready to support commissioners by making available their professional experience and specialist clinical expertise. Pharmacies should make the case to commissioners as to why they should consider the role of community pharmacies.

The hon. Gentleman referred to community pharmacy’s concerns about the new commissioning arrangements, and I hope that I can address some of those concerns and reassure him. The first big concern involves the availability of senior pharmacy expertise and pharmacy’s role in commissioning. I want to assure the hon. Gentleman that the chief pharmaceutical officer for England is already part of the senior management team at NHS England. NHS England is looking at how its regional and area teams can make use of appropriate pharmaceutical advice.

The hon. Gentleman also pointed out that some pharmacists are concerned that they are not represented on CCGs. We deliberately did not prescribe set lists of other health professionals who should be on CCGs’ governing bodies. CCGs must be free to decide that for themselves, because it is they, not us, who know exactly

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what is suitable for their communities. If every single profession were represented on every single board, that would make for bloated and top-heavy organisations, which is exactly the opposite of what we want to achieve. However, CCGs have a duty to get advice from a broad range of health experts. CCGs can involve pharmacy, and I would expect that involvement to be commonplace, given the extent to which pharmacies are involved in people’s care. I am sure that the existing local pharmaceutical committees and the new local pharmacy networks will be more than willing to offer advice and support to commissioners. I hope that they will do so, and that they will make the case to the commissioners that they can improve care.

The second big concern involves the potential for pharmacy-led care to stop. I understand that concern—it is natural at a time of transition and significant change—but I do not share the apprehension. I see a potentially greater role for pharmacies, if they can make their case effectively. NHS England is legally required to commission pharmaceutical services that meet health care needs. It bases that on the assessments of pharmaceutical needs for which the health and wellbeing boards are now responsible. As I said, pharmacy’s reputation is well established. Commissioners are not going to stop effective and proven pharmacy services overnight. I can reassure the hon. Gentleman that, as CCGs have no power under the Health and Social Care Act 2012 to commission pharmaceutical services, they cannot cut or decommission those services either.

Will some things change? Yes, of course they will. We would not have embarked on our reforms of the NHS if there had been no need for change. For example, local authorities have already taken over responsibility for public health services such as smoking cessation services. Pharmacy absolutely has its place in the new NHS. Not only that, but in my view it must surely grow to meet the increasing needs of our communities. The reformed commissioning environment provides new opportunities for pharmacies. If they remain passive and do not seek to make their case, they will suffer, but if they go out and make the case for the central role that they can play, for their accessibility and for the trust that the community has in them, they will be able to thrive and prosper, particularly given the focus on a new integrated care model. They can demonstrate how they can improve health and improve people’s well-being.

The third big concern is that CCGs’ commissioning decisions will be unduly influenced by people with a vested interest in securing contracts and cutting pharmacies out of the equation. The Department’s view is that this is unlikely to happen. The idea that members of CCGs will secure all the profitable and lucrative services for themselves is a pretty negative view, and one that I do not share, but of course we have to be vigilant.

We will not allow a situation to develop where profits come before patient care or patient choice. That would be in direct contradiction of the founding principles of the NHS, and it must not happen. We have put robust governance arrangements in place and guidance was issued last year to all CCGs. Registers of interests must be maintained and available for public scrutiny. Members and employees must declare any conflict or potential conflict in relation to a decision to be made by the group, and there are effective sanctions if those principles are breached. In addition, the General Medical Council

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published updated guidance for doctors last month. It comes into effect a week from today, on 22 April. It includes a section on doctors’ financial and commercial arrangements and conflicts of interest. The GMC has provided supplementary guidance explaining how doctors can put those principles into practice.

I conclude by thanking the hon. Gentleman once again for the opportunity to discuss the crucial role of community pharmacies in the new health and care system. The new arrangements will allow commissioners

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and pharmacists to work closer together, not in opposition. There will be new opportunities for better and more flexible pharmaceutical care arrangements that are both relevant and accessible to local people. Underpinning these will be effective governance—

11.1 pm

House adjourned without Question put (Standing Order No. 9(7)).