Health Bill

My Lords, noble Lords may be relieved to know that I am not going to talk much at all about the smoking business. My views, both as a doctor and a chairman of a strategic health authority are so predictable that you could almost take them as read. I congratulate the Secretary of State, Patricia Hewitt, for finally voting against her own department’s original proposals—although I was sad to see that one health Minister did not support the healthiest option of smoke-free public premises. I hope that that particular Minister will not be around monitoring the performance of my authority on our smoking cessation targets. I add my voice to the voices of the noble Baronesses, Lady Rendell and Lady O’Cathain, who raised the issue of providing better protection for residents of care homes and nursing homes, who often have to suffer the smoking of other residents and staff. I have regularly witnessed that in registered care homes and nursing homes, and we must find some better way in which to protect those individuals. As the noble Lord, Lord Patel, said, this is probably the most important public health measure proposed in the past few decades, and I strongly support the Government’s current proposals. I turn to the new pharmacy regulations, and hope that the Minister will be able to put my mind at rest on a few points. First, I want to say how much I welcome the new pharmacy strategy and the new proposed wider role for community pharmacies in primary healthcare, and to support the increased contribution that they can make to public health and possible practice. We have 37,000 pharmacists in the UK; highly trained, skilled professionals whose talents are often underutilised under the current arrangements. Those noble Lords who have visited Italy, France and many other European countries will know that the local pharmacist often plays a key primary care role, and is expected to give advice and guidance on a wide range of healthcare matters relating to medicines and products and on public health issues. It is enormously beneficial and easy to be able to consult a high street pharmacist on the spot, and to widen access to pharmacy services must be a good thing. On the face of it, the current proposals make a good deal of sense. There will cease to be an obligation for a pharmacist to be physically present at a pharmacy while medicines are being dispensed. There will be a designated responsible pharmacist in overall supervision, but not required to be present at all times. The supervision of the pharmacy may be by remote mechanisms, by robotics, video links, electronic means of viewing prescriptions and so on. But it seems to me—and this has been raised by the Pharmacists’ Defence Association too—that the provisions, if not properly implemented, may have the unintended consequence of lessening the public’s access to a community pharmacist in more deprived areas and provide fewer safeguards for patients in terms of supervision of their medications. The primary role of the pharmacist is to ensure the safe sale and supply of medicines in the pharmacy, and he or she is uniquely qualified to do that. The PDA deals with the many dispensing errors and near-misses, and knows, even though now 80 per cent of medicines are pre-packed and bar-coded, that drug errors still occur, and that technicians and dispensing assistants are not equipped to cope with an unexpected incident where an intervention may have to be made quickly to avoid harming a patient. The prolonged absence of a pharmacist will undoubtedly leave many decisions to assistants and technicians. It looks as if it could be possible under these proposals for a pharmacist to supervise more than one pharmacy at once, by being officially in one pharmacy and providing cover remotely as a supervisor at another. I fear that companies with several pharmacies will simply reduce the number of qualified pharmacists they employ in some areas. The commercial reality of the pharmacy industry in inner-city areas, and in some remote rural areas where there are already recruitment problems and great difficulty in finding locums, could lead to the creation of a two-tier system of well staffed and poorly staffed pharmacies. I do not want to downplay the skills of our valuable registered pharmaceutical technicians, nor our dispensing assistants, but the fact is that they are at their most useful when they work directly with, and are learning from, an expert pharmacist in a close-knit multi-disciplinary team. How many hours will a pharmacist have to spend in the pharmacy per day or week or month in order to be designated as a responsible pharmacist? Has that been considered with regard to patient safety? Will the Minister explain how regulations can be, as it says in the Government’s Health Bill information paper, tightly drawn to ensure that the absence of a pharmacist will be permitted only in specific and defined exceptional circumstances, yet designed to ensure the responsible pharmacist has sufficient time and flexibility to offer other services away from the pharmacy? How can a pharmacist supervise a remote pharmacy over extended periods without compromising safety? How long might he be away for? What about pharmacies that open 100 hours a week or more to satisfy the exemption from control of entry regulations to NHS prescribing status? Can we be reassured that there will be one responsible pharmacist for every community pharmacy? Will the Minister clarify under what circumstances a responsible pharmacist could supervise more than one pharmacy? Finally, what is the remote pharmacist permitted to do when he or she is away from the pharmacy? I hope, because this is one of my fears, that it will be providing healthcare rather than simply driving around town between his six other pharmacies.