Pharmacies

My Lords, all too often in your Lordships' House, I find myself among a group of unqualified enthusiasts. The noble Lord, Lord Clement-Jones, has raised one of the most important issues facing us at this moment. Ever the optimist, I have been searching for some years—and now for some weeks—to try to find one or two gleams of hope for the future of the British economy. One of these is health. The reason for this is quite simple; we employ more people in the health sector than any other country in Europe, spend more money on hospitals, we have greater research and greater benefit—and we have the longest waiting lists of almost anybody in the developed world. My own qualifications in this field are, perhaps, emotional. The only link that I have with pharmacy is to my great-great grandfather on the female side of the line, who was a pharmacist who farmed and found that his cattle got wind and thought that he should do something about it. His name was J.C. Eno, and he invented fruit salts, initially for cattle although later they were taken by the family—although my great grandmother would often sit on the loo all day and then lose her mind and not quite remember. Those were the pharmacists of those days. Two of my great heroes of Victorian England were, first, Jesse Boot, who effectively introduced pharmacy to the masses in setting up Boots and, secondly, Thomas Salt, who found a formula for effectively curing cholera, and the relationship between cholera and having outside lavatories. At the present time, in the pharmacy field, my knowledge is effectively veterinary. Having been brought up on a farm, I knew how to put a mud poultice on a hoof, and I knew about foot rot, which at school later we found was called tinea pedis or athlete’s foot. I knew how a cow got wind and was shown how to stick a knife in to let the air out. Then I found, to my amazement, that the doctors in my family often, when they had problems that they did not know about themselves, would go to see their local vet, their friend. As your Lordships know, a vet is trained for five years and a doctor only for four. However, a pharmacist is trained for four years, takes an exam and then another exam and is one of the best informed people in the whole medical profession. In the United Kingdom, with 32,000 pharmacies, we have an interesting conflict of interests. In most countries, roughly 70 per cent of prescriptions are from pharmacies and 30 per cent from hospitals, but that is changing; more and more are being direct through pharmacies, where the pharmacist is able to prescribe. We have hospitals, which in general should be associated with physical medicine, and we have treatment. I am told that 90 per cent of all visits to a general practitioner lead to a prescription, which takes it back to a pharmacist. If you look at the waiting time and the cost, you find that roughly 20 per cent of all a GP’s activities are related in some case to pharmacy, directly or indirectly. So what can we do about it? The short answer has to be to give the pharmacist a greater opportunity to prescribe and to look after what we historically called ailments, rather than diseases. That could be anything that they know about and prescribe for. I would always go, first and foremost, to what we used to call chemists, which we now call pharmacists. I understand that those who qualify effectively become pharmacists, but there is often a supervisor who may look at a range of things, on a higher level, with other people lower down. On the continent of Europe, there is a much more significant situation, where more drugs and treatments are prescribed by pharmacists than in the United Kingdom. In a general pharmacy in Germany, France or Switzerland, where I have worked, you will find within the shop or retail outlet a lot of men and women in white or green coats—depending on their standing—with the ability to prescribe. When they prescribe, the code goes into the till or computer, and the end product is automatically delivered down the chute by mechanical systems. An order goes out directly to the supplier and there are four to five deliveries a day so they do not go low on stock. If we moved more to these assistants for general practitioners, they could save possibly 20 per cent of their time at work. We now come to one of the most interesting areas—pharmaceutical production. We in the United Kingdom are the most advanced in Europe in research. We spend £6 billion every year on research—more than any other European country. In terms of manufacturing sales, we have almost the third greatest surplus. We have a £4 billion a year surplus in trade in the manufacture of pharmaceuticals. Hardly any other sector in the British economy has that sort of support. Some 72,000 people work in the pharmaceutical industry, or, as some people derogatorily call it, the drug industry. That is an extraordinary base that could be better used. I am not sure what form of regulation is necessary, but you need to look at the clinician. I do not know whether they are called "Mr" or "Dr". The pharmacist is known as the pharmacist these days. When people are not well, I often say, "Go and see a pharmacist". The problem is that it is very difficult to find one except when they are open. In almost every other country in Europe, you have the pharmacie de garde. You can ring up and it will tell you which pharmacist is on duty within a certain distance or time from where you were. Here in England at night where do you find one? I found from my recent studies that you should ask the police. Historically, there would always be someone at John Bell & Croyden in Wigmore Street, which was open 24 hours a day. Now, it is pretty difficult to find pharmacies out of hours and waiting lists for hospitals and A&E departments are considerable. My suggestion is that we should look at the pharmaceutical industry, which is very advanced and would like to do more. We should look at pharmacies and general practitioners and recognise that, in general, hospitals are places for physical medicine rather than for treatment. Somehow, by getting it together, a substantial saving could be made and waiting lists shortened, and people would not have that fear of waiting from the time that they know something is wrong until the time they get their treatment.