Steve Brine: The pharmacists have helped us through this crisis. Yet their future is threatened.

14 Dec

Steve Brine is the MP for Winchester. He was the Pharmacy Minister 2017 – 2019.

Jacob Rees-Mogg recently joined the growing line of cabinet ministers to heap praise on pharmacies for their vital work during the coronavirus pandemic. He called pharmacists “a model of public service”.

Before him, the Health Secretary and even the Prime Minister have repeatedly thanked pharmacy teams and promised support.

The gratitude is genuine and well deserved.

Since coronavirus hit our shores, nearly 70 per cent of the population has visited a local pharmacy for treatment or advice. Throughout the crisis, pharmacies have stayed open when other parts of the health service retreated behind closed doors. In doing that, they have put themselves at risk and incurred huge extra operational costs.

As a former Minister for Pharmacy, I can’t imagine how the country would have coped over the last few months without their support. I agree with Jacob that they have been a bedrock in communities across the land.

So there is plenty of goodwill, but it’s high time to translate this into meaningful support to change the precarious situation on the ground, because pharmacies are struggling to keep vital services going.

To put it quaintly, fine words butter no parsnips. To put it bluntly, pharmacies need a response from government and NHS England in the form of hard cash, urgently. The issue at hand is the £370 million advance payment which was made available to address Pharmacy cash flow pressures caused by the pandemic. I fail to see why this could not be turned into a ‘Covid grant’. Unfortunately, the critical matter of resources is apparently floating about somewhere between the Treasury, NHS England and DHSC. Unless one of these seizes the initiative, they will jointly be held responsible for wearing down a service relied upon by millions of vulnerable people.

My wish is for NHS England’s Chief Executive, Simon Stevens, to step up here and do something wonderful. Infamously, he once told a parliamentary committee that the job of pharmacies is to “dole out pills” but I know that isn’t where he stands and he absolutely recognises that primary care would have fallen over during the pandemic without pharmacies to absorb much of the pressure.

As well as supplying vital medicines to millions of people, pharmacists provide urgent care, give expert medicines advice to people with long term conditions, advise on common illnesses and take pressure off GPs and hospitals.

A pharmacy has never been just about tablets; they’re highly trained healthcare professionals in their own right.

Ministers decide. Officials advise. But to get NHSE to act it may need a push from the big guns in Downing Street. Rishi Sunak grew up ‘above the shop’ as the son of a pharmacist, and his intervention would make a world of difference.

According to research by Ernst & Young, commissioned by the National Pharmacy Association, many pharmacies could vanish due to chronic underfunding. EY says that almost three-quarters of family-owned pharmacies in England are at risk of closure if a serious funding shortfall is not addressed. More than a third are already operating at a loss.

Funding has already been dropping in real terms and will continue to do so for another four years under current arrangements. Meanwhile, pharmacies in England have racked up a £375m debt as a result of unavoidable COVID related costs. It’s my view that NHS England should write this off, so that pharmacies can keep their doors open to the public and be motivated for the next phase of the pandemic response, the vaccination programme where they could really move the dial.

But this isn’t just about COVID bail-outs, the opportunity now is to resolve the structural problems – the market failures – that exist in community pharmacy and also to build NHS services back better.

By developing local pharmacies into neighbourhood health and wellbeing centres, and allowing pharmacists to put their clinical skills to full use, more capacity can be released into an NHS system under severe strain. Local pharmacies should become people’s front door to health (a phrase used recently by Matt Hancock) – dramatically improving access to healthcare, face to face and close to home.

As a Minister, I bored my officials to death by banging on that community pharmacy is not just a key part of the primary care team, but in fact offers pre-primary care too; stopping people from getting ill in the first place, not just treating them when they are unwell. It’s why PCNs (Primary Care Networks) are such an opportunity for the sector.

In my view, pharmacies should be supported to lead the way in a great national effort to re-build the health of the population, which has suffered so much due to COVID and the necessary responses to it. From blood pressure to weight management and mental health, pharmacies could play a key role in the build back better agenda. This could be especially important in deprived areas, in which community pharmacies have a reach that other parts of the health service lack.

So let’s get behind this critical part of the NHS family, which has done so much over the last year to prove its worth and save lives.

Steve Brine: Ministers have seized the chance to finally end the HIV epidemic

4 Dec

Steve Brine is the MP for Winchester, was Public Health Minister 2016-2019 and the Conservative MP on the HIV Commission

The campaign against AIDS, as it then was, was etched in my mind from childhood. I did not need this new pandemic to recall that chilling yet effective tombstone advert from the 1980s.

Norman Fowler is something of a hero of mine. As  Andrew Gimson of the parish reported on earlier this week, when Health Secretary he followed the science when others wanted something far worse. The more I learn about the decisions of those times, the more my respect for him grows.

From 2016-19 I was lucky to serve the party and country as public health minister. I was suddenly in a position to do something to change the modern HIV epidemic. To follow in Fowler’s footsteps.

I engaged, as all good ministers do, with the sector organisations. The Terrence Higgins Trust, National AIDS Trust, and the Elton John AIDS Foundation all lobbied me hard. But not just for retail policies. They had a vision: a country with no new HIV transmissions. They were united in presenting a new scientific possibility: this end to transmissions by 2030. I wanted this for England and took the proposal to my boss, Matt Hancock.

As I told the House of Commons on Tuesday, I was ‘pushing at an open door’. In January 2019, Hancock and I committed England to this ambitious but achievable goal.

On the 32nd World AIDS Day this week, the HIV Commission – on which I subsequently served – issued its final report and recommendations. What followed, for all to see, was the commitment of this Government to that very vision. Conservative minister after Conservative minister reinforced how we wish to see this policy become a practical reality.

Boris Johnson set the tone, becoming the first Prime Minister to pledge to end new transmissions before the end of the decade. Rishi Sunak made the same commitment at the launch of the commission’s recommendations from the floor of the House of Commons putting it in the record in Hansard for perpetuity. At the launch with Elton John, Michael Gove gave a commitment to report annually on progress – one of our key demands.

As if that wasn’t enough, Hancock pledged to work together with the Commission on its ambitious targets – cutting the numbers of people living with undiagnosed HIV by 80 per cent by 2025 – and to increase HIV testing. Lord Bethell, his deputy, told the House of Lords the department would investigate normalising HIV testing. That was all before lunchtime.

Our report had barely been launched for 90 minutes and already recommendation after recommendation was being committed to by my Conservative colleagues. It was a sight to behold. But it turned out the Government was not yet done.

The Speaker kindly granted myself and Wes Streeting, my Labour co-commissioner, an adjournment debate on the HIV Commission’s launch. To everyone’s surprise, the Secretary of State himself took his place at the Despatch Box. He had returned to make yet another commitment: that the HIV Commission would be the basis of a HIV Action Plan, available: “as early next year as is feasible to ensure that the work is high-quality, can be delivered and can set us fair on a credible path to zero new transmissions in 2030.”

He said this was a promise he wanted ‘to make in person’. I was shocked, humbled and filled with pride.

There are many that are cynical about politicians and what we can achieve. Tuesday was not one of those days. A Conservative Government is acting decisively to end an outstanding issue of social injustice in less than a decade is not something to be dismissed.

The work to make it happen starts now. Get this right, my fellow Conservatives, and we could end the five-decade long HIV epidemic ‘on our watch’. Nothing short will now suffice.

Steve Brine: Making the most of vaping to deliver a smoke-free Britain

10 Jul

Steve Brine is a former Public Health Minister, and is MP for Winchester.

Last year, the Government announced plans to make England smoke-free by 2030, building on previous initiatives such as the ban on smoking inside public places, and the introduction of plain packaging for cigarettes and hand rolling tobacco.

A year on, we have yet to see enough detail of how it intends to achieve its ambition, and there are real concerns that England could miss this target unless further clarity is provided.

The UK vaping industry, estimated to be worth more than £1 billion to the economy, can be a valuable partner in helping to deliver on the Government’s objectives and address the smoking cessation plateau.

Regulators and health experts in the UK have already acknowledged that vaping could play a crucial role in reducing smoking rates, providing smokers with an effective tool to quit altogether.

During my time as Public Health Minister, we laid out its plan for adopting a harm reduction strategy, aimed at maximising smoking cessation among adults and minimising uptake by young people.

This policy was driven by previous research conducted by Public Health England, which found vaping to be at least 95 per cent less harmful than smoking cigarettes. Since then, a clinical trial led by Queen Mary University of London found that vape products were almost twice as effective as patches and gum – known as nicotine replacement therapies – at helping smokers to quit.

With vaping, there’s no combustion, no smoke, no tar as found in traditional tobacco products. While vaping is not without risk, and we lack the long view afforded by decades of research science, we know it allows smokers to receive nicotine without the cancerous toxins produced by combustible tobacco.

However, to encourage smokers to try vaping, they need to have confidence that the products they choose are safe.

Recent negative media coverage means trust in the vape category has declined. For example, statements originating in the USA said that vapers could be at greater risk of contracting Covid-19, claims which are wholly unsubstantiated. This could deter smokers from transitioning to vaping, a significantly less harmful nicotine delivery method.

Such developments represent an opportunity for the Government to reappraise the regulatory landscape and improve product quality across the industry, thereby increasing consumer confidence in vape products as a mechanism for addressing public health concerns.

One of the simplest and most effective ways to achieve this would be to regulate non-nicotine products intended for vaping (specifically ‘shortfills’ – or ‘make your own’), which are not currently captured by the Tobacco and Related Product Regulations in the same way as nicotine-containing products are.

This would not only improve consumer confidence, but would ensure the UK retains its position as a global leader in the regulation of vape products and could support the Government’s public health objectives.

As the country moves through this unprecedented period of social upheaval, all efforts must be made to ensure that smoking rates do not rise again. The recent ban on menthol cigarettes will support this effort, provided regulators enforce it and challenge tobacco manufacturers who continue to flout the rules.

Greater efforts must also be made to inform the public about the benefits of vaping and how it has already helped thousands of people to reduce their tobacco use.

To be clear: if the question is ‘should non-smokers start vaping?’ the answer should and will remain no. But if we’re talking about smokers who are struggling to quit, then vaping is undoubtedly one of the better options in their toolkit.

Government and industry therefore need to recognise the opportunity they currently have, and that future regulation must evolve to reflect societal changes.