Dr Luke Evans
MP for Hinckley and Bosworth · Conservative · United Kingdom
“I applaud the hon. Gentleman for raising this topic. Although he and I are in different parties, we have long been on the same page about how important it is to have male role models and about the role of men and boys. Under the previous leadership, we were making progress, with a men and boys summit due to take place this summer.”
“This House will know that I continue to push for the issues affecting men and boys to be addressed, and we were making progress—the last Prime Minister committed to a men and boys summit. Sadly, there has been a reshuffle and that summit has not yet happened.”
“We are talking about resilience, and one of the things that has made resilience worse is Labour’s policy on mandatory advice and guidance, and single point of access. We know that secondary care doctors and GPs are struggling but, more importantly, it is causing actual harm to patients.”
“The Minister has spoken about sovereignty, and she is right, and she will be aware that under the Offshore Minerals Ordinance 1994, any decision on exploration has to come to this country. It just so happens that the very Energy Secretary who banned new licences in the UK will now be that decision holder.”
“When the right hon. Lady came to the House last year to announce her consultation, I called it a mess. Fast forward 18 months: there is now chaos in the outcome and decisions. Make no mistake, the reason we are here now is the threat of the courts.”
“We know that Labour’s NHS policy on mandatory advice and guidance and single point of access has led to deaths. We on the Opposition Benches warned about it, doctors warned about it, and patients warned about it, and we were told repeatedly that it was total nonsense, misinformation, opportunism and even conspiracy theories.”
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“Friend the Member for Bognor Regis and Littlehampton (Alison Griffiths), who is championing and fighting for the services in her area—the worry is that the Government are not explicit on what ICBs should be doing on community hospitals. We have this intention and general belief, but the actual direction of how this will work is clouded. I therefore pose a question to the Government: are they considering a national strategy for community hospitals—or even a definition? That is one of the biggest problems when we look up community hospitals. What is the definition of a community hospital? Are community diagnostic centres included in that, or not? What about intermediate care? What about step-down care? What about clinics that provide endoscopy?”
“Especially when dealing with healthcare, we often forget about wellbeing, and that is what these community hubs can provide. Looking at the Government’s direction of travel, it very much sets out how neighbourhood health centres should look, but it is not quite so clear about how that dovetails with community hospitals. How do integrated health hubs fit in with community hospitals? It is not clear in the 10-year plan, and it is certainly not clear in the documentation coming out. Given that the Government are expecting ICBs to commission those hubs, and given some of the stories that we have heard—for example from my hon.”
“That is exactly what the leftward shift is all about: bringing those services to the community. It may come as no surprise that I have a personal connection to community hospitals—you might expect me to talk about my job, Sir Jeremy, but it actually began much before that. My father was a GP down in Dorset; on Christmas days, before we were allowed to open our presents, we used to visit the community hospital and do the ward round with all the patients. As a child I really looked forward to that—first, because I got to meet Father Christmas, but secondly, because of the family feel of that community hospital had. That is the essence of what these places provide: that ability to be within our communities, to give the support and the family feel that we want to keep hold of and treasure because it is so important.”
“It is a pleasure to serve under your chairmanship, Sir Jeremy. I congratulate the hon. Member for South Cotswolds (Dr Savage) on securing the debate. It is fantastic to have the chance to champion community hospitals and what they stand for and provide. I put on record my thanks to the Hinckley and Bosworth Community Hospital, which does fantastic work in my area, in Hinckley. Also, only last week, I was lucky enough to go to the one-year anniversary celebration for my community diagnostics centre—a £24 million investment, set up by the last Government, that we have now carried through. To date, it has served more than 59,000 patients, and it is expanding the delivery of services that it can provide, meaning that services that are provided within the community and people do not have to travel to the likes of Nuneaton or into Leicester.”
“The Government have set out a great ambition, but the Minister is talking about neighbourhood health centres and we are talking about community hospitals. Where do they dovetail and how do they fit? What definition is she using to put this together?”
“I am sorry to hammer this home, but every single point that the Minister has made has been about community services. She is spot on, but the question is where community hospitals fit in. Are they the correct vehicle that the Government want to use to help deliver some of those services, or are the Government moving away from the community hospital model and into further hubs? Both would be reasonable approaches and could be defended or pulled apart. The question is what the Government are choosing, because it is not clear from the Minister’s answers which it is.”
“The Business Secretary said on the weekend that a lot of time and effort had gone into the defence investment plan, but when pushed he said that he had not read it. The former Defence Secretary and former Minister for the Armed Forces have read it, and they resigned. The Minister for Defence Readiness and Industry said that he had read it in full. Why did he decide not to resign when his two colleagues in the Department did resign?”
“Last month, the Health Service Journal reported that the elective waiting list target was met largely—largely—because a record number of patients were removed from waiting lists in March without receiving treatment. Can the Minister tell the House how many patients were removed in March and what happened to them, and whether she is satisfied that they definitely did not need treatment?”
“It is not just the Conservatives who are raising this issue; it is patients and the Health Service Journal . The answer is that 350,000 people—a city the size of Coventry—were wiped off the waiting list with no treatment, and that is 100,000 more than the month before. If there is genuinely nothing to hide, the Government should not worry about putting out the figures. Will the Minister commit to a review to find out what has happened to those 350,000 patients, or does she believe that waiting list targets should be met by removing patients from the figures rather than actually treating them?”
“Could we have a debate in Government time on performance and image-enhancing drugs? Last month, UK Anti-Doping released a survey that looked at 1,000 young people between the ages of 16 and 25; it showed that a third of them had taken IPEDs, and over 40% had seen repeated adverts for them online. This is a growing concern that I have been raising for the last number of years, and I am really concerned that the situation will get worse before it gets better. Could the Leader of the House use his offices to grant a debate on the subject in Government time, in which we could explore this issue as it relates to health, sport and education?”
“We in the Opposition agree, yet throughout this debate we have heard concerns from across the sector about rising costs, medicine supplies, independent prescribing and dispensing services. The question is whether Government policy is keeping pace with the expectations being placed on pharmacies, or whether Ministers are making it harder for the sector to deliver the growth and innovation they say they want to see. Community pharmacies have repeatedly demonstrated their value to patients in the wider health service. I therefore look forward to hearing from the Minister how he intends to address those concerns and provide greater confidence to a sector that remains vital to communities up and down this land.”
“I would also be grateful if the Minister addressed concerns about the discount abatement—what is called the clawback system. Dispensing practices continue to argue that the current arrangement creates inequalities for them compared with community pharmacies. Equally, community pharmacies are upset about the clawback, so there is an obvious tension. Given that the Government are looking at the long-term structure, I would be grateful if the Minister took that away and considered how we can modernise that aspect to ensure that there is equity in the system as well as an understanding from both sides. Ministers have made it clear that they want pharmacies to play a greater role in prevention and neighbourhood healthcare and in reducing pressures elsewhere in the NHS.”
“Following representations from the sector, implementation has now been paused and central funding has continued. I welcome that decision. However, the uncertainty created caused understandable concerns for practices, their patients and the planning of future services, particularly for those in rural communities. When I wrote to the Minister to raise that issue, he responded that an assessment will take place this year of the long-term provision of dispensing modules and that NHS England will consult relevant bodies such as the Dispensing Doctors’ Association as part of that. Will the Minister provide further details on that assessment today? What criteria will be used? Who else is being consulted? If NHS England is going, who will take that work on? When can dispensing practices expect greater certainty about future arrangements?”
“Dispensing GPs provide essential primary care medicine supplies to 10 million patients in remote, rural and coastal communities, where access to a community pharmacy is limited. For many patients, they are the primary point of access to medicines. Earlier this year, dispensing practices were informed that the central NHS England funding for the EMIS web dispensing module would cease and that the costs would instead be passed directly to the practices. The proposal generated significant concern among dispensing practices, the British Medical Association and the Dispensing Doctors’ Association. Concerns centred on the lack of consultation, the timing of the changes and the potential impact on the sustainability of dispensing services.”
“Behind those numbers are real patients facing delays, uncertainties and difficulties accessing the medicines that they need. Community Pharmacy England has warned that those figures reflect the continuing fragility of medicine supplies in the supply chain and that the wider instability from the middle east crisis is adding pressure. Of course, I cannot hold the Government responsible for that, but it is their duty to look at that volatility and to reassure patients and the sector that resilience is being put in place and measures are being looked at. I would be grateful for an update from the Minister on what that looks like. Before I conclude, I will raise an important point that is affecting dispensing practices. We have not talked about those today, but they are part of the real fabric of the community network.”
“What response does the Minister have to those concerns, and what steps will he take to ensure that independent prescribing is the success we all want it to be? Alongside the financial pressures, pharmacies continue to face significant challenges in the medicine supply chain. Analysis by the National Pharmacy Association earlier this year highlighted rising prices for a number of cancer medicines and concerns about the impact on availability. At the same time, the number of medicine price concessions has reached record levels. There were 204 concessions agreed in April, surpassing the previous record set only a month earlier. Community Pharmacy England has now confirmed a new record of 219 concessions for May, with further requests still under negotiation.”
“But the sector itself is not convinced that the necessary investment is in place. Community Pharmacy England has said: “we are not persuaded that sufficient investment is being made to enable the full and effective introduction of IP…given the workload, enhanced clinical responsibility, clinical governance and infrastructure requirements that it will entail.” It went on to warn that “the addition of IP to the CPCF risked being set up to fail.” That should concern us all in this Chamber. If pharmacies are expected to become a cornerstone of neighbourhood healthcare, as set out in the NHS 10-year plan, what steps are the Government taking to ensure that the necessary workforce, governance and infrastructure are in place to support that ambition?”
“The Government are asking pharmacies to do more while making it more expensive for them to keep their doors open. What discussions has the Minister had with the Chancellor regarding business rates for community pharmacies? Has he even raised the sector’s concerns with the Chancellor, and if so, what response did he receive? Will he press for a package of support similar to that made available to other sectors such as pubs, to help with those pressures? The rising costs also cast a shadow over the Government’s plan to expand independent prescribing through community pharmacy. We can all see that independent prescribing has enormous potential. It could improve patient access to care, make better use of pharmacists’ clinical expertise and help to deliver the Government’s ambition of shifting care from hospitals into the community.”
“The headline findings from Community Pharmacy England’s latest “Pharmacy Pressures” survey, due to be published later this month, show that 100% of pharmacies report that costs are higher than at this time last year and that three quarters are losing money, while 86% say that it is taking longer to procure medicines and 76% say that patients are already being directly impacted by the pressures on their businesses. The National Pharmacy Association put it plainly last Friday when it said it was concerned that much of the funding increase will need to be spent on increased costs, including national living wage contributions, inflation and business rates rises, “rather than addressing chronic under-funding”. Those figures tell a simple story.”
“Over the last two years, the Government have made a conscious choice not to exempt community pharmacies from their taxes and have even voted against that. In the first year of this Labour Government, pharmacies faced higher employer national insurance contributions alongside increases in the national living wage. In the second year, they have lost the temporary business rates support that they relied on, with the replacement not matching the rise in their costs. The sector is clear that much of the additional funding announced through the new framework will simply be absorbed by those rising costs.”
“I expect that the Minister will reference that, but I will let Community Pharmacy England’s response speak for itself: “Accepting this deal does not mean we think it is enough—for this year or the future.” It went on to say: “It means the opposite…the sector is in a critical position, and that we now need urgent work on a sustainable long-term solution, including reform of the contract, funding and reimbursement model.” Given the Government’s enthusiasm for reviews and long-term plans, I would be grateful if the Minister updated us on what meetings he will have to work on the framework and the wider funding model, along with what changes we can expect and in what kind of time. The reality is that pharmacies continue to face mounting financial pressures, many related to the Government’s tax rises.”
“Community pharmacies are one of the most accessible parts of our health service. For millions of patients, particularly older ones, those with long-term conditions or those living in rural communities, the local pharmacy is often the front door to the NHS. They provide expert advice, dispense vital medicines, support prevention and increasingly deliver clinical services that help to reduce pressure on GPs and hospitals—as a former GP, I am very grateful for that—and that is why this debate is so important. Ministers want community pharmacies to do more, but I worry that, at the same time, they are actually making it harder for pharmacies to survive. This debate is timely, given that the Government agreed the community pharmacy contractual framework for 2026-27 last Friday.”
“It is a pleasure to serve under your chairmanship, Ms Jardine, and I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for securing this important debate. It is important that we discuss community pharmacies, given their place not only in the health landscape but in the hearts of many of my constituents and people across the nation. I, too, have visited multiple pharmacies, both in my shadow role and as an MP, and I, too, went to my local pharmacy for my flu jab, back in Newbold Verdon. I am very grateful to them because I found the system very easy to use and to get into. It is really important to see that system change that makes it more accessible and easier for people to make the choice to improve their own health and protect others. There are positives in this debate that we must celebrate.”
“The Minister points to the important partnership between community pharmacies and dispensing GPs. There are concerns about the change in the EMIS module and the future for dispensing practices. If the Minister does not have the answers here, will he write to me about what is happening with EMIS and where he is looking to take dispensing practices in the future?”
““I’ve been stabbed” versus “He racially abused me.” How are the Government going to rebuild public confidence in our culture and in institutions that have attempted to rank people according to perceived oppression, rather than judging each person on their actions and on reality?”
“On page 243 of volume II part III, the Minister’s predecessor, talking about Labour MPs, states: “Every meeting I have is ‘who can we tax in order to pay benefits to others’.” Is that the same experience the Minister is having in every meeting he has?”
“I am going to try to get some clarity, because my hon. Friend the Member for East Grinstead and Uckfield (Mims Davies) asked when there will be written explanations of the draft changes, as did my hon. Friend the Member for Reigate (Rebecca Paul). In both answers, the Minister talked about process. Well, process dictates that there should be written answers, so when will we see them in this House?”
“The Secretary of State is making himself the data controller of all the data that will be in place. What impact does that have on the sections he has just talked about?”
“To be charitable to the Government, there is actually £34 billion that could be spent in defence, given that they had another U-turn on the Chagos deal. Maybe there is a delay in the plan because they are trying to decide how to spend that money, or can my hon. Friend think of another reason?”
“I posed this question to the Minister’s colleague, the Minister for the Armed Forces, when he was last at the Dispatch Box: where is the DIP stuck? He seemed to point the finger at the Treasury, but can I get an update on where the DIP is actually stuck?”
“The Government stand accused by not one but two of the most august Committees in this House of not playing fair in giving across the information. The Minister’s argument is simply that the Government have done nothing wrong. If that is the case, why would both of those Committees come to this House and lay those accusations?”
“Q10. Please could the Prime Minister explain to the House why, if he has done nothing wrong and process has been followed, he needed to force his MPs to vote against an investigation? Is it because he is worried that they do not believe his version of the truth?”
“When the Prime Minister came in, he said that he wanted to do things differently. He has had not one, but two, opportunities—one in an emergency debate tabled by the Opposition—to come to the House and answer all the questions so he would not need to go to the Privileges Committee. Will my right hon. Friend surmise why he has not come to the House to answer on two occasions?”
“I also took part in that debate. The hon. Gentleman will remember and the record will show that the decision was suddenly made during the debate. The Government were going to vote against the Humble Address; the decision was made only because Members on both sides, particularly those on the Intelligence and Security Committee, put themselves forward and said that there was that option. We were having the debate in the first place because the Opposition compelled the Government to submit the papers. The hon. Gentleman cannot say that the decision was just put out there by his side.”
“The Conservative party is effectively a mirror to the Labour party that Labour Members did not ask for but would be wise to study. If they do not believe me, maybe they will listen to the Prime Minister, who closed his speech back in the debate on 21 April 2022 by saying: “if we do not pass this motion and take this opportunity to restate the principles, we are all complicit in allowing the standards to slip. We are all complicit in allowing the public to think that we are all the same, that nobody tells the truth and that there are alternative sets of facts.” —[ Official Report , 21 April 2022; Vol. 712, c. 355.] That is what Labour MPs have to wrestle with, so I hope they listen to the words the Prime Minister said back then.”
“Why were comments in the PM’s box notes left empty? I do not believe that Labour MPs will show the same lack of curiosity that the Prime Minister showed when appointing Peter Mandelson, because they know they have a duty to their constituents to make sure they get it right. How do I know all this? Because my party has been here before. Many of us on the Conservative Benches are the remnants of what our party had to go through—we have seen it. I have spoken before about the sword of hypocrisy, which cuts both ways, but as we learned, it is the infection that gets you. Here we are, nine months on since I made that speech, and the infection is turning into sepsis. The patient is in real trouble. Labour MPs could learn from the Opposition, or they will share the same fate.”
“They will have to explain to their constituents the decision they make and why, and they will have to live with that. That is what an MP does, and it is what an MP should do. But the Prime Minister himself clearly has doubts about his Back Benchers, because he is whipping the vote tonight. If he was so confident that so many of them would come to the conclusion that there was nothing to see here, he would not need to whip it. We know the real reason: there are so many unanswered questions. Labour MPs might say there is no chink of doubt and that no question is unanswered, but how can they explain the inconsistencies from civil servants? Why has it taken months to get this sorted? Why has it required Humble Addresses and emergency debates, yet we are still having these debates nine months on?”
“He set his own standard but he does not seem to meet it. That fits with the way in which the Prime Minister came into Parliament. He talked about change, but he changed his promises. He said he would do things differently, and this is where I agree. When it came to the standards debate, the last Government said that it was House business and did not whip it. This Government have made a change: they are whipping it. The question is why. That leads me on to my next point. I have talked about standards, and now I will talk about doubt. I have heard today that some Labour MPs have no doubt in their mind about the Prime Minister, but I have equally heard that other Labour MPs do. That is really important. If they have no doubt, that is fine—they can vote against the motion.”
“He’s got to go.” He followed that up by saying to Boris Johnson at the Dispatch Box: “There are only two possible explanations. Either the Prime Minister is trashing the ministerial code, or he is claiming he was repeatedly lied to by his own advisers and did not know what was going on in his…own office. Come off it!” —[ Official Report , 30 March 2022; Vol. 711, c. 807.] That is the standard he set himself before he became Prime Minister. Is he following that standard? We only have to look at his actions since he was elected to see that he is not. He gave a donor a pass to No. 10, he took suits, he took glasses, he appointed a donor as the football regulator and, of course, he was the MP who took the most freebies in the last Parliament—more than even the three or four below him in the list combined.”
“The stork, not losing its temper, reciprocates and invites the fox back to have soup at its house. When the stork serves the soup, it serves it in a long, thin glass. Of course, the fox cannot get to it and loses its temper. The moral of the story is to treat others as you wish to be treated. The process that the Prime Minister is going through is due process by the standard he himself set, happening in retort to himself. We only have to look at some of the tweets that he put out. In January 2022, he said: “The Prime Minister is a national distraction. Millions of people are struggling to pay the bills, but Boris Johnson and his government are spending the whole time mopping up their own rule-breaking, sleaze and deceit.”
“I usually come to this House to represent the people of Hinckley and Bosworth, and occasionally other people across the nation, by raising and debating pertinent issues. Today, however, my speech is aimed at Labour Back Benchers, because at the end of the day, regardless of what is said here, it is their decision. When there are 400 of them, it is they who will decide what happens in this debate. I therefore gently highlight two points: the standards that have been set, and doubt. The Prime Minister has set very clear standards since he has been in Parliament. It reminds me of the famous fable of the fox and the stork. Those familiar with it will know that the fox invites the stork in to have dinner. The fox serves soup but mischievously does so on a flat plate and, of course, the stork cannot eat it.”
“The NRS case is so important. I am keen to understand how the Government are ensuring the ongoing provision and servicing of wheelchairs, given that NRS has gone bust. I have been contacted by constituents who worked at high levels in NRS, and who are concerned that those contracts will not be followed up. Is the hon. Member concerned about that, too?”
“What assessment have the Government made to date as to whether that is making a difference, and how we can have improvements? Thirdly—I touched on this in my intervention—many wheelchair users will have had provision from NRS Healthcare. Given the size and scale of the impact of NRS collapsing, there is real concern about servicing their contracts and making sure their wheelchairs are maintained. What have the Government done and what do they have to say on that topic?”
“They will want assurances that, amid the structural change, accountability will not be diluted, responsibility will not pass around the system, and there will be clear leadership to ensure faster, fairer access to the equipment that is so fundamental to independent living. I have three questions to the Minister on that basis. First, as NHS England is abolished through an NHS service modernisation Bill, can the Minister set out clearly which body will hold national responsibility for wheelchair service standards and oversight, and how Ministers will be held accountable when or should services for wheelchair users fail across different parts of the country? Secondly, who will be responsible going forward for overseeing and enforcing the wheelchair quality framework?”
“Many will be keen to hear what progress has been made on that work and whether it will form part of a more coherent approach in provision. Finally, I raise the issue of innovation. In my constituency of Hinckley and Bosworth, local businesses have shown how responsive, user-focused solutions can make a real, tangible difference. I mentioned Mounts and More as a primary example last time. As the national structure evolves, innovation like that must be supported rather than stifled. As the Minister responds this morning, wheelchair users and their families are listening carefully.”
“So it is fair to ask whether those competing pressures risk pushing wheelchair provision further down the list of priorities rather than elevating it to where it should be. Going forward, who will be responsible for overseeing the wheelchair quality framework itself, and how are the Government assessing whether that is genuinely improving outcomes on the ground rather than simply setting aspirations? There are also practical questions that remain unanswered. The Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), previously undertook to look at the reuse and return of disability equipment, which could have real benefits for patients and for public value.”
“As the NHS is reshaped, wheelchair users and their families need to know who is responsible for setting expectations nationally, who is responsible for commissioning locally and who steps in when the system is not working. Without that clarity, there is real risk that the responsibility becomes fragmented and that unacceptable variation goes unchecked. Ministers often rightly point to the role of integrated care boards in commissioning wheelchair services for their local populations, but ICBs are being asked to do a great deal at once—to meet 18-week standards for community services, adopt the best practices set out in the wheelchair quality framework, and now to do so while operating with up to 50% reductions in headcounts and constrained budgets.”
“Ministers have been explicit that they do not intend to publish a national strategy for wheelchair services. At the same time, the Government are embarking on a major restructure of the NHS in England. Understandably, that combination raises concerns about where national oversight will sit in the future, how consistency will be ensured and who will ultimately be accountable when services fall short. During last month’s debate on disability equipment, the Minister acknowledged the uncertainty created by the changes, noting that seemingly small gaps in practice or responsibility can have disproportionate impacts on the quality of life of disabled people. That is precisely why clarity matters.”
“I also thank the all-party parliamentary group for wheelchair users for its work to ensure that wheelchair users are heard, and I thank the Wheelchair Alliance and others who continue to hold this House, Ministers and the Opposition to account on these issues. There is little disagreement in the debate about the nature of the problem. The Government themselves acknowledged last month, in the debate on disability equipment provision, that too many wheelchair users wait too long for the equipment they need, with knock-on consequences for their independence, health and ability to participate fully in daily life. That admission is welcome, but recognition alone is not enough. The question before us is how responsibility, accountability and improvement are to be delivered in practice. On that point, the picture is far less clear.”
“I thank the hon. Member for Bexleyheath and Crayford (Daniel Francis). He is becoming a regular in these Westminster Hall debates, rivalled only by the hon. Member for Strangford (Jim Shannon). It seems that there is a competition to be the one who makes the most representations. On a serious note, last month in the debate on disability equipment provision the hon. Member for Bexleyheath and Crayford spoke passionately and movingly about his personal experiences. We should treasure so much, in this House, people bringing their experience to try to make things better for their constituents, their family and the nation. The hon. Member deserves a lot of credit and I thank him for securing this debate.”