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Health Bill

moved Amendment No. 30:"Page 22, line 16, leave out ““may”” and insert ““shall””" The noble Earl said: My Lords, we had some extremely useful and constructive debates in Grand Committee on the issue of pharmacy supervision, and I return to the subject only briefly because there are perhaps two or three points on which we did not reach as definitive a conclusion as we might ideally have wished. Against that background, I hope the Minister will have guessed that Amendment No. 30, being a rather hackneyed format, is designed purely as a probe. One of the profession’s main worries—I mention, in particular, the Pharmacists’ Defence Association—is the extent to which it is reasonable to allow the pharmacist to be absent from the pharmacy whilst still ensuring that patient safety is not compromised. The Minister made some helpful comments in Grand Committee on remote supervision and the use of technology in improving patients’ access to medicines. I am sure he is right that, as time goes on, we shall see the development of this technology which, in places such as Australia, where distances are very large, probably has an important part to play in ensuring that patients’ needs are looked after. However, in Britain, the arguments for embracing this kind of technology are less strong because pharmacies, as a rule, are no more than a short car or bus ride away from a patient. Many members of the profession feel that the use of technology should not be encouraged as a substitute for pharmacists being physically present in a pharmacy because technology, however good it is, merely introduces new challenges for the maintenance of patient safety. Pharmacists cited a case in California where 4,700 people received incorrect medication when a dispensing robot went wrong. At a broader level, we need to be clear how we justify the absence of the pharmacist from the pharmacy and in what circumstances. Clearly, as we debated before, there are frequently good reasons why a pharmacist in the course of his professional duties has to be allowed to leave the chemist’s shop. But the watchword here, as the Minister himself emphasised, must always be patient safety. The Pharmacists’ Defence Association has advised me of a suggestion by the department of fixing a predetermined percentage of the working day as the maximum period for which the pharmacist will be allowed to be absent from the premises. Personally, I am very doubtful whether a hard-and-fast percentage is the right approach, because having chosen a figure it is always possible to argue for a figure that is higher or lower in different circumstances. A fixed percentage such as 20 per cent is bound to be arbitrary. But we surely need to ask a more fundamental question: whether and to what extent supervision can ever properly take place when the pharmacist is not physically present. Let us leave aside remote supervision through the use of technology, which I have already covered. If a pharmacist is absent from the pharmacy, to what extent is it safe for him to rely on support staff to follow the rules laid down in standard operating procedures? The PDA tells me that it regularly encounters incidents of support staff acting outside their competences and putting patient safety at risk. That is surely worrying. So in creating flexibility for pharmacists to be absent, which on one level I understand the need for very well, we ought to keep in mind that there is an inevitable trade-off for that flexibility in the form of a potential risk to patient safety. None of us wants to see that compromised. If an arbitrary percentage of ““absent time”” were proposed, it would need to be closely justified by reference to the patient safety principle. The regulations will deal with the finer details, but I should be most grateful to hear from the Minister a little more of how the Government propose to square this circle. I beg to move.