Notes from a secret meeting
In Withering's Wisdom our correspondent draws together the threads running through the judicial review hearing and is very disturbed by what he sees
The High Court has been hearing our case challenging the governmentâ€™s imposition of cuts. There have been some extraordinary revelations, one of which is that Philip Hammond, the Chancellor of the Exchequer, is of the view that community pharmacies are inefficient and over-subsidised.
He wants us to â€œshift away from the traditional bricks and mortar business model towards scaled-up innovative supply solutions employing digital technology, where government expenditure is minimisedâ€. Where did that come from? Well, for a start, the deputy director of procurement and efficiency at the DoH seems to have a bit of a chip on his shoulder about community pharmacy.
In a memo to Jeremy Hunt, he wrote: â€œThere are an estimated 25 per cent too many pharmacies, so some level of closures would not necessarily be a bad thing.â€
Theresa May was not amused, apparently. She expressed concerns over the potential effects of the cuts on small- and medium-sized businesses. After all, doesnâ€™t small business make up the beating heart of the Conservative party?
Jeremy Hunt called in the biggest of the big guns: his right honourable friend the Chancellor. Hammond agreed with Hunt. He assured the PM that Huntâ€™s pharmacy proposals had already â€œbeen consulted onâ€. Consulted on? With whom? We werenâ€™t consulted â€“ we were told! Even an un-named DoH mandarin pointed out that â€œit is likely we would need to impose this funding cutâ€, and that such an imposition was â€œunprecedentedâ€.
But that still doesnâ€™t tell us where this dogâ€™s breakfast originated. Now comes the most astonishing revelation of all. In a heavily-redacted 53-page government dossier presented in court, we discovered that the decision to carry out the funding cuts was made on the basis of a single meeting in 2015 with an un-named pharmacy insider. Incredible!
You would think that such a controversial and potentially damaging policy would be made on the basis of a careful consideration of the evidence, such as the official cost of services inquiries, but no, the cuts were decided on the say-so of a private individual in secret.
It seems we are not to be permitted to know the identity of this person. Itâ€™s impossible to know whether they had a vested interest of their own or perhaps a grievance against pharmacists. And yet, thatâ€™s still not the worst of it.
The next chapter in this tale beggars belief. The minutes of the meeting, which state that this anonymous informant was experienced in â€œbuying, selling and managing pharmacy businessesâ€, were then ordered to be destroyed. Destroyed? What conceivable reason could there be for destroying minutes if they represented a reasonable, balanced and considered step in reaching the decision to make cuts?
You couldnâ€™t make it up. Somebody in the DoH knew that what had been done was so far from being reasonable they tried to hide it. Thankfully, the dossier survived, but are there other documents which did not?
The un-named insider told DoH officials that pharmacies were making excess profits and that some were making 40-60 per cent private income on top of NHS income. The numbers donâ€™t even make sense: 40-60 per cent of what? And where is the evidence for it?
The last act of this farce came on the final day of the three-day hearing when the DoH unwittingly revealed the depth of its ignorance. Counsel for the DoH told the court that â€œBoots in Waterloo sells sandwichesâ€.
Hold the front page! It gets worse. Pharmacists â€œlurk at the backâ€ while shop assistants sell shampoo. Is â€œBoots in Waterlooâ€ representative of the entire community pharmacy sector? And, since neither of these activities concerns the NHS, what is the relevance of these comments anyway?
Jeremy Hunt was advised that â€œcareful political handlingâ€ of the imposition of the cuts would be essential. The way the DoH â€œframes the proposalsâ€ would be critical to its success. No doubt government spin doctors have been rubbing their hands with glee that their skills were so badly needed. Mr Huntâ€™s response was to demand that his officials create a â€œcompelling narrative to justify funding reductionsâ€. That is very revealing.
If there was genuine evidence to justify the cuts, why not simply compile a dossier of the evidence? Hadnâ€™t the insider provided the necessary evidence? But no. Instead, the cuts were dressed up as â€œreformsâ€. Hunt was advised that the â€œcore narrativeâ€ relating to the cuts should emphasise the rapid growth in the number of pharmacies in â€œrecent yearsâ€, leading to clusters of small pharmacies in â€œmany high streetsâ€.
In addition, advances in technology â€“ including automated and off-site dispensing â€“ are reducing our costs.
So there is all the justification you need: our funding is being cut to reflect these savings. The phrase â€œcompelling narrativeâ€ is a superb example of Orwellian double-speak: saying one thing while meaning another. It is my fervent hope that the court will get to the bottom of Mr Huntâ€™s â€œcompelling narrativeâ€ and expose his spiteful policy for what it is.
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