Health and Community Care Committee, 25 Feb 2003

Meeting date: Tuesday, February 25, 2003

Official Report 210KB pdf

---

Retail Pharmacies

We move on to agenda item 3, which is on the Office of Fair Trading's report, "The control of entry and retail pharmacy services in the UK". We are joined by the Deputy Minister for Health and Community Care, Mr Frank McAveety. I welcome him to what I believe is his first Health and Community Care Committee meeting as a minister. I am sure that, like his colleagues, he will enjoy the experience. He is just getting in under the wire before dissolution. I also welcome the minister's officials.

I make it clear that the OFT report generated more proactive responses to the committee than any other item that the committee has considered during the past four years. Certainly, an unprecedented number of MSPs have grabbed me for a quiet word in my ear. They represent constituencies throughout the country and are concerned about their local pharmacies. It is obvious that the issue is important to all MSPs and to the public. I ask the minister to make a short statement, following which committee members will ask him questions.

Thank you, convener. I introduce Bill Scott, who is the chief pharmacy officer in the Scottish Executive, and Chris Naldrett, who is the branch head of primary care infrastructure. Mr Naldrett is pulling together responses to and submissions on the OFT report. Having spent all morning signing off letters to MSPs, I can testify to the volume of correspondence to which the convener alluded.

I will sketch out the role of Executive ministers and the process in which we are involved with regard to the OFT report, on which I will be able to respond to questions. I trust that the committee received our written response to the points that it raised previously on the OFT report. I will make several key points that will emphasise and amplify what was said in our letter to the committee.

We are committed to securing a viable network of community pharmacies throughout Scotland and we want fully to utilise pharmacists' knowledge, skills and expertise in working with other members of the health team to deliver the broad health agenda to which the Executive is committed.

On the OFT report, it is important that the committee is aware of the process that we are engaged in. The Executive's health department, in line with other UK health departments, is handling the OFT report. I will explain the time scale within which we are operating. The OFT report, which was published on 17 January, covers the entire UK. The report was sent to ministers in all four UK health departments and the Department of Trade and Industry. Those ministers are responsible for co-ordinating responses to the OFT report from relevant Government departments and for reporting the outcome to the Government's grandly named economic affairs, productivity and competitiveness committee—the EAPC—which is chaired by the Chancellor of the Exchequer. The DTI aims to submit a report and an accompanying action plan to the EAPC no later than 90 days from the report's publication date.

On the key points that were raised in written correspondence to me and to MSPs, I emphasise again that Scottish ministers will make the final decision on what action to take in response to the OFT report. That point was also emphasised in the First Minister's response to the convener's question during First Minister's question time last Thursday.

The OFT report deals with consumer-related issues, which are reserved issues. However, health is a devolved issue, so we can follow a different course of action from those that will be followed by other UK health departments. Within the 90-day time frame, not only must each department carefully consider the OFT report from its own policy perspective, but they must seek the views of the major stakeholders affected by the report's recommendations. Our policy perspective is represented by "The Right Medicine: A Strategy for Pharmaceutical Care in Scotland."

Officials and I have met stakeholders, such as the Scottish Pharmaceutical General Council and other representatives, over the past week or so. I understand that officials will meet with representatives of the supermarket chains tomorrow regarding their response to the OFT report. Folk have been afforded a range of opportunities to put in their submissions.

The convener referred earlier to my coming in under the wire—at present, we are in a limbo situation. We need to get those comments in before we make a final evaluation, although in the meantime we will try to respond to the points that members may raise. The comments will form part of our deliberations over the consultation period, and we hope to arrive at a conclusion in the near future.

We recognise that the OFT report is of substantial public interest and that it has a direct relationship with our commitments to community pharmacies and to "The Right Medicine" strategy. We want to get that balance right, and we are in listening mode to try to secure that and to ensure that we give a measured response when appropriate.

What input did the Scottish Executive have into the OFT report?

The OFT visited officials in the department for a morning and we discussed some factual material about the operation of the system at that meeting. We also gave them a copy of our strategy for pharmacy.

I see; it was a morning's consultation. Does the UK study adequately take account of the greater rural distribution of the Scottish population in its findings?

As regards that level of detail, the OFT should be asked about the range of the assessment that it made before it arrived at its final recommendations. That is a key issue, which many people have raised with me. We are examining whether Scotland's rurality has been taken into account. The OFT report contains an economic case, but it also comprises a lot of built-in assumptions that we are trying to examine robustly. We are trying to arrive at a much more accurate picture that we can compare with what is in the OFT report.

As the convener said, we have been swamped by submissions from pharmacies. I was reading some from Dornoch, Nairn, Strathpeffer and Shetland earlier. They all say that they are pursuing "The Right Medicine" strategy, to which they have signed up, and they believe that the OFT report or any other challenge to the strategy would destabilise community pharmacies. Many of them are investing in consulting rooms so that they can dispense methadone, morning-after pills and so on. Does Scotland need the OFT report? Given that health is a devolved matter, could we bin the report and concentrate on the strategy?

I re-emphasise my opening comment, which was that the decision will be made by Scottish ministers, and we will make our determination in light of "The Right Medicine" strategy, the submissions that we are receiving in the consultation period and the robust analysis that I understand officials will make of the OFT report. That is as much as I can say at this stage. However, I recognise the issues that you raise, which are certainly among our concerns.

The point that I am making is one that has been made to me and many others in submissions. Pharmacists are pursuing the strategy, but if the OFT report goes through, it will contradict the strategy. People are writing in to ask why they should invest in nicotine replacement therapy, staff training, additional staff, drug strategies or rooms that are to be set aside for consultations and the morning-after pill—in short, all the things that you have expected them to do. The OFT report contradicts that work and destabilises the pharmacies.

I certainly back up those comments. I spent part of Saturday morning in one of my local pharmacies, where the pharmacist said that her colleagues were already wondering why they should bother arranging private rooms, for example. They felt they might put things on hold until they see what happens. None of us want "The Right Medicine" strategy to be put on hold; we want it to advance.

Perhaps Bill Scott could expand on how the strategy has been evolving and whether anything within it is contradicted by the OFT report.

We have been encouraged by the way in which pharmacists and the general public have warmed to the strategy. Members are right to recognise that pharmacists are implementing the strategy. We would be concerned if a community pharmacy did not make that investment. The ethos of the strategy is that there should be closer working between all health professionals in the team.

We are considering closely how the OFT report will affect our ability to deliver the strategy. That said, as we constructed the strategy and spoke to people, we did not have any specific control-of-entry system in mind. The strategy is about how the profession can help to deliver better health to the Scottish public.

The convener has already alluded to the strength of feeling about the proposals—no member of the committee underestimates the strength of feeling that exists in our local areas. I note that the OFT consultation lasted half a day. Is the Executive carrying out its own research into the possible effects of the OFT report on pharmacy provision in Scotland? I understand that the report argues that a free market in pharmacy will lead to improved services, but I am finding it difficult to get my head round how that could be the case.

I have talked to people who run pharmacies in my area about the services that they provide, such as contraception advice, methadone dispensing, domiciliary oxygen and delivery of prescriptions following GP home visits. There is concern that those services would go if local pharmacies were no longer in place. Has the Executive done any research into the effects that there would be on local communities if the report's recommendations were implemented?

Chris Naldrett and others may be able to comment on the detail of the time scale, but we have had strong representation on those issues from the Scottish Pharmaceutical General Council. We spent a fair amount of time on that last week. The SPGC is also undertaking its own economic assessment, as well as an assessment of many of the key recommendations in the OFT report. I have asked the SPGC to complete those assessments as quickly as possible and to share the findings with the Health and Community Care Committee. I do not know whether that will happen, but that is the intention.

I assure Janis Hughes that we are starting from the principle of "The Right Medicine" strategy. We believe that a partnership approach will be of long-term value in Scotland, because it recognises the role that the work force, pharmacists and other health professionals play. We want to maintain that partnership approach. The debate is obviously about whether the apocalyptic picture that has been painted in many of the letters that we have received is really represented in the OFT report. We need to get behind that picture to see exactly how accurate it is.

Perhaps Chris Naldrett could touch on some of the processes involved in allowing us to arrive at a much more robust assessment of the OFT report.

We have an array of economists who are studying the report now and are due to give us some information by the end of this week or the beginning of next week. As the minister said, we hope to get sight of the other assessments that are available, including the SPGC's version, and we are obviously looking around for anyone else who will give us copies of their own independent assessments and reports.

We have got the story from the public and from the pharmacists in the welter of mail that has been coming in over the past week. In fact, the volume of mail has been picking up and, even as I speak, the e-mails are coming in faster every hour.

Bill Scott and I are to meet representatives from the Company Chemists Association tomorrow, which will give us the other side of the picture—in some respects, at least. Of course, not all the multiple pharmacies and supermarkets come from the same position—there is a split in that camp, too. Tomorrow's meeting will give us an opportunity to discuss the matter. If we had held that meeting earlier, we could have given you a flavour of the chemists' arguments. We need to know what changes would take place if deregulation were to come into effect and how the services that we require from "The Right Medicine" strategy could be sustained.

You talked about the economic situation, about which you are obviously seeking further information. It is vital that the long-term economic situation is taken into consideration. In my opinion, cost savings that may be gleaned at the outset of the exercise would be vastly outweighed by the long-term effects on people who would not be able to use local pharmacy services because they would no longer be in place. People might not be able to go to supermarket pharmacies or pharmacies that were further away, and they would not be able to get home delivery of medication. The long-term cost effects of that on the health budget would be quite horrendous. That must be taken into account in your deliberations on the economics of the situation.

I fully accept that.

One of the submissions to the committee suggested that the actual savings would be equivalent to about 60p per person in Scotland, but that the cost in extra reimbursement and remuneration to pharmacists would far outweigh that, never mind the point that Janis Hughes has just made. Will you take into account the likely impact of the reimbursement and remuneration of pharmacists and the extra impact of the increase in the NHS prescription bill? Is that one of the things that your economist will consider?

Yes.

Is the Executive taking into consideration the fact that, over the past 20 years or so, supermarkets have already drained the local pharmacies of a large amount of their business—such as the easy, over-the-counter medicines, cosmetics and soaps?

Of the welter of evidence that we have had, one paragraph stands out. It is from Lindsay and Gilmour chemists:

"A switch of resources away from community pharmacies, towards supermarket pharmacies will benefit young, affluent, car owning ABC1's at the expense of C2, D & E's, the elderly, the disabled and mothers with young children, pedestrians and users of public transport."

As the minister, like me, represents an urban area, he knows about the urban dimension and the distance from supermarkets, which is large. Mary Scanlon referred to the problems in the Highlands. Are poorer people going to end up much worse off financially if they have to trek out to distant supermarkets?

We need to consider many of those submissions. Most of the submissions that I have seen so far are about recognising that some flexibility might be needed in how we operate access to pharmacies. However, there is a question about whether the OFT's recommendations will deliver what Janis Hughes mentioned regarding the longer-term economic and health consequences.

I do not want to argue against the flexibility of access to the provision of different services in supermarkets that those in a consumer society want. I also recognise the principle behind "The Right Medicine", which is essentially that the pharmacy is part of a health team that supports many of the particularly disadvantaged communities that we know of throughout Scotland. Those communities require access at the right time and place without any major expense.

That will be factored into our deliberations. Much of that argument is contained in the contributions that we have received so far. It will, I hope, be reflected in how we determine the outcome of our assessment. However it is important—I must stress that—to hear a variety of views to allow considered assessment to take place.

You talked a bit about the views that you heard at the open day on 6 February and at the meeting with the chairs of the Royal Pharmaceutical Society in Scotland and the Scottish Pharmaceutical General Council. I take it that the views that were expressed to you were much the same as those expressed to us, which were about those organisations' concerns.

I would have thought that, at this stage, you would be beginning to formulate your own views about what you have heard. You will be responding by 28 February, I think. Will you give us some indication of your early feelings on what you have heard so far?

I have done some Jesuit training in the past, but I do not know whether it will work here. The Executive said that it wanted to hear the views of the stakeholders. We are not at the end of that process, and it would be inappropriate that the Executive has firm views.

However, many of the representations say, I have said and the First Minister said on Thursday that "The Right Medicine" is one of the key components of our pharmacy strategy for Scotland. The decision will be made in Scotland, by the Scottish health ministers, rather than elsewhere. We are doing a robust assessment of the principles that underpin the OFT report.

That is as much as I can say to the committee today. However, members have an opportunity between now and the final closing date—I am not sure what that is—to give any subsequent views, which we would be happy to receive. I think that we would like to arrive at a decision earlier than was perhaps first thought when we initially encountered the issue in early January.

The Scottish Pharmaceutical General Council raised with us some concerns, which I assume it also raised with the Executive. The council estimates that the average pharmacy's sales of pharmacy-only medicines and over-the-counter medicines accounts for less than 5 per cent of activity. The thrust of the OFT report is that the current regulations should be dismantled in order to reduce the cost of medicines, but given the fact that those medicines account for less than 5 per cent of what pharmacies dispense, is not that a bit like taking a sledgehammer to crack a nut? Does the minister agree that that is an accurate reflection?

The percentage figures are accurate. They will be taken into account in the assessment that we make.

The minister mentioned the importance of "The Right Medicine" and the impact that the OFT report could have on that. I am not sure whether I picked him up right—he can correct me if I am wrong—but did Bill Scott say that "The Right Medicine" did not view control of entry as a crucial issue?

That is right.

I want to ask some questions about that. In the evidence that we have received, the thrust of the argument has been that supermarkets have already indicated their intention to open pharmacies if they can do so. In addition, existing pharmacies might end up clustering around the surgeries of general practitioners in order to be the first port of call for people leaving the surgery to collect their prescription. Given that such developments would remove the stability of many existing community pharmacies, would there not be a direct impact on the Executive's strategy that was outlined in "The Right Medicine"?

The strategy looked at the health needs of the Scottish population and how we can better use pharmacists and their skills to address some of those needs. One issue that we considered was repeat dispensing. About 70 per cent of prescriptions are repeat prescriptions for chronic illness. We are looking at a scheme to allow people to get prescriptions for six months or more from their pharmacy rather than requiring them to go back to the surgery. Obviously, that could change the way in which people use pharmacies.

Surely the point is that, if the abolition of the control of entry regulations directly impacts on the survival of community pharmacies, the whole strategy will be jeopardised? Would not the OFT proposal have a direct impact on the whole thrust of what "The Right Medicine" is trying to do?

We are in the process of looking at the issue. Our judgment on what impact the OFT proposal would have will be based on the evidence that is coming in and on our own work.

I thank the convener and the committee members for letting me join the committee today. The OFT proposal is a seriously big issue out there, especially in my constituency in the far north. I echo Dorothy-Grace Elder's comments that it is fair to assume that the supermarkets would love the business. However, given the fact that chemists and pharmacy businesses in the Highlands are only just viable, it would not take much for them to go down. If this raw market proposal were to go through, pharmacies in town centres would be under threat.

As Dorothy-Grace Elder said, there is, unfortunately, a direct relationship between the poorest sector of society and those with the poorest health record. It is precisely those people—the elderly and the poor—who do not have cars or transport to take them to out-of-town supermarkets who would be the hardest hit if the proposal were to go through in its present form. My angle on that, as my party's equal opportunities spokesman, is that it would be absolutely deplorable from an equal opportunities point of view if that were to happen. I hope that the Parliament will in no way be associated with a change in policy that would impact directly on the most vulnerable sectors of society.

I do not know whether there was a question.

I do not believe that there was.

Do you agree with what I said, minister?

I will amplify and echo what I said earlier: the OFT report was strictly defined and considered the issue from the perspective of the consumer, whereas "The Right Medicine" is based on the health perspective and wider health needs. We support many of Jamie Stone's points, in relation both to rural Scotland and to disadvantaged parts of urban Scotland.

We must get the balance right. As I said earlier, we are carrying out a robust assessment of the economic case in the OFT report and, within that, we are considering how the report connects—or does not—with the strategy that we have been evolving.

As far as I understand the history, the controlled use of the list was introduced in 1987. I am not sure whether any of the officials know about the situation before that, because it was a substantial time ago. Knowledge of that might facilitate our achieving a more rounded perspective. We recognise Jamie Stone's intention and many of the themes that he raises and we will take them into account in our deliberations.

My point is that fair trading could equal unfair health for society.

David Davidson intimated to me some days ago that he wished to pick up on the point that Mr McAveety has just made about what happened before 1987. He was involved at that time in a professional capacity.

Thank you, convener. I declare an interest: I am a non-practising pharmacist. I used to be a community pharmacist and I was the secretary of the Royal Pharmaceutical Society of Great Britain's department in Scotland, which involved the registration of pharmacy premises, not the NHS contract.

Pre-1987, there was what we called leapfrogging. People who had a bit of spare money and the opportunity were prepared to open pharmacies on a speculative basis. Sometimes they failed and, in doing so, they often destroyed the staffing levels and the experience and skill base of existing pharmacies that had developed over the years. I have little doubt that health authorities and health boards are capable of deciding whether someone delivers on a contract, but we do not want to go back to that situation. It ended up with cherry picking and conglomerations of pharmacies away from estates. There was no reason for people to go to pharmacies in rural or suburban areas or in newly built estates; they went to the point of delivery of prescriptions that was nearest to the local surgery.

There has been a period of stability since 1987 and prices have not shot through the roof, as was argued at the time of the changes. The price and value of a pharmacy is dependent on profit and, these days, pharmacy is not the most profitable profession in the world, because the Government looks for value for money.

I did not really come to the meeting as a witness.

You raised this point with me the other day, when it was mentioned in the chamber.

I had a couple of questions for the minister.

I will come back to you.

The OFT report found that, geographically, the UK is well served by pharmacies. Will that change when the industry is deregulated, as the Scottish Pharmaceutical General Council has argued?

We are considering that submission, which might have some validity.

All members have a story from their constituency on the issue. David Davidson mentioned pharmacies in estates—all that I can say is, "I wish." I cannot even get general practitioners to set up satellite surgeries in some estates. There is a genuine concern about the matter in rural areas of my constituency. Those areas are served by family businesses that are part of the community and that provide a link and familiarity that would not be there if people had to travel to pharmacies. People have a good rapport with such pharmacists and can ask them questions; they do not need to look round to see who is in the queue before they decide whether to ask a question. There will be a huge impact on the health of the people of Scotland if we allow a free-for-all.

Those points are strongly put in the submissions that we have received. We have received more material in support of that argument than any other.

The committee sympathises to a certain extent with the minister and understands that he does not want to say anything that will pre-empt a full and thorough assessment of the situation. However, I will have another go.

We will not give up easily.

No, we will not.

One of the contentions in the OFT report is that localised problems with access can be tackled through specific schemes, rather than through universal regulation. What is the minister's view of that? Is there a danger that such an approach might lead to a situation similar to that which exists in some areas—particularly rural ones—with dentists, where difficulties are experienced in attracting appropriate professionals, which forces the NHS to compete with the private sector for skilled workers? Do you have any thoughts on that, minister?

I have lots of thoughts.

Will you share them with us?

The submissions that we have received so far point in the direction that Bill Butler identified.

Are you heading in that direction?

The volume of submissions on the issue is impressive and we must assess them. The uniform contributions that committee members have made will help us in arriving at an overall perspective.

We want to ensure that pharmacies are a central part of the health team and that the agenda is not solely about consumers. With that in mind, and in the context of what the Executive has already published in the "The Right Medicine" and our commitment to ensuring that the decision on the matter will be taken in Scotland, we will take the submissions fully into account in the appropriate time scale, which, I hope, will be short rather than long.

Those comments are helpful. The issue is contentious and has provoked many comments and petitions, including a 3,000-name petition in the north of my constituency and a 2,000-name petition in the south in the past two weeks. Can I take it from what you say that you are happy for the final decision to be the Scottish Executive's and that a swift decision is in order?

Yes.

I think that I am happy with that.

I will try to make Bill Butler even happier by pushing the issue further.

The control of entry regulations were introduced in 1987 as a means of planning the provision of pharmaceutical services to make them match the needs of defined communities. The OFT report recommends scrapping that planned approach to the provision of pharmaceutical services and substituting it with a free market approach. From the submissions that we have received, we know who is on which side of the argument: Asda and Wal-Mart want the free market, while Davidsons Chemists in Dundee—I am sure that it is nothing to do with David Davidson—wants to stay with the planned approach, which it thinks serves communities throughout Scotland well. Which side of the argument is the Executive on?

That will be decided by what is in the interests of the health needs of the people of Scotland.

Is that the planned approach or the free market approach?

A third way might be suggested in the correspondence, although that might be terrifying for you, John.

If there is a third way, it would be worse than the free market approach.

I would edge towards the third way, which is to take a partnership approach and to recognise the role of pharmacies in addressing longer-term health needs. I am in a difficult position this afternoon because of the time scale involved and because we have given a commitment to listen to different views.

I point to "The Right Medicine", the investment in our primary care strategy and innovations such as the community pharmacy strategy in, I think, the Moss Pharmacy in Dundee, which allows access to primary care. We have a range of measures aimed at edging towards coherent longer-term support for pharmacies as part of the health team in Scotland. We want to use that as a template when we make our overall assessment of the OFT report.

If you are asking me whether, in principle, I have a view on whether the market meets those needs, I must say that I do not. If you are asking whether I believe that we have a role in supporting a strategy that considers where elements of the market can be socialised to meet the needs of communities, I have to say that I agree with that. That is what "The Right Medicine" has been about, and that is what we are edging towards. Within that there might be an opportunity for you and I to agree on something.

It has been a long time since that happened.

I know. It is more frightening for you than it is for me, John.

Can I take you back a wee bit? I think that Bill Scott said that there was a half-day consultation by officials. It was not about going out there and seeing a pharmacy in a rural area or a city and all the rest of it, but about looking at the broad range of services that are provided. I pick up what the minister said about the health care team approach and the link with the GP practice, which reviews regularly whether somebody who is on several scripts is using the medicines properly, and how that has an impact on the OFT decision. The submission from Lloyds Pharmacy indicates that the company believes that the report places a disproportionate emphasis on a small cost saving on over-the-counter drugs and that it does not refer to anything that is on NHS scripts. How, then, can we get the message over that we are committed to the health care team delivering for the patients of Scotland?

I ask Bill Scott to reply to the first part of your question, and I will come in after.

I did not personally meet the OFT; colleagues of mine did. The OFT did not visit pharmacies in Scotland, as far as I am aware. I am also aware that the OFT said that it was not the NHS that it was interested in investigating, but purely whether the control of entry regulations distorted the free market for the sale of medicines and what effect that had on prices. The OFT has since reiterated that.

The OFT's report will need to be addressed by ministers of the UK Parliament and the devolved Administrations. We obviously have different powers in relation to that. The Northern Ireland Assembly would have similar powers to those that we have, but does not because of the suspension. The Welsh Assembly's powers are slightly different. We have specific powers, which I have been emphasising this afternoon. Overall, we are committed to looking at pharmacies as part of a health team. That is the broad perspective that will underpin much of what we will say.

It seems as though the report has been skewed to the small amount of OTC sales rather than NHS scripts, which make up 97 per cent of the market for community pharmacies.

There is a very powerful submission by SPGC on those issues, concerning the scale and the balance of that. That is something that we are deliberating on and will make some judgments on.

Did the OFT speak to ministers about the report? Have you had dialogue with the OFT since the report was issued?

No. The OFT has not spoken to any Scottish ministers about the report, and I do not believe that there has been much discussion of it with other UK ministers, although I do not really know.

Nothing has been discussed with the health ministers.

There have been no discussions with the health ministers. There was contact with health department officials, but that was based on a face-to-face meeting rather than on any research. Part of our overall assessment will be to look behind some of the claims that were made on behalf of that investigation. We are getting into the real detail and we think that we are able to put together a reasonably coherent case that will question some of those claims.

It may be appropriate for us to ask the OFT to come and give us evidence on how it came to its determination relating to Scotland.

We will return to the issue at the end of this part of the agenda. Generally speaking, I would go along with that. Bill Scott's comment that it was not the NHS that the OFT was interested in is being echoed by a number of people who have read the report.

I want to come back to the point about patients getting the right medicine. At the end of "The Right Medicine", actions are outlined for 2003, 2004 and 2005, which have been signed up to by all community pharmacists in Scotland. Representations have to be submitted in Scotland this week, and representations have to be submitted in England within 90 days, which takes us up to the end of April. What is the time scale for the deliberations of the OFT and the DTI? I worry that people will simply put on hold any investment in their pharmacy, and no one could blame them for doing so. However, surely that is a threat to your strategy and the actions in the document, which I am signed up to as are all community pharmacists. Is that not likely to derail the strategy, especially the actions that you have outlined for achievement year on year?

Our principal commitment is to "The Right Medicine". We spent an awful lot of time creating a space where people felt comfortable in signing up to that kind of longer-term commitment rather than seeing themselves as commercial enterprises. Alongside that, as I mentioned, we have opened up our modernisation budget and some pharmacies, in partnership with other health professionals, are pulling together incredibly innovative strategies. I do not want to be over-enthusiastic, but the UK pharmacy strategy is a very good document, if not one of the most pioneering documents that has been produced on pharmacy. We want to maintain the momentum.

Even with this sidewinder of the OFT report, there is still a shared partnership agreement. Certainly, at the meeting that we had with it last week, the SPGC was emphatic about seeing that as a strategy for moving forward. The SPGC wanted to draw our attention to its immediate concerns about specific issues in the OFT report, suggesting that that has a relationship with what we want to deliver in terms of "The Right Medicine". Again, that is part of our deliberations.

Given the volume of interest and the nature of the discussions that we have had, I am minded to bring forward our views earlier than I originally thought was required. The First Minister's comments on Thursday suggested that, too. We want to arrive at a conclusion sooner rather than later, largely to address the issue of longer-term planning, so that people will feel reasonably clear about what the direction is in Scotland.

So you recognise that pharmacists are facing uncertainty and that the community pharmacy infrastructure has been destabilised, as we have heard in many submissions.

I recognise that there is a need to ensure that the momentum that has been gathered for "The Right Medicine" is maintained. I want to ensure that it is delivered on.

Will the Executive's submission to the OFT be made public?

That is a good question.

That is why I am here.

I do not have a straight answer to that. Bill Scott and I are due to meet officials from the other departments on Thursday to map progress and developments in the four countries and the DTI's position on the matter, with a view to getting a greater degree of clarity from the DTI on how it expects to play this in terms of timetabling. The different situation in Scotland and Wales is a factor, as has been alluded to. The 90 days run into that period. We have to look at the time frame and where we are.

By the end of this week, although we will probably still be receiving submissions, we will have received the bulk of them. As I said earlier, the economists are committed to giving us a report by the end of the week or by the beginning of next week. We will have had our meeting with officials in the other departments and we will have a pretty clear idea of what timetable we will need to allow the DTI to submit its report to the EAPC. It is then up to us to report back to ministers next week, at least with an initial response.

If the economists' report—

Part of the thinking behind my question was to pick up on the points that were made by Mary Scanlon and then the minister. What the minister and the First Minister have said is that the ultimate decision on whether to act on the OFT report lies with Scottish ministers.

If the Scottish ministers' submission to the DTI makes it clear that they will in no way accept the OFT report, that will allow the momentum of the Scottish strategy to continue and send a clear message to Scotland's pharmacists that Scotland will do its own thing. Obviously, it would be good if that could be made public.

Our views will be clear. I intend to make them public.

Do you agree that there are two major principles at stake? One principle is that the NHS pharmaceutical contract is not a retail commodity, so the OFT and the DTI have no interest in price fixing. The second is that Scottish ministers, although they have devolved powers down to health boards, have a responsibility to ensure that there is an accessible form of pharmaceutical service to deliver the NHS dispensing contract across the whole of Scotland. Do you agree with those principles?

Yes.

That is encouraging, and I thank the minister for that. If that is what the Executive believes, is there any reason why that has not been made public knowledge, or is that just the Executive's style in dealing with an OFT report?

Conscious that the report contained a series of recommendations that would impact on other UK health departments, I genuinely thought that it would be precipitate for me to make a direct view known until I received views from stakeholders. The process in which I have been involved over the past week has presented a fairly compelling series of points on which we will need to reflect before making our final submission.

I emphasise that, as I have said repeatedly this afternoon, "The Right Medicine" and the partnership approach will be a core element of our response. There will also be a recognition that the Executive makes the decision on the recommendation of access to the list. We hope that we will be able to pull all that together and arrive at something in the next 10 to 14 days that will be much clearer, so that we can reassure folk about the uncertainty that has been evidenced today.

Do you agree that, under the devolution settlement, apart from primary legislation on drug controls and so on that emanates from Westminster, the running of the health service is totally devolved to the Scottish Executive?

I have noticed that, yes.

I want to ask a point of clarification. It sounds like the DTI report will be an amalgamation of the comments of the Scottish Executive, the National Assembly for Wales and so forth. Will the report simply be signed off by the people at the DTI, who will then submit it to the Department of Health? Will Scottish ministers give their view more as a matter of courtesy, given the fact that the decision on what we want to do is one that is reserved to Scotland? Will the DTI report to the Government be really little more than information about the respective views of the devolved Administrations?

The DTI has made it quite clear that it could end up with a submission that contains four totally different opinions.

One of the remarkable features of the issue is that this has never occurred before in any policy area. Indeed, it might never occur again, given the fact that nobody could have predicted that one of the constituent parts—the Northern Ireland Assembly—is not even functioning because of what has happened there in recent months.

Are you relaxed about the possibility that Scotland will take a different approach to the matter from that of other parts of the United Kingdom?

I have always been relaxed about that, as you know.

What concerns me is the manner of that different approach. You referred earlier to a "third way".

I have converted you.

Mr Blair has given up on the third way, just as he gave up on beacons for Britain. Would that third way mean that the supermarkets might be allowed to make further inroads into the community pharmacy business? Instead of a total free market, might the regulations be relaxed to some extent? That kind of weak compromise could lead to an entirely free market in the future. There does not seem to be much room for compromise if we are to protect these businesses. Will you spell out what your third way is?

The submissions that we have received have not only been from those who say that there should be no change or that there should be total deregulation. Already, a number of folk, including those who are involved in community pharmacies, have recognised that there might be ways in which a more efficient and flexible delivery could be provided in response to customers' demands.

I can give you two guaranteed assurances. First, any changes would have to go out to full public consultation. Secondly, as I have said already this afternoon, any change would need to be underpinned by the commitment that we gave in "The Right Medicine", which has a role to play in improving access to the health advice that is offered by pharmacies. That is a totally different context, so members need not worry that a Trojan horse is being introduced that might through time bring about the change envisaged by the OFT report, on which people have commented and which people do not support.

My remarks were much more about recognising that things need to adapt and respond to what is happening, in the same way as happened in 1987. There was much alarm when the 1987 regulations were introduced, but the fears that people had then were not realised. The situation may need to be modified to deal with today's changing patterns of public demand. We should be reasonably attuned to that. However, any change must be part of the broad strategy of ensuring that, as other members have said, people have access to pharmacy services wherever they are in Scotland. Access should not be determined by the fact that a person happens to live in a part of Scotland that is economically convenient and profitable for commercial interests.

To pick up on your last point, in our discussions with pharmacist leaders, many of us have been impressed by their willingness to consider whether opening hours might be extended. We certainly welcome the forward-looking approach that is being taken.

I must now bring this item to a close. We have had a good discussion. Margaret Jamieson suggested that the committee might wish to ask the OFT to give evidence so that we can question it about its report. I am in favour of that. Are all other members in favour of that as well?

Members indicated agreement.

That is agreed. Given the time that is available to us, I also ask members to agree that we keep the several written submissions already received from stakeholders—I am sure that they will be happy for their submissions to lie with us—and that we ask for any other submissions to be made in written form at this stage. We will take oral evidence from the OFT.

Members indicated agreement.

At the end of that, we can input the committee's view to the DTI. Because of the timetable, we will miss the opportunity to input our views to the Scottish Executive, but the committee can send its submission loud and clear straight to the DTI. Is that agreed?

Members indicated agreement.

If I may, I suggest that it would be helpful if I could receive a copy of the committee's submission as soon as possible.

Equally, it would be helpful if we could receive a copy of the Executive's submission.

Reciprocity. I love it.

In partnership, we will be happy to provide the Executive with a copy of our submission.

We will now take a short five-minute break.

Meeting suspended.

On resuming—