Day two of the pharmacy funding cuts High Court appeal: what happened?

That’s a wrap of #CutsinCourt. SI said judgment will follow them - no date given. Look out for live interviews on C+D Facebook shortly thanks for following all 😊

— Thomas Cox (@ThomasBioPulse) May 23, 2018

SI sumary of DL: Consideration of maintentace of footprint was not enough to deliver duty; due to effect on services #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Let’s not forget the impact on patient safety and the health and wellbeing of pharmacists and pharmacy teams. #CutsinCourt @ChemistDruggist https://t.co/4EtQIyKskF

— Pharmacist Thorrun, Healthcare Expert (@pharmthorrun) May 23, 2018

DL: SoS only considers footprint. There was no analysis that led to that. There is simply no rationale as to why distane is only factor in discharging duty #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

DL: Cuts in funding for those that stay open diminish services - JE's assertion that a smaller number of pharmacies closed than was predicted, which he has "no evidence" of, is "irrelevant" #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF sits for last time, DL stands for final stretch: SoS assumed that entire #NHS duty can be delivered by maintaining footprint of services - physical distance - via Phas. That's not right because of existing inequalities #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

What happened to ‘No decision about me, without me’ #CutsinCourt @ChemistDruggist https://t.co/iZk1lurL5X

— Pharmacist Thorrun, Healthcare Expert (@pharmthorrun) May 23, 2018

AF: Closing down part of pharmacy market was in forefront of minister's mind, this package was designed to do much more than establish reasonable renumeration, reshaping c p without legislation - that is wrong. It is a case of misuing statutory provision #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF: Crafting of cuts decision within d tariff was misuse of it. Irish case showed reasonable renumeration - micro negotiation steps within complex area of private enterprise. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF: DL seeks to step away from 15% - well you did rely on it, it did have a character and it was important, it cannot be marginalised #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF: It is "entirely wrong" to suggest @PSNCnews reluctance to give information to consultation [challenges DL assertion that body has all info] #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF: It's piquant that early stages of discussion docs was 7% as operating margin, where did that go? Quite obvious it was relevant. We say SoS had to regard this #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF: Phas is premised on there being closures. Deals with NHS duty to provide pharmacy, but not completely #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

GH: Phas is a sort of safety net. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

SI: DH can't assess number of closures so can't assess impact of closures. AF: You need to know scale and scope of closures #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Would somebody think of the patients. #CutsInCourt @ChemistDruggist https://t.co/3MZcbZ3f2r

— Pharmacist Thorrun, Healthcare Expert (@pharmthorrun) May 23, 2018

AF: If you're making descions of this sort you have to consider effects. GH: Closures would have impact on patient access and individual pharmacies #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Sue Sharpe said we'll walk hand-in-hand with you to make these cuts in public interest but @PSNCNews needed to know rationale underpinning them - time pressured SoS into action #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

AF stands to respond to JE's argument, saying that SoS approach to making cuts was "fundamentally wrong" #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Yes. There’s the chance to pick up more unprofitable prescriptions. #cutsincourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

JE on DL point of pharmacies not having capacity to cope with increased demand from others closing - 1) There are powerful commercial incentives for pharmacies to pick up business 2) Impact assessment of services capacity is wholly unrealistic and impractical #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

aka robbing Peter to pay Paul #CutsinCourt https://t.co/LCaSAva0O1

— Lilian Anekwe (@SoMe_Lilian) May 23, 2018

JE: "Purpose of decision was to free up funds for healthcare elsewhere" #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: Decision was based on all patients having access to services. "Deprived areas tend to have more clusering of pharmacies, not necessarily to meet an increased health need". Phas has safety valve for areas where access is critical #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: Phas aimed to confront deprivation by targeting 174 pharmacies in areas where it existed #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: DH addressed inequalities with Phas. DL's argument about NHS having to reduce inequalities was a "sterile semantic" point #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: There was sufficient consultation to ensure fairness #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: 2 suggestions from PSNC to cuts' implementation were taken into account- including quality payments - but 1 was not, which was explained throughly #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: 2 suggestions from PSNC to cuts' implementation were taken into account- including quality payments - but 1 was not, which was explained throughly #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: There was a prolonged period of consultation, @PSNCNews knew that their contributions would be considered #cutsincourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: All decisions flow on "basis of risk, not on level of risk". Rock and hard place argument from JR was a "false dichotomy" #cutsincourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: You can't say number of closures was critical to design of these cuts' implementation #cutsincourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE referring to announcement of cuts in parliament - minister said in answer to question from Barbara Keeley he did not know how many pharmacies would close #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

SI: "I've not come across before" when minister had not confirmed he'd read docs at certain time, here impact was published 2 days before he spoke in Parliament - in another case this could be very significant #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Are closures relevant or not? Mixed messages from JE from what I’m reading. #cutsincourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

Breaking for lunch hour now. JE to speak for another hour, facing DL @NPA1921 argument, continuing until 1630 #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

#CutsInCourt https://t.co/SYw8fakhQs

— James Waldron (@JamesPharma) May 23, 2018

GE: It doesn't matter what the number is. It's about imposing efficiencies and maintaining access. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Judges continues to press JE on 15% claim, GH: "The data is clearly very weak. What's its purpose in the paragraph?" SI: This study is "factually meaningless". It may not be surprising if the minister read this and nothing else before he made speech. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Would be interested to hear @PSNCNews's take on this. I thought they were blindsided by @DHSCgovuk's #pharmacycuts announcement in Dec '16? #CutsInCourt https://t.co/X0bjKWfITj

— James Waldron (@JamesPharma) May 23, 2018

GH: Minister chose this 15% profit point in announcing cuts - why did he choose it? JE: It doesn't reveal nature of decision-making. It did not reveal a reliable basis. [Judges refuting whether it was irrelevant part of decision as one of few bits of data reasoning] #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

I don't think that's the argument? Clearly his duty is to patients and equality of access to healthcare, and ensuring #pharmacycuts are not detrimental to wider #NHS #CutsinCourt https://t.co/5YKG7TLz4G

— Lilian Anekwe (@SoMe_Lilian) May 23, 2018

JE: @CompaniesHouse data was "in no way fundemantal to the whole edifice". JB: Why should we say it's not central? #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: PSNC was consulted over almost a year on details of proposals - they were given numerous opportunities to provide counter proposals, so as to enable an intelligent response #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

But what if closures caused by cuts lead to inequality? #CutsInCourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

JE: Case claims that being so unfair as to be unlawful - how central was the information to decision of funding cuts. Is it crucial? #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

This goes back to Alison Foster's argument from yesterday - @PSNCNews can't do its job without understanding what @DHSCgovuk thinks of #pharmacy #CutsInCourt https://t.co/MewoQtC36l

— Grace Lewis (@Grace_Lewis88) May 23, 2018

Who are these "trade bodies" Hunt supposedly asked about #pharmacy? Could they be the source of the sector "insider"? #CutsInCourt https://t.co/gF5yH2pY9j

— Grace Lewis (@Grace_Lewis88) May 23, 2018

GH: Seems to be misdirected that DH did not go to PSNC - point is if Sec of State had enough information or approach it in a rational way. JE: He asked trade bodies if there was anything to say about it. GH: Asking is not a delegation #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JB: You have a duty to consult. JE: We did. It's a rational approach to information gathering. "Entirely inaccurate" that PSNC were not told of effect of cuts on pharmacies. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

This is @DHSCgovuk 'sflawed premise in a nutshell. Still waiting for any data to show reducing patients' healthcare access improves efficiency #CutsInCourt https://t.co/Tzrm5QhOOb

— James Waldron (@JamesPharma) May 23, 2018

JE: "This was about macro-market efficiency. If some of them that are less efficient go to the wall, then so be it". If some of them do close then others will have an opportunity to pick up demand - they get paid more #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

We'll be the judge of that...#CutsInCourt https://t.co/soWoa1EKmM

— Grace Lewis (@Grace_Lewis88) May 23, 2018

Yeah, no big deal #CutsInCourt #MoveOn https://t.co/p1Np4npEn4

— Lilian Anekwe (@SoMe_Lilian) May 23, 2018

But OK to assume margin of 15% across the board when it suits #CutsInCourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

Heathrow Airport explains absurdity of Phas #CutsInCourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

Show your working @DHSCgovuk. Prove the savings = efficiency line isn't a fallacy #CutsInCourt https://t.co/bQCr4hqOYb

— Lilian Anekwe (@SoMe_Lilian) May 23, 2018

JE: One has to accept the possibility that may drive pharmacies to closure. Savings would drive efficiencies across sector but could put some pharmacies under pressure #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: Our was a considered case. We could have asked for more info (from likes of PSNC) but we decided "it wasn't helpful, profitable or needful to do so". Overarching strand is need to make efficiency savings in NHS in retail pharmacy sector #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: Drawing from drug tariff Irish case, likely to be one AF referred to yesterday. Shows duty to consider or investigate was not being done at all, while in cp funding cuts "it's being done in spades". #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JB: This is based on a prediction rather than a fact-finding exercise? JE: It is, not only that however. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: I had privilege of being Justice Collins' [of High Court case] pupil so I feel able to put his case forward. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: If you add all the pillars together that went into the decision you end up with a "fat document", as well as consultation with @PSNCNews among others #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Sure, and that is of course a terrible situation. But that doesn't help account for 130+ pharmacies that have apparently *already* closed. The part I'm surprised about is that so many closures have taken place silently #CutsInCourt

— James Waldron (@JamesPharma) May 23, 2018

Wow. I wonder where these are? Will the @DHSCgovuk share its data? #CutsInCourt https://t.co/di5fBycOIj

— James Waldron (@JamesPharma) May 23, 2018

Assuming half of the 190 "unviable" @LloydsPharmacy branches were ultimately closed, that still doesn't account for another 40-odd closures across the country. Have you had many closures in your area? #CutsInCourt

— James Waldron (@JamesPharma) May 23, 2018

But how many of these pharmacies forced to close provided vital services and health care for their local population? It's the clusters argument all over again - shouldn't be about numbers #CutsInCourt https://t.co/232BKflBKV

— Grace Lewis (@Grace_Lewis88) May 23, 2018

This doesn't seem correct, is this meant to be net opening and closing? #CutsInCourt https://t.co/63aKVD374G

— Kristoffer Stewart (@PharmKristoffer) May 23, 2018

134 pharmacies closed in 2 years. More than 1 a week. But does that include @LloydsPharmacy branches that have closed? Or a net difference? Not sure I trust @DHSCgovuk's figures... #CutsInCourt https://t.co/PBsPczmMTr

— Lilian Anekwe (@SoMe_Lilian) May 23, 2018

Number of pharmacies hanging on by their fingernails = most of the remaining ones. #CutsInCourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

Money may have stayed in the pot, but the pot isn't necessarily shared evenly to where it is needed when the pharmacies close #CutsInCourt https://t.co/vUwxNLft6T

— Kristoffer Stewart (@PharmKristoffer) May 23, 2018

I doubt this will be the last appearance of laughter in #CutsInCourt as @DHSCgovuk tries to justify its approach to #pharmacycuts https://t.co/MeGhOtT15S

— Grace Lewis (@Grace_Lewis88) May 23, 2018

JB: Cuts were closure insensitive because when pharmacies did close it didn't take money out of pharmacy budget. AF: We take no issue with that [DH bench erupts in laughter] #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Interesting development. Hopefully JE has fought himself into a corner saying the money goes back into the NHS & then contradicting himself by saying it goes to other pharmacies. #CutsInCourt

— Allisons Chemist (@AllisonsChemist) May 23, 2018

Judges have diverted JE's argument, onto whether the money freed up by a pharmacy that has closed would be spread to others, therefore not benefiting the #NHS, or if would go to NHS budget #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

SI: It wouldn't profit the #NHS budget to have fewer pharmacies, if there's a fixed or very marginally lowered establishment payment. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE: Process involves realising that cuts need to be made across NHS, prioritising cost-savings [then outlines cuts]. #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

2/2 How is this fully informed, rational decision making by DHSC @Jeremy_Hunt? Sounds significantly more like making a decision and then tailoring supporting documents to justify that decision. #CutsInCourt

— Andrea James (@HealthRegLawyer) May 23, 2018

JE: The process [of Sec of State clearing the decision] is not entirely incoherent. They come in a package. Essence of decision was reduction in funding #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JB says he would find it helpful if there were dates on all of the documents JE draws from #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

The tone in which this question was asked interests me. #CutsInCourt https://t.co/0IaWEBcSRO

— Allisons Chemist (@AllisonsChemist) May 23, 2018

JE: The process [of Sec of State clearing the decision] is not entirely incoherent. They come in a package. Essence of decision was reduction in funding #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JB says he would find it helpful if there were dates on all of the documents JE draws from #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

The tone in which this question was asked interests me. #CutsInCourt https://t.co/0IaWEBcSRO

— Allisons Chemist (@AllisonsChemist) May 23, 2018

JB: "Is this a common way of decision-making in this department? There's no paper record of clearance, it's just to be inferred?" JE: There are 3 pillars in the decision #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE points to market background and context for cuts by @DHSCgovuk head of pharmacy Jeannette Howe's statement. Judge JB: "We don't have a document formally recording the decision"? SE: No #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE starting by defining the "statutory context" of how Sec of State renumerates dispensing of community pharmacies. Funds paid for by taxpayer so "priorities need to be made". #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

JE is asking the judges to move papers around in their files, some confusion over where they go #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

DL has asked the three judges if they received a note with 2 points he said he emailed yesterday afternoon, they said they had not, so he's passed them copies #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Day 2 has begun with Alison Foster, appearing for @PSNCNews, giving more evidence from a sizable pile of docs on the drug tariff #CutsinCourt

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Protestors massed outside High Court against NHS changes in another area to #CutsInCourt - judicial review of plans to allow private companies greater role pic.twitter.com/3QxjN5P7Nl

— Thomas Cox (@ThomasBioPulse) May 23, 2018

Day 2 - potentially last - of #CutsinCourt saga due to start in 64 mins with James Eadie @DHSCgovuk tackling yesterday’s arguments from Alison Foster @PSNCNews and David Lock @NPA1921. They will respond after. Anyone keeping me company in the stalls?

— Thomas Cox (@ThomasBioPulse) May 23, 2018