Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I beg to move, That the clause be read a Second time.

Andrew Turner (Isle of Wight, Conservative)

On a point of order, Mr. Key, could you indicate whether there has just been a Division?

Robert Key (Salisbury, Conservative)

No. There was no Division, because there was no one on your side saying what they wanted to do.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

Which of course, in parenthesis, was because had we forced the Division, that would have precluded—in the way these things are handled—being able to bring this back on Report, so quite rightly we had to do that.

Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour)

On a point of order, Mr. Key. May I clarify the position? The new clause was negatived in the sense that the Committee disagreed with it. That was a vote, therefore, even though there was not a Division. A decision was made in relation to it, but not a Division.

Robert Key (Salisbury, Conservative)

It was a decision, not a vote.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I am grateful for your clarification, Mr. Key. As far as we are concerned, it has left us with the option of being able to make sure that that is brought back on Report. It would have been closed out had we forced a Division—so no one should read into the fact that we were not pressing it to a vote the absence of our continuing earnest underlying new clause 1.

New clause 6 concerns an issue that our discussions about pharmaceutical needs assessments have not yet raised, and that is the provision of pharmaceutical services for patients living in cross-border territories. We touched on the subject in relation to other matters in the Bill. My constituency is widely affected by it; a significant number of my constituents in various villages such as Farndon, Shocklach, and Higher Wych, make use of Welsh NHS services. The Welsh Affairs Committee estimates that there are more English patients registered with Welsh GPs than vice versa—about 20,000 English patients with a Welsh GP and about 15,000 Welsh patients with an English one. In 2007, there was a net flow of 5,354 patients into Welsh primary care services from England.

The localisation of entry into the pharmaceutical list, through the pharmaceutical needs assessment, could impact negatively on those patients. If Wales grants applications to provide services on the basis of its Welsh population, and an English PCT does the same for its area, English patients registered with Welsh GP practices could find there is inadequate provision of pharmaceutical services in their area. My amendment seeks to ensure that Welsh Ministers take that into consideration when monitoring the PNA process, so that pharmaceutical services in cross-border territories do not suffer, and patients in those areas get a fair deal. The new clause is to probe the Minister about what provision the Government have made to ensure that residents of such areas have access to the same calibre of pharmaceutical services as elsewhere in England.

Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour)

The provision of general medical services and pharmaceutical services is governed by powers within the National Health Service (Wales) Act 2006. Such powers are within the devolved competence of Welsh Ministers, and if the new clause were accepted, it would derogate from the devolved competence of Welsh Ministers in respect of their functions in relation to health.

Additionally, the measures do not accord with—and, in fact, run contrary to—the principles underpinning the protocol for the cross-border commissioning, which was agreed between the Welsh Assembly Government and the Department of Health on 1 April and which will continue until the 31 March 2011. That protocol sets out agreed procedures for commissioning NHS  health care for residents in England who are registered with a GP in Wales, and for residents in Wales who are registered with a GP in England.

While the PCT retains the legal responsibility for its resident population registered with a GP in Wales, local health boards commission such services on the basis of clinical need, and as a minimum, the Welsh Assembly Government’s standards for access to health care, irrespective of the location of the provider. That means Welsh GPs are required to work to the standards and targets set out by the Welsh Assembly Government for all the patients that they see and treat, irrespective of the patient’s place of residence. For those reasons, Welsh Ministers have confirmed that the new clause would not be accepted, so I hope that it will not be pressed.

We have set up, with great care, a relationship with the devolved Administration in Wales. That has been carefully negotiated and the arrangements have been agreed up until 2011. This clause would change everything, without full consultation and with no discussion.

I appreciate that it is important to deal with these issues appropriately, but I assure the hon. Member for Eddisbury that if an MP, on behalf of their constituent, raises an issue with a Minister about the provision of health care by a Welsh GP to an English patient, the Minister will be able to pass it to the Welsh Health Minister, and the Welsh Assembly Government would then respond to the letter in the same way as that from an MP. There are ways in which these matters can be dealt with but trying, in effect, to write a new derogation from the relationship with Wales is really not the way forward.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

As I said, this is a probing new clause, so I will not press it. What is important, given that last element of the Minister’s response, is that I am glad to note that the Department of Health would, for instance, pass on a complaint that I might write to him on behalf of my constituent who has a problem with a GP in Wales with whom they are registered, to the holder of the equivalent ministerial position in Wales.

I am grateful for that assurance, because outside the Department of Health—which I have had no cause to write to on behalf of a constituent—my experience to date in about 70 cases that I have taken up over the past decade has been, at all times, for my letter to be passed to the Welsh Assembly’s equivalent Minister, then, if I receive a response at all, to hear that I have no rights as an MP and that they therefore respond to me as to any other citizen in the country. The quality of response has been extremely poor compared with the assurance that the Minister just gave, so I am grateful for that, not least as I rather hope that the rest of Whitehall will note what he has just said and that for once, after a decade of trying, I might get somebody in the Welsh Assembly to listen to the enormous issues that spread right across the Welsh border with Cheshire along the River Dee. That has been helpful from a more general point of view, and I hope that the Minister realises the enormous consequences of the commitment that he has just given, which I will now be able to pray in aid across the whole of Government.

That said, I note the care with which he thinks that the protocol has been negotiated and the number of years that it is meant to last, but it does not work in all  respects. There are significant shortcomings in the way that the protocol operates, and there have been some real problems, not so much in primary care services, but certainly in emergency services, resulting in a number of patients coming across the border from Wales to access the shorter waiting times at the Countess of Chester hospital. Meanwhile, we have had a number of English patients wanting to access the free prescriptions in Wales. The protocol is fairly frayed, at times, and causes an enormous amount of casework for local MPs.

Sandra Gidley (Romsey, Liberal Democrat)

The hon. Gentleman mentioned the free prescriptions in Wales. How much of a factor is that in the disparity? Are people actively choosing to go over the border and register with a Welsh GP because of the free prescription charges or are other factors at work that a good pharmaceutical needs assessment could, potentially, address?

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

That is an interesting question. I shall be careful not to stray too far, but it covers cross-border pharmaceutical services in so far as the needs assessment is taking place within a village where it is literally 200 ft down to the old Roman bridge to cross the River Dee from Farndon to Holt in Wales, where they also have a pharmacy. Those needs assessments have, for these purposes, been taking place in completely separate countries yet, in truth, the proximity of those two pharmacies compared with many facilities across many other, more rural parts of my constituency has shown that there is a difficulty at these points in how territories are defined.

Most importantly, at the moment it is too early to tell; there is not enough evidence, and it is anecdotal about people with long-term conditions and who do not get free prescriptions in England. However, particularly if they are of working age, there is some evidence of attempts to register with Welsh GPs in order to access free prescriptions. On that basis, I am happy to withdraw the new clause, but we have had a rather useful discussion. I beg to ask leave to withdraw the clause.