Health: Drug Tariff Part IX

Part of the debate – in the House of Lords at 5:28 pm on 24 January 2008.

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Photo of Lord Roberts of Conwy Lord Roberts of Conwy Conservative 5:28, 24 January 2008

My Lords, I support my noble friend Lord Howe on the Front Bench and compliment him on raising this debate on the Government's aims in reviewing Part IX of the Drug Tariff for the provision of stoma and urology appliances. In his opening speech he examined the review in great detail and presented valid criticisms of its methodology. I shall not follow him down that path. I raised some issues about the review in Questions for Written Answer last year when the Government received such a volume of responses to their consultation that they postponed changes planned for last July.

Before I proceed, I declare my interest as a patient user of stoma items and have been for a decade. I hope that my personal experience and account of it will give noble Lords a clearer insight into the sensitivities involved in this area. Ten years ago, I was diagnosed as suffering from diverticulitis and underwent a colostomy operation, which resulted in the removal of the sigmoid section of the colon. The operation left me with a stoma which enables excretion through it into a bag on my lower left side. I would have wished to spare the House these medical details, but they have to be presented to enable anyone who is unfamiliar with a colostomy to appreciate what is involved in the physical management of the resulting stoma.

Over the 10 years I have had no significant problems, which I attribute in no small part to the high quality of the prescribed items used, from the flange surround of the stoma, which has to be changed weekly, to the bag attachment, which I change as necessary, at least on a daily basis and sometimes more frequently. I must also commend the reliability, celerity and smoothness of the home delivery service providing these essential items, without which I really do not know how I could live a near normal life. In my case, the items are supplied by an assembly and distribution company at Fittleworth in West Sussex. The items include some made by ConvaTec, a Bristol-Myers Squibb company, which has a manufacturing plant in north-east Wales—a plant that I opened 25 years ago.

In the early stages of managing my stoma, there were accidental mishaps, all due to my own inexperience or lack of care. Mercifully, none occurred in public. I can only imagine one's consternation and others' disgust if these accidents happened coram publico. Such accidents are, of course, always possible, but the excellent quality of the items supplied means that one can depend on and be confident in their reliability, which is clearly of vital importance.

When one reads about the history of this lengthy review, and the Minister's reply to me on 9 May last year that savings might be made of some £27 million in the total cost of Tariff List items of some £169 million, one cannot but wonder what is to be sacrificed. One hopes that it will not be the quality or reliability of the products. My noble friend on the Front Bench in his opening speech gave us an indication where those cuts might occur. The suppliers, who numbered about 68 last year, are fearful that all kinds of sacrifices will be required of them to the disadvantage of their patient customers. Coloplast, one of the major suppliers, is especially concerned; it believes that it will bear a disproportionate part of the cost cut and will have to abandon the making of certain products. Research and care services are also at risk.

The Minister at the Department of Health last year was the noble Lord, Lord Hunt of Kings Heath, who told me on the Floor of the House:

"Let me make it absolutely clear that the last thing I want to do is to inhibit the provision of the kind of services that he"— that is, me—

"has described. This is about value for money and ensuring that we move away from the difficult-to-understand financial regime and payments to the various contractors to a transparent system that is based on value and enhancing the service to the public. We should make sure that that happens".—[Hansard, 24/4/07; col. 556.]

There were other assurances to the same effect. On 12 June, he told me in a Written Answer:

"In conducting this review, a key objective has been to maintain and improve the quality of patient care".—[Hansard, 12/6/07; col. WA 243.]

Like my noble friend, I sincerely hope that the Government adhere to the principle that the object of the review is to improve patient care.

I hope that the Minister will reassure us today that the quality of the service will not deteriorate—and I am sure that my hope is endorsed by the 450,000 patients who receive the 4.5 million dispensed items covered by the tariff lists. Those figures were given to me by the Government, so they must be right. Many of those patients are victims of other illnesses and are highly vulnerable. We must make certain that we do not add to their suffering.