Clause 4 - Personal medical services, personal dental services and local pharmaceutical services

NHS Reform and Health Care Professions Bill – in a Public Bill Committee at 4:30 pm on 29th November 2001.

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Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health) 4:30 pm, 29th November 2001

I beg to move amendment No. 92, in page 3, line 41, leave out ' ''behalf),'' ' and insert ' ''functions),'' '.

This is another minor, consequential amendment. Clause 4 removes the current bar on the Secretary of State delegating his own powers in respect of PMS and PDS pilot schemes by inserting a new subsection (1A) into section 9 of the National Health Service (Family Care) Act 1997. However, subsection (1A) does not take account of the fact that section 9(1) was amended by the Health Act 1999. In the amended section 9(1), the words ''functions on his behalf'' were replaced by ''his functions''. Amendment No. 92 corrects that minor drafting error, so that the new subsection (1A) applies the wording of the existing section 9(1A) as amended by the Health Act.

Amendment agreed to.

Question proposed, That the clause, as amended, stand part of the Bill.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Clause 4 deals with the important subject of personal medical services and local pharmaceutical services. I want to ask about the implications of the clause for Wales. There is concern about maintaining a level playing field between the nations on issues such as pharmaceuticals. The National Assembly for Wales has recently set up an all-Wales medicine strategy group to evaluate medical techniques and medicines, in much the same way as the National Institute for Clinical Excellence does. The group intends to issue its own guidance that will apply even if NICE is considering an issue. Will the National Assembly for Wales be able to allot money for

pharmaceutical services differently from such allocations in England and, if so, will the Minister give his view on that? Is there not some concern that, with the advent of such changes, important medicines could be available in one country but not in another? What are the implications of having different sets of guidance?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am always happy to talk about clause 4, which is a familiar friend of mine. As we have discussed, the Bill will transfer almost all primary care functions of existing health authorities to PCTs. That lies at the heart of the initiative to shift the balance of power. However, there is a technical and legal tension between the principle of shifting the balance of power in the NHS and the legal architecture of the National Health Service (Primary Care) Act 1997, with which the hon. Gentleman may have had some involvement.

We do not need to look today at the origins of that Act, but the underlying principles of PMS and PDS are correct. The architecture of the 1997 Act has not prevented the Government from using PMS to extend the reach of primary care services through a range of important and innovative ideas to many parts of the country, including run-down council estates where residents never had access to primary care services.

As I implied earlier, the legal structure of the 1997 Act prevents us from using the Bill to transfer all the functions in respect of PMS and PDS to primary care trusts. Of course, we could have chosen to do that, but only by requiring Parliament to scrap the 1997 Act and by rewriting the entire legal framework around the delivery of personal medical services. That would have diverted Parliament from discussing more important issues, but there is another way of doing it; the way that we have chosen in clause 4.

The heart of the problem is that the 1997Act requires a distinction to be made between the commissioner and the provider of PMS or PDS. For example, in the majority of PMS pilots, the commissioner is the primary care trust and the provider a GP, a group of GPs or a nurse-led organisation. In some pilots, the primary care trust itself is the PMS pilot provider and the health authority is the commissioning organisation. To transfer all the local authority PMS functions directly to a primary care trust would, in such cases, result in a primary care trust commissioning PMS from itself. Obviously, we cannot accept that. It would not comply with the 1997 Act, and would go directly against the grain of that legislation. The options are either to rewrite the Act or to confer limited functions in respect of PMS or PDS on strategic health authorities.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Boiled down, the Minister's objection is that it would interfere with the internal market. Is that right?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

No, it is not right. This is a sensible divide. Under the legislation put in place by the hon. Gentleman's party, it would not be possible to do what we want to do without vandalising the legislation. There is a sensible reason to separate the functions in the manner that I have described. The Government do not subscribe to the principles of the internal market

or to the mechanisms that the hon. Gentleman's party put in place to deliver them because they were a shambles. They littered the NHS with bureaucracy and created armies of people sending bills and chasing invoices. None of us wants to go back to that. Perhaps the hon. Gentleman does, but I do not think that he would find himself able to stand before a Committee, armed with a raft of supportive comments from outside organisations, if he were minded to go down that path.

The principle behind clause 4 is clear, although this is a complex area for legislation. The hon. Gentleman asked about Wales and local pharmaceutical services. The Health and Social Care Act 2001 certainly applies to Wales in relation to LPS. My understanding is that the National Assembly for Wales has not yet decided whether to use those powers. As a result of the Bill, it will be possible to delegate LPS functions—for which we took powers from the Health and Social Care Act 2001—but because we are at an earlier stage in relation to LPS than we are with PMS, we shall invite proposals for the first LPS schemes early next year. We do not intend to delegate the approval of LPS pilot schemes to strategic health authorities at this stage.

I hope that I have dealt with the hon. Gentleman's concerns and I commend clause 4 of the schedule to the Committee.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I am grateful to the Minister for his explanation of the general provisions of clause 4. However, I do not think that he has amply responded to my specific concern about pharmaceuticals. The LPS services are governed by the same Act in both countries. I understand that Wales is developing a method of evaluating medical techniques and medicines that is parallel and similar to NICE, which gives guidance in this country. There must be a significant bearing on local pharmaceutical services if the guidance is different in the two countries. How will the Minister reconcile that? Is it something that the Government agree with? Are they happy to run two schemes either side of the border? Is the Minister not happy with it? Does he think that it is not a problem? What is the position with regard to the guidance that is to be given? Will it affect the costs for medicines and the way in which doctors look at medicines?

If NICE states that a medicine is clinically excellent, good value for money and affordable, a lot of doctors and hospitals might think, ''Well, if I could afford it, I would try to use that medicine.'' Similarly, if NICE does not approve a drug, that is a problem for the company that makes it, and it has ramifications round the world. If the National Assembly for Wales has a body that performs a similar function to NICE but is quicker—the Assembly's motivation seems to be to get answers more quickly and, perhaps, to reduce the medicines bill in Wales—the guidance in Wales could end up differing from the guidance in England. That must have an impact on local pharmaceutical services. Given that the clause deals with that issue, surely the Minister is able to tell us the implications.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

There is a familiarity about what happens in these debates whenever the subject of Wales comes up. The reluctance to discuss matters is surprising, because I thought that Conservatives were the new force for the new age. It is surprising that that party is still fundamentally resisting what devolution involves. Devolution means the Government in Westminster deciding what is appropriate for the national health service in England, and the National Assembly for Wales making similar decisions for Wales within its remit.

That is the devolutionary settlement. The hon. Gentleman has problems with that and I am sorry that I cannot help him. [Interruption.] Conservative Members say that they do not have problems with the settlement, but they always do, because they cannot understand that there might be a difference between the way in which the National Assembly approaches the discharge of its functions and how we in England, and the Secretary of State, approach that. I have dealt with the point about the LPS scheme in England, for which I am accountable to Members of this House. The hon. Gentleman knows perfectly well that I am not accountable for the decisions of the National Assembly for Wales. It takes its decisions within the framework of the primary legislation determined in this House; that is what it intends to do in relation to LPS.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

There is no need for the Minister to get touchy. I am asking him what the implications are, which I would have thought was a good thing. The Opposition has been rather helpful today in ensuring that important Welsh matters were debated, when there was precious little time. We agreed to a change in the programme motion so that those matters could be discussed. We are not criticising; we are asking what the implications are. From what the Minister has said, the implications are that certain medicines will be provided on one side of the boundary between the two countries and perhaps not on the other, and he is content with that.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

With great respect to the hon. Gentleman, he is putting words into my mouth. I made it clear to him, and to the Committee, that the National Assembly for Wales is responsible for the decisions that it takes under the Health and Social Care Act 2001 in relation to LPS. I am not accountable for that. The National Assembly's decisions have no implications for his constituents or mine, who use the NHS in England. If he is asking me to assess the implications for the NHS in England, I can tell him that there will not be any. He is also wrong in his description of NICE and the applicability of its guidelines, because the NHS in Wales follows those guidelines. It is mischievous of him to suggest, in relation to the clause, that we are proposing a legislative framework for access to medical treatment and drugs that will discriminate against people either in Wales or in England. That is not true.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I am genuinely shocked. I asked a simple question, and wanted some elucidation. It is my understanding that the National Assembly is setting

up the all-Wales medicine strategy group and that that body will evaluate medical techniques and medicines in much the same way as NICE. I also understand that it will issue its own guidance, ahead of NICE, if NICE is considering an issue. If I am wrong and NICE's guidance will be followed in Wales, the Minister has only to tell me and I shall be pleased with that elucidation. However, he does not seem to be saying that. He seems to be saying that NICE guidance will still apply in Wales; he implies that I am wrong, but does not say so directly. The Under-Secretary of State for Wales is present, and I would be grateful if he described the position of the all-Wales medicine strategy group. It is a fair subject to consider in connection with the important developments in local pharmaceutical services.

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales

I can add nothing to what my right hon. Friend the Minister for State has made clear. I cannot understand why the hon. Gentleman cannot take on board what has happened with the devolution settlement. It has been explained and explained. Perhaps we need to hold a tutorial on the subject.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Imagine my confusion. The Minister of State said that NICE applied to Wales, as I thought. However, I am seen as mischievous and unfair because I pointed out something that I believed to be true, which was that the all-Wales medicine strategy group would do the same sort of work as NICE. I asked how the two interact, but Ministers seem defensive and suggest that I am criticising Wales or the National Assembly. That is not so. I am asking how the groups relate, and they ought to know.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman is labouring the point. I do not know whether he has ever raised his concerns with NICE; I suspect not. [Interruption.] He says that he has only had concerns since yesterday, but we need not to dwell on that observation. It might be educational and informative for him to study what the NICE guidelines say about applicability to Wales. I shall arrange for him to see them so that he can see how the system works. NICE can apply its recommendations differentially, which is how it has always approached its task. The NICE guidelines apply to Wales unless specified otherwise. For the life of me, I cannot understand the point on which he is detaining the Committee.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I think that the Minister understood the point only too well, but could not answer it.

Photo of Peter Atkinson Peter Atkinson Conservative, Hexham

My hon. Friend has not had a great deal of success with the Minister, so I shall try to help by simplifying the question. Perhaps he should ask what the all-Wales medicine strategy group does.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

If other members of the Committee want me to ask that question, I am happy to ask the Minister or the Under-Secretary to explain the role of the all-Wales medicine strategy group.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The Opposition are getting to the point of puerility. The question has nothing to do with the schedule and clause. As the hon. Gentleman knows because he has read the documentation, the National Assembly for Wales is responsible for the working of the strategy group, so it determines its functions, roles and responsibilities. That is the proper constitutional settlement.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

What an extraordinary thing. We are here with a Minister of State in the Department of Health, the Under-Secretary of State for Wales and an army of civil servants, but we cannot be told what a certain body does when we are considering a clause that mentions ''local pharmaceutical services'' in its title. The Minister of State tells us that pharmaceutical services have been set up under legislation that applies to England and Wales. We have set aside time this afternoon specifically to consider the situation in Wales because we accept that it is important, yet neither Minister knows what the all-Wales medicine strategy group does.

Question put and agreed to.

Clause 4, as amended, ordered to stand part of the Bill.