NHS Reform and Health Care Professions Bill

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Mr. Heald: 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.

Mr. Hutton: 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.

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

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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.

Mr. Touhig: 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.

Mr. Heald: 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.

Mr. Hutton: 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.

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

Mr. Peter Atkinson (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.

Mr. Heald: 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.

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Mr. Hutton: 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.

Mr. Heald: 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.

Schedule 3

Amendments relating to Personal Medical Services and Personal Dental Services

4.45 pm

Mr. Hutton: I beg to move amendment No. 107, in page 59, line 13, at end insert—

    'The 1977 Act

In section 15 of the 1977 Act (duty of Health Authority in relation to family health services), in subsection (1ZA), after ''duty of'' there is inserted ''each Strategic Health Authority and''.'

The Chairman: With this it will be convenient to take Government amendments Nos. 108 to 111.

Mr. Hutton: Once again, I am afraid that I have to bring several minor and consequential amendments to the Committee's attention. The amendments are minor, and are either consequential on the transfer to a strategic health authority of the functions of a health authority in relation to PMS and PDS, as set out in schedule 3, or they are tidying-up measures. To provide consistency in the Bill, amendment No. 107 extends the duty to perform any functions in relation to PMS and PDS prescribed in regulations made under section 15(1ZA) of the 1977Act to a strategic health authority. That is in line with the transfer of PMS and PDS functions, as set out in the schedule.

Amendment No. 108 makes a similar consequential change to the Trade Union and Labour Relations (Consolidation) Act 1992, which includes in the definition of worker those individuals who perform PMS and PDS in accordance with arrangements made by a health authority. The amendment simply takes

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account of the fact that such arrangements will be made by a strategic health authority, rather than a health authority.

Amendment agreed to.

Amendments made: No. 108, in page 59, line 23, at end insert—

    'The Trade Union and Labour Relations (Consolidation) Act 1992 (c. 52)

    In section 279 of the Trade Union and Labour Relations (Consolidation) Act 1992 (health service practitioners), in paragraph (a), after ''by a'' there is inserted ''Strategic Health Authority,''.'.

No. 109, in page 59, line 30, at end insert—

    'The Health and Social Care Act 2001 is amended as follows.'

No. 110, in page 59, line 31, leave out 'of the Health and Social Care Act 2001'.

No. 111, in page 60, line 17, at end insert—

    'In Schedule 1 (exempt information relating to health services), in paragraph 11, after ''request to a'' there is inserted ''Strategic Health Authority or''.'—[Mr. Hutton.]

Schedule 3, as amended, agreed to.

Clause 10

Expenditure of NHS Bodies

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

Mr. Heald: Will the Minister outline the effect of the clause?

Mr. Hutton: Schedule 12A of the National Health Service Act 1977 defines the expenditure of health authorities and primary care trusts. It also provides health authorities with the authority to apportion drug costs to primary care trusts. Clause 10 will amend schedule 12A so that PCT expenditure mirrors that of the current health authorities and will give the Secretary of State the authority to apportion drug costs between the PCTs. He must have that function because the resources will pass directly from him to the PCTs. There is no longer any residual role for the health authorities in that process because of the way in which the transfer of resources will be carried out in the NHS. The clause also allows the existing health authority position to be preserved in Wales and defines expenditure for local health boards.

Mr. Heald: I understand the apportionment of costs for medicines, but will the Minister explain how it operates in the terms of the relationship between England and Wales?

Mr. Hutton: I suspect that I shall have to write to the hon. Gentleman about that.

Mr. Heald: I am grateful. I am sorry to hark back to this, but if the all-Wales medicine strategy group issues guidance that allows beta interferon to be prescribed in Wales and a prescription is subsequently presented to an English pharmacist and is accepted, what will happen to the allocation in the authority areas?

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Mr. Hutton: I am not sure that I shall be able to answer every point that the hon. Gentleman raised. However, it might be helpful if I explained one or two points by way of background.

Clause 10 deals with two issues. The first is the division of PCT expenditure between that which is subject to resource and cash limits and that which is funded on a demand-led basis. The second is shifting expenditure on prescribed drugs from the PCT that is responsible for dispensing them to the PCT that is responsible for prescribing them. Once upon a time, all family health service expenditure fell outside the scope of the main allocations made to health authorities, and were funded separately on a demand-led basis. However, as a matter of policy, elements of family health services have been brought within the scope of health authority allocations and the discipline of resource and cash limits.

Present schedule 12A of the NHS Act provides the legal basis for dividing the expenditure of health authorities into two principal categories. The first is main expenditure, which is the legal term for expenditure that falls within the scope of health authority allocations. The second is general part II expenditure, which is the legal term for family health service spending that falls outside the scope of health authority allocations and is still funded on a demand-led basis.

Currently, health authorities are responsible for arranging the provision of pharmaceutical services. Accordingly, the cost of prescriptions initially hits the health authority responsible for the chemist that dispenses the prescription. The cost of drugs is included in the allocations of health authorities on the basis of the need of their populations to have drugs prescribed for them. The present schedule 12A provides the legal means of transferring the cost of drugs from the health authority where they were dispensed to the health authority where they were prescribed. As PCTs are taking over responsibility for family health services, including pharmaceutical services, clause 10 must amend schedule 12A, so that the cost of drugs can be transferred from the PCT that is responsible for the dispenser to the PCT that is responsible for the prescriber.

I know that that is not an answer to the hon. Gentleman's point, but I hope that it explains some of the processes involved more fully than my original remarks did. The hon. Gentleman asked me for more information about the exact nature of the process for apportioning costs, and I am happy to write to him about that.

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