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Andrew George (St. Ives): Does my hon. Friend agree that in constituencies such as his and mine, the proposal will resolve none of the problems about which constituents have complained, and that, if anything, it will create problems that result in their complaining to us about expensive and inaccessible services?
Mr. Carmichael: My hon. Friend's analysis is absolutely right. In particular, I do not look forward to being the MP who receives complaints about the pricing practices of his wife's practice.
The point needs to be made that an enormous amount of bureaucracy will be attached to this proposal, the genesis of which was a handful of ill-considered complaints from groups that, to be frank, have rowed back at a rate of knots. The only people who are now driving this proposal forward are those in the Competition Commission, rather than those who stand to be most directly affected.
The full bureaucratic madness of the Competition Commission's thinking becomes apparent only when one considers its suggestion that a large and prominent sign should be displayed in all veterinary surgeries, advising clients on the price of the 10 prescription-only medicines most commonly prescribed or dispensed by that surgery in a typical three-month period. There are several problems with this proposal. It will involve a substantial amount of extra work for vets, and a cost that must ultimately be passed on to the clients. If five different presentations or sizes of the same drug are produced by the same manufacturer, should they be considered as five different drugs? If they are grouped together, should prices be listed for each of the preparations? Should the cost include the cost of additional packaging?
Additionally, the list would have to be regularly changed as new prescriptions became available, or as the season dictated the increased use of a particular medicine. Crucially, there would be pressure from clients to be prescribed a cheaper preparation, when a more expensive alternative might be better suited to the case. The fundamental question, to which I hope the Minister has an answer, is this. If the issue is one of transparency, why is the burden being placed only on vets? Why will pharmacists not have to comply with the same regulations or prepare the same lists?
I want to look briefly at the recommendations for legislative change. The main recommendation is that the Secretary of State should change the law to allow
veterinary surgeons to dispense a veterinary prescription, whether or not the animal concerned is under their care. The Government accepted this in the statement of 9 July, which is to be deeply regretted. The recommendation is a cause of massive concern within the veterinary profession. Again, it betrays a fundamental lack of understanding of the profession and its ethical standards and practices. As a friend of mine in the profession said, "It is a very bad idea to enshrine stupidity into legislation." This measure would undoubtedly lead to confusion in the chain of responsibility. Who would bear responsibility for any adverse reaction to the medication: the prescriber or the dispenser? As the British Small Animal Veterinary Association stated:
- "The potential for confusion of clinical responsibility outweighs the benefit of potential competition."
When giving evidence to the Select Committee earlier this year, a Minister from the Department for Environment, Food and Rural Affairs said that we must rely on the private sector for disease surveillance. It is my contention that unless something is done—and done quickly—to encourage vets into large animal practice, we are almost guaranteed another major disease outbreak sooner, rather than later. Any savings made through adopting proposals such as those offered by the Competition Commission will be small beer compared with the cost of another outbreak of foot and mouth disease or swine fever. During the foot and mouth outbreak of 2001, many vets in private practice with large animal experience felt it their duty to leave their practice and help in the fight to control the outbreak. It was difficult and often deeply distressing work. As the number of vets with farm animal experience fall, there simply will not be the same battery of expertise to call on in any future outbreak. The Government's own animal welfare strategy stands to be threatened by their own competition policy.
I started my speech with a declaration of interest regarding my wife's practice, and I conclude with an offer to the Minister. He is welcome to send some of the suits from the Competition Commission to Orkney to work alongside my wife and her colleagues and to spend time in her surgery and on the farms. They would then see the realities of the situation in which they seek to interfere; they would see how good a service we get from our vets, and how much damage the proposals stand to do.
10.20 pm
The Minister for Rural Affairs and Local Environmental Quality (Alun Michael): I congratulate the hon. Member for Orkney and Shetland (Mr. Carmichael) on promoting the family business—and
also on the offers that he has made to the House. He is right to point to the important role of the Department of Trade and Industry in leading on competition policy. The Department for Environment, Food and Rural Affairs has responsibility for the topic of this debate—the prescription of medicines by veterinary surgeons—and that is why I am replying to the debate. I should mention that the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Exeter (Mr. Bradshaw), takes the lead on animal welfare and veterinary issues, but he is unable to come to the debate tonight. I cannot come to the debate with his expertise, but I have been able to cast a fresh eye on these issues in order to stand in for him.The hon. Member for Orkney and Shetland raised a series of practical questions, including the list proposal and a number of others, but it is precisely because such issues need to be dealt with from a practical perspective that we are approaching them in consultation with the professions and the industry.
The hon. Gentleman was sweepingly critical of the proposed changes, but I congratulate him on spotting the fact that leaves are falling from the trees at present. Consultation on detailed proposals will start later this year. The formalities are that a 13-week consultation has been agreed by the Department of Trade and Industry, which set the autumn as the time for its consultation on the draft statutory instrument. We are already talking to veterinary organisations, and we will use the Royal College of Veterinary Surgeons code of professional conduct to implement the proposals where possible, rather than seeking to do so by statute.
Of course there are practical issues to be dealt with, which is why we are working with representatives of the profession to get them right. It does not help to refer disparagingly to alleged comments at meetings with officials of any Department, when none of us can check the veracity of such reports and no one has the opportunity to offer a correction.
As for the history of the proposals, the Competition Commission inquiry into the supply of prescription-only veterinary medicines was set up following complaints from farmers and pet owners about the cost of veterinary medicines. Those complaints were made to Ministers in the Ministry of Agriculture, Fisheries and Food, but MAFF Ministers had no statutory responsibility for the costs of veterinary medicines, so they referred the complaints to the Office of Fair Trading. I should say that DEFRA Ministers now would be in exactly the same position as MAFF Ministers were then.
The statement of issues to be considered by the Competition Commission was published on 16 April 2002. The inquiry focused on the supply of prescription-only medicines, on the ability of pharmacies to compete with veterinary surgeons at retail level, and on asking whether monopolies existed in the supply of those medicines, as was alleged.
The Competition Commission consulted veterinary groups, pharmaceutical companies and other interested parties, first to find out how the market worked and then, in September 2002, on its emerging findings, and likely remedies and recommendations. The report was submitted to the Secretary of State for Trade and
Industry and published on 11 April 2003. It recommended a number of remedies for that Secretary of State, and also made recommendations for DEFRA.The commission's findings were that three complex monopoly situations operated against the public interest—precisely what the complainants had said. Those monopolies were recognised as being interconnected. Taken together, the commission said, they were preventing, restricting and distorting competition in the supply of prescription-only medicines, thus increasing the cost of those medicines at all levels of the supply chain, as well as to animal owners and keepers.
To address these findings, the Competition Commission proposed nine remedies under the Fair Trading Act 1986 and made 11 recommendations to the Department for Environment, Food and Rural Affairs for changes in the regulation of veterinary medicines. The Government accepted all the remedies and most of the recommendations. The main effects will be to require vets to display the prices of the most commonly used prescription-only medicines; to require vets to offer a prescription routinely; and to allow veterinary surgeons to dispense a prescription for any animal, whether under their care or not. The commission went on to propose to give the widest distribution regime to all authorised products, which is consistent with product safety, and to improve the veterinary medicines directorate's procedures to minimise delays and consequent costs of authorisation. Finally, it wanted to encourage the proportionate cost of medicines to all animal owners and keepers.
The Government accepted the Competition Commission's report and agreed that changes in the marketing of veterinary prescription-only medicines were necessary to address the complex monopolies. The Government want to make veterinary prescriptions more widely available; to create greater competition in all levels of the supply chain; to give consumers greater choice and increased price transparency; and to reduce costs to owners and keepers. That applies as much to farmers as to owners of pet animals.
We thus come to the issue of how the Government will implement the changes. We have made it clear that we intend to do so in consultation with the veterinary profession and other interested groups. As I pointed out earlier, we will use the Royal College of Veterinary Surgeons' code of professional conduct rather than legislation, where possible.
Several concerns were raised, following the publication of the report, and the Government recognise the main concerns that have followed our response. The fears were that the proposed changes might lead to large animal practices becoming unavailable in some areas, which could result in an increase in the cost of veterinary services to farmers. It could also affect the ability of the Government to use private vets to implement important initiatives such as proactive farm health planning under the animal health and welfare strategy. It was also suggested that widening the veterinary surgeon's right to dispense another veterinary surgeon's prescription could blur the lines of responsibility for the health and welfare of the animal. Finally, it was felt by some that it would be unfair if vets
were not allowed to charge for writing a prescription. I should mention that the Select Committee on Environment, Food and Rural Affairs is to report shortly, following its inquiry into veterinary services, and it may also raise related issues in its report.We now come to continuing actions and other possible initiatives. As I have made absolutely clear, the Competition Commission's findings are being pursued through consultation with interested groups. Where possible, they will be implemented through the Royal College of Veterinary Surgeons' code of professional conduct rather than by legislation. Also, as part of the animal health and welfare strategy, DEFRA will establish a working group with the veterinary profession to consider the report of the Select Committee and to look at the future roles and availability of large animal practices.
The services supplied through the highlands and islands veterinary scheme in the hon. Gentleman's own constituency is an example of a specific provision which has been designed and implemented to meet the particular needs in one location. It may well be necessary to consider others that are appropriate for specific circumstances. Equally, large animal veterinary practices may find increased opportunities to develop the way in which they work with their farming clients. We are already aware of one practice that has linked the cost of its services to the price that the farmer receives for his milk, creating a clear business incentive for them both to succeed together.
Additionally, the effectiveness of the Competition Commission's remedies will be monitored by the Office of Fair Trading, which will also continue to monitor the provision of prescriptions by veterinary surgeons and their subsequent dispensing elsewhere and to consider whether the prohibition on charging for the provision of a prescription should be lifted after three years. The practicalities will be looked at and considered.
The animal health and welfare strategy recognises that there are concerns about the availability of prescribed veterinary medicines and associated problems such as "off label" use. The strategy includes a new initiative to assess the current availability of veterinary medicines and to discuss with the pharmaceutical industry how those concerns can be met. We are now considering how to take those issues forward as part of the implementation arrangements for the strategy.
I suggest to the hon. Member for Orkney and Shetland that two strands are evident: the strand of implementing the recommendations of the Commission, which are being approached with the veterinary profession, not separately from it; and the question of how the animal health and welfare strategy is taken forward, which is again being worked on in association with the profession. The monopolies identified by the Competition Commission have to be addressed. That was accepted when the report was made.
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