Examination of Witness (Questions 60-79)
Thursday 15 May 2003
MR DAVID
LAMMY MP
Q60 Dr Taylor: One of the tremendous
problems for the ordinary person is the length of time it takes—five
and a half years—for cases to go through. We understand
there is a white paper coming out on it. Have you any idea when
it is coming and have you, as somebody with experience in this
field, any explanation for five and a half years? What is it that
takes that time? Will the white paper address that?
Mr Lammy: We asked the CMO to
look into this and to come forward with proposals. We expect to
be in a position to share those shortly.
Q61 Dr Taylor: Shortly? A month?
Mr Lammy: Shortly. I have to say—and
I know that you will respect this—this is perhaps the most
complex technical difficult and ethical area of health policy,
not just for this country but for all major western democracies.
Indeed, different countries have gone down different roads on
this. In New Zealand they have a no fault scheme. Some countries
have a more tariff based scheme. Others, like our own, have very
much a legal framework on top of the complaints procedure by which
people go through. I think there are two things that are key to
this. The first thing is that we have wanted to ensure that the
complaints work that I have just been talking about and that has
been outlined and raised today has not gone off in tandem, but
the CMO has kept in very close touch with that work; it has been
very much in the same pie and is in the same trajectory consistent
with that work. That is the first thing. The second thing is that
because we asked the CMO to be radical, to look at this from the
fundamentals of: is the system we have currently fair? Is it something
that the public purse should be happy about? Is it transparent?
Is it simple for people to access? In looking at all of those
issues he also looks abroad to what is happening. It is complex.
It has taken a while. We will be there shortly, but I think we
all respect, because of the nature of what we are talking about—and
I certainly do, having been a practitioner—that it is important
that we deliberate and get it right rather than get it quickly.
Q62 Dr Taylor: I have to pull the
Minister's leg about the word "shortly" because on one
occasion you answered a written question to me saying "shortly"
and the answer was already out.
Mr Lammy: That is the speed with
which I respond to your enquiries.
Q63 Julia Drown: Can I turn to responsibilities
over hospital environment. The Government has made progress on
issues like in-patients having access to hot evening meals and
recent patient surveys show that hospital food being good or acceptable
has risen from 87% last year to 98%. The Government is saying
a lot of that is because of modern matrons and the work that modern
matrons are doing in hospitals. I wondered how confident you are
that improvements that have been cited are directly because of
the Government initiative on modern matrons?
Mr Lammy: I do not have direct
responsibility for modern matrons, but they obviously cross into
parts of my portfolio. In a sense a lot of my feeling about modern
matrons is when I have gone to individual Trusts and seen them
in action. I know that we responded in the NHS plan to create
modern matrons of this perception from the patient—it is
very much a patient-led initiative—and patients on wards
themselves wondered who was responsible. I suppose we all had
a very strong image. The matron in terms of iconography in Britain
is quite strong. I am not sure if that has anything to do with
Hattie Jacques, but it might have. In a sense it is rather ironic
that the changes we made around 1966 started to see matrons disappear.
They did not disappear entirely, but they became directors of
nursing, moved up into the Trusts as an organisation, but what
people wanted were senior nurses who took charge of an environment,
took charge of food, co-ordinated bed management and other things.
I think that is going on and I am seeing changes towards that.
Again, we are only 18 months or so down the road.
Q64 Julia Drown: Was it right to
do it as a national initiative, saying that this must happen?
Or is there a feeling in the Department that perhaps that was
too prescriptive? I know, for example, with the Foundation Trusts,
you are saying they do not need to have modern matrons any more.
Is there some thinking that perhaps that was too prescriptive?
Mr Lammy: I am not aware of that,
but I not the minister directly responsible for this. I am not
aware that there is a feeling of prescription here.
Q65 Julia Drown: It seems that it
was right to have a national policy.
Mr Lammy: As I have just said,
I am not aware that there is a feeling that it is prescriptive,
but I am not the minister responsible for modern matrons.
Q66 Julia Drown: You are responsible
for A&E and a month ago there was the announcement that there
were going to be modern matrons in A&E as well and there were
going to be specific funds around that. Are you happy with that
initiative?
Mr Lammy: I am very happy with
that initiative as I argued passionately to have it. I do believe
that A&E is the shop window of the NHS.
Q67 Julia Drown: Will that apply
to Foundation Trusts too?
Mr Lammy: Yes, I think as currently
configured it will.
Q68 Julia Drown: So there will have
to be modern matrons in A&E but not on the rest of the wards.
Mr Lammy: From my memory it will,
but can I write to you because I do not want to give you the wrong
information and can I write to you as a particularly technical
point.
Q69 Julia Drown: I would be interested
particularly in the reasons behind it as well.
Mr Lammy: I will write with that.
Q70 Sandra Gidley: As you are well
aware, current focus is on the OFT report into control of entry
into pharmacy. Recently in Westminster Hall you did not really
give any reassurances or answers other than that the Department
of Health were considering all the evidence. Surely everybody
who has anything to say about this has now written to the Department
of Health. What is the Department of Health's current view on
this?
Mr Lammy: What we do know and
what I did say in that debate were a number of things, Sandra.
The first thing, as I made clear, is that community pharmacists—in
inner city constituencies like mine, in rural constituencies,
in urban constituencies—play a key and fundamental role
and there is a very important role they also play for vulnerable
people. They play an excellent role for the elderly and disabled
people in terms of delivering prescriptions and that kind of service,
and being available at the bottom of the road. They play a fundamental
role for drug misusers in terms of methadone treatment and other
things. I heard a lot of testimony from pharmacists themselves
and from people. I sign the letters, I have seen the petitions.
I said at the time that going through the Division was like running
a gauntlet. Every member of Parliament was coming to me to lobby
on behalf of the pharmacist and that is because of the key role
that they play. Indeed, we set out our vision—a very clear
direction of travel for pharmacists—in Pharmacy in the
Future a few years ago. We raised clear issues that we wanted
to develop with pharmacists. One of those issues was around the
national contract. You will understand that pharmacists, to some
extent, also want—rather like dentists—to be liberated
not just to be behind the counter serving pills and we pay them
in a way that really meets the needs in the past, but also around
the work that they are doing on LPS, prescribing themselves, supplementary
prescribing and there are also issues around the skill mix, the
other people in the pharmacies whom we believe can do more. All
those things, that direction of travel, was set out in Pharmacy
in the Future and we had a lot of sign up. A lot of work we
did with the PSNC, the NPA and pharmacists themselves. The OFT
report was always an issue on the horizon in terms of control
of entry and they raised some very serious concerns about competition.
Our response to those concerns about competition were that we
are grateful for the report, we are grateful for the issues raised—there
were some very important issues raised—but we also understand
that pharmacists are health providers, there is a wider dimension,
and we want to come forward with a balanced package to deal with
both the issues of competition, the issues of access and equity
and the modernisation issues as well. We will be doing that by
the recess.
Q71 Sandra Gidley: You said all the
right things about pharmacy, but what discussions have you had
with the DTI on this?
Mr Lammy: I suspect that you know
that when the Government says—as I have said—that
we will be coming forward with a response in July, we do not detail
the discussions we have had with DTI; it does not work like that.
It is the Government's response; it is not the Department of Health
response. We will come forward with those proposals by recess.
Q72 Sandra Gidley: What would you
like the Department of Health response to be, if you get your
way?
Mr Lammy: It is not about getting
my way; it is about the Government, in the usual manner, coming
forward with its response. I think that if you read the words
of the Secretary of State for Health, it was she who said that
she understood that pharmacists were not just shop keepers. I
have to say, in the meetings that I have had with the PSNC representing
pharmacy interests, that there are competition issues as well.
Of course we will look at competition. We will also be looking
at those issues of vulnerability. We will be wanting to see a
balanced package. We want the direction of travel to build on
the work of Pharmacy in the Future.
Q73 Sandra Gidley: One point about
the OFT report that has actually received little attention is
that there are concerns in some quarters that there could be increases
in the somewhat erroneously named doctor dispensing. Do you have
a view on whether an increase in doctor dispensing is a good thing
or a bad thing?
Mr Lammy: Clearly that was a feature
of the report as well. I think there is a relationship between
pharmacists and doctors that is currently working well. That is
the testimony that I have heard. The BMA have had strong views
on this and we will be considering those as well.
Q74 Sandra Gidley: So you are not
yet ready to say whether it is a good thing or a bad thing?
Mr Lammy: What I respect is this
House and I think the right place for me and the Government to
make those responses is at the right time, which is in July, through
this House. I do not think it is right for me to make them with
you.
Q75 Sandra Gidley: So we are not
going to hear it on the Today programme first, then?
Mr Lammy: Well, you will not be
hearing it here, that is what I can say.
Chairman: We want to look at dentistry,
Minister. This Committee looked at that area a little while ago
and I think it is encouraging to see that a number of the points
we put forward have been picked up by the Government. So while
we may be critical on occasions of other areas of policy, I think
there is a degree of support for some of the points that have
been brought forward.
Q76 Julia Drown: I think I am allowed
to sneak a question in on the NHS Direct before we move on to
dentistry. I want to ask you about problems that have been raised.
I certainly had one constituent who raised with me the fact of
the phone which was not answered for a significant period of time.
What is being done to address that because clearly it is only
going to be successful—and continue to be successful—if
people have the confidence that the telephone will be answered
when they ring it?
Mr Lammy: All the surveys we have
done, and the independent survey from the National Audit Office,
suggests that the satisfaction rating for NHS Direct amongst the
public is fantastically high.
Q77 Julia Drown: I realise I am dealing
with the exceptions where it does not go right.
Mr Lammy: If there is an individual
problem then, again, as the Minister responsible for NHS Direct,
write to me and I will investigate and deal with it.
Q78 Julia Drown: When I have done
that, the response has been that there have been occasions when
it has been very busy and I have had an apology and a hope that
it does not happen again. One thing that occurred to me is that
as they are all run on a regional basis, is there not a way, if
the phones are particularly busy in one region, being able to
divert them straightaway to another region so that we can guarantee
much more clearly that the telephone will be answered within a
reasonable period of time.
Mr Lammy: It was my understanding
that that currently goes on. The diversionary system is currently
in place. We are building on the capacity of NHS Direct as it
takes over the out of hours service and we will look at all these
things. I just repeat, yes, things will go wrong on occasions
and right across the NHS things will go wrong. Perfection does
not exist; it cannot. However, I think that is the exception rather
than the rule. I cannot remember what the figure was, it may well
have been up into the late 80 or 90% of people who were very satisfied
with that service.
Q79 Julia Drown: I appreciate that.
In terms of confidence in the system it is not the 90% that gets
reported, it is the small percentage that goes wrong that gets
reported and then that undermines 100% of people's confidence.
It should not do, but I know that is how it works.
Mr Lammy: We have always to strive
for that one constituent to encourage them not to judge it but
to see beyond it.
Julia Drown: I think that they want to
know that if they are phoning at the super busy time they will
still get a response. I think it would be useful if you could
write to the Committee so that we know at what point how long
the telephones have to ring before it switches over. Sandra, did
you want to come in with something here?
| 
