Examination of Witnesses (Questions 80-94)
4 MARCH 2004
LORD WARNER,
MR MILES
AYLING, MRS
ANNE RAINSBERRY
AND DR
CHARLES DOBSON
Q80 Jim Dowd: So you are considering
it at the moment?
Lord Warner: We did take action.
I do not at this particular time want to give a timetable. There
are some relationships between this and the negotiation of a new
community pharmacy contract because at the moment part of their
income is derived largely from profits of generics, so there is
a complex issue here to be dealt with. Certainly the last thing
we want to do is damage the network of community pharmacists.
Q81 John Austin: Could I just ask
on the rise in the cost of a number of generics that Jim Dowd
referred to, is that rise because of the manufacturer's price
or is it a rise due to the mechanism by which the NHS purchases
those drugs?
Lord Warner: I do not think there
is a single answer. There is certainly a pricing issue. It is
complicated because there are some drugs which are coming in through
parallel trade which are quite low. There are some drugs which
do not come in that way. There are different purchasing arrangements
between community pharmacists and hospitals. As a generalisation
I think you will find that bulk purchasing in hospitals drives
down the price more than the individual purchasing in the community
pharmacy world. There are different sets of arguments in different
parts of the NHS and in relation to different types of drug.
John Austin: You mentioned earlier that
you were responsible for the arm's length bodies.
Q82 Mr Jones: When is your review
likely to be completed, Minister?
Lord Warner: Our aim, and I emphasise
"aim", is to produce the report before the summer recess.
Q83 Mr Jones: Do you foresee any
mergers of these bodies in the review?
Lord Warner: We have communicated
with each of the bodies. We are still at the stage of getting
more information from them about their work, their costs, their
functions. What is already clear is that there is in some areas,
and it would be wrong of me to go into too much detail at this
stage; it would not be fair to the bodies concerned, some overlap
of functions. There is also a big general issue which you may
have picked up on in terms of the government's work through Sir
Peter Gershon on back office services. It is a phenomenon of the
arm's length bodies that they have all set up their own finance
departments, their own human resources departments, their own
IT systems, their own estates management functions. Those back
office functions, which are essential but they do not relate to
what you might call the front line services, are certainly an
area where we are looking pretty critically in this review to
see whether you can streamline them and make savings. Even if
you did not have mergers per se you would be joining organisations
together in some way in the provision of those back office services.
Whether that would be a full scale merger or not will vary from
place to place.
Q84 Mr Jones: The committee recently
were in Scandinavia and spent some considerable time being briefed
by officials of public health organisations within various countries.
It was remarked on in Finland that virtually all European countries
have a public health function which is separate from their departments
of health but they have this health education perspective and
role to play. We do not have any such body and I know I quoted
Derek Wanless earlier but I quote him again. He argues that without
a health education authority no one organisation has clearly assigned
responsibility for the health educational role. He sees this as
a problem. Do you see it as a problem and do you have any plans
to rectify it?
Lord Warner: There is a body—you
can argue that it is not strong enough, not resourced enough,
etc—called the Health Development Agency which did succeed
the old Health Education Council, so there is a body which exists
in this area. One of the issues now for the government, both in
considering the Wanless report and in taking forward this consultation
on public health before it gets to the White Paper and as part
of the arm's length body review, is whether this body needs to
be strengthened, changed, adapted, whether there is a case for
a different format in terms of a public health arm's length body.
I cannot go any further than that this morning. This is territory
which is not my responsibility but also we are at the beginning
of a public health consultation and policy formulation.
Q85 Mr Jones: Can I remark on what
would appear to me, from many conversations that we have had,
that the public health agenda is in a different culture from the
curing people of being ill agenda and that the clinician viewpoint
(or even the social services viewpoint) is about dealing with
a problem that currently exists whereas the public health agenda
is dealing with something that is foreseen and trying to stop
it existing, so it may well be appropriate that you do not try
and carry out that public health function within a department
which is largely about looking after people who are already ill.
Lord Warner: There are two strands
to this, are there not? There is the provision of the service
and there is the surveillance and strategic policy formulation.
The Health Development Agency is clearly not a service delivery
agent. Much of the public health delivery is down at the local
level through directors of public health.
Q86 John Austin: Nor does it have
health promotion as part of its functions.
Lord Warner: No, but there are
some educational functions around that which it took over, as
I recall, from the—I will clarify this and write to the
committee but I think you will find that it does have some educational
functions. The point I am trying to make is that there are down
at the local level directors of public health on the ground, there
now at the PCT level, and you may argue that they are not resourced
adequately but there is a potential local delivery mechanism.
Q87 Mr Jones: It is not so much the
local delivery mechanism that concerns me.
Lord Warner: No; we were talking
about the strategic position.
Q88 Mr Jones: It was particularly
our experience in Finland, which is a country which is a leader
in this field. As well as the local delivery system it is clear
that it is a national strategy worked out by a national body with
a high profile which has driven successfully some of their policies.
We do not have such an organisation. Perhaps we should.
Lord Warner: What I was trying
to say in my earlier answer was that this is an issue to be dealt
with as part of the consultation and leading up to a White Paper
on public health and in the light of consideration of Derek Wanless's
review. All I was trying to say was that there was a body in existence;
I was not claiming it met all the needs that you are suggesting,
and that there were local delivery mechanisms. It is now for the
government to consider this issue in the light of the Wanless
proposals.
Q89 John Austin: Some of us have
a suspicion that the Health Education Agency was wound up because
the government of the day did not like what it was saying.
Lord Warner: I was otherwise gainfully
employed at the time.
Q90 Mr Burstow: You also have within
your brief research and development. I wondered if you could say
what work is currently being done to ensure that the department
has a robust standardised and systematic approach to the commission
research. If you cannot outline what it is today would you perhaps
send us some more details on what that systematic and standardised
process actually is?
Lord Warner: I am happy to write
and elaborate on some of those issues. Of course, a lot of the
research which impinges on health is done by the Medical Research
Council which is not the responsibility of the Department of Health.
We have in this country a complex research system in relation
to health. We have the Medical Research Council in one position.
We have, unusually in Europe, a very powerful, strong and not-for-profit
research sector with bodies like Cancer UK, and we have the government
machinery in the Department of Health as well, so one is spending
time in the Department of Health ensuring that one is not duplicating
these other strands of activity and the department's Director
of Research and Development, Sir John Patterson, and his team
work on that particular basis. It might be helpful to the committee
if I sent a short paper to you showing how that particular system
works because it is not a simple system and a lot of the money
in that programme is devolved down and has been historically down
at the local level to ensure that there is also a robust and strong
local research capability as well to carry forward research in
particular trusts.
Q91 Mr Burstow: That would be very
helpful. The reason I asked the question primarily is because
of some briefing I had last week regarding the issue of diabetes
and the need to develop practical methods for early detection
of diabetes and susceptibility to diabetes that the National Screening
Committee has said needs to happen. My understanding is that there
has been no scoping study done in advance of individual pieces
of research being commissioned which could result in research
coming up with information or results that are irrelevant to the
primary need because of the absence of scoping in the first place.
That is why I am a little bit anxious as to whether there is a
systematic process in place to see whether scoping is always done
before research monies are spent.
Lord Warner: I would need notice
of the question, but I have taken notice of the question and I
will respond to it.
Q92 Dr Taylor: As Minister in charge
of research are you aware of the very real distress among the
research community about the Human Tissue Bill as it stands at
the moment?
Lord Warner: I am only too well
aware of that and if you are in the House of Lords there are a
very large number of eminent scientists and doctors who never
miss an opportunity to express their concerns to you. We are considering
those concerns and, if only for the purposes of self-preservation,
I hope we will be able to resolve them before I take the Bill
through the House of Lords.
John Austin: Minister, you have offered
to write to us on a number of points. I am sure our Clerk can
clarify with your officials the areas that we have sought information
about.
Q93 Mr Amess: Chairman, could I ask
a very quick question? We obviously understand that the government
has no plans at present to change the law on euthanasia but what
is the government's position in terms of Lord Jopling's Bill?
Lord Warner: I am not the minister
responsible for dealing with this, although I will have to deal
with it in the House of Lords. I do not have policy responsibility
in this area. It is Rosie Winterton's responsibility. I would
suggest that if you wish to pursue this question you might correspond
with or see Rosie.
Q94 John Austin: Could I express
our thanks to you, Minister, on your first appearance before us.
I hope it was relatively painless.
Lord Warner: I enjoyed it very
much.
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