1. Mr. David Amess (Southend, West) (Con): What the responsibilities of local authorities are to provide rehabilitation services for blind and partially sighted people. [56290]
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): Local authorities and the NHS are responsible for providing rehabilitation services for the visually impaired that are based on need. We have increased investment in both to ensure that commissioners have more money over the next two years with which to develop services.
Mr. Amess: In a written answer to me on 28 November last year the Minister said that it was the responsibility of local health and social care bodies to commission facilities according to local needs. As he will know, Guide Dogs for the Blind conducted a survey which showed that 20 per cent. of such bodies did not provide rehabilitation services because of lack of funds and lack of qualified staff. Will he please do all that he can to deal with that?
Mr. Byrne: The hon. Gentleman is the secretary of the all-party parliamentary group on eye health and visual impairment, and has done a great deal to draw attention to the issues. I think there is consensus in all parts of the House that local communities are best placed to design the shape of services, but we made it clear in a recent White Paper that the director of adult social services will need to undertake a strategic assessment of local needs. Given that more than 300,000 people in the country are blind or visually impaired, we expect their needs to be given prominence in the plans.
Mr. John Baron (Billericay)
(Con): Despite what the Minister says, the fact remains that, as we have heard from my hon. Friend the Member for Southend, West (Mr. Amess), some local authorities are simply not providing essential services. Given that Guide Dogs for
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the Blind estimates that at least 80,000 people are not receiving any dedicated rehabilitation services just because of where they live, and given that the Minister's Department has even refused to be represented on the Guide Dogs for the Blind project group that is looking into the issue, will the Government stop washing their hands of the problem, and end the postcode lottery by establishing minimum entitlements to care for all blind and partially sighted people so that they can lead more independent lives?
Mr. Byrne: We set out clearly the standards that we expect to operate in the national service framework that was published last year. It is incumbent on us to specify the right pathways of care, and we have done that, along with Guide Dogs for the Blind. It is also incumbent on us to ensure that the right level of resources is there, which is why local government is entering its ninth successive year of real-terms increases.
The Opposition cannot on the one hand say that we should abolish all targets and have some sort of clinical free-for-all, and on the other hand say that there must be some kind of central direction. They cannot have it both ways. What we must do is ensure that the framework is right and the resources are there, and that is exactly what we have done.
2. Sandra Gidley (Romsey) (LD): If she will make a statement on recent changes to the domiciliary oxygen service. [56291]
The Minister of State, Department of Health (Jane Kennedy): The home oxygen service has seen little change since 1948. Patients and health professionals have been pressing for a modernised service for some time. Of the approximately 60,000 patients who use the service, 30,000the majority of the highly dependent patientstransferred to the new service before 1 February following an agreement between the suppliers.
Sandra Gidley: The Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), the Minister responsible for public health, is on record as stating that the new oxygen service
"was always planned to be phased in over a six-month transition period and not 'suddenly switched'."
Will the Minister confirm that if the new oxygen regulations had been in force as planned, doctors would not have been allowed to write prescriptions after 1 February and pharmacists would not have been able to supply according to those prescriptions? They would not have been able to bail the system out as they have, in effect saving lives. Will the Minister acknowledge that an administrative blunder has actually eased the situation?
Jane Kennedy:
It is a shame that the hon. Lady added that last point. I very much appreciate the way in which community pharmacists, in particular, have worked with primary care trusts to deal with the problems that occurred during the first few weeks of the new service. As for the first part of the hon. Lady's question, if we
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phased in the service we clearly had to phase in the way in which we managed patientsexactly the way in which we have managed the 30,000 patients who are the most dependent of all. Obviously we must ensure that the oxygen service gives each patient the service that he or she requires, and that is why, when it is operating fully, the new service will prove very effective indeed.
Mrs. Linda Riordan (Halifax) (Lab): Is the Minister aware that, in west Yorkshire, Air Products, which was contracted to supply home oxygen from 1 February, has failed to do so, leaving patients high and dry? Local pharmacists who have lost their contracts with Air Products are kindly supplying the much-needed oxygen and keeping hospital admissions down. Will the Minister explain why the system has been changed, given that it was working so well before?
Jane Kennedy: The system was not working well. Only 55 per cent. of pharmacies supplied oxygen cylinders. Supplies were delivered to the most dependent patients by other suppliers. This is not a process of privatisation; it will deliver a better service to patientsprecisely the service that patients and health care providers have been asking us to deliver.
Andrew Rosindell (Romford) (Con): Does the Minister not accept that the system that her Government have imposed simply is not working? Many of my constituents are suffering as a result, as are constituents of my hon. Friend the Member for Hornchurch (James Brokenshire). Many of the patients of Mr. Tariq Mahood, a pharmacist in the Mims pharmacy in North street, Romford, have not had the oxygen that they desperately need. Will the Government please review this policy as a matter of urgency?
Jane Kennedy: We have been doing that, and I followed the operation of the new service not only from 1 February but during the weeks beforehand. We have seen a surge in the number of general practitioner orders for patients with continuous or long-term needs, and it is not yet clear precisely why that has happened. There could be a number of reasons, including GPs reviewing the number of patients using high volumes of cylinder oxygen, or people beginning to exercise choice across the wider range of services now available. We are working closely with primary care trusts, GPs and patients to ensure that patients receive precisely the service that they need. As I have said, I am grateful for the way in which pharmacies and PCTs have co-operated with suppliers to ensure that these early problems with the service are ironed out very quickly.
Dr. Phyllis Starkey (Milton Keynes, South-West)
(Lab): One of my constituents has experienced the problem of oxygen cylinders that delivered the previously prescribed speed of oxygen no longer being available. That has prevented him from going to a day care centre, which is not willing to cope with the potential medical crisis. Might not such problems have been avoided if the scheme had been piloted? That way, they could have been identified in just one area and the lessons learned before the scheme was rolled out across the country.
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Jane Kennedy: I am grateful to my hon. Friend for raising the case of her constituent; I will look into the detail of it. Clearly, the intention is to improve the service on offer, not to diminish it. The new service was consulted on extensively and it is a response that we have been planning since 2003. My hon. Friend suggests that we could have piloted it, but as I have said, 30,000 patients went on to it before 1 February and the suppliers have co-operated to ensure delivery. Once we have ironed out the early problems that some patients are experiencing, the new service will prove very popular indeed.
Steve Webb (Northavon) (LD): Back in the middle of January, I challenged the Minister in a written question on the changes to the home oxygen service, making specific reference to the impact on patient safety. Her reply was blandness itself. Does she now accept that the change-over has been botched and that, potentially, lives have been lost? Will she take responsibility?
Jane Kennedy: I congratulate the hon. Gentleman on his re-appointment to the Front Bench as health spokesman. His question was posed in characteristically robust terms, but no, I do not accept that patients' lives are at risk in the way that he describes. As I explained in my earlier answers, I am aware that there have been problems, and we are working very hard to address them. As I have also said, it is important that the new service delivers oxygen to those who need it when they need it. These early problems have come about for a range of reasons, and I anticipate that we will get over them very rapidly.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Does the Minister not understand that this has been a shambles? The position is very simple. She says that there are many reasons for the problems, and no doubt she will find many people to blame for the shambles, but the reality is that pharmacists were de-stocking on oxygen cylinders because they expected the contractors to provide them, and GPs believed that they could send orders through to the contractors and did not seem to realise that they should do so only for repeat prescriptions. The net result is that the contractors ended up with thousands of orders that they had no means of prioritising or responding to. The Minister says that she examined the new service beforehand, but as I say, it is a shambles. She should have thanked the pharmacists for bailing the Department out in her first answer to the hon. Member for Romsey (Sandra Gidley), not in her second. She should also say sorry to the patients, pharmacists and GPs who have had to cope with the Department's failed administration.
Jane Kennedy:
I have not blamed anyone for the shambles[Interruption.] Opposition Members should wait for my answer. I have said that there were problems, and that we are working hard to overcome them. As perhaps we should have anticipated, one of the problems was that some patients would ring up to inquire about the new services on offer. We did not have the number of telephone lines that we could have made available had we anticipated those inquiries, and we can learn lessons from that. The suppliers have experienced difficulties in responding to telephone orders, and have
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increased the number of lines available for dealing with queries. Equally, there have been variations in the amount of details being given as we have changed from using prescriptions to using proper order forms for arranging supplies. The order form requires GPs to give more details than was the case in the past.
We are learning from all those factors, and we are working with suppliers and the health service to ensure that the service that we deliver is precisely the one that we intend to deliver, and the one that suppliers are committed to delivering in the future.
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