Examination of Witness (Questions 80-99)
ANDY BURNHAM
MP
26 OCTOBER 2006
Q80 Mr Amess: Is it fun sitting that
side?
Andy Burnham: Fun is not the first
word that would spring to my mind, David.
Q81 Mr Amess: The Royal Pharmaceutical
Society of Great Britain said "...there is no doubt that
delays to the implementation of the service caused confusion and
we question why this exercise was undertaken during the winter
months." We all appreciate that the aim of switching to new
providers was said to save money and to improve the quality of
service—wonderful if you can achieve both things—but
do you believe that has been achieved? If it has not, when will
it be achieved?
Andy Burnham: I think we will
end up with a better service for the public. But I do not want
to give an answer that is evasive. Has it been a good experience
for those who used the service this year? For many people, no.
In terms of whether or not we should learn from the process, then
absolutely the Department of Health should learn from the process.
Will it deliver a better service? I am absolutely confident that
it will significantly improve the quality of service that patients
who require home oxygen get.
Q82 Mr Amess: If I may say so, the
Committee greatly appreciates your honest and frank reply to the
question. That is wonderful. What is being done to resolve the
problems in terms of the waiting lists and access to these portable
cylinders?
Andy Burnham: It may help the
Committee if I give some figures from the latest state of play
with regard to switchover to the home oxygen service. Obviously
I have brought the figures with me. Overall, the number of people
now receiving home oxygen—so obviously not going through
the pharmacy route—is somewhere between 75,000 and 78,000
people. Looking around the regions at the number of people whom
we know about who are yet to be transferred to the service, the
transfer has been completed in the North East region; the Eastern
region; South West London; Thames Valley; Hampshire and the Isle
of Wight; South East London; Kent; Surrey; and Sussex. In the
following regions there is still some work to be done: East Midlands
(1% of patients have yet to be transferred); West Midlands (1%);
North West (2%); Yorkshire and Humber (1%); Wales (2%); North
London (1%); and the South West (1%). I am far from complacent
on this subject. I meet with officials regularly and, though it
has been difficult, I would pay tribute to the job they have done
in difficult transitional times. Where you are dealing with such
a critical service, I think the Department has managed what has
been an extremely difficult situation well. There are complicated
reasons as to why in February this year there was a real problem,
but, as you can see, the transfer is not complete but it is not
far from being complete. While we obviously have to make sure,
until that transfer is complete, that everyone has access to oxygen,
the emphasis also now is on very closely monitoring performance
standards, improving the service to patients, ensuring they get
the right equipment, ensuring they get costs reimbursed for electricity—issues
such as that, which are a part of the contract with each of the
suppliers.
Q83 Mr Amess: I am glad to hear that
you are the Minister with responsibility for the East of England.
Andy Burnham: That is correct.
You know where to come!
Q84 Mr Amess: I do. I have been tipped
off, so I am very pleased that in this particular issue you are
doing well. Can you tell us something about the difficulty there
was regarding the contract with the South West region and the
eight months that it took to switch from Air Products to BOC?
Andy Burnham: I was aware of the
publicity around the service, David, and officials, rightly, met
me very early on to talk about the issues and I tried to come
up to speed very quickly on the transition to the new service.
It became clear, looking at the figures around the regions, that
there was differential performance, let us say, in terms of how
quickly patients were being transferred over. There was obviously
a cause for concern there, in that supplies within pharmacies,
where people were not able to access the home oxygen service,
needed to be able to maintain their supplies through traditional
routes, so there were clear issues that had to be managed. As
you will know, one supplier, if I remember correctly, had seven
of the regional contracts and it became clear that we were not
seeing sufficient progress, particularly in the South West, towards
making transition possible under the terms of the contracts. We
had discussion over the summer about what was the right course
of action to take, and I am pleased to say that, with cooperation
all round, a sensible outcome was reached where the contract was
switched to a different supplier. There has been good cooperation
all round in facilitating that switch, and, as a result, we have
now seen the progress that we were hoping for. It was the right
thing to do. It has enabled the other supplier to improve its
performance in the other regions where it still has contracts,
by being able to focus its resources. Dare I say—and ministers
probably should not touch wood—it has gone well in terms
of improving the transition, but, as I say, we keep these things
under very close review.
Q85 Mr Amess: A point has been made
to the Committee about the National Pharmacy Association apparently
being unaware of the six-month transitional period following the
switch to the suppliers in February 2006.
Andy Burnham: I am unaware of
that point. I have to say that predates my time in the Department,
but there was a transitional arrangement that was clearly published
by the Department so I would be surprised were that to be the
case.
Q86 Sandra Gidley: Perhaps I could
clarify, Minister. Your predecessor described the process as a
shambles on the floor of the House, so I am glad that close attention
is being paid to this. Most community pharmacists were advised
to run down their stocks by 1 February. Most of them, rather wisely
I think, realised there would be problems and, because they are
committed to patient service, retained their stocks. If all had
gone according to plan, my understanding is that at that stage,
after 1 February, a doctor should have been ordering via a different
system, which a pharmacist would not have been allowed to supply
against. For administrative reasons that did not happen, so pharmacists
were able to bail out the system. The original aim was to phase
all patients off, to transfer patients, by 1 February, and everybody
in the sector understood that, and that is why the National Pharmacy
Association said that this had come as a surprise, because they
had not expected to be in a position to bail out. I understand
it was not your problem and you were not the Minister at the time,
but what went wrong? Why was that transfer so badly managed?
Andy Burnham: As I have mentioned,
there does need to be a learning process from handing over such
a critical service. I would agree with you and I would like to
put on record my recognition of the role the community pharmacy
has played throughout the course of this year to ensure access
and supply to patients who need it—and you were right to
highlight that fact. With their help, some of the transitional
problems have been negotiated. In terms of whether they were informed
or how it was that this situation arose, obviously there were
transitional arrangements put in place, but it would seem that
a combination of factors in the first week of the new service
led to the system being unable to cope. It seems that for a whole
range of complicated reasons—in terms of people ordering
emergency supplies who did not need them, or problems with the
way in which the new form (the HOOF, as it is being called) was
being filled in so that the information was not sufficient—a
whole set of problems came together at the same time. I think
you are right—let us not evade the question—consideration
has to be given to how that could have been done better, particularly
on such a critical service. Phasing, not just in terms of time,
but in terms of region, would perhaps, it seems to me, have been
a sensible thing to have done, but these are things we will look
at—and I am happy to share with the Committee the conclusions
we draw with regard to the next contracting round.[4]
Q87 Sandra Gidley: Clearly there have
been problems, because a parliamentary answer on 24 July said
that the Department had received 241 written representations concerned
with this service. People do not usually write in if they are
ecstatic about something, sadly. It has been difficult to get
a figure to compare that with, because parliamentary questions
asking how many complaints there were before have been answered—but
with a non-answer. I think you are right when you say that the
patients are receiving better equipment but the problem has been
purely distribution. What was wrong with a system where you had
several thousand distributors who were flexible, who knew other
suppliers in the network, who generally could manage a very rapid
delivery to patients even though there was not an official emergency
supply? What was wrong with that system, to want to change over
to a smaller number of larger logistics' suppliers without that
patient focus?
Andy Burnham: I think there was
a review of the service by one of the Royal Colleges back in 1999
which advocated moving to a service, in this way, which was home-based
and delivered around the patients' needs. As I say, the pharmacies
provided a very valuable and dependable service for many years.
In terms of moving to a service delivered in this way, pharmacy
companies were not ruled out from seeking to take the contracts
for any particular region, working with subcontractors, so I do
not think it was a case of not wanting pharmacies to be involved,
but, as I said to David Amess, I am confident that the service
is a better service and will better meet patient needs, both in
terms of the modern equipment that it makes available to patients,
in terms of lighter cylinders, and the range of equipment to which
they can get access. In terms of their convenience, it is a better
system, but, as I was saying, we must improve some of the service
standards and make sure that it is as good everywhere all around
the country.
Q88 Sandra Gidley: Are there any
plans to do a patient satisfaction survey?
Andy Burnham: The other group
I would like to pay tribute to during this process has been the
British Lung Foundation. Through their Breathe Easy groups they
have facilitated patient feedback about the quality of the service
in the different regions and that has been crucial to maintaining
the quality of the service. They did a survey, if I remember rightly,
earlier in the year, not long after the new service had been introduced.
I have been meeting the chair reasonably regularly, Dame Helena
Shovelton—because obviously that feedback is crucial information
for the Department in terms of how the service is impacting on
the ground—and when I last met her, in the last couple of
weeks, she was talking of another survey to their Breathe Easy
groups around the country, particularly with the Christmas holiday
period and with other issues about service standards. I welcome
that kind of feedback. It is good that the British Lung Foundation
have played that role throughout the period.
Mr Amess: Chairman, I think this Minister
has answered my questions rather well and I look forward to him
looking after the East of England.
Q89 Chairman: Could I ask a supplementary
question to that. The legacy of coal mining in the health profile
in your constituency will not be dissimilar to mine. Have you
had any letters from patients about the transfer over to the new
system for home oxygen in you casework?
Andy Burnham: I met my Breathe
Easy group not too long ago and, on the whole, they were saying
they thought it was a good service. In my constituency office,
I do not recall receiving many letters on this.
Q90 Chairman: No. I have not received
one, which is surprising. I have been actively involved in home
oxygen for the last 15 years now, about getting it into people's
homes.
Andy Burnham: One of the reasons
for that might be that a lot of work was done to identify patients
in that transitional period to which Sandra Gidley referred. I
should say, to develop this, that the PNC and the Department of
Health prepared a joint letter at that time to inform pharmacists
about the six-month transitional period. When that work was being
done, I am sure your PCT, like mine, immediately flagged up as
a place where, given the high levels of COPD, there are significant
oxygen users, so I would guess that there was a lot of focus given
because of the high level of users in those particular areas.
Q91 Sandra Gidley: Turning to the
new pharmacy contract, why is there a statutory limit on the number
of Medicine Use Reviews that each pharmacy can undertake per year?
Andy Burnham: There is flexibility
within the funding that we have allocated for Medicine Use Reviews
to enable pharmacies to go to a certain level, but, if I understand
the contract correctly—and sometimes that requires sitting
down in a room with a cold towel to my head—there is a limited
pot of money allocated within the contract for Medicine Use Reviews
and clearly that means there has to be a limit on the number that
can be carried out.
Q92 Sandra Gidley: Why is there a
pure allocation per pharmacy, when some clearly see many more
patients than others or are larger and employ more pharmacists?
Should there not be more flexibility in that, probably based around
prescription volume?
Andy Burnham: I think so. As far
as I can see, those which have registered early to become accredited
to provide patient Use Reviews will end up providing more in this
year than those who have been slower off the mark. That is a good
thing because it is important that the allocated resources are
used to make full use of Medicine Use Reviews. But this element
of the contract was a negotiated element with the PSNC.
Q93 Sandra Gidley: You mentioned
funding. Why has the budget been slashed from £39 million
in 2005-06 to £15 million in 2006-07?
Andy Burnham: I think there was
flexibility built in at the beginning, without knowing exactly
how many Use Reviews would be carried out. Obviously we can now
plan with figures. I do have some figures if they are of interest
to you on the number of Use Reviews that have been carried out.
These figures have been agreed and negotiated with the PSNC. The
number of reviews is growing at a pretty encouraging rate.
Q94 Sandra Gidley: There was a slow
take-up, which was rather disappointing, I must admit, but the
rate has escalated quite remarkably, and it seems odd to cut the
funding at a time when the number being performed is increasing
quite significantly.
Andy Burnham: Yes. I think it
is a realistic figure, based on the number of reviews we expect,
so that figure has been brought down. There are 3,843 accredited
pharmacies now doing Medicine Use Reviews and there were 148,195
Medicine Use Reviews in 2005-06. I think the figures for this
financial year are to reflect that level but obviously to build
in some growth for Medicine Use Reviews. That is the reason why
that has been done, but, as we continue to discuss and negotiate
with the PSNC, it is something that we would keep under review.
Q95 Sandra Gidley: Patients and pharmacists
seem to like the Medicine Use Reviews. GPs have complained frequently
that the format of the review does not fit easily with the systems
they use; it has to be manually inputted. Is there any way that
the Department is planning to look at streamlining this service
more, so that it has greater buy-in from GPs and the information
gained from that is of benefit to GPs?
Andy Burnham: The point you make
is a very good one. I cannot say that I am aware of any work to
do that, but it is a very good point so I will take that point
away and see if I could give you an answer. I think one of the
more exciting things in the Department, which is linked to this
and has yet to achieve fruition, is the Expert Patient Programme.
It is allied to Medicine Use Reviews, in that you help people
to understand their own condition and their need for medication
and how to control their condition. I think generally that work
does need to be better integrated with primary care and general
practice, helping people basically to take more control of their
condition. I see those two things as being a crucial part of that.
However, I think you have made a good point.
Q96 Dr Naysmith: While we are on
the subject of pharmacies and pharmacists, Minister, this is a
very unfair question, I know, but you will be aware that Pfizer
has recently said that it is going to limit the distribution of
its drugs through one distributor, and a number of small wholesalers
of drugs to the pharmacy trade are complaining about this. Do
you have any views on this business of a restriction on the distribution
of drugs?
Andy Burnham: From my seat the
issues that would arise for me, I would say, are principally supply,
so continuity of supply to all parts of the country and then,
secondly, the issue of cost, whether it would increase the cost
of any particular product to the NHS. Obviously this arrangement
has not yet taken effect but as we have been assured—and
obviously departmental officials have had discussions with Pfizer
about the arrangement—we are assured on both points that
there would not be any detrimental impact of the new arrangement.
However, it is something obviously that we would want to be reviewing
to ensure that there was not any detrimental impact. Interestingly,
just as an aside, obviously I do not have responsibility for Northern
Ireland but I was there earlier this week talking about medical
regulation with Paul Goggins, the Minister of State, and it came
out that, as I understand, the wholesaler concerned does not have
an operation in Northern Ireland at present, so there may be issues
for other health ministers within the devolved countries. As far
as I am concerned as the minister responsible for the pharmaceutical
industry, we have clear assurances on those points about supply
and cost.
Q97 Dr Naysmith: Just finally, the
reason they give for this is because they want to combat counterfeit
drugs. Do you think this is a real problem and do you think this
is one way of counteracting it? Do you agree with them?
Andy Burnham: Yes, in short. I
think the industry does have a genuine and legitimate concern
about counterfeit drugs and the integrity of the supply chain
of their products. Internet sales of certain things are obviously,
I do not know how many e-mails everyone else gets but my parliamentary
e-mail used to be jammed with the things—
Q98 Sandra Gidley: No!
Andy Burnham: Maybe that says
something about me rather than you, Sandra. It is probably a derogatory
comment about myself; I had better leave that subject! Yes, I
think there are genuine issues about the integrity of the supply
chain, the quality of the products, the ability to know that the
products are of high quality, and the counterfeiting issue, which
is, as I say, a very large issue for industry. So there are legitimate
reasons. We understand why they would want to do it but from our
point of view we just want to be sure that it does not have a
detrimental impact on the two crucial areas that I mentioned.
Whether or not the OFT take a different view in terms of whether
you would describe it as vertical integration, I do not know.
Those matters are not for our Department. On the key things that
we are bothered about we are satisfied currently.
Q99 Sandra Gidley: I was not going
to but can I just pick up on the finance. You mentioned that the
pharmacy contract involves going into a darkened room with a cold
towel on your head. The whole area of discounts and claw backs
and NHS finance around the pharmacy contract I think requires
double cold towels. It is by no means clear. There are lots of
concerns that discounts will be affected and there will be a consequential
effect on the claw back by the Department, and there could actually
be a financial implication for the Department so I would hope
rather than just receiving reassurances that some work is done
to assess the financial impact of this move. Can we have your
reassurance on that?
Andy Burnham: Certainly, there
has been considerable research done on the impact of the contract
on the ground and work to ensure that the sums that were negotiated
with the PSNC as part of the contract are being met. You mention
the claw back. Because we are doing that level of detailed work,
it justified an adjustment to the contract value in terms of the
price of generic drugs. So, you are right, as far as we are concerned
this was a contract negotiated in good faith and it cuts both
ways. It has got obligations on both sides and the way we want
to proceed is with a very constructive relationship with pharmacies.
Alluding back to the point I made before, as Minister I am really
conscious—and I know this is something you are very passionate
about—of the role community pharmacy could have and will
have in the future in terms of a greater role in helping people
manage their own care and their own condition, and I want a contract
that enables people and opens up the kind of extended services
and pharmacies that we hope the contract will bring. In principle,
I think it is a good thing but it needs goodwill on both sides
to make sure that it delivers for both sides.
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