Select Committee on Health Minutes of Evidence


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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