Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 100 - 112)



  Q100  Mr Campbell: We have got a situation where evidence suggests that the availability of pre-payments, PPCs, are not being taken up. In fact the Breast Cancer Care Report said that less than 40% responded to taking up the PPCs. There has got to be something wrong there when cancer patients, who obviously need the medical treatment, are not taking this up. Again, it comes down, I think, to the information.

  Mr Brownlee: Can I respond by saying that the use of PPCs—I have not got figures for particular conditions, but the use of PPCs has clearly increased over the last five years since the PPA has taken responsibility. They have taken measures in terms of writing to people to remind them when the PPC runs out, campaigns through various organisations to make sure the existence of PPCs are known. The use of PPCs is going against the trend in terms of the reduced percentage of items that are in fact paid for. The use of them over the last five years has gone up by something like 50% in terms of items, and, whereas the growth of items has gone up by about 30% over the last five years—and I have taken five years purely because that is the time when you are trying to do something about it—the use of PPCs has gone up per item in terms of items spent by about 40%. I am not trying to say there is not more that should be done, but it is going in the right direction.

  Dr Harvey: I think certainly the PPA would say that this is why they are continuing to work with patient groups, and if there are ways they can do things better that is what they will be striving to do.

  Q101  Mr Campbell: I think we certainly need to see more take up. Can I go to the Social Exclusion Unit   Report 2003 Making the Connections. It recommended that the department develop options to provide information and advice assessing healthcare facilities, including transport issues. Is the Department giving any credence to this sort of thing?

  Dr Harvey: We understand that this is an issue that is also under consideration at the moment and is one of the issues that has been raised around the consultation.[12]

  Q102  Mr Campbell: There are lot of things under consideration here. It was 2003 when that report came out. It is 2006 now. How long are we going to wait for these things to happen?

  Dr Harvey: I think this is an issue that has been raised again within the consultation and therefore it is one of the issues that is being considered around the White Paper at the moment.

  Mr Campbell: I am afraid we are going to have to consider it in our report as well. Thank you, Chairman.

  Q103  Chairman: Could I ask you a general question. The cost of healthcare, I think most people would say, is going to be driven up by technological innovation and by the introduction of new drugs as well. What work has the department done to estimate the likely costs of such developments and assess whether they are affordable without a significant increase or an extension of charges that we have talked about this morning in terms of the prescription charges, et cetera?

  Mr Brownlee: Clearly, we do work in terms of forecasting costs, so it does not happen—I mean this is a wider group in terms of our finance colleagues, I think. I do not think that we have been asked to do any specific work in terms of if this happens therefore charges should be at a higher level. What we have said about charges being looked at annually—I do not want to repeat what we said half an hour or so ago—but I do not think we look at the level of the charge in relation to the cost of particular medicines. If the average cost of the medicine was going to go up by X%, therefore charges should go up by a similar percentage.

  Q104  Chairman: My own PCT is accepting that in the next financial year, not in this one, it could cost them a million pounds more than they currently pay. Has the department looked at that in any sense of charges?

  Dr Harvey: I think in terms of the costs of new innovations as they are coming forward, clearly the department determines the work programme for the National Institute of Health and Clinical Excellence and through that we do look—a horizon scan—at both those new pharmaceutical agents that are in development at the moment and, indeed, those new devices that are likely to come to the NHS in the future, and, indeed, we do look within the funding envelope generally for the NHS at the sorts of impacts of those new technologies: because, as you are very well aware, in terms of quality of patient care, the Department is trying to ensure that patients have high quality patient care and, in fact, where innovative medicines should be used for their conditions that they are indeed used, and that is why we have those drugs going through the National Institute of Health and Clinical Excellence so that we can have clinical and cost effectiveness advice for the NHS on those drugs. What we have not done is specifically looked across at prescription charges in relation to that, but we do, indeed, look and forecast the sort of impacts that those new innovations would have on the NHS.

  Q105  Chairman: Quite clearly, if there is mention of one particular drug or one technological innovation, if there was a family of drugs coming into the NHS that was going to substantially move, let us say, just the drugs bill up inside the NHS because of this new family of cancer drugs and things like that, would you have to look at the issue that currently you get somewhere in the region of, I think you said, £426 million from prescription charges? Would that inevitably mean an increase in there?

  Dr Harvey: I think we have very much looked at it in terms of the overall NHS expenditure, what that means in terms of the drug bill growth, and I think I am right in saying that the drug bill growth is round about 8% per annum. At the moment it is relatively flat. We have just made a new agreement on PPRS, the Pharmaceutical Price Regulation Scheme, where, in fact, we have a 7% price reduction on medicines, and that is a five-year scheme. We do, indeed, look at it in terms of growth of the drugs bill and, indeed, the growth of both branded and generic medicines and, indeed, the take up of generic medicines when branded medicines have come off patent.

  Q106  Chairman: There is no direct correlation between the drugs bill and the cost of my prescription then?

  Dr Harvey: We have not specifically looked at the prescription charge in relation to that.

  Q107  Dr Naysmith: A chance to ask a couple of tidying up questions really for Mr Dyson and Dr Cockcroft relating to things that they mentioned during their evidence. One is that under optical services you said that there has been some apprehension in the profession about how the new system was likely to work in the Health Bill, and you had met some particularly small practitioners—particularly it is small practitioners in my area that I am interested in—and you were able to reassure them that they misunderstood the qualities in the Bill, and presumably they went away quite happy after you had reassured them. Is there any chance of getting something in writing about what you used to reassure them submitted to the Committee?

  Mr Dyson: Of course, yes. The Minister has written to a number of stakeholders to make clear that the purpose in introducing the Bill was to do two things, it was to strengthen controls over redemption of optical vouchers and, more relevantly in the context of sight tests, it was to remove some restrictions on the range of providers who can provide a sight test. The Minister has reassured stakeholders that this is not about altering the current system whereby sight tests are paid for.

  Q108  Dr Naysmith: It would be nice to see that sort of evidence.

  Mr Dyson: I am very happy to provide that.

  Q109  Dr Naysmith: Dr Cockcroft, again talking about dental services this time, there seems to be a bit of apprehension around orthodontics, which I am sure you are aware of, and now that it is moving towards the primary care trust who will be responsible for commissioning services, as I understand it, which was not the case before, how do you intend to oversee this and make sure that services do not just disappear? In particular, there is supposed to be some sort of appeal procedure, which has not appeared yet but orthodontic practitioners would like to see soon. I notice this is a very fast moving situation, but I want to raise it today because I know there is quite a lot of concern.

  Dr Cockcroft: It is not only orthodontics, even the generalist, this is the first time the PCT has had the responsibility for the whole service. A lot of orthodontic services were provided through general dental practitioners or specialists working in primary care before the system came in. It has been a huge area of uncertainty for orthodontists, and part of my job since I have become Acting Chief Dental Officer is to go out and meet lots of people, and I am doing that. It has been a specific issue for orthodontists for a couple of reasons. One is because they have to work under PDS agreements if they are only doing orthodontics.

  Q110  Dr Naysmith: It is the long-term nature of the contract as well.

  Dr Cockcroft: Yes, whereas the generalist contract is open-ended. If they are only providing specialist services, it has to be under a PDS agreement, which is necessarily time limited. The legislation does not contain any specific time limit, but in the guidance we have provided to PCTs we have said quite clearly that the starting point for an orthodontic contract will be a five-year contract, and we have been working very closely with the British Orthodontic Society, who seem very reassured by that.

  Q111  Dr Naysmith: As I understand it, there are some problems to do with appeal procedures about providing future income.

  Dr Cockcroft: I was not aware of that. We have it very clearly in the primary legislation—and they are all entitled to a contract if they have a contract now—that, if they are unhappy with the terms of that contract, they have a right of appeal to the Litigation Authority, and that is binding on the PCT, although it is not necessarily binding on the clinician. We would hope it would not get to that situation in most cases, but obviously there is a protection for specific people there; but part of the process recently has been a much clearer process of giving information, a real programme of concentrated information provision to practitioners, and I think there is less degree of uncertainty and misinformation—like Mrs Atkins was talking earlier on about the child list thing—than there was relatively recently.

  Q112  Chairman: First of all, a short apology. We have run on a few minutes longer than we originally said we would do on this. Thank you all very much indeed for coming along and giving us this information. I am sure it is going to be enormously useful for us in terms of the rest of the inquiry and other witnesses as well, including your ministers, I suspect. Thank you very much indeed for your evidence.

12   Note by witness: The White Paper-Our Health, our care, our say: A new direction for community services, Cm 6737, January 2006, has been published and makes reference to transport, including patient transport services etc on pages 150-152. Back

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