Examination of Witnesses (Questions 100
THURSDAY 19 JANUARY 2006
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 PPCsI 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 yearsand I have taken five years purely because
that is the time when you are trying to do something about itthe
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.
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 happenI 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 annuallyI
do not want to repeat what we said half an hour or so agobut
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 looka horizon scanat 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
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
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 practitionersparticularly it is small practitioners
in my area that I am interested inand 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
Q108 Dr Naysmith: It would be nice
to see that sort of evidence.
Mr Dyson: I am very happy to provide
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
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 legislationand
they are all entitled to a contract if they have a contract nowthat,
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 misinformationlike Mrs Atkins was talking
earlier on about the child list thingthan there was relatively
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