Examination of Witnesses (Questions 640
- 659)
THURSDAY 16 FEBRUARY 2006
RT HON
JANE KENNEDY
MP, MS ROSIE
WINTERTON MP, DR
FELICITY HARVEY
AND MR
BEN DYSON
Q640 Mr Campbell: I heard Jane mention
the monthly prepayment certificate before. You just mentioned
that. I just caught the end of what you said.
Jane Kennedy: It is not monthly
at the moment. We are looking at that.
Q641 Mr Campbell: Could you expand
on that?
Jane Kennedy: The Prescription
Pricing Authority, who are the responsible body for administering
the whole scheme and for making sure that reimbursement of
prescriptions takes place, are looking at how they could develop
such a scheme, and they will be reporting to me shortly on that.
Mr Campbell: That is good.
Q642 Mr Burstow: In addition to that,
are there other options being looked at? Are they essentially
looking at potentially a charging cap, so that, once you have
paid a certain amount in a given period of time, you do not pay
any more? Is that another option that is being considered?
Jane Kennedy: It is capped anyway,
and at the moment they are looking at both.
Dr Harvey: It is a four-monthly
certificate, but they are looking at monthly payments towards
that, and they are also looking at the other thing that was raised
by Citizens Advice, which was a reduced price PPC for those holding
an HC3.
Q643 Chairman: What about the issue
of somebody who may not at the beginning of the year, or at any
one time, know that they are going into a situation of long-term
conditions that is going to mean a lot of medication but, probably
three or six months down the road, suddenly realise that the amount
of expenditure is quite high? I think one country we had evidence
from put an annual cap on what somebody would pay on prescriptions
and, if they met that cap, they would not pay any more for the
following three months. Have you looked at anything like that?
Dr Harvey: We are certainly aware
of the situations, particularly in the Scandinavian countries,
where that applies. There is the issue of the administration cost
around all of that, but I think that is also why we are looking
more at the monthly payments for PPCs and issues around the HC3
low-income scheme.
Q644 Chairman: Okay. Another area
we would like to look at is the cost of travel but in different
circumstances than going to your local hospital. I have a constituency
case I have been dealing with now for a number of years. One of
my constituent's daughters was living in Sheffield, which is next
door to me, and has ended up suffering from mental illness. She
had to go into long-term care, and she is still in long-term care
now. She was sent initially to Milton Keynes. Her mother could
not get down to Milton Keynes to see her. She is an elderly lady
and I do not think she has got a lot of income. I eventually got
the system to move her a bit nearer. She is now in North Nottinghamshire,
but she certainly could not get on a bus to go and see her. Why
do we allow this situation? If it might have been a member of
a family who went to prison, they could actually get travel costs
to go and visit that person in prison. I had a letter from her
a few weeks ago saying could we get her even nearer to North Nottinghamshire.
If we could move her back to Sheffield she could go and see her
on the bus a lot more. Why is it that we pay for people to go
and visit prisoners and yet we cannot do that for people in long-term
care in situations like that?
Ms Winterton: Can I, first of
all, make a general point about the mental healthcare provision.
It is something that I am looking at, the general commissioning
of mental healthcare, particularly in the relationship between
the public sector and the private sector and how we can strengthen
commissioning so that it is, in fact, closer to home in general.
Q645 Chairman: It is very likely
that these people will go into a place because of the status of
that place, in terms of whether it is a secure unit or not, and,
under those circumstances, we are not going to have one in every
borough. I accept that entirely. I just think that it is very
unfair that under those circumstances the family could visit,
which could be very much for therapeutic reasons, and assist and
certainly help a mother to see her daughter, and yet she does
not get any assistance in being able to do that. Is that something
that you could look at when you are looking at the issue of long-term
care?
Jane Kennedy: It is something
that we could look at. I think we have focused the help in terms
of transport on the patient so that the hospital transport scheme
is focused on helping patients who have travel costs. This is
a fair point, and I can appreciate the difficulties that some
families of patients in those circumstances face. We would be
happy to consider what the Committee has to say on this.
Chairman: If somebody in the family had
done wrong to society and been under lock and key, they could
get assistance to go see them.
Q646 Mr Burstow: Can I pick up this
point. There was a report done a couple of years ago by the Social
Exclusion Unit, Looking at Making Connections. It was published
in 2003. It estimated that about 1.4 million people are put off
taking up healthcare because of issues of access to transport
and affordability of transport and so on. Preparing for this inquiry,
what we have found it very difficult to do is to discern quite
how the Department went about responding to the recommendations
of that Social Exclusion Unit report. Can you tell us what you
did with the recommendations to try and improve information for
patients about how they could access transport and, indeed, this
issue of how relatives can also have access to transport?
Ms Winterton: There are two things.
There are instances where people can apply for a social care grant
for travel to see relatives in those situations. I think there
is also an issue that is being looked at in terms of the wider
expansion of the Choose and Book programme, and within that there
is a look being taken at transport for visitors as well and I
think, particularly in terms of mental health, that is something
that we can look at within that.
Q647 Mr Burstow: Specifically the
Social Exclusion Unit report from three years ago. How was that
taken forward?
Jane Kennedy: First of all, the
White Paper that we have just published sets out ways in which
we respond to the recommendations of that report. They had one
specific recommendation, which was that we should abolish the
hospital transport scheme, which we have resisted because we actually
think there is a value in helping those patients who would otherwise
face costs specifically. However, there is a broad responsibility
for ensuring that, as we are developing services and moving forward
with our programme of taking services closer to people in the
communities, local transport plans will also be required to play
a role in making sure that transport arrangements in any given
area take into account the accessibility of health service and
health service provision. It is not just a health department responsibility
to make sure that health facilities are accessible.
Q648 Mr Burstow: On that last point—the
model of care of having healthcare closer to home—one of
the problems that can arise, and certainly in my own area where
that model of care has now been put forward and has been taken
forward, you may have very localised care facilities but they
will not be able to provide the full range of diagnostics. Although
you may have a local care hospital or a local facility on your
door step, you still have to go right the other side of my local
authority area, or further afield, still to get to the one that
provides the service that you need. In some cases that may wind
up with far more complex journeys than the original journey to
the local key hospital. How is that going to be picked up? Is
that simply going to be left very much to local transport plans
and an interaction between the NHS locally and transport providers?
Jane Kennedy: No, because if a
patient requires, for medical reasons, to travel a distance for
a diagnostic such as that and they fall within a category of patient
for which the patient transport service will be able to provide
transport, then they will be transported, so that will be provided.
As I say, the other element of it is that for those patients who
are not so critically ill that they require transport or have
a condition which does not qualify for that support, there is
the other scheme, which we have defended, which is the hospital
transport scheme.
Q649 Mr Burstow: So why are 1.4 million
people a year turning down healthcare because of transport issues
according to the Social Exclusion Unit?
Jane Kennedy: As I say, our response
to the Social Exclusion Unit report is contained within the White
Paper, and if we take services more locally and provide services
more locally, for example Clatterbridge Hospital in my area, a
big cancer unit, well respected, has been developing for many
years a system in which consultants go out and run clinics in
localities around Merseyside and Cheshire and North Merseyside,
so they will take their services to patients in Southport and
deliver chemotherapy services in Southport. The patient does not
have to go all the way through Liverpool to the Wirral to receive
the treatment at the hospital. This is not rocket science, it
is a simple process. It is a very sensible process of taking services
out to where people want them, which is as close to home as they
can have them.
Q650 Mr Burstow: That is a good example
of where that will work, but the point that I am making is again
from practical work of modelling a better healthcare closer to
home model of care. In my area they have recognised that there
will be some services that will be provided in satellite facilities,
but only one of them. They will not be moving around. There will
still be people who have to travel further to get to those facilities.
It is how those people are addressed when we know already 1.4
million people a year turn down access to healthcare because of
transport difficulties. I am not clear how that is being fixed
through what is being put forward.
Jane Kennedy: We are taking services
closer to people. That is how we are fixing it.
Q651 Chairman: Could I ask you if
you are happy that patients have adequate access to information
regarding eligibility for assistance with health charges and if
the Department do any checks on this. Last week we had in Citizen's
Advice who said that health providers are not required to display
information about the NHS Low Income Scheme. I know when you go
into a GP's surgery there are leaflets and all sorts of things
in there, but they do not have to provide this information on
the NHS Low Income Scheme. They described it as quite amazing
that they did not. Do you have any views on that?
Jane Kennedy: The Prescription
Pricing Authority is working with the Citizen's Advice Bureau.
They have taken that finding very seriously and they are working
with them to provide more information and working with the NUS
to make sure there is information available to students on healthcare
and health advice, so it is something that they are responding
to.
Ms Winterton: I am not sure if
you make something a requirement, if somebody says that they were
not then given it, whether you get into some legal difficulties.
I am not sure whether that might be an issue if you put a requirement
and then somebody says, "Yes, but I was not actually told
it"—the definition of how you have displayed some information
and whether it was drawn to their attention but there is certainly
very heavy guidance, I think, on good practice as to how people's
attention should be drawn to it.
Jane Kennedy: For example, pharmacists
are not contractually obliged to do it but good practice dictates
that it would be something they should do.
Q652 Chairman: I suppose that is
one of the issues with new GP contracts and everything else as
to whether or not you could make it a provision. What you are
saying is if somebody says it falls short you then get into a
mess of proving or disproving that information was available at
the time when somebody went into a surgery. Is that what you are
saying?
Ms Winterton: It occurs to me
that might be an issue around it and trying to do it through good
practice may be the preferable route.
Jane Kennedy: The HC11 form that
does give guidance on the support that is available and on the
Pre-payment Certificate is available from pharmacists and GPs
and contractors. It is also available in JobCentre Plus and two
major supermarkets, I understand.
Chairman: You are not prepared to name
them. Richard has got a question about that.
Q653 Dr Taylor: That is the next
question about the HC11. I am ashamed to say I have not looked
at one myself but we are told it has got 77 pages and it is the
major part of Age Concern's volunteers' work, to try to help people
fill in this form. How could this be simplified? I think it was
the CAB who said, "One thing you could do is say if you are
entitled to a means-tested benefit then you get your free prescriptions".
That would be so easy and it would save so many people so much
time as opposed to this 77 page form. Is it 77 pages?
Jane Kennedy: Yes. 79. But it
does cover all the costs and all the help that you can get that
is available, so it is of necessity detailed. However, there is
a quick guide which my glamorous assistant will show you!
Q654 Dr Taylor: Does the quick guide
separate each of the sorts of things that you can claim for?
Jane Kennedy: It gives details
of what benefits would passport you through to receiving free
prescriptions.
Q655 Dr Taylor: Is there a short
form on that that they have to fill in to claim it or do they
still have to go back to the 79 page book?
Ms Winterton: The form is HC1.
Jane Kennedy: This is the advice
booklet which explains what is available.
Q656 Dr Taylor: How difficult is
the form because Age Concern pointed out the extensive amount
of time their members spend helping older adults complete the
form? How many pages is the form?
Jane Kennedy: I do not have an
answer on that but we can find out. However, the patient partnerships
have done a survey of opinion on the form. I think 94% of those
who responded to the survey said they found the form easy to fill
in. We need to check because you have obviously got different
information from us.
Q657 Dr Taylor: It is just from Age
Concern.
Jane Kennedy: The HC1 form is
16 pages.
Q658 Dr Taylor: The form is 16 pages?
Jane Kennedy: Yes, 16, one-six.[1]
Q659 Dr Taylor: Could you possibly
leave us a form because I think it would be terribly useful if
we saw it.
Ms Winterton: Would you like this
quick guide?
Dr Taylor: Absolutely. Yes, please.
1 Note by witness: The Prescription Pricing
Authority (PPA) offer an HC1 form completion service which is
available by phone. Back
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