Health and Social Care Bill
Administration: Great Britain
(6) The Secretary of State may by regulations indicate the payments to be made in the event of a pregnancy that is carried beyond the twenty-ninth week, but is not carried to term or live birth..
The Minister owes it to Parliament to take the Bill seriously; after all, he is proposing itthe rest of us are trying to scrutinise it. Following that gross disrespect, we move to amendment No. 64.
Amendment No. 64 seeks to probe Government thinking, but it sounds to me as if they cannot be bothered to think and, if necessary, amend the Bill on the issue of payments to mothers who, for whatever reason, at the later stages of pregnancy, when it is often at the most tragic, do not carry their babies to full term. I hope that, for once, the Minister will take the matter seriously, because outside this Room, people think it is extremely serious.
I note from the draft regulations that a woman who has given birth to a child, or a stillborn child, is entitled to payment of the health in pregnancy grant, if she was at least 25 weeks pregnant, and before that birth, had received advice on matters relating to maternal health from a health professional. Of course, I should be more than willing to withdraw the amendment if I received adequate assurance that the regulations touch on it. My anxiety is that the need to have received health advice will become the trigger, rather than the needs of the mother, who will no doubt be going through extraordinarily difficult times, when anything that would help her health, not least through diet and nutrition, so that she can overcome desperate stress and grief must be our primary focus.
Mr. Bradshaw: The draft regulations published by the Medical Research Council, which I circulated to the Committee some time ago and which, incidentally, included the list of professions that would be involved in the work, set out the detail about the entitlement conditions. In particular, regulation 2 of the draft sets out the conditions in relation to pregnancy, and refers specifically to women who have a stillbirth after the 25th week of pregnancy. That would include the exceptional cases where a pregnancy has to be terminated on medical grounds after the normal 24-week limit for legal abortion. I assure hon. Members that we have carefully considered this most sensitive matter. When a woman loses her baby, we do not want to add to the distress that she and her family will be facing, by placing additional requirements on her. Accordingly, where a woman meets the specified conditions of entitlement, as set out in clause 121, and claims within the time specified in regulations set out under clause 122, she will continue to be entitled to the grant, regardless of the outcome of her pregnancy.
Mr. O'Brien: As I said, I am happy to withdraw the amendment and I am glad that we have been able to ensure that all those points were properly aired on the record. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Question proposed, That the clause stand part of the Bill.
Mr. O'Brien: The Patients Association supports Tambathe Twins and Multiple Births Associationand Bliss on multiple births. Although we have raised these points already during our proceedings, the Minister was rather short on his answers, so we did not get the reassurance we sought and I shall have to detain the Committee for a short while. The Patients Association is
concerned to learn that the Health in Pregnancy Grant proposed in the Bill will penalise mothers giving birth to twins and multiple births.
The Minister will recall that there were a series of reasons for that concern, which it was important to consider. Indeed, they were reprised by my hon. Friend the Member for Tiverton and Honiton in her contribution. There was concern about the focus on the birth, which is what the Government pray in aid, as compared with the health of the baby and the mother, who is under much greater demand when it is a multiple birth. One must think carefully about making these grants available to individual human beings, be they boy or girl, on the basis of health rather than simply as an event of birth. I wonder whether the Minister would like to amplify his comments on that point, given that he chose to keep his remarks rather short during our previous attempt at the subject.
Mr. Bradshaw: The way the grant will be administered is the same as for other pre-pregnancy grants such as the healthy start voucher, which is administered regardless of the number of babies that a pregnant woman is expecting. The evidence suggests that women with twins do not have additional nutritional requirements to those with single births.
Question put and agreed to.
Clause 122 ordered to stand part of the Bill.
Clauses 123 to 126 ordered to stand part of the Bill.
Northern Ireland: health in pregnancy grant to be excepted matter
Question proposed, That the clause stand part of the Bill.
Mr. O'Brien: The clause makes the health and pregnancy grant an excepted matter, and therefore outside the competence of the Northern Ireland Assembly. As we are discussing a matter that is applicable to England and, through the auspices of Welsh Ministers, in Wales, with a reference to Scotland from time to time, will the Minister tell us when pregnant mothers in Northern Ireland might expect to have the same opportunities and be under the same protection, in terms of their health and that of their unborn babies?
Mr. Bradshaw: This is the same system as applies to child benefit in Northern Ireland. The Northern Ireland Assembly has approved the legislative motion for the Bill, including the health and pregnancy grant.
Question put and agreed to.
Clause 127 ordered to stand part of the Bill.
General and supplementary
Question proposed, That the clause stand part of the Bill.
Mr. O'Brien: I wonder whether the Minister would give some explanation about subsection (2), given that it relates to the Immigration and Asylum Act 1999. I assume that it disallows illegal immigrants from claiming
In a connected issue, on 26 November last year, my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) asked the Chancellor whether A8 nationals resident in the UK will be eligible for the proposed health in pregnancy grant. As the Committee will know, the A8 countries are the new EU entrants: the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia. The ministerial response was, as I have come to expect from the Treasury, somewhat equivocal:
The Government are introducing from April 2009 a one-off payment to expectant mothers, known as the Health in Pregnancy Grant, to help them during the important last weeks of pregnancy. Only women ordinarily resident in the UK will be able to claim the payment.[Official Report, 26 November 2007; Vol. 468, c. 51W.]
Could the Minister tell the Committee what ordinarily resident means, in practical rather than legislative terms, and under what circumstances nationals of the A8 countries will be classed as being ordinarily resident? Consequently, is the answer to the question yes, or no?
Mr. Bradshaw: Under subsection (2), the health in pregnancy grant will follow the long-standing Government policy that those who have not established their right to remain permanently in the UK, should not have welfare provision on the same basis as those whose citizenship or status here entitles them to benefits and assistance when in need. To ensure that people who are subject to immigration control and who are in the UK illegally are not entitled to the health in pregnancy grant, subsections (2) and (3) apply section 115 of the Immigration and Asylum Act 1999 to the health in pregnancy grant. Section 115(9) of that Act defines
a person subject to immigration control
someone who is in the United Kingdom unlawfully (either an illegal entrant, or someone who has overstayed his leave); someone who is here on limited leave with a condition that he will have no recourse to public funds (e.g. a visitor or a student); someone who is here under a maintenance undertaking; or someone whose leave has been extended to allow him to pursue an appeal. These classes embrace asylum seekers if they are subject to immigration control in this sense (an application for asylum does not itself confer an entry status or leave to remain), and a number of other persons subject to immigration control.
Question put and agreed to.
Clause 128 ordered to stand part of the Bill.
Duty of Primary Care Trusts
Anne Milton: I beg to move amendment No. 67, in clause 129, page 85, leave out lines 20 and 21 and insert
(a) have regard to the standards set out in statements under section 41 of the Health and Social Care Act 2008, and
(b) produce an annual health improvement plan..
The amendment, crucially, would insert into the Act a duty on primary care trusts to produce an annual health improvement plan. All NHS bodies currently have a duty, under section 45 of the Health and Social Care (Community Health and Standards) Act 2003, to ensure that they have arrangements in place for the purpose of monitoring and improving the quality of care. Clause 129 would amend the National Health Service Act 2006 to insert a duty on primary care trusts to make arrangements to secure continuous improvement in the quality of care provided by or for them. This new version of the duty is intended to be more closely aligned with that imposed on local authorities by section 3 of the Local Government Act 1999. The existing duty in section 45 of the 2003 Act would cease to apply in relation to English NHS bodies. Responsibilities for the duty of care would thus be placed with commissioners of NHS services and primary care trusts.
The amendment would put a condition on PCTs to produce an annual health improvement plan. I believe it is still the case that primary care trusts produce an annual health report. That is important as it reports on what has happened within its area in the previous year. However, that focus on future improvement is crucial. Many parts of the Bill, in relation to maternity grants, the weighing and measuring of children and here under the clause, make reference to the publics health. I would urge the Minister, as I said in my brief intervention on the discussion of the previous clause, that this is non-party-political issue. We will move on to obesity and I am restraining myself from talking about it now, but it is terribly important that we deliver better health for the public.
Public health is in many ways a dispiriting area to work in because, particularly with measures that have long-term outcomes, one is looking for improvements over the course of five years. The health improvement plan would help those working in the field to keep their focus and allow them to be measured against what they are delivering and indeed, measure themselves. It is disappointing that on the state of public health in July 2006, the chief medical officer warned that raiding public health budgets can kill. Although it is not so much the case this year, in previous years we have seen PCTs responses to budget deficits as raiding the public health budgets. Unfortunately, public health money is always seen as soft money, partly because of those long time frames for outcomesthere is no immediacy. I do not know that newspapers such as the Daily Mail report public health very much and it does not have the sexy image that many other parts of healthcare have, but it is equally if not more important.
If we look at the figures for the number of people employed in public healthI should reiterate my interest, which is that my husband is a public health physicianbetween 2005 and 2006, with no more recent figures available, the number of full-time equivalent public health staff in the NHS was cut by 4 per cent. It went down from 1,324 to 1,268. Of those, the number of public health consultants was cut by 6 per cent., going down to 687. PCTs are working with
Mr. Bradshaw: I have a lot of sympathy with the sentiment that the hon. Lady has expressed, but as she may be aware, under section 24 of the National Health Act 2006, each primary care trust is already required to produce an operational plan, setting out its strategy for improving the health of the people for whom it is responsible, so the amendment is unnecessary.
Anne Milton: I do not know whether that is producing quite what we want. I think that in considering the Bill, which addresses many public health issues, it is important to have reiterated just how important public health is, however, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 129 ordered to stand part of the Bill.
Clause 130 ordered to stand part of the Bill.
Funding of expenditure in connection with provision of pharmaceutical services
1A (1) Section 164 of the NHS Act (remuneration for persons providing pharmaceutical services) is amended as follows.
(2) In subsection (1), for determining authorities substitute the Secretary of State.
(3) Omit subsection (2).
(4) Omit subsection (3)..
No. 230, in schedule 12, page 167, line 11, at end insert
1B (1) Section 165 of the NHS Act (section 164: supplementary) is amended as follows.
(2) In subsection (3), omit paragraph (b).
(3) In paragraph (4)(b), for determining authority substitute Secretary of State.
(4) In paragraph (5)(a), for determining authority substitute Secretary of State.
(5) In subsection (9), for determining authority substitute Secretary of State..
No. 240, in schedule 12, page 167, line 22, at end insert
( ) at the end of subsection (10) insert
but shall give directions to a Primary Care Trust with respect to remuneration determined by him in accordance with section 164(3)..
No. 241, in schedule 12, page 167, line 36, at end insert
3A (1a) The Secretary of State shall designate any element of remuneration determined by him in accordance with section 164(3) which is not remuneration referable to the cost of drugs..
Sandra Gidley: Clause 130 and schedule 12 deal with money for payment of pharmaceutical services, commonly known as the global sum. Currently the nationally agreed figure is administered nationally and everyone knows what the situation is. In its consultation, Modernising Financial Allocations for NHS Pharmaceutical Services 2007, the Department of Health proposed devolving the global sum to primary care trusts baseline allocation. In doing so, the Department stated that it would
continue to set the levels of fees and allowances for community pharmacies in negotiation with the Pharmaceutical Services Negotiating Committee and in discussions with the NHS.
The Bill introduces the necessary amendments to the National Health Service Act 2006 to permit the global sum to be devolved, but does not include provisions to ensure that the Secretary of State will continue to set the levels of fees and allowances nationally, following consultation with the Pharmaceutical Services Negotiating Committee. Clearly there is concern that the longer term aim is perhaps to have different fees in different areas and fees set by primary care trusts.
Currently, section 228 of the National Health Service Act 2006 requires the Secretary of State to pay sums equal to pharmaceutical services expenditure to primary care trusts. Such sums are distinct from the main expenditure and require the Secretary of State to determine the remuneration of persons providing pharmaceutical services after consulting with the Pharmaceutical Services Negotiating Committee. The Bill removes the distinction between pharmaceutical services expenditure and a primary care trusts main expenditure from section 228 and therefore removes any obligation to make a determination of the remuneration of persons providing pharmaceutical services. To give effect to the stated intention of the Department of Health to continue to set the levels of fees and allowances for community pharmacies in negotiation with the Pharmaceutical Services Negotiating Committee, the Bill must retain an obligation on the Secretary of State to determine some elements of the remuneration of persons providing pharmaceutical services. In its current form the Bill does not do that.
The Bill amends schedule 14 of the National Health Service Act 2006 and adds a new paragraph 3A. That will authorise the Secretary of State to designate elements of remuneration payable by primary care trusts to persons providing pharmaceutical services, which is not remuneration referable to the cost of drugs. The designation has two effects; first, the Secretary of State will be obliged to apportion the total to primary care truststhat will be accomplished by transferring the global sumand secondly it will make primary care trusts accountable for those sums. Almost all fees and allowances paid to persons providing pharmaceutical services are not referable to the cost of the drugs being provided. However, the Secretary of State is under no obligation to designate any elements of the remuneration. To give effect to the Department of Healths intention to continue to set the levels of fees and allowances for community pharmacies in negotiation with the Pharmaceutical Services Negotiating Committee the new paragraph 3A should oblige the Secretary of State to designate certain elements of remuneration. That is what the amendments would do.
Section 164 of the 2006 Act provides that the Secretary of State is a determining authority who determines the remuneration to be paid to persons who provide
Section 165 of the 2006 Act requires that before the Secretary of State makes a determination that relates to all persons who provide pharmaceutical services, such as a determination of dispensing fees, he should consult a body appearing to him to be representative of persons to whose remuneration the determination would relate, namely the Pharmaceutical Services Negotiating Committee.
Sections 164 and 165 do not place an obligation on the Secretary of State to determine the remuneration of persons who provide pharmaceutical services and the Secretary of State could, with no further legislative amendment, decide to authorise primary care trusts to determine remuneration for persons providing pharmaceutical services, including dispensing fees. The community pharmacies in England provide an accessible health care resource that is greatly valued by members of the public. In a recent Readers Digest survey only firefighters were more highly valued. It is a very useful health resource. Other health care professionals such as doctors and dentists have nationally agreed fee structures. 85 per cent. of a typical community pharmacys income comes from the NHS and certainty of income levels from this source is essential.
The payment by primary care trusts of remuneration to persons providing pharmaceutical services, which has been determined by the Secretary of State, must be mandatory. Unlike providers of general medical services, who have legally enforceable contracts, providers of pharmaceutical services do not operate under a contract that can be enforced by the provider. The Secretary of State may issue directions to PCTs with respect to the application of sums paid to them and to ensure that the fees and allowances determined by the Secretary of State, after consultation with the Pharmaceutical Services Negotiating Committee, are properly paid to persons providing pharmaceutical services. Direction must be issued to oblige PCTs to pay that remuneration.
There seems to be some uncertainty about the future of the payments. We are seeking to regularise a situation where the Government have made promises that do not appear to be incorporated in the Bill. I hope that the Minister will look kindly on the amendments. There is one small problem with the transfer of the global sum: because payments are made in arrears, the transition from one method of payment to another needs to be looked at carefully to ensure that PCTs have their act together and that there is no hiccup in the distribution of payments.
Kelvin Hopkins (Luton, North) (Lab): I have had these problems explained carefully to me by a representative of pharmacists, and I ask my hon. Friend the Minister
Anne Milton: I want to reiterate the point made by the hon. Member for Luton, North. Local pharmacies almost have an air similar to local post officesa big topic at the moment. Local pharmacies are increasingly important in the delivery of some preventive matters, such as screening, and in respect of issues such as chlamydia, pregnancies and all the rest. It is important that any change does not undermine their business or make it more difficult for them to continue.
Mr. Bradshaw: Hon. Members have raised some important points. These are matters of concern to pharmacists. I will spend a little time dealing with the concerns raised by the hon. Member for Romsey. Amendments Nos. 229 and 230 would remove the ability for anyone other than the Secretary of State to determine the remuneration paid for the provision of pharmaceutical services. Current legislation enables the Secretary of State to determine such remuneration himself or to authorise others, such as PCTs, to do so. Under these amendments, the Secretary of State would have to set the fees, allowances and payments for all categories of pharmaceutical services, whether those services were agreed nationally and provided by all pharmacy contractors, or commissioned locally by PCTs from certain pharmacies to meet local needsfor example, services for drug misusers. That would undermine the existing community pharmacy contractual framework, whereby PCTs determine the remuneration for the local enhanced services that they commission and fund from community pharmacies.
I share the hon. Ladys desire for the NHS to commission a wider range of services from pharmacies. They are often in the most accessible location and can provide services tailored to meet local community needs. Having attended its annual conference last year, I know that that view is also held by the pharmacy profession, the all-party group on pharmacy and others. We believe that the amendments would undermine the ability of local PCTs to continue to commission existing local enhanced services from pharmacies, never mind extending the services that they fund through pharmacies.
Amendment No. 240 would require the Secretary of State, where he determines remuneration for pharmaceutical services, also to give directions to PCTs in respect of that determination of funding. That is unnecessary because, where the Secretary of State has made a determination of the fees and allowances to be paid to community pharmacy contractors, that determination has to be honoured by PCTs. So that amendment would add nothing.
Amendment No. 241 would require the Secretary of State to designate any element of remuneration determined by him for pharmaceutical services. Designation allows costs to be charged to a PCT other than the PCT where the pharmaceutical service was provided. That would enable certain elements of
When the Department consulted on the proposals, we indicated our intention for the Secretary of State to continue to determine the fees and allowances for the national elements of the community pharmacy contractual framework, in negotiation with the Pharmaceutical Services Negotiating Committee and in discussion with the NHS. Those national elements are the essential services provided by all pharmacy contractors and advanced services, such as medicines use reviews, which pharmacies choose to provide.
Concerns have been raised, including by the hon. Lady today, that that might not continue to be the case. We recognise that pharmacy owners need to know the remuneration that they will receive for those substantive parts of the contractual framework, so that they have the confidence to continue to invest in their businesses. I should like therefore to take the opportunity strongly to reinforce our commitment that the Secretary of State will, indeed, continue to set the fees and allowances for the national elements of the community pharmacy contractual framework. In light of those reassurances, I hope that the hon. Lady will withdraw her amendment.
Sandra Gidley: I thank the Minister for the explanation. Clearly, as he said, it is important that enhanced services continue to be commissioned locally. I fully support that. I do not want any unintended consequence for enhanced services, so the amendments may not be perfect. I was pleased to hear the Ministers clarification that the intention is for the Secretary of State to continue determining national rates. Will he write to clarify where that is stated in the Bill? Also, where is the protection that I alluded to during my opening comments, so that payments cannot be determined by PCTs in the future? I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Schedule 12 agreed to.
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