Clause
122
Administration:
Great Britain
Mr.
O'Brien:
I beg to move amendment No. 64, in
clause 122, page 78, line 25, at
end insert—
‘(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 it—the 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.
1.30
pm
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
Tamba—the Twins and Multiple Births Association—and 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.
Clause
127
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.
Clause
128
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
the health in pregnancy grant. Does that stand also for those who have
claimed asylum but not yet heard the outcome of their application? This
is an important issue because so many of those women who come
in either as illegal immigrants or as asylum seekers are of
child-bearing age.
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”
as
“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.
Clause
129
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 public’s 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 outcomes—there 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
health—I should reiterate my interest, which is that my husband
is a public health physician—between 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
tight financial constraints these days and there is a feeling that they
must deliver on those headline figures. It is absolutely crucial that
we get PCTs to focus on public health improvement; to produce a plan
would make a substantial difference.
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.
Schedule
12
Funding
of expenditure in connection with provision of pharmaceutical
services
Sandra
Gidley:
I beg to move amendment No. 229, in
schedule 12, page 167, line 11, at
end insert—
‘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).’.
The
Chairman:
With this it will be convenient to discuss the
following amendments:
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 trust’s 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 trusts—that will be accomplished by transferring
the global sum—and 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 Health’s 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
pharmaceutical services. However, he may also authorise any primary care
trust to be a determining authority, which is particularly needed to
allow primary care trusts to determine payment for locally commissioned
enhanced services. Some fees and allowances apply to all persons
providing pharmaceutical services, for example the dispensing fee. In
its consultation, the Department emphasised the importance of
continuing to set the level of those nationally. 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 Reader’s 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 pharmacy’s income comes from the NHS and certainty of
income levels from this source is
essential.
1.45
pm
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
to ensure that whatever the Government do, they protect those local
pharmacies who would find these problems difficult and might have their
continued existence threatened. Local pharmacies are important for
local communities, and I want to ensure that that is taken into
account. I am not suggesting support for the amendment, but I hope that
my hon. Friend will take into account what has been
said.
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 offices—a 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
needs—for 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. Lady’s
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
pharmaceutical services to be charged to the PCT where a prescription
was issued, while other costs would be borne by the PCT where the
pharmacy was based, thus avoiding a PCT with a pharmacy that provides
services to a wide area—such as an internet
pharmacy—inappropriately bearing the costs of pharmaceutical
services for people resident elsewhere. Designation would not be
appropriate for certain types of expenditure, which will be borne by a
PCT where the pharmacy providing the service is based. That amendment
would require the Secretary of State to make a designation in respect
of all remuneration determined by him for pharmaceutical services, even
where such a designation is
inappropriate. 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 Minister’s 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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