Dr.
Pugh: The problem with the amendment is that it does not
go far enough. The line that we will take both on Report and in
Committee is that cigarette vending machines are out of order and that
we support the British Heart Foundation’s attempt to eradicate
them totally. Let me briefly explain why.
Cigarette
vending machines are anachronistic and date back to the times when
shops closed at 6 o’clock, and desperate smokers looking for a
cigarette could only get them from a vending machine. On Sundays, too,
it was hard to get a supply of cigarettes. As a result, the machines
came into being.
Mike
Penning: I apologise for taking up the hon.
Gentleman’s time, but what a load of tosh. I have never heard so
much rubbish in my entire life. If someone goes into any pub in this
country, they are highly unlikely to be able to purchase cigarettes in
any other way. To say that it is something to do with the machines
being used late on a Saturday night and that they are an old-fashioned
anachronism is completely wrong. Whether we like it or not, it is the
only way in which cigarettes can be purchased in most premises these
days. That is because of the stock issue, to which I alluded
earlier.
Dr.
Pugh: Clearly, it would be a disincentive for people to
smoke if they had to leave the premises to get cigarettes. On a
personal note, my son recently gave up smoking. The most difficult
situation for smokers when they have given up is after they have had a
few pints and they are relaxed, so if we are looking at a measure that
will prevent people from going back to smoking, banning the machines is
probably the best one.
The machines
are not just anachronistic, but slightly odd—after all, we do
not have alcohol-dispensing machines with controls on them. There must
be some reason why the Europeans, having explored the logic, have gone
down the route of largely abolishing them. We were talking about flaky
evidence and evidence pointing both ways, but the evidence here is
entirely clear cut. The machines represent a small section of total
cigarette sales, but one in six child smokers use them.
There is no doubt that the evidence shows that children
disproportionately use them. The evidence also shows that attempts to
get round that by having token systems or monitoring and other such
measures simply do not work.
We
have talked about displays before. One of the great arguments for not
having displays is that it will stop people from going back to smoking
and it will stop children from smoking. Vending machines encourage
people to go back to smoking because, in the pub, they can be found
very easily. They are clearly used by children and will continue to be
used no matter what controls are brought in, because children, when
they want to smoke and get round legislation, are very canny at doing
so.
Gillian
Merron: I appreciate the points that have been made, but I
will answer them under the next set of amendments or on clause stand
part, should debate on that.
The direct
effect of amendment 91 is that it would compel the Governments of
England and Wales to regulate vending machines. I can confirm that it
is the intention of this Government to introduce new regulations on
vending machines to ensure that under-age sales are prevented. The
Department is already working with key stakeholders in the vending
machine business and enforcement agencies to develop draft regulations
that will allow practical, effective and cost-effective solutions to
the problem. We will have the draft regulations ready for consultation
as soon as we can, and we are committed to commencing them from October
2011. I
confirm that Welsh Ministers will consult with relevant health and
business organisations and with members of the public in Wales before
determining how detailed regulation on the sale of tobacco products
from vending machines will be taken forward under their jurisdiction.
The effect of the tobacco provisions in the Bill is to devolve powers
on tobacco displays and vending machines to the relevant national
authorities. We note that the amendment will cut across that intention,
thereby imposing a legislative imperative on the Welsh Assembly
Government. Under the principle of devolution, we believe it is
appropriate to leave it to them to decide how and when to use their
powers. I therefore hope that the hon. Member for Hemel Hempstead will
not pursue the amendment.
Mike
Penning: Reading through the other amendments, this is
almost a stand part debate. I appreciate your leniency, Mr.
Key, in allowing it to
happen. Having
listened to the Minister, I think that my probing amendment has done
its job. We have heard more from the Minister in the past five minutes
than is written anywhere on the face of the Bill about the
Government’s proposals. On the next set of amendments I shall
tease out a fraction more, but I beg to ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn.
The
Chairman: I am of the opinion that we have explored the
matter fully and it will not be necessary to have a clause stand part
debate. Clause
22 ordered to stand part of the
Bill. Clauses
23 and 24 ordered to stand part of the
Bill. Schedule
4 agreed
to.
Clause
25Pharmaceutical
needs
assessments
Mr.
Stephen O'Brien: I beg to move amendment 34, in
clause 25, page 28, line 6, after
‘area’, insert
‘including an assessment of local
needs for the services of dispensing
doctors.’.
The
Chairman: With this it will be convenient to take the
following: amendment 35, in
clause 25, page 28, line 9, at
end insert— ‘(za) placing a
duty on primary care trusts to consult patients, Local Involvement
Networks and members of the public on local needs for pharmaceutical
services.’. Amendment
33, in
clause 25, page 28, line 16, at
end insert— ‘(e) requiring
the Secretary of State to implement pilot schemes for primary care
trusts in carrying out pharmaceutical needs assessments before they are
rolled out nationally; and for those pilot schemes to be evaluated 12
months after they
commence.’.
Mr.
O'Brien: Amendment 34 would place a duty on PCTs to take
into account the services of dispensing doctors in their assessment of
local pharmaceutical needs. We have now moved on to the clause dealing
with pharmaceutical services in England and the needs assessments as
they are proposed in the Bill. Amendment 35 would ensure
that patients are consulted as part of each pharmaceutical needs
assessment. Amendment 33 proposes pilot schemes for
PNAs. Amendment
35 would ensure that each PNA includes patient consultation. The
principal purpose of the PNA should be to enhance local pharmaceutical
services for patients and ensure that the area covered by the PCT is
adequately provided for. We agree with the concept of giving
PCTs local control over the provision of pharmaceutical services, but
we want to make sure that patient choice is enhanced rather than
overruled. At present, the Bill does not make any provision for
patients to express their views in the assessment—an odd
omission, given that patients are the users of the services provided
under a PNA. Will the Minister confirm that the regulations will make
provision for patient consultation? My amendment would ensure that PCTs
include the results of such a consultation in their published PNAs, so
that patients can be assured that their views were taken into account.
If a PCT goes against the wishes of patients, the general public will
be able to see that that is the case by examining the
consultation.
Accounting
for the views of patients in PNAs is particularly relevant in rural
areas, where pharmaceutical services are less abundant. Many patients
have to travel long distances to access services, and consequently
people make extensive use of dispensing doctors, so that they can
combine their visit to the doctor and the collection of their
medicines. There is nothing in the Bill to prevent PCTs from cutting
those services. As my noble Friend Lord Howe argued in the other place,
many of the pharmacy community are concerned that the current PNAs
are “disproportionately
focused on cost-effectiveness and not enough on health
need”. That
means that these services face a real risk of being
axed. I
have already fought a real battle on the subject in my
constituency—with some success, I am glad to say. It revolved to
some extent around the definition of what is rural and what is
associated with an urban or suburban environment. Having said that, if
any sort of assessment
militates against the extension of dispensing
doctors, it would be a very real threat to the rural community.
Amendment 34 would ensure that the services of dispensing doctors are
taken into consideration in PNAs, along with the views of patients, the
majority of whom want to keep the services of dispensing
practices. 4.45
pm On
the management of dispensing practices, I am sure that the Minister
will come back to me with the same assurance that his colleague the
Minister of State, Department of Health, the hon. Member for Corby
(Phil Hope), gave in December 2008: that the Government do not intend
to make any changes to the current arrangements for the dispensing of
medicines to patients by GPs. However, I am slightly less inclined to
trust the good will of the Government, given that they made that pledge
last year before the publication of the Bill but they have clearly left
a gaping hole in the legislation on that matter.
It is of more
concern that the Government appear to be ignoring the wishes of NHS
patients. Some 62,675 patients registered with a dispensing practice
responded directly to the pharmacy White Paper consultation to express
their support for no change to GP dispensing. However, the Bill makes
no provision for PCTs to consider the services offered by dispensing
doctors in their needs assessment. What firm and evidence-based
assurance can the Minister give that patients who are registered with
dispensing practices will not see those services axed by their
PCTs?
It is fair to
say that many of the satellite surgeries of doctors’ practices
are, particularly in rural areas, cross-funded because they have a
dispensing practice. Far from doctors seeking to increase the drawings
from their own practice, it is cross-subsidy that enables them to have
a satellite service to reach out into the more remote rural areas. The
dispensing practice enables
that. Amendment
33 proposes pilot schemes, which would enable the PCT and the
Government to investigate whether the local assessment of
pharmaceutical needs results in adequate provision of services. It
would also give PCTs a chance to experiment with the format and content
of the PNA to ensure that any complications are addressed and that the
assessment is wide ranging enough to be taken into account when a
provider applies to the pharmaceutical
list. The
Government’s own White Paper on pharmacy concedes
that “there
is considerable variation in the scope, depth and breadth of
PNAs”.
It also
states: “The
structure of and data requirements for PCT PNAs require further review
and strengthening to ensure they are an effective and robust
commissioning tool which supports PCT
decisions.” Although
I realise that the Government see the Bill as the occasion for review
and strengthening, a pilot programme would be the opportune moment to
examine and trial the content of PNAs in a practical setting. PCTs
would also be able to adapt to producing more rigorous PNAs. Examples
of best practice could be disseminated before the scheme is rolled out
across the country.
Anne
Galbraith’s 2008 review of NHS pharmaceutical contractual
arrangements, which was published alongside the White Paper, made the
point
that “Pharmaceutical
Needs Assessments...should have a consistent structure across all
PCTs and have national comparability in breadth and
depth.” One
potentially negative consequence of localisation is that there will no
longer be a framework for ensuring that PCTs maintain that
comparability across the country. Of course, the regulations will seek
to qualify the information contained in the PNA and the manner in which
it is conducted. However, we have not had sight of those regulations,
so we do not know the extent to which they guide PCTs on the form and
content of a PNA. If the Government were to run a pilot scheme and
report back to Parliament with the results in 12
months’ time, they would have a solid evidence base
from which to move forward. In addition, PCTs would have
increased knowledge of how best to utilise the PNA to gain the best
possible access to pharmaceutical services for their
patients.
Dr.
Pugh: I have to apologise for the fact that my hon. Friend
the Member for Romsey is not here, because she is the expert on this
subject and would have a great deal more to say than I have. I have no
problem with the general tenor of what the Government are endeavouring
to do. Public authorities have always had to strike a balance so that
naked commercial interests do not dominate the pharmaceutical world.
The needs of the community are paramount, and there has always been a
need to structure the market publicly in some way. Anybody who has been
an elected councillor or any sort of elected representative will have
been lobbied at some point by a pharmacy or a dispensing physician
about their position, their share of the market and the placing of
other facilities close to
them. I
agree with the hon. Member for Eddisbury that whatever is done needs to
be properly and thoroughly evidence-based, and if it is not
evidence-based everywhere, it will not be well done. It cannot be
lobby-based, because there are plenty of powerful interests in the
pharmaceutical world and many prosperous commercial practices that will
weigh in heavily to get their way if left to their own devices. I
therefore warm to the amendments because they would preserve the rights
of dispensing practices, particularly in rural areas, and they make
clear that the market must serve patients rather than simply appear by
accident and as a result of commercial
happenstance.
Mr.
Mike O'Brien: I, too, represent a rural area where
dispensing doctor’s practices exist and operate, and I very much
understand the concerns of some GP practices that, in order to maintain
satellite practices, they sometimes have to have funding from a
dispensary. Indeed, a dispensary provides a facility for local people
in such communities. At the same time, there is always a concern where
doctors both prescribe and dispense, and it is right to exercise
caution when dealing with that. Dispensing clearly offers an income, so
we need to be careful that we deal with the issue appropriately. I
believe that, in most cases, doctors act with a professional integrity
on which we can broadly rely. However, we need to be continually aware
that individuals may not always act with such integrity; the
appropriate disciplinary procedures for doctors will deal with
that.
On
Second Reading, the hon. Member for Eddisbury
said: “The
move to pharmaceutical needs assessments is
welcome.”—[Official Report, 8 June 2009; Vol. 493,
c. 612.] I am
glad that he said that. I make it clear that, as we announced before
Christmas, we will not change the current system for determining
whether doctors can dispense to their patients. On primary care trusts
in rural areas where most dispensing by doctors takes place, it is
important that such services are considered within their overall
assessments of
needs. It
has been asked whether services by dispensing doctors could be at risk
from bad PCT decisions on new applications. The current regulations
already contain provisions to take into account any prejudice to
existing service providers in rural areas from new applicants, and I
stress that that safeguard will continue in the new regulatory
system. The
clause requires PCTs to undertake and publish their assessments of
pharmaceutical needs in accordance with regulations. The Department
will work closely with interested parties, including NHS and contractor
representatives, as well as doctors, on drafting the requirements. I
announced last Thursday the formation of an advisory group for that
very purpose. However, not all PCTs need to resort to the services of
dispensing doctors. It is important that such services are available
for the patients who use them in rural areas, but they have little
relevance, if any, in non-rural PCTs across the country. We need to get
the issue right, and I hope that my reassurances have been satisfactory
and that the amendment will be
withdrawn.
| 
