Gillian
Merron: Yes. I am sorry that I was not quick enough off
the mark, Mr. Key. I am sorry to disappoint the hon.
Gentleman, but I shall reiterate some of my points. We can only go on
what the new clause before us says; it would be difficult to enforce
and would not do the job required. I can confirm that I will examine
the full range of effective measures that we can take in the tobacco
control strategy. I feel that we will get a better job done when we
have
that.
Mike
Penning: This is the second time that the Minister has
said that it would be difficult to enforce measures against the proxy
purchase of tobacco, but the alcohol legislation on the statute book
specifically has such measures. Why would it be more difficult to
enforce measures against the proxy purchase of tobacco than to enforce
the existing legislation on
alcohol?
Gillian
Merron: I had thought that we had talked about the
difference, but I shall have to go through it again. New clause 1,
which is before us and is all that the Committee can deal with, is
rather different from the provisions on alcohol. There has been
reference to alcohol and tobacco being different. There are some
limited legal circumstances in which alcohol can be drunk by under-18s,
as we know if we look at the detail of the legislation, whereas tobacco
should always be out of
reach. I
very much welcome the zeal with which the hon. Gentleman puts his case,
because—as I have heard in
the Chamber as well as in Committee—not all right hon. and hon.
Members on the Opposition Benches share his zeal. On tobacco display,
on one of the points on which I had hoped—hope—for
greater support, our proposals are there because we want to protect
children from the addiction of smoking, which damages their health so
badly. Mike
Penning: Will the Minister give
way?
Gillian
Merron: New clause
1—
Mike
Penning: Does that mean
no?
Gillian
Merron: I am asking the hon. Gentleman to be a little
patient. New
clause 1 as drafted does not do the job. I have given an assurance that
we are very keen to tackle this issue, but doing it by creating an
offence of proxy purchase, which does not exist in any other country
and so we have little to draw on, would mean having to prove the
intention to sell it on to a child. That would be the only way to count
it as a proxy purchase offence.
Mike
Penning: I will not be long, but yes, I do speak on this
subject with zeal. If the Minister looks at Hansard and at the
time I spent on the Select Committee with her hon. Friends, she will
find that I was much more zealous there, particularly with the
Secretary of State when she tried to bring forward a piece of
legislation that was fundamentally flawed. But the key to being an
Opposition Member is that we have a free vote—a conscience vote.
Why is there not a free vote on the Government’s Benches? If the
hon. Lady wants to talk about zeal, she should let her Back Benchers
have a
vote.
Gillian
Merron: Mr. Key, I am sure you know that these
matters are subject to the usual channels. I am glad to hear that the
hon. Gentleman will be withdrawing or not pressing new clause 1, and I
hope we can make progress.
Sandra
Gidley: What I am struggling to understand is that the
Minister sounds sympathetic, the Bill has been some time in preparation
and the issues have been raised numerous times in debate on the Floor
of the House, possibly in an Opposition day debate initiated by the
Conservative party, yet we do not have any attempt by the Government to
address a very real problem. Why is that? Why so
slow?
Gillian
Merron: To reiterate once again, I believe that it is
right to draw together all the concerns and we will address them,
whether it is through legislation, information, guidance or a
connection in the tobacco control strategy. I should have thought that
hon. Members would be glad that we will be responding to a very full
consultation, which has included retailers, those who do and do not
smoke, and those who have to deal with the scourge of smoking. I do not
want legislation that does not do the job. I want, as we all do,
legislation that will do the job. If the hon. Lady feels that the
approach taken in the
new clause is the right way, doubtless she will pursue the matter. I am
disappointed that it appears we will not be testing it in
Committee.
Sandra
Gidley: The Minister almost seems to be making a good
argument to defer the whole Bill until we have the tobacco strategy. I
cannot see why the Government have cherry-picked some of the things
that they like and that they think are a quick fix, and yet again
thrown into the long grass measures that would make a real
difference.
Gillian
Merron: The new clause would not make the real difference
that we all seek. As I have said, we will address the matter in full on
all levels later in the year through the tobacco control strategy, and
it will be informed by the consultation’s 100,000 responses. It
appears that new clause 1 will not be promoted and I welcome
that, but I hope that the spirit in which I welcome that is
understood.
The
Chairman: Because I had put the question that the clause
be withdrawn, and the Minister by speaking indicated that she did not
wish to see it withdrawn, the Committee must now come to a
decision. Question,
That the clause be read a Second time, put and
negatived.
New Clause
6Cross
border pharmaceutical
services ‘After paragraph 13
of schedule 1 of the National Health Service (Wales) Act 2006 (c. 42)
add— (14) The Welsh
Ministers must ensure that residents of England registered with Welsh
general practices receive the same access to pharmaceutical services as
residents of England registered with English general
practices. (15) The Secretary
of State may issue guidance on the representation of English residents
registered with Welsh general practices by Members of Parliament to
Welsh Ministers.”’.—(Mr. Stephen
O'Brien.) Brought
up, and read the First time.
Mr.
Stephen O'Brien: I beg to move, That the clause be
read a Second time.
Mr.
Andrew Turner (Isle of Wight) (Con): On a point of order,
Mr. Key, could you indicate whether there has just been a
Division?
The
Chairman: No. There was no Division, because there was no
one on your side saying what they wanted to
do.
Mr.
Stephen O'Brien: Which of course, in parenthesis, was
because had we forced the Division, that would have precluded—in
the way these things are handled—being able to bring this back
on Report, so quite rightly we had to do
that.
2.30
pm
Mr.
Mike O'Brien: On a point of order, Mr. Key. May
I clarify the position? The new clause was negatived in the sense that
the Committee disagreed with it. That was a vote, therefore, even
though there was not a Division. A decision was made in relation to it,
but not a Division.
The
Chairman: It was a decision, not a
vote. Mr.
Stephen O'Brien: I am grateful for your clarification,
Mr. Key. As far as we are concerned, it has left us with the
option of being able to make sure that that is brought back on Report.
It would have been closed out had we forced a Division—so no one
should read into the fact that we were not pressing it to a vote the
absence of our continuing earnest underlying new clause
1. New
clause 6 concerns an issue that our discussions about pharmaceutical
needs assessments have not yet raised, and that is the provision of
pharmaceutical services for patients living in cross-border
territories. We touched on the subject in relation to other matters in
the Bill. My constituency is widely affected by it; a significant
number of my constituents in various villages such as Farndon,
Shocklach, and Higher Wych, make use of Welsh NHS services. The Welsh
Affairs Committee estimates that there are more English patients
registered with Welsh GPs than vice versa—about 20,000 English
patients with a Welsh GP and about 15,000 Welsh patients with an
English one. In 2007, there was a net flow of 5,354 patients into Welsh
primary care services from England.
The
localisation of entry into the pharmaceutical list, through the
pharmaceutical needs assessment, could impact negatively on those
patients. If Wales grants applications to provide services on the basis
of its Welsh population, and an English PCT does the same for its area,
English patients registered with Welsh GP practices could find there is
inadequate provision of pharmaceutical services in their area. My
amendment seeks to ensure that Welsh Ministers take that into
consideration when monitoring the PNA process, so that pharmaceutical
services in cross-border territories do not suffer, and patients in
those areas get a fair deal. The new clause is to probe the Minister
about what provision the Government have made to ensure that residents
of such areas have access to the same calibre of pharmaceutical
services as elsewhere in
England.
Mr.
Mike O'Brien: The provision of general medical services
and pharmaceutical services is governed by powers within the National
Health Service (Wales) Act 2006. Such powers are within the devolved
competence of Welsh Ministers, and if the new clause were accepted, it
would derogate from the devolved competence of Welsh Ministers in
respect of their functions in relation to health.
Additionally,
the measures do not accord with—and, in fact, run contrary
to—the principles underpinning the protocol for the cross-border
commissioning, which was agreed between the Welsh Assembly Government
and the Department of Health on 1 April and which will continue until
the 31 March 2011. That protocol sets out agreed procedures for
commissioning NHS
health care for residents in England who are registered with a GP in
Wales, and for residents in Wales who are registered with a GP in
England. While
the PCT retains the legal responsibility for its resident population
registered with a GP in Wales, local health boards commission such
services on the basis of clinical need, and as a minimum, the Welsh
Assembly Government’s standards for access to health care,
irrespective of the location of the provider. That means Welsh GPs are
required to work to the standards and targets set out by the Welsh
Assembly Government for all the patients that they see and treat,
irrespective of the patient’s place of residence. For those
reasons, Welsh Ministers have confirmed that the new clause would not
be accepted, so I hope that it will not be
pressed. We
have set up, with great care, a relationship with the devolved
Administration in Wales. That has been carefully negotiated and the
arrangements have been agreed up until 2011. This clause would change
everything, without full consultation and with no discussion.
I appreciate
that it is important to deal with these issues appropriately, but I
assure the hon. Member for Eddisbury that if an MP, on behalf of their
constituent, raises an issue with a Minister about the provision of
health care by a Welsh GP to an English patient, the Minister will be
able to pass it to the Welsh Health Minister, and the Welsh Assembly
Government would then respond to the letter in the same way as that
from an MP. There are ways in which these matters can be dealt with but
trying, in effect, to write a new derogation from the relationship with
Wales is really not the way forward.
Mr.
Stephen O'Brien: As I said, this is a probing new clause,
so I will not press it. What is important, given that last element of
the Minister’s response, is that I am glad to note that the
Department of Health would, for instance, pass on a complaint that I
might write to him on behalf of my constituent who has a problem with a
GP in Wales with whom they are registered, to the holder of the
equivalent ministerial position in Wales.
I am grateful
for that assurance, because outside the Department of
Health—which I have had no cause to write to on behalf of a
constituent—my experience to date in about 70 cases that I have
taken up over the past decade has been, at all times, for my letter to
be passed to the Welsh Assembly’s equivalent Minister, then, if
I receive a response at all, to hear that I have no rights as an MP and
that they therefore respond to me as to any other citizen in the
country. The quality of response has been extremely poor compared with
the assurance that the Minister just gave, so I am grateful for that,
not least as I rather hope that the rest of Whitehall will note what he
has just said and that for once, after a decade of trying, I might get
somebody in the Welsh Assembly to listen to the enormous issues that
spread right across the Welsh border with Cheshire along the River Dee.
That has been helpful from a more general point of view, and I hope
that the Minister realises the enormous consequences of the commitment
that he has just given, which I will now be able to pray in aid across
the whole of Government.
That said, I
note the care with which he thinks that the protocol has been
negotiated and the number of years that it is meant to last, but it
does not work in all
respects. There are significant shortcomings in the way that the
protocol operates, and there have been some real problems, not so much
in primary care services, but certainly in emergency services,
resulting in a number of patients coming across the border from Wales
to access the shorter waiting times at the Countess of Chester
hospital. Meanwhile, we have had a number of English patients wanting
to access the free prescriptions in Wales. The protocol is fairly
frayed, at times, and causes an enormous amount of casework for local
MPs. Sandra
Gidley: The hon. Gentleman mentioned the free
prescriptions in Wales. How much of a factor is that in the disparity?
Are people actively choosing to go over the border and register with a
Welsh GP because of the free prescription charges or are other factors
at work that a good pharmaceutical needs assessment could, potentially,
address?
Mr.
O'Brien: That is an interesting question. I shall be
careful not to stray too far, but it covers cross-border pharmaceutical
services in so far as the needs assessment is taking place within a
village where it is literally 200 ft down to the old Roman bridge to
cross the River Dee from Farndon to Holt in Wales, where they also have
a pharmacy. Those needs assessments have, for these purposes, been
taking place in completely separate countries yet, in truth, the
proximity of those two pharmacies compared with many facilities across
many other, more rural parts of my constituency has shown that there is
a difficulty at these points in how territories are defined.
Most
importantly, at the moment it is too early to tell; there is not enough
evidence, and it is anecdotal about people with long-term conditions
and who do not get free prescriptions in England. However, particularly
if they are of working age, there is some evidence of attempts to
register with Welsh GPs in order to access free prescriptions. On that
basis, I am happy to withdraw the new clause, but we have had a rather
useful discussion. I beg to ask leave to withdraw the clause.
Clause,
by leave, withdrawn.
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