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Baroness Masham of Ilton moved Amendment No. 36:


Page 19, line 3, at end insert--
("( ) In giving any directions under this section the Secretary of State shall ensure that there is no diminution in the range of additional pharmaceutical services in an area.").

The noble Baroness said: In moving this amendment and speaking to Amendment No. 40, I seek to improve the present situation for patients. The Government have for some time been encouraging a primary healthcare-led NHS, as all noble Lords will know. Patients are now staying in hospital usually for far shorter periods of time than they did a few years ago and many more are being treated for serious conditions in the community.

It has been brought to my attention by the Tissue Viability Society, with which I have been associated in a voluntary capacity since its inception, that there is a problem, which these amendments seek to rectify.

In recent years there has been an explosion in the range of dressings available to manage wounds. There has also been much research activity to determine the efficacy of many of these products. Many of the modern products have been demonstrated to be considerably more effective than the traditional dressings such as gauze.

One area where there has been a great improvement is in the management of cavity wounds. Cavity wounds are deep wounds which may be caused by drainage of an abscess or a surgical operation or be chronic wounds such as pressure sores. They take time to heal and can cause much discomfort to the sufferer. Several products have been developed specifically for this type of wound.

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They are easier to apply and much less painful to remove than ribbon gauze, the traditional type of dressing, as well as being more effective.

As patients are discharged earlier from hospital, more and more patients with cavity wounds are being cared for by district nurses. Unfortunately, their task is made more difficult by the fact that there are no modern dressings for cavity wounds available on general practitioner prescriptions.

At a recent meeting between the Surgical Dressings Manufacturers' Association and the drug tariff team from the Department of Health, it was announced that there was no need for cavity wound dressings to be added to the drug tariff as district nurses are already obtaining them.

Anecdotal evidence supports the view that many district nurses do manage to obtain cavity wound dressings. However, that is said to be through "doing swaps" with their local pharmacists. That is, a prescription is obtained for a product listed on the drug tariff and that is exchanged for a different dressing of equal price value. Although it is purely for the good of the patient, it is an illegal practice. The Department of Health could be seen to be encouraging such actions. At present there is insufficient evidence to determine the extent of the practice; however, it was found that about one-fifth of dressings used in cavity wounds were obtained by illegal means. There are also problems in obtaining a selection of bandages for the treatment of leg ulcers in the community.

I am sure that the Minister and the Committee will agree with me that the most cost-effective procedure is getting the patient back to full health as quickly as possible. The greatest expense is in nurses' time treating patients whose wounds or ulcers will not heal. Different patients respond to different medication and dressings. There needs to be a choice and the drug tariff needs to be kept up to date as better and more effective products come on the market.

I hope that the Committee will support this amendment, and the one for Scotland, which ensures that the Secretary of State sees that there is no difference in the range of pharmaceutical products to treat patients wherever they may be, either in hospital or in the community. I beg to move.

Lord Rea: The Minister will have heard the plea of the noble Baroness, Lady Masham. I hope that she will be able to say that not only will there be no diminution in the range of additional pharmaceutical services but that there will in fact be an augmentation along the lines suggested. I shall be interested to hear the Minister's response.

Baroness McFarlane of Llandaff: I support the noble Baroness, Lady Masham. It has been my experience in the past that district nurses have been unable to obtain the specific kinds of dressings in the community that have been used in hospital for the patient. When a patient is discharged he or she sometimes has a temporary supply from the hospital;

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then in the interest of cost that source dries up and they are unable to obtain suitable dressings in the community. I support the amendment.

Baroness Gardner of Parkes: I was very interested to hear the comments of the noble Baroness, Lady Masham. However, I was slightly puzzled. I could not quite see how the amendment reflected what she said. That slightly confused me. For example, it refers to no diminution in "additional" pharmaceutical services. That seemed difficult to follow. I wondered whether the noble Baroness meant pharmaceutical suppliers rather than services. I was a little lost. I completely agree with her about the need for special dressings and so on. However, I was not sure whether this amendment quite said what she intended. I shall be interested to hear the Minister's reply.

Baroness Miller of Hendon: The Government favour a wider role for pharmacists. We have, for example, introduced a scheme whereby pharmacists provide advice on the safe keeping and correct administration of medicines to residential homes and to nursing homes. Community pharmacists are also among those who take part in syringe and needle exchange schemes for drug misusers.

We also support local management of services. Health authorities are best placed to fit services to the needs of their population. Some services provided by pharmacists will be required throughout all geographical areas of all health authorities. Others may be a priority in some areas only. Syringe and needle exchange is a good example of this type of service--it is only in some places that there is a need for it.

Therefore, while we support an increase in the choice of services which can be purchased from pharmacists, we believe that health authorities should, wherever possible, be left to decide which services are needed in their area. They should not be obliged to spend public money on a service which is not a priority for their patients. The proposed amendment would hinder health authorities from tailoring services to local needs, and therefore the Government cannot support it.

I understand the noble Baroness's serious concerns about the availability of dressings on GP prescription. I can reassure her that the list of dressings available through this route can be extended without new legislation. I understand that community trusts already provide dressings through the district nurses whom they employ and that there is no legislative reason for the amendment. It would not help in any way to add the amendment to the Bill. I hope that the Committee will reject it.

Baroness Masham of Ilton: I thank all Members of the Committee who have spoken. I wish first to say to the noble Baroness, Lady Gardner, that I am in the hands of the excellent Clerks to the House of Lords. Perhaps they will consider what she said and correct the wording so that I may bring it back at the next stage.

I wish to say to the Minister that I am told that the drug tariff list needs to be changed because district nurses are obtaining some of these products and dressings through the back way, illegally. I hope that the

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Minister will take the matter back and discuss it with her department. I can put her in touch with the Tissue Viability Association and we shall see what happens at the next stage. Therefore, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

7.15 p.m.

[Amendments Nos. 37 to 41 not moved.]

Clause 23 agreed to.

Clause 24 [Terms and conditions etc.]:

Baroness Jay of Paddington moved Amendment No. 42:


Page 20, line 9, at end insert--
("( ) In deciding on any standards relating to quality of service to be included in the terms or conditions specified in any direction, the Secretary of State shall, in relation to any additional pharmaceutical service included in the direction, have regard to any standards for that service promulgated by the professional body representing pharmacists.").

The noble Baroness said: I apologise for my loss of voice. Amendment No. 42 deals again with the issue of trying to establish consistent national and local standards of quality for pilot schemes, this time in the pharmaceutical area.

We have debated the whole issue in relation to several amendments this afternoon in general terms and we return now to the issue of pharmacists and pharmaceutical standards. The Royal Pharmaceutical Society, which promulgates and maintains national standards for the profession at a personal and professional level, is concerned that there should be national minimum standards for any additional pharmaceutical service which is provided under one of the pilot schemes.

As the registering body for pharmacists, the society already publishes standards for many aspects of professional practice with which all registered pharmacists are required to comply. But there is concern that the Bill as drafted at present would appear to permit a health authority to contract for a specific additional pharmaceutical service with different contractors and to have different standards for the services provided by those individual contractors.

The Royal Pharmaceutical Society has pointed out that already in existing legislation there is a recognition of the standards which it promulgates and which are the guiding force in the professional bodies. They would like to see an amendment such as the one now before the Committee which would provide similar criteria for the additional pharmaceutical services which could be provided under the pilot schemes.

The NHS pharmaceutical services regulations for 1992 require a pharmacist whose name is on the pharmaceutical list to provide pharmaceutical services and exercise any professional judgment in connection with the provision of such services in conformity with the standards generally accepted in the pharmaceutical profession.

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This amendment, if it were adopted, would simply extend that understanding about the standards that are generally accepted to the pharmacy services which could be provided under pilot schemes. Indeed, it does not require any new development of criteria, as we discussed earlier in the afternoon, but simply the extension of existing criteria to the new pilot schemes. I beg to move.


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