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Health Bill [H.L.]

8.20 p.m.

Consideration of amendments on Report resumed.

Clause 42 [Expenditure of Health Boards and other bodies]:

Lord Macdonald of Tradeston moved Amendment No. 77A:

Page 32, line 21, at end insert ("or
(e) remuneration which is referable to the cost of drugs for which the Health Board is accountable in that year (whether paid by it or by another Health Board)").

The noble Lord said: My Lords, in speaking to Amendment No. 77A I shall also speak to Amendments Nos. 77B, 77C and 77D. These amendments are the Scottish equivalent to government Amendments Nos. 13, 15 and 17 debated and approved by the House last Monday.

In brief, the amendments refine the definition of the prescribing costs that will be included in a health board's unified budget, the provisions for which are made by Clause 42 of this Bill.

Your Lordships have already considered the principles behind the amendments at some length. I shall refrain from going over that ground in detail again today. However, to recap, the provisions introduced by the amendments need to be considered against the introduction of funding health boards through the concept of unified budgets.

The White Paper, Designed to Care, announced the introduction of unified budgets to provide a single financial envelope to cover the commissioning of hospital and community health services, primary care prescribing and investment in general practice infrastructure.

At present the funding streams for such items are, with limited exceptions, allocated and managed separately from each other. Clause 42 introduces provisions for Scotland that unify the hospital and community health service funding stream with that of general practice infrastructure. The amendments before you now bring primary care prescribing into the financial envelope and, in so doing, will give health

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boards and, in turn, Scottish primary care trusts, greater flexibility in deciding the most appropriate balance between the three areas of expenditure.

As explained when the equivalent English amendments were introduced earlier this week, while the effect of the amendments is to bring all prescribing expenditure within a unified cash limit, they do not put a cash limit around prescribing expenditure itself. Health boards, and through them Scottish primary care trusts, will be able to transfer funds into and out of their prescribing cost provision to reflect the relative priorities and the financial needs of the local area.

On Monday, the noble Baroness, Lady Carnegy, asked if primary care infrastructure resources in Scotland would be protected within the unified budget. I have written to her, but to put the matter on the record I can reassure your Lordships that those resources will be protected in Scotland as they will be south of the Border.

The amendments themselves are essentially technical. Their primary effect is to make health boards responsible for the cost of drugs prescribed by the GPs in their areas and not, as at present, for the cost of drugs dispensed in their areas. However, they also provide for the Secretary of State to make appropriate funding flow arrangements between health board areas to ensure that dispensing practitioners continue to receive their remuneration in exactly the same way as at present.

The amendments complete the provision for introducing unified budgets in Scotland. That will give health boards and, in turn, primary care trusts in Scotland increased financial flexibility to secure more cost-effective care and greater value from the total resources available. I therefore commend these amendments to the House. I beg to move.

Baroness Carnegy of Lour: My Lords, I thank the Minister for the extremely clear letter that he wrote to me. He wrote very promptly and explained everything very well.

I have shown the letter to the British Medical Association--he may also have done that--and it was concerned about the matter. The matter has been considered by bodies in Scotland, and they too are reassured, although there are two questions which I believe the noble Lord will find easy to answer.

First, they want assurance of the ability of local health co-operatives to go back to the primary care trust if they run out of money for prescribing. The arrangements that the noble Lord has just described will mean that individual doctors in Scotland will be able to prescribe all the necessary medication to fulfil the clinical needs of their patients. It would be helpful if the noble Lord could reassure them on that.

Secondly, when the unified budget comes into being, will savings from the prescribing budget remain for use with the primary care trust, or will they revert to the health board for use, for example, in acute hospitals? Perhaps it may not be possible to answer that immediately. I was not able to give the noble Lord notice of that question. I repeat: will any money saved

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on prescribing revert to the health board, or will it be used in acute hospitals; or can it be retained within primary care?

Lord Macdonald of Tradeston: My Lords, I can assure the noble Baroness, Lady Carnegy, that if the local healthcare co-operatives run out of money they will be able to turn to the primary care trust and ensure that their needs are properly met.

On the second question, I am advised that any savings will remain within the primary care trust resources.

On Question, amendment agreed to.

Lord Macdonald of Tradeston moved Amendments Nos. 77B, 77C and 77D:

Page 32, line 22, leave out ("paragraph (b), (c) or (d)") and insert ("paragraphs (b) to (e)").
Page 33, line 4, at end insert--
("(11) In this section and section 85AB, "drugs" includes medicines and listed appliances (within the meaning of section 27).").
Page 33, line 4, at end insert--
("Further provision as to expenditure on drugs.
85AB.--(1) For each financial year, the Secretary of State shall apportion, in such manner as he thinks appropriate, among all Health Boards the total of the remuneration referable to the cost of drugs which is paid by each Health Board in that year.
(2) A Health Board is accountable in any year for remuneration referable to the cost of drugs to the extent (and only to the extent) that such remuneration is apportioned to it under subsection (1).
(3) Where in any financial year any remuneration referable to the cost of drugs for which a Health Board is accountable is paid by another Health Board, the remuneration is to be treated (for the purposes of this section) as having been paid by the first Health Board in the performance of its functions.
(4) The Secretary of State may, in particular, exercise his discretion under subsection (1)--
(a) so that any apportionment reflects, in the case of each Health Board, the financial consequences of orders for the provision of drugs, being orders which in his opinion are attributable to the Board in question;
(b) by reference to averaged or estimated amounts.
(5) The Secretary of State may make provision for any remuneration referable to the cost of drugs which is paid by a Health Board other than the Health Board which is accountable for the payment to be reimbursed in such manner as he may determine.
(6) The Secretary of State shall determine what remuneration paid by Health Boards to persons providing pharmaceutical services is to be treated for the purposes of section 85AA and this section as remuneration referable to the cost of drugs.").

On Question, amendments agreed to.

8.30 p.m.

Lord Macdonald of Tradeston moved Amendment No. 78:

After Clause 45, insert the following new clause--

("Indemnity cover
Indemnity cover for Part II services

.--(1) After section 28B of the 1978 Act there is inserted--
"Indemnity cover.
28C.--(1) Regulations may make provision for the purpose of securing that, in prescribed circumstances, prescribed Part II practitioners hold approved indemnity cover.

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(2) The regulations may, in particular, make provision as to the consequences of a failure to hold approved indemnity cover, including provision--
(a) for securing that a person is not be added to any list unless he holds approved indemnity cover;
(b) for the removal from a list prepared by a Health Board of a Part II practitioner who does not within a prescribed period after the making of a request by the Health Board in the prescribed manner satisfy the Health Board that he holds approved indemnity cover.
(3) For the purposes of this section--
"approved body" means a person or persons approved in relation to indemnity cover of any description, after such consultation as may be prescribed, by the Secretary of State or by such other person as may be prescribed;
"approved indemnity cover" means indemnity cover made--
(a) on prescribed terms; and
(b) with an approved body;
"indemnity cover", in relation to a Part II practitioner (or person who proposes to provide Part II services), means a contract of insurance or other arrangement made for the purpose of indemnifying him and any person prescribed in relation to him to any prescribed extent against any liability which--
(a) arises out of the provision of Part II services in accordance with arrangements made by him with a Health Board under this Part of this Act; and
(b) is incurred by him or any such person in respect of the death or personal injury of a person;
"list" has the same meaning as in section 29;
"Part II practitioner" means a person whose name is on a list;
"Part II services" means general medical services, general dental services, general ophthalmic services or pharmaceutical services;
"personal injury" means any disease or impairment of a person's physical or mental condition and includes the prolongation of any disease or such impairment;
and a person holds approved indemnity cover if he has entered into a contract or arrangement which constitutes approved indemnity cover.
(4) The regulations may provide that a person of any description who has entered into a contract or arrangement which is--
(a) in a form identified in accordance with the regulations in relation to persons of that description; and
(b) made with a person or persons so identified,
is to be treated as holding approved indemnity cover for the purposes of the regulations."
(2) In section 19A of the 1978 Act (medical lists), at the beginning of subsection (3) there is inserted "Subject to any provision made under section 28C,".

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(3) In section 25 of that Act (arrangements for provision of general dental services), in subsection (2)(b), the word "and" before sub-paragraph (iii) is omitted and after that sub-paragraph there is inserted "; and
(iv) any provision made under section 28C".
(4) In section 26 of that Act (arrangements for provision of general ophthalmic services), in subsection (2)(b), after "practitioners" there is inserted "and any provision made under section 28C".").

The noble Lord said: My Lords, this amendment stands in the names of myself and my noble friend Lady Hayman. It applies to Scotland and is the same in all essential respects as Amendment No. 19, which was moved by my noble friend Lord Hunt and debated thoroughly on Monday evening. With your Lordships' leave I shall, therefore, be brief.

The Government's intention is to ensure that GPs, dentists, pharmacists and optometrists practising in family health services in Scotland are able to meet any damages that might be awarded against them in cases of death or personal injury caused to their patients. This includes cover for other persons prescribed in relation to the practitioner such as employees, assistants or deputies. These practitioners employed in NHS trusts are automatically covered by NHS indemnity.

As in other parts of the UK, the vast majority of practitioners in Scotland already act responsibly by arranging suitable indemnity cover for their work. By ensuring that every relevant professional is covered in future, this amendment seeks to address the small minority of practitioners in Scotland who are not so responsible. The scheme would work in the way described by my noble friend on Monday, and I do not propose to repeat what has already been covered.

This amendment will enable patients to be protected and properly compensated on those rare occasions when something goes wrong. Where a patient is deserving of compensation, we believe that he or she should be able to receive it.

Perhaps I may now reply to a question of which the noble Baroness, Lady Carnegy, has been kind enough to give me notice. She wanted to know why "indemnity" is referred to rather than "membership of a medical defence organisation". The intention behind this provision is to ensure that all practitioners are indemnified so that a patient can be sure of getting proper compensation, when that is warranted. As my noble friend explained on Monday, that indemnity might be obtained from a range of sources. It would not be appropriate in this Bill to limit how such indemnity should be obtained. This is especially so as the clause covers those providing ophthalmic and pharmaceutical services as well as doctors and dentists. The principle underlying the amendment has been warmly welcomed by your Lordships' House. I beg to move.

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