House of Lords
Tuesday, 4th May 1999.
The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.
Prayers--Read by the Lord Bishop of Exeter.
Medicines: Prescription and Supply
Lord Clement-Jones asked Her Majesty's Government:
- What action they propose to take in the light of the review on prescribing, supply and administration of medicines by Dr. June Crown.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): My Lords, the final report of the review on prescribing, supply and administration of medicines was issued for consultation and comment on 8th March. Comments have been requested by 7th June and we will be considering what action to take on the recommendations of Dr. Crown and her colleagues in the light of all the comments received.
Lord Clement-Jones: My Lords, I thank the Minister for that reply. At this stage will the Government give a commitment to establish the prescribers advisory committee which was recommended by Dr. Crown to extend prescribing rights? Will the Minister also give a commitment to publish the strategy on community pharmacies which has been delayed since last autumn when the Secretary of State promised it--it is now long overdue--which would enable the pharmacy profession to have a much clearer view of its own future in the context of the Crown report?
Baroness Hayman: My Lords, as the noble Lord knows, the establishment of a prescribers advisory committee is one of the main recommendations of the report. The report suggests that professional groups should be allowed to submit applications to that committee. I am sure that we shall receive comments on that proposal during the consultation process. It would be wrong of me to prejudge that consultation, although obviously we are looking at ways in which we can provide better health outcomes, greater convenience for patients and better team working among health professionals, as the Crown recommendations also seek to bring about. The community pharmacy strategy is taking a little longer than we expected. Many good ideas have been suggested and there are some complex issues to consider. Our commitment to providing high quality primary care, including pharmacy care, near to people's homes is clear. We shall publish that document as soon as we can.
Baroness Gardner of Parkes: My Lords, will this process address the problem of prescribing as between hospitals and other bodies? As I am sure the Minister is
aware, it used to be the case that a person leaving hospital received two weeks' prescription. That was then reduced to one week's prescription as it comes out of a hospital's budget. It is often not easy for a patient to get to his or her GP within a week to obtain a supply of whatever he or she needs on prescription. Will that problem be addressed by this report?
Baroness Hayman: My Lords, I do not think that it will be addressed specifically by this report because the report concerns extending authority to prescribe medicines to groups of professional people with specific training and experience other than doctors. Therefore it will not alter the situation as regards general practitioners. I appreciate the problems which the noble Baroness has mentioned. Perhaps as a result of the establishment of new primary care groups and their relationships vis-a-vis secondary care some sensible protocols will emerge between the two groups.
Earl Howe: My Lords, what prescribing protocols will be put in place for the new walk-in primary care centres, particularly if those centres are manned by nurses?
Baroness Hayman: My Lords, we are currently involved in nurse prescribing, as recommended by the first Crown report. There was some take-up in the first year--that was last year--and the majority of health authorities will begin participating in the scheme in earnest from April this year. Some 1,200 nurses had received the required training in prescribing by the end of March 1999. We expect the remaining 20,000 to receive training by the end of next year and the balance by 2001. If those nurses--they must be district nurses or health visitors--with special training are involved in the walk-in centres, they will be governed by those arrangements.
Lord Glentoran: My Lords, does the noble Baroness foresee that the role of the pharmacist in the pharmacy will significantly change as a result of this measure?
Baroness Hayman: My Lords, certainly pharmacists comprised one of the groups that the Crown report examined. There is potential for extending the role of pharmacists beyond their current role and beyond their role of giving advice to patients. This could potentially save time for busy general practitioners and provide more convenient services for patients. We need to do this in a safe and cost-effective manner. That is why we have undertaken consultation on the matter. However, there is great potential in this area.
Viscount Addison: My Lords, is it possible that advice may also be given to patients in terms of complementary medicine to supplement the advice given about drugs and prescriptions?
Baroness Hayman: My Lords, pharmacists advise their patients across a wide range of areas. Community pharmacists are particularly valued for their independence of view. I am not sure that their training
allows them to give a full range of advice on alternative medicines. Obviously the Crown review was looking particularly at prescription medicines.
Lord Campbell of Alloway: My Lords, can the Minister say whether the gratuitous advice, which is given in good faith, is subject to any form of legal liability? Is the advice exempt from legal liability because it is gratuitously given in order to help?
Baroness Hayman: My Lords, like all pharmacists, community pharmacists are a highly trained group of professionals who are subject to professional regulation. Their role of providing advice rather than treatment is well established within the health service and comes within the normal parameters.
Lord Rea: My Lords, one of the recommendations in the report is that,
- "new groups of professionals would be able to apply for authority to prescribe in specific clinical areas, where this would improve patient care and patient safety could be assured".
Baroness Hayman: My Lords, my noble friend makes an important point which, in a way, echoes the point made by the noble Lord, Lord Campbell of Alloway. It is important that we maintain the standards of both advice and, particularly, prescription. It is because we have the safety of patients uppermost in mind that we think it right to enter into a consultation period about the recommendations of the Crown report.
Widows' Pensions
2.45 p.m.
Baroness Castle of Blackburn asked Her Majesty's Government:
- Whether and, if so, when an explanatory booklet was circulated by the Benefits Agency to contributors to SERPS, warning them of the effects on widows' pensions of Section 18 of the Social Security Act 1986.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Hollis of Heigham) : My Lords, Section 18 of the Social Security Act 1986 introduced changes to the way SERPS would be calculated for those retiring or widowed after April 1999. The main changes were the abolition of the "best 20 years" provision and the reduction in the accrual rate from 25 per cent to 20 per cent. DSS leaflet NP46, previously NP32, A guide to Retirement Pensions, has
given details of these changes since April 1987 and leaflet NP45, previously NP36, A guide to Widows' Benefits, since April 1996.
Baroness Castle of Blackburn: I think I find the Minister's Answer slightly evasive. I believe she is aware that we are all extremely anxious about the dilemma in which so many contributors to SERPS now find themselves with the halving of widow's entitlement through their SERPS pension. It is that upon which the Minister concentrated so excellently the last time this matter was discussed. Is it not true that her reply means that there has been no notification by this Government--we were not responsible for what happened in April 1996--and there have been no Benefits Agency communications to contributors warning them of the coming reduction in the widow's pension? As they were promised initially by John Major that they would have 14 years' notice to rectify this reduction by other means-- and that notice now turns out to be a matter of months--will the Government not give their mind to how to rectify this scandal? If they do not express a willingness to revert to the original SERPS formula for widows, will they at least delay introduction of the change for a decade in order that some of the scandalous failure to give proper notice can be rectified?
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