Health and Social Care Bill

---

[back to previous text]

Dr. Brand: This is an interesting schedule. I wonder why it has been determined that the Secretary of State or the Welsh Assembly should have to give permission for that work rather than that the health authority should make its own proposals, with the Secretary of State or the Assembly acting as the court of appeal should a party feel aggrieved by the authority's decision. I fail to see how the Secretary of State can better judge than the health authority what is needed locally. The health authority's commissioning function will be undermined by the authority becoming a mere agent of the Secretary of State.

Sir George Young: I welcome both Government amendments. They bring some order to the almost free-for-all envisaged under paragraphs 4.13 and 4.14 of ``Pharmacy in the Future''. I have one specific request. Amendment No. 219 provides that the health authority should make an assessment of the likely effect of its proposals on existing services and that a copy must be sent to the Secretary of State. Will the Minister ensure that a copy is sent also to the local medical and pharmaceutical committees, so that they too can be confident that a thoroughly informed assessment that takes account of all the local circumstances has been made of the impact of the proposals? I see no reason why those committees should not have a copy. It would enhance confidence in the decision-making process.

Mr. Denham: I shall answer first the hon. Member for Isle of Wight. In common with other personal family health services legislation, it was thought that all pilot schemes should be agreed by the Secretary of State. Both sides in the previous Parliament thought that to be a sensible balance when bringing new elements into established national contractual arrangements. It seemed to provide adequate safeguards on all sides. If everything is successful, as we hope and intend, it is envisaged that permanent arrangements will enable the health authority to take the decisions at local level. We are being prudent, having borne in mind the element of innovation and experiment.

The hon. Member for Runnymede and Weybridge talked about preliminary approval and the Secretary of State's approval. It is unlikely that there would be changes between the outlying specification set out at preliminary approval stage and the final scheme as a result of discussions from providing parties. We do not envisage that, at preliminary approval stage, the health authority will have a final, detailed and complete specification for every element of the service, against which providers simply submit commercial bids as though it were, say, a building project. That will allow the Secretary of State to pick up significant or problematic variations between preliminary and final approval.

In answer to the right hon. Member for North-West Hampshire, there is no reason why health authorities should not share the results of their assessments with local medical committees and pharmaceutical committees. We should deal with the matter in guidance in due course. It is important that people have confidence in the system.

The crucial question is whether we need to accept the amendment. Typically, 70 per cent. of the business of a community pharmacy is NHS business. The only danger of our current system is that if it were interpreted as narrowly as the hon. Member for Runnymede and Weybridge suggested, we would consider that 70 per cent. as though it were 100 per cent. of the income, and so overstate rather than understate the impact of an LPS contract to provide NHS services. The LPS contract is, of course, for the provision of NHS services, and we shall consider the impact of the new NHS service on the existing NHS service.

The hon. Gentleman said that everything would be okay if one could show that there would be no detrimental effect on NHS business. Obviously, we intend there to be no such effect, but in considering the wider issues of public health interest, the availability of over-the-counter medicines and so on, health authorities would in practice take stock of whether the new LPS provision for NHS services would have any impact on the wider provision for the local community. Although I understand where the hon. Gentleman is coming from, I believe that he is wrong.

The hon. Gentleman asked me to consider various matters. I once said that we would consider some matter and was told that, under parliamentary convention, that meant that I would table an amendment about it on Report. Having been caught like that before, I shall not be so caught again, although, as a reasonable man, I shall have a think about these matters. That is no commitment to table amendments on Report.

Mr. Hammond: The Minister has accepted that there needs to be an assessment of the impact on over-the-counter sales opportunities. The only issue is whether that needs to be clear in the Bill. I should be grateful if he had a think about that, as it is simply a different interpretation of the narrow duty placed on health authorities by his own amendment.

Mr. Denham: There is nothing further for me to say.

Amendment agreed to.

Amendment made: No. 219, in page 61, line 17, at end insert—

`( ) Sub-paragraphs (3) to (6) of paragraph 2 apply in relation to an application for preliminary approval of proposals under this paragraph as they apply in relation to proposals under that paragraph.

Effect of proposals on existing services

. —(1) Proposals for a pilot scheme submitted under paragraph 2, or included in an application for preliminary approval of proposals under paragraph 4, must include—

(a) an assessment by the Health Authority of the likely effect of the implementation of the proposals in the Health Authority's area on the services mentioned in sub-paragraph (2);

(b) any assessment supplied to the Health Authority by another Health Authority under sub-paragraph (4).

(2) The services are—

(a) pharmaceutical services (within the meaning of section 41 of the 1977 Act);

(b) local pharmaceutical services provided under existing pilot schemes or LPS schemes (within the meaning of Schedule 8A to the 1977 Act);

(c) general medical services provided under arrangements made under section 29(1) of the 1977 Act;

(d) personal medical services provided under arrangements made under section 28C of the 1977 Act or under pilot schemes made under section 1 of the National Health Service (Primary Care) Act 1997.

(3) If it appears to a Health Authority that the proposals would, if implemented, affect any of the services mentioned in sub-paragraph (2) provided in the area of another Health Authority, they must consult that other Health Authority about the proposals before submitting them under paragraph 2 or including them in an application for preliminary approval under paragraph 4.

(4) A Health Authority consulted under sub-paragraph (3) must prepare an assessment of the likely effect of the implementation of the proposals on those services and supply it to the Health Authority which consulted them.'.—[Mr. Denham.]

Schedule 2, as amended, agreed to.

Clause 31

Designation of priority neighbourhoodsor premises

Mr. Denham: I beg to move amendment No. 208, in page 30, line 24, leave out from beginning to end of line 25.

The Chairman: With this it will be convenient to take Government amendment No. 221.

Mr. Denham: The clause provides a power to make regulations that allow health authorities to designate neighbourhoods and premises for the purpose of local pharmaceutical services pilots. The idea is that the development of LPS is not undermined by the operation of existing national arrangements for pharmaceutical services. If a health authority and its local partners wanted to discuss and prepare pilot schemes, they should have the breathing space to do so, without constantly being faced by the pressure that someone else might apply to open a pharmacy in the same place under the national arrangements.

Under existing national arrangements, health authorities are obliged to consider applications from people wishing to provide pharmaceutical services in their areas. If the application satisfies certain tests, health authorities have no choice in practice but to grant it, so there clearly could be conflict and disruption between the desire to develop a local pharmaceutical services pilot and an application from a scheme under the national arrangements.

With LPS, we want something much more proactive. We want a two-way process in which existing contractors and other prospective pilot scheme participants come forward with ideas that they want to discuss with health authorities, while health authorities will look for opportunities of their own to develop pilots. It would be wasteful if health authorities had to do that and deal with applications to open pharmacies under the national arrangements.

There must be limits to such designations. We have no desire to see deliberate or inadvertent planning blights. The clause provides for us to make regulations, rather than conferring the power directly on health authorities. The regulations will be able to set limits on which places may be designated and the period for which designation may be maintained. The clause also ensures that we can take timely action should the designation system be misused. If necessary, the Secretary of State and the National Assembly for Wales will be able to direct a health authority to cancel a designation.

On reflection, however, we think that one part of the clause is unnecessary. Its purpose is to allow health authorities to defer part II applications. That is stated explicitly, so we do not think that the further reference to health authorities giving priority to LPS schemes in some other unspecified way is necessary. Amendments Nos. 208 and 221 delete that unnecessary power by deleting the relevant paragraphs.

That is probably sufficient introduction for the amendments.

 

---

Prepared 1 February 2001