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House of Lords

Tuesday, 8th July 2003.

The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.

Prayers—Read by the Lord Bishop of Newcastle.

NHS: Specialised Commissioning

Lord Ashley of Stoke asked Her Majesty's Government:

    Whether they will require strategic health authorities to monitor and keep the Government informed about the progress being made regarding the formation of consortia to purchase specialised services; and whether they will give strategic health authorities the power to require primary care trusts to form consortia for the purchase of such services.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner): My Lords, primary care trusts decide whether they wish to form purchasing consortia for specific specialised services. Overall arrangements for commissioning specialised services are performance managed by strategic health authorities. In turn, strategic health authorities are subject to a national process of assessment which will include their processes for strategically reviewing the commissioning of specialised services. There are no plans to change those arrangements.

Lord Ashley of Stoke: My Lords, is my noble friend aware that this Question is about people with rare but serious conditions that are very expensive to treat? The Government seem to be failing some of them. Currently, only the combination of primary care trusts and consortia can handle these cases and cope with the expense. In my view, and according to that Answer, all the Government seem to be doing is making recommendations or guiding and advising. What they should be doing is demanding that primary care trusts establish consortia and requiring them to carry out that work. Without such a combination, these people will remain neglected, and that would be inexcusable. It is the Government's job to see that primary care trusts are not left to their own devices. They are reluctant to combine, but unless they do they cannot treat this small but vital number of very important cases, some of them people with life-threatening conditions.

Lord Warner: My Lords, I am aware of my noble friend's concerns. However, it is also true that the Government have tried to shift the balance of power—the title of the document published in 2002—to devolve more responsibility to a lower level. We have also issued guidance on the commissioning arrangements for specialised services to try to address some of the concerns expressed by my noble friend. However, we have not just issued guidance. A Department of Health survey showed that, in the first three years of their existence, regional

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specialised commissioning groups had made significant advances in establishing commissioning arrangements for those specialised services. Those included in particular the eight national priority services, which I will not go into but which I am sure are well known to many noble Lords. The survey also looked at the commissioning arrangements for other specialised services and found very reassuring evidence that things were going in an extremely satisfactory manner.

Lord Clement-Jones: My Lords, this House last debated specialised services in April 2003. During that debate, the answers given were widely at variance with answers which have subsequently become available from John Hutton, the health Minister, and indeed from Ministers in this House. The guidance given in April clearly lacks the clarity needed by those who are now responsible for commissioning. Will the Minister undertake to reissue that guidance in a much clearer form?

Lord Warner: No, my Lords.

Lord Campbell of Croy: My Lords, has any consortia of this kind for buying these services yet been formed? If so, how many?

Lord Warner: My Lords, I am not sure that I understand the drift of the noble Lord's question. We do not collect a lot of information of this kind centrally, as I thought I had made clear. However, if he would like to write to me about particular concerns I shall be happy to make inquiries.

Lord Walton of Detchant: My Lords, if one accepts, as one must, that clinical research is a vital function of the National Health Service, can the Minister assure us that that will be preserved and enhanced in the arrangements that he has been talking about? There is no doubt at all that the results of research not only nourish but produce major developments in clinical care. Will he also take account of the parlous state of clinical academic medicine at the present time, which is very serious when one talks about the future of clinical research in the United Kingdom?

Lord Warner: My Lords, on the latter part of the noble Lord's question, I am aware of the concerns about academic medicine. Work is under way, particularly in relation to a number of inquiries—but that is rather wide of the Question. On the particular issues of research in relation to commissioning, nothing in these new arrangements for commissioning should damage the research interests.

Baroness Finlay of Llandaff: My Lords, will the Minister explain what specific plans are in place to monitor the commissioning of cancer services given the need for the exceptional tracking exercise recently?

Lord Warner: My Lords, the arrangements for monitoring specialised cancer services are the same as for other specialised services; they are as indicated in my

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earlier Answer to my noble friend Lord Ashley. It will be for the department to assess with strategic health authorities, when they assess their accountability, the performance in this area.

Baroness Lockwood: My Lords, does my noble friend the Minister agree that primary care trusts also have strategic responsibilities not only in connection with specialist commissioning but in a wider area? Does he agree with me that, particularly in metropolitan areas, primary care trusts tend to think of their own corner and not of the strategic role they clearly have?

Lord Warner: My Lords, I understand my noble friend's concerns. Primary care trusts have a responsibility in relation to their particular areas and in relation to specialised services, which go much wider. As I said, we have carried out a survey which, without being complacent, is rather reassuring about the way in which primary care trusts are tackling specialised services.

Lord McColl of Dulwich: My Lords, I wonder if the Minister could help us in this rather confused area. Who is responsible for, say, providing the services for children who need kidney transplants, and to whom are they accountable?

Lord Warner: My Lords, about 36 specialised service areas are defined. I am trying to skim down the list to see whether the services the noble Lord mentioned are included. My eyes do not immediately alight upon them so I do not think they are included. However, I shall write to the noble Lord.

Baroness Masham of Ilton: My Lords, what will the treatments be called? They used to be called supra-regional specialties and then out-of-area treatments. Will the money follow the patient?

Lord Warner: My Lords, as I tried to say earlier, they are called specialised services. A set of national definitions identifies those services—36 in all. They are covered by PCT consortia for commissioning where populations of 1 million or more are covered by those services. That is about as far as I can go.

Royal Mail: Transport Policy

2.44 p.m.

Lord Berkeley asked Her Majesty's Government:

    What evidence Postcomm will require from Royal Mail in order to determine whether it will be able to meet its performance after withdrawal of its rail freight services.

The Parliamentary Under-Secretary of State, Department of Trade and Industry (Lord Sainsbury of Turville): My Lords, Postcomm is in the process of

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considering the action plans Royal Mail has presented to it to underpin this year's service quality targets. I have no doubt that one of the issues it will be looking at will be the potential impact of implementing Royal Mail's multi-modal transport review.

Lord Berkeley: My Lords, I am grateful to my noble friend for that Answer. I declare an interest as chairman of the Rail Freight Group. Does he not agree that as Royal Mail is a government-owned company it should comply with government policy to use as much rail freight as possible rather than road? Should it not also in its appraisal use the Government's appraisal and methodology in comparing the benefits and the costs of road, rail and air for value for money, environmental benefit and performance? Will he ensure therefore that Postcomm requires the Royal Mail to do that as part of the review?

Lord Sainsbury of Turville: My Lords, it is for Postcomm to ask those questions. On the figures that I have the air and road only network results in fewer carbon emissions than the air, road, rail proposal. It also involves fewer lorry movements although more miles per annum. It is arguably a better environmental scenario.


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