The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, most of the report's recommendations on artificial limb services are for local health authorities and trusts to address. External auditors are now auditing their performance. We would expect the NHS to act on their findings.
Baroness Lockwood: My Lords, I thank my noble friend for that not very reassuring reply. Can he give an assurance that the needs of, and service to, the patient will in future be considered to be the prime criteria, rather than the lowest prices that are put forward? Can he further tell the House how he thinks that this might be achieved, given the decrease in expenditure on contracts for the supply of artificial limbs? That expenditure declined from £53.3 million in 1991-92 to £29.3 million in 1994-95. It then rose to £36 million in 1998-99. Does my noble friend agree that this still leaves a tremendous leeway which will need to be made up if the service is to be adequate?
Lord Hunt of Kings Heath: My Lords, it is worth making the point to my noble friend that the Audit Commission reported on a number of services. It recorded that, in relation to artificial limb services, while there were instances of uneven services, as well as some problems, overall a considerable number of favourable comments were received from users of the service. I can assure my noble friend that the NHS Purchasing and Supply Agency is working with trusts, the industry and users to improve standards in future service contracts.
As regards the budget, I think that the total spend is around £65 million a year. The latest figures for 1998-99 show that £36 million reflected the cost of contracts awarded to private sector companies. The remainder of the budget comprised the costs of NHS overheads and NHS staff employed at the centres.
Lord Hunt of Kings Heath: My Lords, as to the various recommendations made by the Audit Commission in its report, which, as the noble Lord has suggested, does not cover only the services referred to in the Question before the House today, we are giving those the most careful consideration. Clearly, we want to ensure that we provide as high quality a service as possible. I can assure the noble Lord that we are discussing ways of making real improvements in the quality of service with the NHS Purchasing and Supply Agency. It has a pivotal role to play in specifying the level of quality that is required.
Lord Clarke of Hampstead: My Lords, can my noble friend tell the House what options are available to users of the service? Furthermore, what options do they have as regards contributing to the design and range of choice in such matters? Does my noble friend agree that it is the users who are best able to comment on these issues?
Lord Hunt of Kings Heath: My Lords, I certainly agree with my noble friend's latter point. If we are to provide high quality and effective services, it is important to involve the users of those services in the specification of such equipment and services. In looking back over the past few years, I would have to say that I do not believe that users have been sufficiently involved in those discussions. Clearly, the NHS plan sets out an overall philosophy for the much stronger involvement of users of services in the future. We shall have to ensure that that relates to artificial limbs as much as it does to other services.
Baroness Barker: My Lords, does the Minister agree that one of the biggest problems faced by older and disabled people is lack of access to occupational therapists? While massive increases have been announced for the NHS, no such investment has been mentioned for care services. While that situation persists, many of the problems outlined in the report, Fully Equipped, will continue.
Lord Hunt of Kings Heath: My Lords, the noble Baroness is right to suggest that overall, in relation to services for people affected in the way that she has mentioned, we need to adopt a holistic approach which would embrace both health and local government. Unless we can do that, we shall not be able to provide the kind of readily accessible, high quality service that is required. Clearly, the Government's development of new flexibilities in the way in which health and local government can work together is one important factor in progressing that. I accept also, in relation to occupational therapists, that it is very important, in future workforce planning, to take account of the requirements of local authorities--
Lord Ashley of Stoke: My Lords, is my noble friend aware that he has done some very good work on this issue? However, I am afraid that I must differ in my interpretation of the Audit Commission's report. Whereas my noble friend has said that some favourable comments were made--I agree that that was the case--the most riveting comment made by the Audit Commission was that most of the equipment is cheap and shoddy. That is not good enough, either for my noble friend or for the House. Does he agree that overall experience has shown that investment in equipment saves money both for the user and for the taxpayer? What progress has been made since these issues were raised some time ago?
Lord Hunt of Kings Heath: My Lords, perhaps I may say first that, overall, in relation to artificial limb services, the Audit Commission considered that there had been a more favourable response to those services than was the case for some of the other services that it reviewed. That was the point that I made earlier. However, of course I accept that, in terms of the quality of the equipment and limbs that are purchased by the NHS, we want them to be of the highest possible quality. For example, in relation to silicone cosmesis--which is one issue about which most people are concerned--we have established a group to look at the relevant issues and to advise us on what needs to be commissioned in the future. I can assure noble Lords that, through the work of the NHS Purchasing and Supply Agency, we shall involve users and we shall ensure that the NHS has available to it high quality equipment to purchase.
The Minister of State, Department of the Environment, Transport and the Regions (Lord Macdonald of Tradeston): My Lords, the Government have been looking closely in the Road Haulage Forum at the economic and structural factors that affect the road haulage industry. The forum's work has shown that there are many different issues involved, including some over-capacity. Government decisions will continue to be taken in the interests of an efficient and competitive industry.
Lord Macdonald of Tradeston: My Lords, scrapping old vehicles may be useful if it is linked to higher entry requirements and so on. The Government keep an open mind on all such ideas, including the possibility of issuing a vignette or "Britdisc" for British hauliers, which would mean that there would be a levy on foreign lorries using our roads. Scrappage may be of assistance to the industry, but I must stress that no decision has been taken.
Lord Berkeley: My Lords, does my noble friend agree that the absences from the Benches opposite indicate that party's lack of a coherent policy on fuel duty? Does he further agree that the figures produced by NERA, the AA and OXERA show that users of the heaviest lorries pay only 70 per cent of their true track and environmental costs? Is my noble friend taking this into account in the forthcoming policy formulation?
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