HL Deb 29 June 1977 vol 384 cc1107-9
Lord WINSTANLEY

My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government whether the decision of the Central District of Sheffield Area Health Authority to forbid all prescribing for hospital out-patients is in accordance with existing Government policy.

Lord WELLS-PESTELL

My Lords, I understand that at their meeting on 13th June the Sheffield Area Health Authority (Teaching) decided to approve certain limitations on prescribing in hospitals in the Central District and recommended a similar limitation in their two other districts. This decision was agreed with representatives of hospital doctors, the local general practitioners and retail pharmacists, and the Community Health Council. My right honourable friend the Secretary of State for Social Services welcomes locally agreed prescribing policies which contribute to rational drug therapy, and it appears that satisfactory local arrangements were reached in this instance.

Lord WINSTANLEY

My Lords, is the noble Lord aware that the decision to which he refers appears to be in conflict with the recommendations in the circular letter of the Department of Health and Social Security that no attempt by health authorities should be made to arrange that the hospital out-patients, … are referred to their general practitioners for prescribing"? Is the noble Lord also aware that, if this practice becomes general, it will cause grave inconvenience and even distress to thousands of patients and would also cost the nation a great deal because hospital dispensing is much cheaper than dispensing under the family practitioner committee arrangements?

Lord WELLS-PESTELL

My Lords, I do not accept that the decision is in conflict with the guidance circulated by my Department in 1976. Furthermore, I would remind the noble Lord that this is an arrangement which has been entered into by agreement with everyone concerned, including the doctors. The noble Lord will know that there is in each district a management team and a family practitioner committee. I am saying—and my Answer said—that this was the outcome of consultations which led to an agreement with all the parties concerned; that is, the consultants and the family practitioners.

Lord PLATT

My Lords, although I am in general agreement with what the noble Lord has said, he used the carefully chosen words, "some restrictions on prescribing". I should like to ask him to clarify the difference between the wording of his Answer and the Question which reads, "forbid all prescribing", because there is a fundamental difference.

Lord WELLS-PESTELL

Between?

Lord PLATT

My Lords, between "some restrictions on prescribing", of which no doubt I should approve, and the Question which says, "forbid all prescribing". Does the Minister mean us to understand that the term, "forbid all prescribing" is not correct?

Lord WELLS-PESTELL

My Lords, the "restriction"—to use the word that has already been used—which is placed upon the hospitals in the three districts concerned, relates to out-patients. If out-patients attending a hospital are in need of a prescription, then it is a matter for their general practitioner. There will be exceptions to that. For example, drugs obtainable only through the hospital will be provided to out-patients: emergency treatment, notwithstanding the fact that the person is an out-patient, will be provided; and there are certain cases of hardship which would also be applicable —I am thinking particularly of the elderly and infirm who might find it difficult to go to their general practitioner, in which case the hospital will provide.

Lord SEGAL

My Lords, could my noble friend be a little more specific and give some information as to the direction in which the limitations should operate? Are they intended to cover certain groups of drugs for specific diseases or are the limitations on quantities only?

Lord WELLS-PESTELL

My Lords, the limitations are not in respect of certain drugs or quantities but merely to try to establish what I think general practitioners would accept; namely, that it is the doctor who has the clinical responsibility. I believe that it is the general regard that the general practitioner has the clinical responsibility for the patient and should be the person who prescribes.

Lord BYERS

My Lords, the noble Lord has said that all parties have agreed to this. Does he include the most important party; namely, the patient?

Lord WELLS-PESTELL

My Lords, I am tempted to say, Yes, because the Community Health Council, which exists to watch and safeguard the interests of the patient, was agreeable to this course.

Lord DAVIES of LEEK

My Lords, may I ask my noble friend whether there is any possibility of there being a shortage of hospital pharmacists as opposed to pharmacists in retail shops? At one time there was such a shortage. Did that influence this decision?

Lord WELLS-PESTELL

No, my Lords.

Lord DAVIES of LEEK

I thank my noble friend.

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