HL Deb 03 November 1986 vol 481 cc939-53

5.15 p.m.

Read a third time.

Clause 3 [Pharmaceutical services]:

Lord Harris of High Cross moved the amendment: Page 7, line 20, at end, insert— (" ( ) Without prejudice to the provisions of section 42 of the 1977 Act and subsection (2) of section 27 of the 1978 Act, the Secretary of State may make financial and other arrangements and regulations applicable to such arrangements for the provision of pharmaceutical services, drugs, medicines or appliances pursuant to prescriptions issued by medical or dental practitioners by registered pharmacists, whether or not such pharmacists carry on business pursuant to any entry on a list under those two sections")

The noble Lord said: My Lords, it may be remembered that at the Report stage I told the noble Baroness on the matter about which we were arguing that I should pursue her. I said then "privately and persistently". I have to apologise to your Lordships that persistence has won over privacy, because I wish to move an amendment that offers a considerable advance on the amendment that I put forward at Report stage.

I withdrew that amendment and said that I hoped that its appeal was sufficient to fructify in the mind of the noble Baroness as time went by. I offered the amendment as an olive branch and the noble Baroness said that she thought it might conceal the apple of temptation. I thought a lot about that. Accordingly, I return to the issue and I am openly proffering her a positive fruit basket which leaves her and her colleagues with wide choice for future nourishment but without any suggestion of forced feeding. In other words, this is an enabling change and not a mandatory one.

All the amendments to Clause 3, moved from various parts of the House at earlier stages, have been directed at the central objection that Clause 3 as it stands conflicts headlong not merely with the Government's commitment but with a widely shared commitment towards encouraging competition, new enterprise and efficiency throughout our economy. This clause conflicts with that objective even to the extent of drawing a strong rebuke from the Office of Fair Trading. At its simplest, Clause 3 entrenches a presumption against a new pharmacist entering the market unless he can prove that it is "necessary or desirable".

My earlier amendment would have permitted any qualified pharmacist to set up shop and to dispense NHS prescriptions without commanding a professional fee under the full contract. In place of the present cost-plus system, a newcomer would simply have been reimbursed the cost of making up the prescription. That was rejected. The amendment that I now move is an open-ended and permissive change. It would simply give the Secretary of State the power to introduce at any time alternative arrangements for allowing qualified pharmacists to dispense prescriptions in the absence of the present full cost-plus contract, which is all that Clause 3 now allows. Thus it leaves open the door for the Government to adjust the financial incentives and disincentives in future without going through the trauma of new primary legislation and yet another National Health Service (Amendment) Bill in a year or two's time.

It is perfectly plain from our debates that the present Clause 3 would not have been necessary if the prevailing set of incentives had brought about the desired location of pharmacies. That is why the Government are now abolishing the basic practice allowance; that is why they are now offering compensation to smaller pharmacies that surrender their contracts; and that is why they are reducing the minimum number of prescriptions for eligibility for the essential small pharmacy bonus. But the DHSS cannot possibly know in advance whether these stricter provisions will lead to too few or, as I think more likely, too many closures. Likewise, the Department of Health and Social Security cannot know what pattern of community service would be favoured by the public in the years ahead.

In their briefing note on the new contract, the DHSS experts say that the undoubted merits of competition are not relevant in this case because, the nature of the produce is invariable".

In my view, that is another example of expert nonsense. The traditional chemist shops are already giving way to a wide variety of competing retail outlets. There is the phenomenon of drug stores that do not handle prescriptions—at least, do not yet handle prescriptions. There is an increasing number of chains, old and new, that derive no more than perhaps 5 per cent. or 15 per cent. of turnover from dispensing; and there is the preponderance of independents that look to the National Health Service for more than 70 per cent. of their business.

Even such neat categories do not exhaust the extending range of differing services and product mixes which are still at an early stage of competitive evolution. For example, Safeway already has 26 pharmacies in its 127 supermarkets, providing what the company calls "a caring service in immaculate surroundings". Safeway would like still more pharmacies with their caring service. Both the Nuffield Report and the consultative document on Primary Health Care envisage the possibility of far-reaching changes, not least in developing the pharmacists' role with advice and even treatment for some ailments. In this week's Pharmaceutical Journal there is a most impressive story of a Midlands based pharmacy company—Lloyd's chemists—which celebrated the opening of its one hundredth pharmacy. This one hundredth pharmacy is the first in the group to include a "pharmacy advice room". The company's policy, it says, it to include such a feature in future new premises wherever possible. It goes on to tell of the remarkable enterprise. of Mr. Lloyd, who in the space of 13 short years has built up a new business.

At Report stage the noble Baroness teased me for promoting what she thought were the vested interests of the large multiples against the small pharmacists, of which she and others see themselves as the champions. The point I wish to emphasise with all possible urgency is that the scope for future creative enterprise is certainly not confined to the large chains, which incidentally all developed from small beginnings, even as did the Co-op. What would become of a young enterprising pharmacist today—a budding Jesse Boot—who invents a better way of serving the needs or changing preferences of potential customers? If he finds suitable premises he can move in and apply under Clause 3 for a contract. According to the regulations he may wait for up to two months to be turned down by the new local sub-committees. He may then appeal and hope to receive a reply in the space of a further three months. Therefore, he would have his premises for five months without knowing whether he was a pharmacist or merely a soap salesman.

As an alternative he may be faced with buying up an existing chemist and paying perhaps £10,000 to £50,000 extra as a premium for an NHS contract, but in a location which he would not choose for his new enterprise. The insistent question is why an enterprising pharmacist should not be allowed the opportunity of selecting premises for his new style of business and then dispensing NHS prescriptions on a strict cost reimbursement basis, without the professional fee or profit element which at the moment averages over 60 pence per item prescribed? If that option is denied to him the most enterprising pharmacist may be prevented from putting his ideas to the test. But for every new entrant of this kind who accepts these terms the NHS stands to save up to £22,000 a year on the average of 35,000 prescriptions.

In my final appeal to the noble Baroness I will try flattery—it has sometimes been known to work. I would say perfectly earnestly that since 1979 one of this Government's greatest merits has been that they have accepted change and have taken a longer view than most of their predecessors in designing their policies. I approve of that. However, I fear that in this Bill, in Clause 3, the Government are in danger of letting themselves down. It is true that the developments already in train will not be completely frozen by this new paraphernalia of restriction, but they will be delayed and distorted and that may cost the DHSS dear. If some new variant of drug stores were to take more of the traditional chemist's trade from existing pharmacies, the latter would become more and more dependent on NHS dispensing and, through the PSNC, would demand higher fees to offset a declining turnover.

This amendment would enable the DHSS to protect itself from that possibilityof escalating costs. If it were applied to take the plus out of cost-plus for new pharmacists, it could eventually save tens of millions of pounds a year. I strongly commend the amendment to the noble Baroness as giving her the best of both worlds. It would commit the Government to nothing, yet would leave open the door to adjusting the financial incentives and disincentives precisely as the PSNC set out to do at the beginning of this long and so far unhappy story. I beg to move.

Lord Ennals

My Lords, I have to say that I have never known the noble Baroness give in to flattery. I have never tried it, of course, but I have heard others try it. I hope that the flattery that has come from the noble Lord will not convince her to do anything unwise. I doubt whether it will.

I have just three rapid points to make against the amendment. The noble Lord is a very good advocate of competition, and I can understand his point. However, I believe that the competition of giving this opportunity to Safeway, Tesco and all sorts of other large chains would largely be at the expense of the existing and often small high street pharmacist. Throughout the debates we have had on this Bill my concern has mainly been to preserve the interests of the high street pharmacists, largely because I believe they provide the best service for the community and for the individuals who need their help. It is an enormous advantage to have a small pharmacist who knows you, your needs and your normal prescriptions and is ready to give advice.

My fear, therefore, is that if the amendment were to be carried we should be faced with a number of closures that would not be in the public interest. Small pharmacists would be pushed out of business, and that is a trend in all sorts of other types of trade all over the country. I do not look upon prescriptions as being trade. It is a service, and while I have expressed doubts about the methods of granting licences, I believe it to be a service that is linked with and is part of, the National Health Service. It is not a field in which commercial competition should play an unrestricted role.

Finally, the noble Lord referred to the Nuffield Report. There is nothing in the Nuffield Report which could be said to recommend the proposals contained in the amendment. I hope that the House will reject it.

5.30 p.m.

Baroness Trumpington

My Lords, as he said, the noble Lord, Lord Harris of High Cross, moved a similar amendment at Report stage. However, nothing that the noble Lord has said this afternoon has changed my mind. The practical effects of this amendment would be exactly the same. Pharmacies that could afford to operate on a cost-reimbursement only basis would be exempt from the "necessary or desirable" test. The amendment of the noble Lord, Lord Harris of High Cross, is totally contrary to the Government's policy of support to small businesses.

As I explained to your Lordships at Report stage, only the large stores with multiple outlets, where pharmacy is a small proportion of a bigger enterprise, would be able to take advantage of this proposal. The noble Lord, Lord Ennals, has just said exactly the same thing. and I find this new spirit of togetherness between us utterly charming. Only the multiples, with their marketing strength, economies of scale, and ability to command discounts not available to the small pharmacist, would benefit.

Because only a fixed level of NHS dispensing is available, the mutliples would take NHS business away from other smaller NHS pharmacies. As a result the small businessman would suffer. Indeed the small businesses would be driven from the high streets.

Once the cost-reimbursement only pharmacists had cornered the market they could then apply to the local family practitioner committee for a contract under the "necessary" or "desirable" criteria. Having driven out the small pharmacist, they would have a very good chance of success and would obtain not only the cost-part of the contract but also the plus-part. The illusion of savings for the taxpayer and better services for patients created by the noble Lord, Lord Harris of High Cross, would have disappeared for good.

The noble Lord, Lord Harris, said that this amendment would allow financial incentives to be introduced. The Government already have the powers in current primary legislation to change the remuneration structure and to change financial incentives for pharmacies. Therefore, we do not need this amendment. The noble Lord, Lord Harris, also said that the new arrangements will stop new contracts in new shopping centres. The new arrangements for allocating new national health pharmacy contracts will not stop new contracts being allocated in new shopping centres and other places where patients need them. Neither will they hinder development of the pharmacist's role. On the contrary, they will provide a firm foundation for such development.

I do not wish to deprecate the valuable contribution of companies like Underwoods and Safeways. Quite rightly, they are seeking to improve their share of dispensing trade, and it is likely that the right to dispense NHS prescriptions will help the non-pharmacy parts of their businesses as well. But it is the duty of Government to provide a fair balance of advantage between all those involved in dispensing, from the small businessman to the large company. All should have an equal chance.

This proposal would give an unfair advantage to the multiples. It sits very uneasily with the proposed new arrangements for allocating NHS contracts. As I explained at Committee stage, the option of financial incentives as a means of achieving a better distribution of NHS pharmacies has been considered carefully and rejected. It would mean many small pharmacies going to the wall. This proposal is merely a variation on that theme.

I should also point out that different patients require different types of service. A trip to the local supermarket to change a prescription is not everybody's cup of tea. The elderly and the disabled, in particular, would in all probability have difficulty finding their way around and would prefer a different environment. That is not to say that the service would be better or worse; but we have to consider very carefully the needs of all patients.

The underlying point is that we have to maintain a fair balance when setting arrangements for NHS pharmacy contracts. The new contract for community pharmacists aims to create a fair and reasonable balance at the same time as achieving a better distribution of services. To do so requires more than the "necessary or desirable" test. The new contract proposes more cost-effective mechanisms for influencing NHS pharmacy distribution through a new remuneration structure which gives incentives to efficient pharmacy provision; and a financially enhanced essential small pharmacies scheme. There will also be special arrangements to allow those contractors dispensing less than 16,000 prescriptions a year to relinquish their contracts on advantageous terms, or to relocate their businesses where they could better serve the needs of patients.

Therefore, this is an integrated package of measures which provides a fair balance of advantage to all involved. This proposal would drive a coach and horses through the new contract. It would load the system firmly in favour of the multiples. That is simply not acceptable.

Lord Harris of High Cross

My Lords, I am naturally disappointed by the noble Baroness's reply on this matter. I remain totally unpersuaded that the Government have got right this time, any more than it did before, what the Nuffield Committee I think called "the set of incentives"—the structure of incentives. We have seen a reduction in the number of pharmacies from 15,000 down at one time to as low as 10,600 in 1980, and we have seen over the last year an increasing number of new pharmacies coming in, encouraged—as I still believe—by the anxiety to beat the gun and obtain a contract with the NHS before this Bill comes into effect.

It has to be said that it is [...]tally unpersuasive to defend this clause as it stands on the basis of encouraging small businesses. That is simply party-political rhetoric. The whole point about encouraging small businesses is to remove obstacles to entry and to encourage people with new ideas to put them to the test by going to the market place, offering something different and better and testing whether it will work. The idea of encouraging small businesses is not to create a favoured species—in this case of chemists' shops, where you say that you are defending existing chemists' shops against the threat of the large multiples. The whole basis of improvement comes from the threat and challenge of competition to stir and stimulate improvement by the incumbents.

To the extent that this contract protects the incumbents against the inroads of competition it will perhaps prolong their existence in a tolerable and moderate way of business without giving the stimulus that is necessary to follow the example that I quoted from Lloyd's with their new chemists. The noble Lord, Lord Ennals, said that it had nothing to do with the Nuffield Report. The point I was making was that there was a new entrant—Lloyd's in the Midlands, which I do not know if the noble Lord, Lord Ennals, knew about from the Pharmaceutical Journal issued this week—who has made an effort to set up a consulting room in pleasant surroundings in order to go further than just taking the prescription and telling the patient to come back in half an hour, whether or not it is raining outside. It seems to me that such improvements will increasingly come and will not be confined to the large chains.

Finally, my observation was that despite the efforts to maintain a quiet life with the PSNC, in the end you will not defeat competition or block the ceaseless enterprise of people with vision and an idea that works better than the present system. To say that only the chains will benefit is absurd. If the chains wish to monopolise the market they can go out and from their great capital resources buy up existing chemists. By buying up existing chemists they will have bought a contract. There is no proposal here to withdraw the contract, if these dreadful chains move in and acquire the local chemist's shop. The big chains will have things their way in the sense that to the extent that a new man setting up with meagre resources, who has a new idea but who cannot afford the new premium to get in round the back of the local sub-committees—I call them hanging committees—that are meant to keep them out, will find it more difficult. I am glad to reflect that small men have overcome these problems in the past. No doubt they will do so in the future. I shall withdraw this amendment before any more is said.

Amendment, by leave, withdrawn.

5.40 p.m.

Baroness Trumpington

My Lords, I beg to move, That the Bill do now pass.

This small Bill has grown like Topsy during is passage through this House. Provisions have been added following constructive and cogent debate on a number of important health service issues. The strongly held convictions of your Lordships have always been expressed with the utmost courtesy and kindness, for which I am most grateful. I should like to thank noble Lords from the Opposition Benches, Cross-Benches and indeed my own side of the House for their contributions. We have not always agreed with them, but I suggest tentatively that the Government have responded flexibly and responsibly. On the lifting of Crown immunity from health authorities in respect of health and safety legislation, we have recognised the concerns of all sides of the House, accepted the provision in Clause 2 and moved amendments to ensure that that clause has the desired effect. On the new arrangements for allocating NHS pharmacy contracts, we gave careful thought to the views expressed by noble Lords on all sides in Committee. Subsequently, we introduced changes to meet those views, but which leave the long-term objectives of the proposed new arrangements firmly intact.

On the remuneration of the family practitioner services contractor professions, we have demonstrated our firm commitment to act fairly and reasonably when considering their remuneration. We have given clear assurances to allay the concerns of opticians over the outstanding sight test fee overpayments.

We have approached all those issues in a spirit of conciliation rather than confrontation. We have taken a positive rather than a negative approach. Our aim has been to meet the concerns of noble Lords: and, at the same time, the position of those who will be affected by the Bill have been firmly at the forefront of the Government's deliberations—the NHS patients, the professions and others who provide those services, and the taxpayers who pay for them. May I express my deepest gratitude to noble Lords for doing likewise. It would be wrong if I did not conclude by thanking my doughty and trusty Whip, my noble friend Lord Hesketh, for his efforts on my behalf. I beg to move.

5.45 p.m.

Lord Ennals

My Lords, this is a Bill which gives one both pleasure and a little disappointment. I must be careful not to sound as if I am using flattery because flattery normally is designed to produce favours to come, and I am not expecting any.

I want to thank the noble Baroness and the Government for accepting the pressures which came from so many sources, especially after she argued exactly the opposite on Second Reading. Greater wisdom or more votes—I am not certain which it was—finally convinced the Government that following the tragedy of 39 salmonella deaths at Stanley Royd—there was a good deal of pressure from both sides of the House—they had to bring forward an amendment. They realised that that should be done to cover the whole sphere of work in the NHS.

Following a major defeat in this House the Government decided to accept, and indeed to improve on, an amendment that I tabled to include other areas of hospital work, under the heading-of the safe disposal of clinical waste. It would have been easy to send the proposal to the other place and, with their majority overwhelmingly to have defeated it. If they had, we should have been scowling at each other instead of smiling. The areas that are covered come from the Health and Safety Commission: The waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research which by nature of its toxic, infectious or dangerous content may prove a hazard or give offence unless previously rendered safe and inoffensive. Such wastes include human or animal tissue or excretions, drugs and medicinal products, swabs and dressings, instruments or similar substances and materials". That is what we managed to add to Clause 1.

We won one battle and lost another on pharmicists. The House has greatly improved the system of granting NHS licences for new pharmacists, without damaging the principle of protecting the National Health Service and the pharmacists from the dangers of leapfrogging and from the consequences which I feared would have followed had we accepted a previous amendment.

We did not succeed in giving financial protection to small high street chemists, many of whom will suffer a significant fall in income. I am sure that some will be forced out of business. The Government know that they will and have produced an estimate of how many people they think will be forced out of business as a result of their decisions. Others will struggle on, but they will do so with difficulty. I fear that the removal of compensation for those dealing with fewer than 16,000 prescriptions a year is unfortunate and is a short-sighted measure introduced by the Government, and I deeply regret it.

The noble Baroness achieved a significant improvement for the professions, including opticians, by limiting the period of back-dated profits which can be clawed back by the DHSS.

I want to express my thanks to all who have taken part in the debate. I wish to express my thanks, in particular, to the noble Baroness for taking so seriously the concerns which were expressed in this House. I have been in the other House as well as in this House, and I believe that the handling of this Bill was a good example of the way in which your Lordships' House can effectively fill its role as a revising Chamber and hand into law a Bill that is better than the one we had received.

Lord Winstanley

My Lords, the noble Baroness will recall that on Second Reading noble Lords on these Benches gave the Bill a cautious welcome. We send the Bill on its further journey with goodwill, but that is tinged with some caution. I shall say briefly why in a moment.

I echo what the noble Lord, Lord Ennals, said about the fact that your Lordships' House has undoubtedly improved the Bill. That was done wisely by extending all the provisions of the Health and Safety at Work Act to hospitals and not merely to kitchens. The noble Baroness, when pondering over our wisdom in doing that, may like to note figures which have recently been published which show that the incidence of postoperative infection in our hospitals has increased by 19 per cent. during the Government's lifetime. I do not for a moment blame the Govrnment for that.

Post-operative infection does not flow from hospital kitchens, which were formerly to be dealt with; it flows much more from the matters to which your Lordships have now extended this part of the Bill. That response is wise.

In that connection may I ask the noble Baroness one question at this last stage of the Bill? She will recollect that she inserted an amendment which was responsible for what now is Clause 2(4) which states: This section shall have no effect in relation to anything done or omitted before its commencement. At the time I did not ask what that meant. I made my own assumption, and I should like to tell the noble Baroness what I think it means. I think that it means that if somebody did something wrong a long time ago they cannot be prosecuted for it under the Bill. However, the Health and Safety Executive, when investigating an outbreak of legionnaires' disease or whatever may find that the design of the water cooling system was faulty. That provision does not in any way relieve the hospital of the requirement to put it right under the Health and Safety at Work Act. I hope that the noble Baroness will confirm that my interpretation of the new words is correct.

I express regret in respect of one part of the Bill. This explains my remark that I still have some caution. The noble Baroness, who has been immensely helpful during the progress of the Bill, might have been more helpful towards her own cause had she accepted the amendment that would have reversed the presumption in the Bill that applications to provide pharmaceutical services will be refused unless the applicants can somehow demonstrate that they must be allowed. We would have liked to reverse that situation so that the presumption was that an application by a properly qualified and experienced pharmacist to set up a National Health Service practice would be accepted unless the sub-committee of the family practitioner committee could show a good reason for refusal.

I accept, as the noble Baroness has said, that, at the end of the day, it makes no real difference. But it does make a difference to the way that this Bill may be looked at by pharmacists and by young pharmacists. I fear that they may have the suspicion that the Bill is intended to be exclusive rather than to be helpful. Had the noble Baroness been able to accept a change in the wording, she might find that some of the troubles that I fear may arise at a later stage will not occur.

I shall say no more, save to echo what has already been said, namely, that all on these Benches and indeed, I believe, on the Government Benches are deeply grateful to the noble Baroness for her courtesy and consideration and for the manner in which she has listened to arguments during consideration of the Bill. I would go further. I would like to thank her for the fact that when we have been told that Ministers will write to us, they have always written rapidly and clearly in respect of points that we wished to have explained. For that, we are most grateful. I say no more, but look forward to an answer at some time to the question that I raised.

5.53 p.m.

Lord Boyd-Carpenter

My Lords, it would be churlish on the part of one who, both before and after the introduction of the Bill, argued against the continued application of Crown privilege to the health service not at this stage of the Bill to express appreciation and gratitude to my noble friend and to the Government for the amendments now set out in Clauses 1 and 2. The Government are entitled to full credit in respect of kitchens under Clause 1. They responded to a view expressed from both sides of the House before the Bill was introduced. It was thought strongly by many noble Lords, as by many people outside, that various outbreaks of illness arising from bad conditions in hospital kitchens made it not only indefensible in principle but nonsense in practice to treat hospital kitchens as pail of the activities of the Crown.

On the broader application of the removal of Crown privilege—an amendment supported by noble Lords on both sides—I express my great appreciation to the Government for having accepted the decision of the House and for having now got the Bill into a sensible form providing for the removal of what was an anomaly and an anachronism. Now that the National Health Service and its vastly important equipment is not treated as protected by Crown immunity, we have taken a real step forward.

I am happy to have the opportunity to agree for once with the noble Lord, Lord Ennals, when he commented a moment ago upon how the whole process of the Bill and its progress are a good example of the working of this House. I agree that this House working together, with Members from all quarters concentrating on making the Bill better, has improved the measure considerably. I do not know of course whether the noble Lord's party still has the abolition of this House as part of its programme or policy. No doubt the noble Lord will make his own view—it is very obvious—known in the relevant quarters. If he requires any assistance in so doing from this side of the House, I for one am wholly at his disposal.

Finally, I should like to thank my noble friend Lady Trumpington. She has a most characteristic—if you like, idiosyncratic—method of handling legislation that is quite extraordinarily effective. She seems to get it through with the minimum of ill will and with the minimum of waste of time. I am not really clear how she does it. I would have gone further in this respect but for the warning a few moments ago given by the noble Lord, Lord Harris of High Cross, about the dangers of flattery. I shall therefore wrap it up a little by recalling the incident of the young man, who taking a girl home one evening from a party, suggested that she called at his flat to inspect his stamp collection. The reply was. "Young man, philately will get you nowhere."

Lord Cullen of Ashbourne

My Lords, I should like to thank the Government for the way that they responded to arguments on Clause 4 put forward by my noble friend Lord Mottistone and myself, and supported by the noble Lord, Lord Ennals. The compromise that was reached is, I know, considered fair by many opticians to whom I have spoken. I should like particularly to thank my noble friend Lady Trumpington for the part—I suspect, the large part—that she played in achieving the compromise.

Lord Carmichael of Kelvingrove

My Lords, I hope that I shall not raise an unpleasant note when everyone is so happy that the intentions of the Bill are, by and large, good. I wish to make some comments which I hope will take only a couple of minutes. I apologise to the House and to the noble Baroness for the fact that I was not able to participate in last week's debates. I was indisposed and had to go home early. I hope that I have now more or less recovered.

I wish to deal with the amendment that the noble Baroness proposed to Clause 5. I received strong representatons from a number of bodies in Scotland—the clause really applies only to Scotland—that I feel that I must raise with the noble Baroness. Clause 5, 13A., deals with voluntary organisations that provide services to those mentioned at the beginning of the clause. But no definition is given of the type of voluntary organisation involved. This seems to be lacking. If there is to be joint planning alongside statutory bodies, some indication should surely be given of which voluntary organisations are included.

The same clause should contain, I believe, in subsection (1)(c), an obligation to publish reports. Instead, there is a rather loose direction For the publication of joint plans at such times and in such manner as the bodies who have made joint plans … consider appropriate". These important bodies should surely be required to produce, in some schematic way, reports so that the public will be able to understand whether or not progress is being made.

Clause 5 13B states that the Secretary of State may. after consultation, with health hoards set up joint liaison committees. There is no compulsion. But there is great necessity to bring about co-ordination in respect of services for, consultation with, and representation of the disabled in the community. I believe therefore that there should be something mandatory. I hope that the Minister will think seriously about issuing a code of practice on the progress on the setting up of these bodies so that the disabled, the elderly and others, can be reassured, or otherwise.

I hope that I am not going outside the custom of the House in asking questions at this late stage. But the amendment was put down very late. Owing to the circumstances that I have explained, this is the only opportunity that I have had to raise these points. I hope that the Minister will take the opportunity either to reply to some of those points now or that she will write to me later.

6 p.m.

Lord Kilmarnock

My Lords, I think we are all agreed that the Bill leaves this House distinctly improved. The noble Baroness's claim to have behaved in a flexible and responsible manner is, I think, largely justified. We have also had the notable example of a new axis formed between the noble Lord, Lord Boyd-Carpenter, and the noble Lord, Lord Ennals.

As my noble friend Lord Winstanley said, we are delighted that the Government have broadly accepted the new clause on health and safety at work, although he expressed a reservation to which it will be interesting to hear the noble Baroness reply.

The Government also took account of the disquiet expressed on both sides of the House on the composition of the proposed sub-committee of the family practitioner committee. I, with the noble Lords, Lord Ennals and Lord Prys-Davies, proposed a slightly different balance with seven voting members, three of whom were to be non-contracting pharmacists. This is rather different from the government proposal to have only five voting members, with two non-voting contracting pharmacists. As my noble friend Lord Winstanley said on Report, a vote may be a rarity and we must simply see how the Government's proposed structure works.

On those grounds, I think that the House can congratulate itself on having performed its revising function commendably. However, there is one other matter on which I must touch before the Bill leaves us. It is the question of the essential small pharmacies in Scotland, to which I referred in Committee and on Report and which was addressed by the noble Baroness's noble friend Lord Glenarthur on Report. Despite the noble Lord's reply on that occasion, I still find it hard to see why Scottish essential small pharmacies are being treated so ungenerously. I have received quite a lot of correspondence on this topic, as, I believe, has my noble friend Lord Taylor of Gryfe. A letter from a Scottish chemist today accepts that only one pharmacy in Scotland will be £11,000 a year worse off than its English equivalent, but complains that the average Scottish ESP could still be £7,000 worse off than its equivalent south of the border.

The noble Lord, Lord Glenarthur in this speech on 28th October, said (at col. 698): The Government are contributing the same proportional amount of support to the schemes on both sides of the Border". However, that takes no account of the point I made, which was that the proportionality was not fair because of the difference in the percentage of ESPs between Scotland and England and Wales. South of the Border only some 2 per cent. of all pharmacies are ESPs, while in Scotland this rises to 4.4 per cent. for obvious geographical reasons. There is thus a much larger professional pool to fund essential small pharmacies south of the Border than north of it. That is why the Scots need proportionally more help to fund their scheme, particularly if it is to expand. I think that the noble Lord, Lord Glenarthur, did not take that argument into account in reply to me on Report. I hope that it will be taken into account on this occasion.

One of the main attractions of the Bill to my colleagues and myself, and perhaps one of our main reasons for deciding to support it, was our hope that it would lead to more essential small pharmacies in areas of multiple deprivation such as outlying city housing estates. If the Scots do not get a bit more in the kitty for essential small pharmacies, they have no means and no hope whatever of achieving any expansion of pharmacies in such areas.

We are not talking about a very large sum. My suggestion on Report was that in Scotland the Government should match the £120,000 that the profession is offering to the scheme by an equivalent amount, which means raising their current offer by £60,000. This would allow slightly fairer treatment to Scottish pharmacies and permit a modest expansion of ESPs. The noble Lord, Lord Glenarthur, replied that that would totally upset the arrangement for on-costs and other details which are different in Scotland and which Scottish chemists want to keep, but I cannot for the life of me see why a very small additional subsidy for Scottish essential small pharmacies should drive a coach and horses through these other arrangements unless the Government decide that it should. I can see no rhyme or reason for such a decision if the Government genuinely want to secure an improvement of pharmacy services in deprived areas, which I understood was one of the main motivations behind the Bill.

We can do nothing about this by way of amendment because none of this is in the Bill and negotiations are still taking place. However, I have no doubt that my colleagues north of the Border will continue to make a fuss about this, and rightly so, if negotiations do not at least produce an acceptable compromise. We all know what happens when the Scots make a fuss. It is usually a very considerable fuss, as it was over rateable values. The Government would be well advised to set aside the very small annual sum that I suggest to encourage a small expansion of pharmaceutical services in deprived areas.

I hope that the noble Baroness will convey this modest proposal to her colleagues at the Scottish Office for further consideration. As I said, there is nothing that we can do in the Bill, but the matter will not go away. I hope that in everyone's interest, including their own, the Government will give it further thought.

With that reservation, we on these Benches wish the Bill a fair wind when its provisions are translated into action. We shall of course want to keep a close eye on its operation.

Lord Taylor of Gryfe

My Lords, I apologise for delaying the House on this matter, but I was not present when your Lordships discussed it previously, although I raised the question of anomalies in the compensation for essential Scottish pharmacies in Committee.

As the noble Lord, Lord Kilmarnock, has stated, the Scottish ESPs will be £7,000 worse off than those south of the Border; £16,000 compared to £23,000. In order to correct that glaring anomaly, the figures are as follows. To bring them into line requires a payment of £270,000, minus the amount that the contractors have agreed to pay the other chemists of £120,000, minus the amount that the Government have offered to provide so far, £55,000; and so to correct this glaring anomaly would cost the Government £95,000.

I do not wish to open up the debate at all, but I should very much welcome it if at this late stage the noble Baroness could make some hopeful noises in that regard, keeping in mind that whatever is said will be subject to negotiation, although the negotiations have been going on since August. If she will respond to the plea made by the noble Lord, Lord Kilmarnock, it would help me, because last night I received late representations from my local pharmacist raising this matter very seriously. I hope that I may be given some assurance.

Baroness Trumpington

My Lords, I should like, if I may, to reply first to the noble Lord, Lord Winstanley. His interpretation of the clause is perfectly correct. The noble Lord, Lord Carmichael, I hope will forgive me if I do not reply to such a detailed matter at this late stage of the proceedings. I trust that he will be content with a letter from me.

With regard to the noble Lords, Lord Kilmarnock and Lord Taylor of Gryfe, my noble friend Lord Glenarthur said on Report that an assurance had been given that no essential small pharmacy in Scotland would be worse off under the new scheme which is still being negotiated. I note the noble Lords' words and I will make sure that they are passed to the right quarter.

Finally, I thank noble Lords for their kind welcome to the Bill and their sweet words about me. I thought that my noble friend Lord Boyd-Carpenter was going to tell the story of the Scotsman who was walking his girl home and asked her to marry him. She accepted with alacrity. They walked on in a deathly silence, and the girl asked, "Why are you so silent, Jock?", to which Jock replied, "I'm thinking I've said too much already".

On Question, Bill passed, and returned to the Commons with amendments.