HL Deb 27 June 1995 vol 565 cc601-3

2.48 p.m.

The Countess of Mar asked Her Majesty's Government:

Whether they will make an allocation of central funds to enable general medical practitioners to refer patients suffering chronic symptoms after exposure to toxic chemicals to consultants with specialist knowledge and facilities for the purposes of diagnosis and treatment.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, the Government allocate resources to health authorities to enable them to purchase healthcare for their local populations. It is already possible for GPs to refer patients suffering chronic symptoms of toxic poisoning for specialist treatment.

The Countess of Mar

My Lords, does the noble Baroness appreciate that the medical profession is the first to admit that it knows little about the chronic effects of toxic chemical exposure? Does she understand, too, that extra contractual referrals are extremely difficult in some cases because the GPs do not understand the history of the patients? It can also happen that the paying authorities—a health authority, for example—will not allow ECRs for various reasons. Will the Minister consider setting up supraregional units, perhaps using the West Country as a model, with another, say, in Glasgow, followed by other regions? GPs could then refer patients to consultants not just for organophosphate poisoning but for poisoning by the many thousands of chemicals and combinations of chemicals in use today.

Baroness Cumberlege

My Lords, on the first point, the noble Countess will be aware that much research is going on. She is quite right; there is a lot more that we need to learn about organophosphates and poisoning generally. As to the second point, only 2 per cent. of all referrals are ECRs and there are few reasons why they should be refused. If patients feel they are not receiving the service they need, they always have the option of asking for a second opinion.

On the third point, I have just received a paper from the noble Countess which outlines regional proposals for an assessment and investigation unit. I received it about 20 minutes ago. It is an interesting proposal that I would wish to pursue with officials.

Baroness Masham of Ilton

My Lords, will the Minister examine an individual case with which I have been dealing from the Harrogate health district? It is of a farmer who is suffering from organophosphate poisoning and the health authority has refused to pay to send him to a specialised unit. He was accepted by both Glasgow and Guy's hospital in London, but the authority refused to pay because his case was considered to come under the heading of research. It said that it could not be sure that there would be any clinical help.

Baroness Cumberlege

Yes, my Lords, I should be delighted to pursue any individual case. I am surprised that the person was refused treatment; it is something I shall investigate.

Baroness Jay of Paddington

My Lords, does the Minister agree that the noble Countess has rightly drawn attention to a new and serious health problem? If dogma about extra-contractual referrals and the operation of the internal market prevent the Government giving central funds to help to promote proper care, will they consider funding research from central NHS funds under the NHS R&D programme?

Baroness Cumberlege

My Lords, I remember that when the internal market was first introduced, there was real concern about ECRs, particularly from the noble Baroness opposite. Those fears have not been justified. When we have problems we pursue each one so that we know their extent: it is minimal. Much research is going on at the moment. There are tenders out from the department for research institutes wishing to pursue the subject and put forward proposals.

Baroness Robson of Kiddington

My Lords, I accept the Minister's reply about extra-contractual referrals. However, is it not above all important that the average general practitioner be given greater information and education in order to recognise the symptoms before he can even begin to refer the case?

Baroness Cumberlege

My Lords, toxicology is covered in the initial training of doctors. There are also postgraduate courses available of which doctors can avail themselves. Indeed, the department produced a hook, Pesticide Poisoning, which was published and circulated. On two occasions the Chief Medical Officer has written to all doctors in England explaining the problem. On the last occasion, the letter was also signed by the chief executive of the Veterinary Medicines Directorate. So we are trying to give the issue maximum exposure. However, it is important that research is carried out. That is exactly what the Government are doing.

The Countess of Mar

My Lords, does the noble Baroness appreciate that the papers and letters to which she referred all deal with acute poisoning by toxic chemicals? There is nothing about the effects of chronic poisoning. Secondly, I have received a number of complaints about the failure of ECRs. If I give the noble Baroness a list of the problems, will she kindly investigate them for me?

Baroness Cumberlege

Yes, my Lords.