§ 2.41 p.m.
§ Lord Hunt of Kings Heathasked Her Majesty's Government:
What advice they give to health authorities on the funding of support services for those suffering from muscular dystrophy.
§ Baroness Ramsay of CartvaleMy Lords, we are committed to providing patients with a modern and dependable NHS. Quality of care to patients is the first priority. The changes which we put in place will support that principle. Integrated care, based on partnerships, will replace the internal market and provide a more holistic approach to care for patients with neurological conditions such as muscular dystrophy. The White Paper, The New NHS, promised that new arrangements for commissioning specialised services would be in place by April 1999. A draft guidance document, covering both what the new arrangements should look like and which services should be covered, was issued in the week beginning 6th April, with a deadline for responses by 1st June.
§ Lord Hunt of Kings HeathMy Lords, I thank my noble friend for her encouraging response. Does she agree that with the introduction of primary care groups there may be a problem with those groups providing sufficient support to the charities concerned because of the relatively small number of patients with which each primary care group will be involved? Will the Government consider offering guidance in this area?
§ Baroness Ramsay of CartvaleMy Lords, we intend to move from annual contracts to longer term agreements. These agreements, which will reflect dialogue between clinicians and will focus on health improvement and quality objectives, will increase the emphasis on programmes of care that cross traditional boundaries to meet patients' needs best. Health authorities will have lead responsibility for drawing up health improvement programmes which will bring together the NHS, local authorities and other important actors to secure improvements in health and healthcare. Primary care groups will be involved in both the development of health improvement programmes for their local population and, in the future, in commissioning services from local providers in line with these programmes. Guidance on the establishment of primary care groups was issued in April and further guidance on the development of commissioning by primary care groups will be issued in due course.
Lord Campbell of CroyMy Lords, as a vital support service for muscular dystrophy is an efficient wheelchair system, do the Government consider that needs are being met satisfactorily all over the country; and if not, will they encourage co-ordination and the dissemination of good practice within the more than 150 different wheelchair services that now exist?
§ Baroness Ramsay of CartvaleMy Lords, I know that the noble Lord will be well aware that the Muscular Dystrophy Group was a leading participant in the effective campaign, "Batteries not Included". I understand that the noble Lord, Lord McColl of Dulwich, among others, was a participant in that campaign. As a result of that, the NHS executive introduced electrically powered, indoor, outdoor wheelchairs (EPIOCs) to the NHS at a cost of £27 million over four years. In December 1996 guidance was issued to health authorities, trusts and wheelchair services 1026 setting out how the initiative should be implemented. The provision of EPIOCs is accelerating but the funding is incremental. With regard to the thrust of the noble Lord's question, not all needs or expectations can be satisfied immediately. We can only do our best.
§ Baroness Gardner of ParkesMy Lords, I do not know whether the rest of the House is as amazed as I am, but it appears to me that the responses we are being given by the Minister do not apply to the Question on the Order Paper. I must ask the noble Baroness to answer the Question on the Order Paper which states,
To ask Her Majesty's Government what advice they give to health authorities on the funding of support services for those suffering from muscular dystrophy".If the answer is that they give no advice but leave the matter entirely to local health authorities, the Minister should at least say that.
§ Baroness Ramsay of CartvaleMy Lords, I am sorry the noble Baroness is not pleased with my replies; the person who tabled the Question seemed to be satisfied. The whole situation is changing. I thought I had made that extremely clear in my first two replies. I said in my first Answer that the draft guidance covers what the arrangements for commissioning specialist services should comprise and which services should be included. The draft guidance sets out as a starting point the long list of specialist services mentioned by the Audit Commission in its report Higher Purchase. That list will clearly need some amendment—additions, deletions and refinements—before the final guidance is issued.
I have been asked to consider what constitutes specialist services, and what should be included. The aim is to be as inclusive and cover as broad a range as possible in the consultation on the draft guidance. The document has been widely circulated. Recipients have been asked to suggest anyone they think has been wrongly omitted from distribution. The pack has been published on the NHS Internet site. The whole matter of guidance for groups such as the Muscular Dystrophy Groups is at the heart of the draft guidance which at the moment is subject to consultation. As I said, the system is changing.