HL Deb 05 June 2000 vol 613 cc922-4

3.6 p.m.

Lord Walton of Detchant asked Her Majesty's Government:

Whether the replacement of extra-contractual referrals (ECRs) by out-of-area transfers (OATs) has been successful in making highly specialised treatment in the National Health Service available to those in need.

Lord Hunt of Kings Heath

My Lords, extra-contractual referrals were abolished because they encouraged ad hoc provision of varying standards. In their place, new regional arrangements and long-term service agreements are being established to enable fair access to clinically effective and cost-effective services. Out-of-area treatments have been introduced mainly for emergencies. Therefore, out-of-area treatments are not intended as a direct replacement for ECRs.

Lord Walton of Detchant

My Lords, I thank the Minister for that reply. Does he accept that one of the great strengths of the National Health Service, in which I used to work, was the fact that people who required highly specialised treatment could be referred to centres of excellence without constraint? That possibility declined sharply under the system of extra-contractual referrals. We now have evidence that out-of-area treatments or transfers are failing to satisfy the need for such specialist treatment in special cases. I give as an example the case of a young boy, aged 12, with cerebral palsy. On medical recommendation, he needed an intrathecal transplant. He was refused such a transplant because he could not be referred from his own health authority to the appropriate centre of excellence. The money was found by a charity and eventually the transplant was carried out privately.

Lord Hunt of Kings Heath

My Lords, I wish to make two points. First, in 90 per cent of cases the extra-contractual referrals have been replaced by long-term service agreements. I believe that more stability is achieved through long-term service agreements than through a system of one-off extra-contractual referrals, in which there was great instability.

So far as concerns the need for special services, I very much agree with the noble Lord that it is important that we invest in those services. Equally, we need a rational system of decision-making as to how they should be funded and to what extent. I believe that the new speciality commissioning that we have introduced at national and regional levels allows for that.

Lord Clement-Jones

My Lords, the Minister will recall that the department published new guidance on out-of-area treatments only two weeks ago. Despite its incredibly opaque language, it is clearly designed to discourage referrals to specialist out-of-area hospitals. Yet, can the Minister confirm that GPs still have absolute discretion to refer their patients to the hospital that they believe is best for the treatment involved? Will the Minister undertake to amend the circular to that effect?

Lord Hunt of Kings Heath

My Lords, I am disappointed that the noble Lord uses the term "opaque" when referring to a Department of Health circular. So far as concerns the substantive points that he raises, of course, clinical freedom remains as it always has done. The point about out-of-area treatments is that they are concerned mainly with out-of-area emergencies. We are developing a system of long-term service agreements which will ensure that stability, certainty and agreement exist among health authorities and primary care groups as to which specialist services should be funded and by how much. I believe that that is a much more effective system for the future than we ever had in the past.

Lord Pilkington of Oxenford

My Lords, given that the criticisms of the noble Lord, Lord Walton, have been levelled by many more professionals in the health service and the Government have been in power three years, why do they find it necessary to have a summit? What will that summit do?

Lord Hunt of Kings Heath

My Lords., the summit is meeting at this very moment and I am sure that it will have important discussions about the future development of the NHS. Surely it is better that decisions about specialist services and their funding are made in regional specialty groups and by the national specialty commissioning process, so that proper choices are made about where resources should be spent and services developed. That is a much better, more rational system than the ad hoc arrangement we inherited.

Lord Clement-Jones

My Lords, is not one problem with the new payment system that some specialist hospitals that were particularly reliant In the past on the ECR arrangement now find that their income lags behind their activity by as long as three years. As a result, they face considerable financial instability. Does not that pose a significant risk to the continuation of some specialist services and the development of new services?

Lord Hunt of Kings Heath

My Lords, in the first year of operation there were problems with some specialist centres that were, perhaps, over-reliant on out-of-area treatment income, where the time lag was clearly a factor. We have given clear instructions to regional offices that they are to manage the situation effectively. As the system develops, less and less of that resource will come from out-of-area treatment because centres will be covered by long-term service agreements. That is the most appropriate way forward for the centres.