National Health Service: Specialised Treatments (Hansard, 22 April 2004)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)
My Lords, all primary care trusts are now actively involved in one of the 26 local specialised Commissioning groups set up across the country. As members of these groups, PCTs work together to Commission specialised services. This year's work programme for each Commissioning group demonstrates that a substantial number of specialised services are now being planned collectively. For certain specialised services where the financial risks are high, collective funding arrangements are in place, including financial risk-sharing between PCTs.

§ Baroness Masham of Ilton
My Lords, I thank the Minister for that reply. Is he aware that the Specialised Healthcare Alliance and the Royal College of Physicians are concerned that while some PCTs are doing their job well, others are inadequate? Does he agree that postcode prescribing for specialised services is unacceptable, when it can be a matter of life and death, and of quality of life for patients?

§ Lord Warner
My Lords, I am aware of the survey that the noble Baroness mentioned, although I have not read it, because I understand that it is still in draft form. We welcome the broad findings of that survey, which was carried out by the Specialised Healthcare Alliance. It shows that a good start has been made by PCTs to work together to Commission specialised services. It makes the point that a number of improvements can be made. We shall be looking at those suggestions carefully, and we hope to respond to them positively. The Government have made clear our position on postcode prescribing, and we are taking action to try to improve the implementation of NICE guidance in that area.

§ Lord Ashley of Stoke
My Lords, is my noble friend aware that the Audit Commission and the Commission for Health Improvement have both said that some primary care trusts lack management capacity, basic information and the capacity to monitor their output? In view of these well informed comments, would not the best way forward be to focus on improving these aspects of the work of the primary care trusts?

§ Lord Warner
My Lords, I recognise the points made by my noble friend, but as my Answer made clear, we have made big steps forward since the Government issued guidance in March 2003 in the area of specialised Commissioning. I accepted, in response to the supplementary question asked by the noble Baroness, Lady Masham, that improvements could be made that have come out of the survey. We will be taking those forward. I do not accept, however, that PCTs are not working together now to improve the way in which they collectively Commission specialised services.

§ Baroness Gardner of Parkes
My Lords, is the Minister aware that one of the real difficulties is where a small specialty is involved? Is he aware of the situation at Hammersmith hospital regarding pulmonary hypertension? Although this is meant to be funded through the regional specialised Commissioning group, unfortunately it has not considered it a priority, although it has a national designation. There must be other similar specialties where small numbers of people are suffering from a highly dangerous condition that is expensive to treat. What special arrangements are made for these people?

§ Lord Warner
My Lords, there are two tiers of specialised Commissioning. There is Commissioning in relation to specialties where the catchment area is 1 million to 2 million people, and there is another area where the specialised Commissioning is done for catchment areas of 3 million to 6 million people. At the national level, there are very few rare diseases that are nationally Commissioned, but these are where the treatments are extremely expensive. I do not have information on the position in Hammersmith, but I will look into it, and I will write to the noble Baroness.

§ Baroness Hayman
My Lords, may I declare a non-financial interest on taking up the chair of the Specialised Healthcare Alliance, which comprises 26 patient groups affected by these regulations? Is my noble friend satisfied 381 with the role that strategic health authorities are playing at the moment in the monitoring of these arrangements? Does he agree that they must be effectively engaged if the arrangements are to be equitable for patients across the country?

§ Lord Warner
My Lords, as the noble Baroness mentioned, the survey suggests that improvements could be made in the way in which strategic health authorities are pursuing their role in this area. We accept that, where there is a need to make improvements, they should be made. It is certainly the role of the strategic health authorities to monitor the performance of all the trusts in their area.

§ Lord Addington
My Lords, does the Minister agree that there is some concern about where specialist services fall and about the position of different types within existing patterns for purchasing products? Will the Government keep that under review, and when will we hear the results of any such review?

§ Lord Warner
My Lords, the Government keep such issues under review, which is why we will study carefully the findings of the specialised Commissioning survey that has been mentioned on several occasions. I could delight your Lordships' House with a large number of splendid examples of good specialised services Commissioning. I could mention the east Midlands and South Yorkshire, where the 13 PCTs come together; the 30 PCTs doing good work in the West Midlands on haemophilia and pulmonary hypertension; or the good work going on in London in genetics, haemophilia and sickle-cell screening. There are many more such examples, and we should not give the impression that good Commissioning of specialised services is not going on.

§ Baroness Wilkins
My Lords, is the Minister aware that those good Commissioning arrangements are not working effectively for people with a spinal cord injury? The Spinal Injuries Association helpdesk receives many inquiries from people who have spent a long time in a general hospital and have developed severe complications—MRSA, pressure sores and so on—as a result. Treatment for people with a spinal cord injury has deteriorated rapidly under the new arrangements.

§ Lord Warner
My Lords, there are 11 spinal injury units in the UK, including eight in England. It is the responsibility of SHAs and primary care trusts to assess the healthcare needs of their population and Commission services in this area. I am aware that there has been a little trouble in Stoke Mandeville, but those issues have been resolved. The Government have done much to improve services in this area.

§ Earl Howe
My Lords, is the Minister aware that one of the problems with specialised Commissioning that does not appear to have been brought out by the survey is the bureaucratic nature of the application process? Before a doctor can prescribe a treatment, he 382 or she must, if the treatment is expensive, apply to the PCT for approval for the treatment. That application process is extremely bureaucratic and imposes a delay that, in some cases, may be life-threatening. Will the Government examine that concern seriously?

§ Lord Warner
My Lords, we have shifted the balance of power so that it is down to the PCTs to decide priorities in their area and their system. I take note of what the noble Earl said, but we must accept that local priorities are the order of the day.