HL Deb 15 June 1989 vol 508 cc1635-7WA
Lord Shepherd

asked Her Majesty's Government:

Following the White Paper Working for Patients, what steps they are taking to ensure that the national screening services for breast and cervical cancer will not suffer as a result of the devolution of the health service; and whether they will ensure that the highest quality radiotherapy services will be available to those who need them for curative and palliative purposes.

Lord Henley

Under the Government's proposals, health authorities will primarily become purchasers rather than providers of care, which will make them more free to look at their wider public health role. They will have a clear responsibility to determine the health needs of their residents and to ensure that these are met. Screening will play an important part in health authorities' strategies for the prevention of ill health and we would expect them to continue to implement the national breast and cervical cancer screening services.

The provision of radiotherapy services is the responsibility of health authorities. The Government will continue to take whatever steps are necessary to enable them to provide the highest possible quality of service.

Lord Shepherd

asked Her Majesty's Government:

How they will ensure that patients requiring expensive drug treatments (in particular, cancer patients), are not denied treatment because of the potential drain on the budgets of their GPs and that there will be no economy of diagnostic or treatment services to the detriment of patients.

Lord Henley

Indicative prescribing budgets for general practitioners and practice budgets for those larger practices which opt for them will be set at sensible and realistic levels and in discussion with each practice to reflect the needs of patients in that practice. This will include the needs of patients requiring expensive drug treatments (including cancer patients) where the general practitioner has clinical responsibility. There will therefore be no question of any patients not receiving the drugs or treatment they need.

Lord Shepherd

asked Her Majesty's Government:

Whether, following the White Paper Working for Patients, they will ensure that patients' choice is not restricted through the negotiation of contracts by GP practices and district health authorities, nor subject to restriction of contingency monies for treatment outside these contracts.

Lord Henley

District health authorities will be working closely with FPCs and GPs in their districts to ensure that the new contractual arrangements reflect the preferences of GPS and their patients. The determination of the size and deployment of the contingency reserve for extra-contractual treatments will take full account of precisely the same considerations.

Lord Shepherd

asked Her Majesty's Government:

What incentives they will provide to ensure continued funding for research in all aspects of patient diagnosis and treatment following the National Health Service (NHS) review.

Lord Henley

The main agency through which the Government supports clinical and biomedical research is the Medical Research Council. Its budget has been increased by 12 per cent. from £ 150 million in 1988/89 to £176 million in 1989/90. The White PaperWorking for Patients contains a commitment to ensure that the service costs to the NHS of medical research are met without putting one hospital at a competitive disadvantage compared with another.

Lord Shepherd

asked Her Majesty's Government:

Whether they plan to employ specialist managers (such as superintendent radiographers) in the NHS to ensure the best technical management of services; and whether this will ensure the best and most efficient services to patients.

Lord Henley

It is for individual NHS employers to determine the appropriate management arrangements to secure the best and most efficient service to patients, within the framework of central guidance.

Lord Shepherd

asked Her Majesty's Government:

Whether patients who have access to large GP practices which successfully negotiate favourable contracts are likely to receive a better service than those elsewhere; and, if so, what they will do to prevent such a "two-tier" system coming about.

Lord Henley

All practices which can demonstrate the necessary management capabilities will be eligible to apply to become practice budget holders. Practices with a list size of less than 11,000 patients may group together with other practices for this purpose. Budget holders should certainly be able to improve the service to their patients through the new freedoms of individual purchasing power, financial virement between different parts of the budget and referral to private as well as NHS hospitals which the scheme will confer. The Government's policy is to allow GPs to opt for budget holding status rather than impose the system on all GPs, which would be the only way immediately to universalize its benefits. GPs will of course be able to apply to join the scheme at any date.

Lord Shepherd

asked Her Majesty's Government:

Whether they plan any consultations with the College of Radiographers concerning the possible overuse of radiation in health care, and other matters connected with the provision of an efficient service to patients.

Lord Henley

Yes. These are matters in which the Government take a continuing interest and on which they will continue to consult the relevant professional bodies, including the College of Radiographers, as necessary.

Lord Shepherd

asked Her Majesty's Government:

How they will in future ensure that temporary and accident and emergency patients have as ready and immediate access to GP and hospital treatment as they now have; and whether there is a danger that the treatment provided will be adversely affected because the GP or hospital which accepts the patients for treatment will bear the costs.

Lord Henley

All patients will continue to receive immediate access to emergency treatment wherever it is needed. Where treatment is provided by a GP—with or without a practice budget—that GP will continue to receive a "temporary resident's fee". Where hospital treatment is needed, it is proposed that the cost of emergency admissions which do not require in-patient care should be borne by the hospital treating the patient. Provision for this would be included in hospitals' contracts for core services. Where in-patient treatment is necessary, it is proposed that the hospital should charge the cost to the patient's district of residence. There is no reason why these arrangements should adversely affect the quality of care provided.

Lord Shepherd

asked Her Majesty's Government:

Whether, following the White Paper Working for Patients, they are satisfied that patients and their relatives will not be expected to travel unreasonable distances for treatment or to visit those undergoing treatment.

Lord Henley

Yes.