Domiciliary Oxygen Services (Hansard, 12 June 2003)

§ Baroness Andrews

In 1999 the Department of Health asked the Royal College of Physicians to lead a multidisciplinary working party to devise new clinical guidelines for the use of domiciliary oxygen. Although the working party's terms of reference precluded making specific recommendations about alterations in service provision, a number of the guidelines had implications for the content of the existing domiciliary oxygen service and for the way in which the service is delivered. It was clear, therefore, that this vital resource—that has seen only one significant change, the introduction of oxygen concentrators, in the past 50 years—had become out of date, both in terms of the service offered to patients and its cost effectiveness. It was against this background that the then Parliamentary Under-Secretary of State, my noble friend Lord Hunt of Kings Heath, directed that a review of the domiciliary oxygen service should take place.

This review is now complete and we are ready to move forward to create a modernised and integrated service for the provision of domiciliary oxygen.

At present domiciliary oxygen is ordered for patients by general practitioners. The service consists principally of the provision of oxygen either from large cylinders supplied by community pharmacies, or delivered by way of an oxygen concentrator, installed in the patient's home by a contractor.

The modern, integrated service that is proposed represents a considerable advance on this organisational and service model. The new model will transfer responsibility for ordering oxygen for long-term oxygen therapy from general practitioners to specialist consultants in hospital. This will relieve general practitioners of the bureaucratic burden of writing prescriptions, effectively on the direction of 68WA hospital doctors. (Patients who need long-term oxygen will invariably have their needs assessed by hospital staff). The hospital consultant will decide, in discussion with the patient, what the patient's needs for oxygen are. For example, many patients would benefit from having oxygen available in a form that allows them greater freedom of movement both in and outside the home than is possible with large cylinders or oxygen concentrators. General practitioners will continue to be able to prescribe oxygen for patients who need small amounts of oxygen.

Once the hospital consultant or general practitioner has discussed and determined the patient's need for oxygen, it will be the responsibility of contractors to work closely with the patient and decide what technology—that is, what type and method of oxygen supply—will best suit the patient's therapeutic need, and to provide it. These specialist contractors will be well placed to keep pace with developments in the technical aspects of service delivery, so patients will benefit from advances in technology as they are developed.

Thus the modernised integrated service represents a sensible division of responsibility in the provision of domiciliary oxygen services. It places clinical responsibility for assessing oxygen need with doctors, and places technical decisions on the best and most up-to-date method of delivery with service contractors.

Over the next few months a specification for the provision of the integrated service will be drawn up. Contractors will be invited to tender against this specification and contracts will be let. It is expected that the integrated service will be fully operational early in 2005. The current arrangements for the provision of domiciliary oxygen will continue as at present to cover this transitional period.