Health Bill [HL]

My Lords, I shall speak also to Amendment 65. In Grand Committee, a number of us raised concerns about the rolling out of pharmaceutical needs assessments and, in particular, what we saw as the lack of readiness within PCTs to implement the new system in the way that the Government clearly intend. The noble Lord, Lord Faulkner, and I expressed the worry that PCTs are not yet well equipped to gauge the needs and preferences of those who live in rural and less densely populated areas. A few months ago, the Government published a White Paper, Pharmacy in England: Building on Strengths—Delivering the Future. I thought that it was a very well written document but in it the Government made a very frank admission about PCTs in relation to pharmaceutical needs assessments. They said that there was, ""considerable variation in the scope, depth and breadth of PNAs"." We can read between the lines on that. They went on to say: ""The Government, however, concludes that commissioning development within PCTs is not yet at a stage where PCTs can be charged with full responsibility for contracting. A different approach is required while important developmental work to build commissioning systems and structures is under way"." My concern is that the Government now appear to be formalising a process that is not yet fit for purpose. Unfortunately, I do not think that it is being oversensitive or overcritical to sound a note of warning about PCTs’ competence in this area. In Grand Committee, I highlighted the concern about the ability of PCTs to commission enhanced and advanced services. Data from the NHS Information Centre tell us that between 2006-07 and 2007-08 the number of out-of-hours services commissioned by PCTs from community pharmacy declined by 9 per cent; in the same period the number of home delivery services commissioned from pharmacy declined by 47 per cent; and only 138 community pharmacies out of more than 10,000 were commissioned to provide prescribing services to GPs. Those figures do not tell one that PCTs are very adept at implementing change with the necessary element of speed. Noble Lords who read the Pharmaceutical Journal may have seen a recent article which lambasted two particular PCTs in the Home Counties, which I shall not name, for the snail-like pace at which they deliberated and then further deliberated over the provision of emergency hormonal contraception, a service that is already accepted as an enhanced community pharmacy service to be rolled out nationally. The same PCTs came up with a bizarre formula for promoting smoking cessation services, which made no sense at all to the local LPC. On PNAs, I am worried that we simply do not yet know enough about how the needs assessments will actually work. It will take time for PCTs to get up to speed with them, just as it has in other fields of activity. The amendment that I spoke to in Grand Committee would have obliged PCTs to take into account the needs of rural populations when carrying out a pharmaceutical needs assessment. One runs into difficulties when trying to define what "rural" really means in this context, so I have not brought that amendment back again. Instead, I have tried to reflect the underlying concern voiced by a number of noble Lords, which was the perceived risk to dispensing doctors posed by the PNA process. We know very well how highly valued the services of dispensing doctors are to communities in less densely populated parts of the country. The fear is that, in allowing a new pharmacy to open in a particular area, a PCT may not fully take into account the impact that that may have on existing services delivered by dispensing GPs. About 4 million people are currently looked after by such GPs and, while I would not want to suggest that the livelihoods of dispensing doctors should be insulated against all possible competition, the knock-on effect of a narrowly based PNA decision could be very serious. Three months ago, the Commission for Rural Communities published a bulletin in which the special challenges of delivering healthcare in remote rural areas were well articulated. Although on average those who live in rural areas have a high quality of life, the poorest and most disadvantaged residents, of whom there are many, experience consistently lower levels of physical and mental health. To make life more complicated, much of this rural deprivation is hidden. The rural elderly are not only more reliant on health services but also reluctant to use them because of the long travel times involved. Public transport, as we know, can be quite poor. It is significant that GPs and community nurses undertake more home visits in rural areas and see a lower number of patients per day than their urban counterparts, largely because of travel distances. Also, out-of-hours services may be located further afield than is ideal. At the back of it all is the funding formula: per capita NHS funding for more affluent rural areas is 30 per cent lower than it is for more deprived urban areas. That is because the age profile of different areas has considerably less weight in the funding formula than is perhaps appropriate and right. This is not an amendment that is appropriate to press to a Division. However, I would ideally like an assurance from the Minister that the regulations to be published on this subject will include a mandatory requirement that the needs of rural populations, the needs of the elderly and the needs of the disabled must be fully taken into account in future PNAs. I hope that this is something that can be considered. I beg to move.