Health and Social Care Bill

My Lords, I speak to Amendment 239A tabled in my name. The Minister will remember the protracted debates surrounding the drug tariff and the concerns of the thousands of people who use a wide range of incontinence products and services. As anyone who knows what life is like if you have to depend on the reliability of a stoma bag or a catheter, these products and services provide the bedrock of our dignity. Soiling ourselves in public is one of the deepest fears we all share, and despite the dry sound of the wording—I forgive the unintended pun there—this is what the amendment is about. The months and years of negotiation around the drug tariff were finally resolved, but concerns have now been renewed with this Bill. Currently, it is the Secretary of State’s duty to set the drug tariff’s national framework. This sets the price and standards of prescription products such as stoma appliances, and the fees that pharmacies and appliance contractors can charge for their services, such as a home delivery service. But now the Explanatory Notes to the Bill suggest that, in the future, the drug tariff will be split. The NHS Commissioning Board will determine the level of fees and allowances paid for pharmaceutical services, while the Secretary of State will determine the reimbursement price for actual products. This amendment would require the NHS Commissioning Board to consult with appropriate representatives of patient groups and the industry before determining the payments. It is a probing amendment to get clarity on the relationship between the Secretary of State’s powers to set national frameworks and those of the NHS Commissioning Board in relation to pharmaceutical expenditure. There are concerns that changes to this system and any reduction in the Secretary of State’s powers to set national pharmaceutical reimbursement and remuneration will lead to the potential fragmentation of services across the country and deteriorating quality of care, with patients unable to get the products they need to ensure their well-being and independence. There is particular concern about the implications for the services that pharmaceutical contractors provide to patients. These should be determined separately from the products that patients use. Obviously, being taught how to use an appliance properly is essential for its effective and safe use, but without that support in the community, there is a much greater likelihood of inappropriate usage, the increased risk of infection and higher rates of device wastage which will result in greater costs for the NHS and much more risk for patients. There is a need for greater clarity about what the changes to the Secretary of State’s powers would mean in practice and what the impact of these changes will be on the future stable supply of these products and services. There are around 400,000 people in the UK who use urology and stoma products on a long-term or lifelong basis and, of these, around 150,000 who use a dispensing appliance contractor to deliver their products rather than a pharmacy. It is important that a wide range of products is available as people’s needs vary so much. It is essential that someone can continue to receive a product in which they have confidence. What is more, these are invasive products, so the clinical services offered by pharmacies and dispensing and compliance contractors are also critically important to being able to steer clear of hospital and maintain your ordinary life and work. At present, the existing pharmaceutical service regulations provide patients with choice: choice of a clinically appropriate product and a delivery method that suits their needs as long-term users. It is vitally important that this security is protected in the new NHS architecture. There are already concerns about the fragmentation of arrangements. Some PCTs have introduced restrictive formularies in an attempt to limit patient product choice, while others have tried to restrict choice of supplier by introducing a preferred provider. There is concern that the number of such developments could expand once the number of commissioning organisations increases, creating more and more postcode lotteries. I would ask the Minister four questions about what is an essential service, despite the amount of talking that goes on in the Chamber. First of all, what powers will the Secretary of State have to determine reimbursement prices for products and remuneration fees and allowances for pharmaceutical contractors? Secondly, how will the changes to the Secretary of State’s duty to determine pharmaceutical remuneration affect the drug tariff? Thirdly, what is the Government’s position on the future of the drug tariff? Finally, how will the Government ensure that patients and industry are consulted before the NHS Commissioning Board and/or the Secretary of State determine pharmaceutical remuneration? I beg to move.