Health Bill [HL]

I shall speak also to Amendment 113. For a number of years, as my noble friend Lady Cumberlege mentioned, the Government have spoken of pharmacy as an untapped resource. The reforms that have so far been put in place have not really changed things appreciably, in the sense that patients use pharmacy in a way that might lead to improved health outcomes. For that reason, last year’s pharmacy White Paper, Pharmacy in England, and the Review of NHS Pharmaceutical Contractual Arrangements published by Anne Galbraith were welcome developments. Both those documents found that effective commissioning by PCTs in the area of pharmacy was still some way off. Four structural changes were recommended. I shall not go through them, but the fourth one is the only one to be contained in this Bill—that is, proposals to change pharmaceutical needs assessments. The White Paper and the Galbraith report identified major shortcomings in the ability of PCTs to commission pharmacy services. The strong implication of the White Paper was that PCTs needed to embrace what amounts to a cultural change if they are to come close to approaching world-class commissioning standards in this area. As we have just debated under the previous group of amendments, many in the pharmacy community do not think that PCTs are capable of writing accurate or robust PNAs that are kept up to date and respond to locally changing patterns of demand or need. The sort of thing that I hear from the pharmacy world is that very few PNAs have been updated since they were first introduced in 2005, largely because of a lack of resources. I am told that it is common practice for PNAs to be largely ignored in appeal cases—that is, cases heard to consider applications for new pharmacies to be included in the pharmaceutical list. Some PCTs do not have a PNA at all and many that do exist are simply a commentary on what services are currently on offer, rather than anything more forward-looking. Could the Minister tell us of even one example of a new pharmacy contract being awarded as a result of a specific need being identified for a new pharmacy within a PNA? There may be one, but I have not heard of it. If this system is to work as it should, it is essential for PNAs to be continuously updated and to be linked to a PCT’s wider strategic services delivery plan. The relevant regulations need to be quite specific on this score. In Amendment 111A, therefore, I am proposing that in order to make faster progress in the long run we should initially take things more slowly by introducing PNAs by means of pilot schemes. The Government have so far ruled out piloting PNAs on the grounds that that would delay their full benefits. I think I see things a bit differently—in fact, I know I do. We embark on this exercise from where we are, not from where we would ideally like to be, and where we are is, as I have described, a situation where PCTs are struggling to do the things that they should. We need to monitor progress closely, which is why there is a good case for enabling PCTs to refine their approach over a limited period of time, and then for those PCTs that have taken part in the pilots to share best practice with others. It would be helpful to hear the Minister’s thoughts on all that. The basic problem with the creation of PNAs is that they do not address the areas of major concern that were raised during the Government’s consultation exercise. For example, we do not know the extent to which PNAs will in practice be based on robust, high-quality data. Unless they are, they are likely to remain as crude tools that are disproportionately focused on cost-effectiveness as opposed to local health needs. We do not know how effectively PCTs will use PNAs, especially given their record to date of disinvesting in enhanced services such as out-of-hours opening and local delivery, as I pointed out in the last group of amendments, although I will go away and consider the reply that the Minister gave a moment ago. Nor, importantly, can we have confidence that PNAs will create a basis for commissioning pharmacy services that is consistent and rational across the country. There is much to be said not only for pilot schemes but for a national framework for PNAs that could be adapted at local level to suit local conditions. A national template would include data sets and statistical models from which each PCT should work in order to ensure, first, that the PNA was robust and, secondly, to give clarity for contractors. If there is not to be such a framework, we have to ask how robust the process is likely to be and how precisely assessments will translate into service delivery. Those are the uncertainties here, and I am afraid they are fairly basic ones. I look forward to the Minister’s reply. I beg to move.