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Lords welcome pharmacist prescribing and local pilot
schemes
Proposals for pharmacist prescribing and local pharmaceutical services
(LPS) schemes were welcomed by members of the House of Lords on February
26 during a debate on the Health and Social Care Bill that lasted nearly
five hours. But peers from all three major political parties expressed
disquiet about the Bill's provisions on the disclosure and processing
of patient information.
Moving the second reading of the Bill, Lord Hunt (Parliamentary Under-Secretary
of State, Department of Health) began by stating that the Bill underpinned
the National Health Service plan and was an important part of NHS modernisation.
Its powers to establish new contracts for pharmaceutical services and
to extend prescribing would help to break down barriers between staff
groups and give professionals the opportunity to make the most of their
skills and deliver better services to patients.
Later, as he went through the Bill clause by clause, Lord Hunt said that
the proposed alternative legal framework for providing pharmaceutical
services under locally agreed contracts was a key element of the Government's
programme for pharmacy. The services would first be provided under pilot
schemes, which were intended to develop and demonstrate innovative ways
of providing high quality, cost-effective services to patients (see above).
Clause 67 introduced new safeguards for the use of information about patients.
The Government was taking powers to use information without consent but
only after stringent tests had been passed. Without that part of the Bill,
important services such as cancer registries were at risk of collapsing
as the medical professions were unsure of the legal basis underpinning
the flow of patient information. The clause did not outlaw independent
reports on NHS services or seek to restrict medical research. By providing
powers to regulate the disclosure and processing of patient information,
it would protect patient information from being used for purposes that
ran contrary to the interests of the patient and the NHS.
Lord Howe (Opposition health spokesman), welcoming the proposed extension
of prescribing rights to a wider range of health professionals, said that
it was high time that pharmacists were allowed greater responsibilities
in the supply of medicines.
On Clause 67, Lord Howe said that the Opposition would oppose strongly
any controls on the collection of anonymised patient data. Access to such
data was essential to developing new drugs and monitoring the safety and
effectiveness of existing drugs. Neither the NHS Executive nor Ministers
had provided a coherent explanation of why the proposed powers were needed.
It was difficult not to agree with the pharmaceutical industry, which
felt that the Department did not understand the implications of what it
sought to do.
Lord Clement-Jones (Lib Dem health spokesman) said that his party welcomed
the extension of prescribing rights and local pharmaceutical services
pilots, but would also want to look closely at how exactly they were to
be regulated and make sure that the necessary flexibility was provided.
Baroness Carnegy (Con) said that allowing pharmacists and other professional
people to prescribe was one of the Bill's more welcome proposals.
Lord Astor (Con) said that clarification was needed on whether those with
prescribing rights would be independent of existing prescribers and on
whether relevant professional groups, including pharmacists, would be
represented on any advisory body created to consider and advise Ministers
on the award of additional prescribing rights.
On Clause 67, Lord Astor said that the clause had been tacked on to the
end of the Bill and was well beyond the proposals outlined in the NHS
plan. It had been rushed through the House of Commons without consultation.
Groups ranging from medical charities to professional bodies had expressed
deep concern that the Secretary of State would secure sweeping powers
over the use of identifiable and anonymised patient data. The clause was
profoundly objectionable in form and substance.
Lord Rea (Lab) said that some were afraid that Clause 67 gave the Department
too much leeway to reveal confidential patient information while others
feared that, by overprotecting patient confidentiality, vital data for
compiling data bases such as the cancer register would be lost. He believed
that the means existed to satisfy both parties, provided sufficient safeguards
were built in.
Lord Turnberg (Lab) said that Clause 67 was written in obscure language,
and much of what was proposed depended heavily on regulations yet to be
written. He was keen for some reassurance on the contents of the regulations
and how they would be enacted.
The pharmaceutical industry had expressed concern that its use of "anonymised"
data, which could not harm individual patients, would be prohibited, thereby
damaging the industry and thus the NHS. His own concern was whether anonymised
data could be used for non-commercial reasons such as for research or
for monitoring the incidence of disease in the population.
Baroness Northover (Lib Dem) said that too much discretion in the Secretary
of State's hands could prove a temptation in areas where there was conflict
of interest — for example, in whether to allow into the public domain
anonymised data that would reflect poorly on the Government's performance.
That kind of decision was far better held in independent hands.
Lord Hunt gave an assurance that the powers to allow the use of patient
confidential information without consent were intended to be used only
to safeguard the continued operation of key services that were in the
patient and public interest and could not be carried out by other means.
Indeed, those safeguards were built into the Bill.
Having received its second reading, the Bill now goes to a committee of
the whole House of Lords.
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