Item 2 is the legislative consent memorandum on the UK Health Bill. We are required to consider the legislative consent memorandum and to report to Parliament. We will receive a verbal report from the convener of the Subordinate Legislation Committee, Sylvia Jackson. Thereafter, we will take evidence from the Deputy Minister for Heath and Community Care before we move into private session to consider the report that we will have to make to Parliament.
Thank you. The Subordinate Legislation Committee considered three aspects of the legislative consent memorandum on the Health Bill. I can report on them very briefly because there was little to concern us.
Thank you. I am not sure whether this is a one-off situation because of the particular circumstances of the legislative consent memorandum that we are considering. I suspect that we will in the future simply receive written reports, as per normal.
Absolutely.
You are free to go, if you want to get away. [Interruption.] I was a little precipitate—before Dr Jackson leaves, I invite members to put questions to her. No member has indicated that they have a question for the member—I know them too well. I thank Dr Jackson for her attendance.
I thank you for giving me the opportunity to explain the provisions of the Westminster Health Bill for which we are seeking consent, and to explain our reasons for doing so. I start by wishing all members of the committee a happy new year, in the same spirit in which the convener opened the meeting.
Thank you. Members want to ask a number of questions.
A similar proposal was consulted upon prior to the Smoking, Health and Social Care (Scotland) Bill. I wonder why the Executive did not include the proposal in the bill at that time, but now supports a similar proposal.
That is because some of the arrangements were not in place then. I do not know whether Kathleen Preston knows the background of the different statutory provisions that have come forward in both Parliaments.
My understanding is that when what is now the Smoking, Health and Social Care (Scotland) Act 2005 was going through Parliament, it was not clear what the United Kingdom Government's proposals for the Medicines Act 1968—which is on reserved matters—were going to be. As a result of the changes that the UK Government is making to the Medicines Act 1968, it is necessary to make this consequential amendment to the NHS Scotland Act 1978. There is currently a requirement that drugs must be dispensed under the supervision of a pharmacist. Because the corresponding provisions of the Medicines Act 1968 will be changed, it is necessary to give Scottish ministers the power to prescribe by regulation circumstances in which that requirement will be relaxed.
My understanding is that there was quite a lot of support for the changes at the time, but there were concerns about the implications for staff training and about which pharmacy support staff it would be appropriate to allow to take on those responsibilities. Have those fears been allayed?
I said in my opening statement that we will, following the provisions being put in place, consult on regulations before they are introduced. The issue that Kate Maclean raises is one of the matters that we want to ensure is fully addressed before regulations are introduced. It is important also to say that although there is, as I said in my opening remarks, a new power for pharmacists to delegate responsibility for carrying out actions, the pharmacists will retain responsibility for supervision. Even if they are not personally present, it will still be the pharmacists' responsibility to ensure that staff who act on their behalf are fully trained and are competent to do so.
That will obviously place quite a responsibility on pharmacists. If a pharmacist delegates responsibility, he obviously needs to know his staff very well and training needs to be carried out on a continuing basis. Can you clarify what responsibilities the pharmacist will delegate to trained staff? I assume that if the pharmacist is not on the premises, there will not be a pharmacist there.
Examples might include an event at which across-the-counter medicines can be sold. At a summer event, such as a rock festival, a pharmacist might make provision for medicines to be supplied from temporary premises; that could be a relatively routine process. That example is among the kinds of unusual circumstances in which such delegation might occur. More commonly, the sale of general sale-list medicines is another example. Although it is important to ensure that anybody who buys any kind of medicine from a pharmacist is able to access advice about it if they require it, certain types of medicine are fairly routine in character and could be sold across the counter by a trained person who knows what is appropriate for different conditions.
Do you therefore expect pharmacists to draw up protocols to which their staff must adhere strictly, or would you expect staff to phone the pharmacist?
We expect that pharmacists will put in place procedures whereby if they are not present and a pharmacy assistant is asked for advice about a general sale-list medicine that an individual patient wishes to purchase, that assistant could obtain clearance or authorisation from the pharmacist. We expect that it will be possible for members of staff acting on the pharmacist's behalf to seek and obtain advice.
From your letter to us, it seems that you plan to restrict pharmacists to being responsible for two pharmacies. However, some people might have six, seven or eight pharmacies.
Again, we will consult on that at the appropriate time. The letter indicates the areas on which we might consult. At the moment, the requirement is that a pharmacist be present on the premises. Clearly, to increase the number of premises for which a pharmacist may be responsible from one to two will broaden the provision significantly. We will consult on whether there might be circumstances in which we would go beyond that provision.
Do you expect pharmacy staff behind the counter to be trained in conducting blood-sugar tests and blood-pressure estimations, or are those tasks specifically for the pharmacist?
I ask Bill Scott to respond.
We are attempting to make the best use of the skills of all the staff in the pharmacy. The staff will operate under standard operating procedures: they will undertake work in areas where they are trained to be competent, but they will have to adhere rigidly to a standard operating procedure. The pharmacist will still be in overall charge and will approve the standard operating procedure.
Will the Executive always fund that or will pharmacists have to find from within their businesses the money to train staff?
I do not think that the Executive will continue to fund that training. The intention was to get a critical mass of staff in a pharmacy. Clearly, pharmacists have businesses to run and they will make representations as contractors when we consider in the negotiations any burdens that will be created by the NHS requirements.
Many people might be anxious that the present service will be diluted and that, unless more pharmacists come on board, the same number of pharmacists will treat the same number of people, but will have extra duties.
Our action is based on our consultation. Although I acknowledge Jean Turner's point, the consultation evidenced significant support for the kind of direction that we seek to make.
My question is supplementary to Kate Maclean's and Jean Turner's points about the costs of training and staffing. I accept what the minister said about further consultation on the regulations. Will you also commit to undertake a financial assessment of those costs as part of the consultation?
I ask Bill Scott to respond again. He is the chief pharmacist; he has considerable dealings with the sector on that matter and is more directly aware than I am of its expectations in respect of support for training costs.
There was overwhelming support for what we are trying to do in our initial consultation on manpower. Pharmacists see the proposals as being a way of helping them to manage their situation. A fair number of highly qualified technical staff already work in pharmacies. The proposals will also apply to hospital pharmacies. There will be standard compliance costs with any changes in regulations, and those costs will be attached to subsequent changes.
Nanette Milne wants to move on to another aspect of enforcement.
Paragraph 20 of the memorandum refers to "the package of reforms" under the legislation. Will the minister clarify what is being referred to?
That phrase refers to the range of measures that I have outlined and to which Bill Scott referred. Those measures are about enabling the pharmacist not to be present when medicines are being dispensed, ensuring that other pharmacy staff who take on such routine responsibilities are properly trained and supervised and that there is accountability through keeping records of responsible pharmacists. Our ensuring that such a record exists will be key to the package of reforms that will allow other members of the pharmacy's staff to undertake certain duties that the pharmacist currently undertakes.
Unsupervised staff will keep records of everything they do when the pharmacist is not present.
It is clear that staff would keep records of any medicines that are prescribed and dispensed.
Staff activity would be monitored through standard operating procedures. They will have to contact the pharmacist about any deviation from those procedures.
Once the proposals have been agreed to, do you intend that the Medicines and Healthcare products Regulatory Agency will continue its role of enforcing the Medicines Act 1968 in Scotland, and that that will include enforcing the new record-keeping requirement?
Broadly speaking, yes.
We think that some monitoring of compliance with the requirements will be done through the inspectorate of the Royal Pharmaceutical Society of Great Britain, which currently undertakes some work on behalf of MHRA.
I wrote to the committee on that subject to clarify that point.
How do you envisage the permanent record being kept? Will it be kept electronically? If so, are additional costs on the community pharmacy sector or the Executive expected?
I invite Bill Scott to answer that question, too.
Thank you.
It is handy that you have Bill Scott with you.
I must admit that it is.
It has not yet been determined whether there should be paper or electronic records, but it is likely—with modernisation of our services—that records will be electronic. Currently, we have a package of measures relating to e-pharmacy, of which the records will clearly be part.
I accept that the community pharmacy sector is geared up to providing the e-pharmacy service, but will the proposals incur additional costs on that sector? Does the Executive think that there will be additional costs on it in ensuring that the package of reforms is introduced?
It is clear that there will be some costs, but the current indications are that those costs will be de minimis costs on pharmacists. I cannot see why the Executive would have to bear any costs from what we are developing because it will be for community pharmacists to keep the records.
The potential benefit from the de minimis costs is clearly much more significant than the costs are, because it is part of the modernisation process across the board, which may allow pharmacists to do other work more efficiently than they do at the moment.
Paragraph 22 of the memorandum states:
That relates to the duties that might be undertaken by pharmaceutical societies. They are to do with some of the professional judgments that pharmacists are best placed to make, for example in respect of dispensing medicines.
That is correct. The responsible pharmacist will have to determine what duties can suitably be undertaken by other members of staff. However, the clinical duty of assessing the appropriate prescription will have to be undertaken by the pharmacist; they will not be able to delegate that duty.
Again, the other duties relate to the package of reforms. They are to do with the supervision of staff.
Shona Robison has a question on recovery of NHS costs.
The minister may remember the debate that we had in Parliament on the issue, when members expressed concerns that the recovery scheme could result in increased insurance premiums for individuals and employers. The review of employers' liability compulsory insurance has now been carried out. Is the Executive satisfied that the insurance market has addressed the issues that were raised in that debate about potential inequalities in premiums?
Members will be aware that the introduction of the recovery provisions has been delayed to accommodate the consequences of the ELCI revision. In short, the answer is that it is felt across the board that the provisions now acknowledge the changes that have been made in that regard and are compatible with them.
I would like more information on how the scheme will be administered and the level of funding that might be required to administer it.
I am sorry—I did not follow that.
How will you collect the money and administer the scheme? We all know that lots of people over the years have had insurance pay-outs in relation to road-traffic accidents. I assume from what I have read—I may be wrong—that you intend to claw back money from people who have had pay-outs and who have required treatment from the NHS. Will that be done through the insurance companies?
Having been ably supported by Bill Scott on the previous subject, I now move on to Ross Scott.
NHS costs will be recovered from the compensator, not from the person who is compensated. A person who is involved in a road-traffic accident and who is compensated for that will not pay the NHS costs—the insurance company that compensates them will pay those costs. The scheme will be operated by the compensation recovery unit in the Department for Work and Pensions on behalf of the Scottish Executive and the Department of Health. Insurance companies will have a legal obligation to notify the CRU of instances. The CRU will follow up cases with individual hospitals, assess the cost, recover the money and pass it back to the appropriate NHS body.
It strikes me, as an ordinary person, that if the insurance companies have to pay, that might put premiums up. You say that it will not be the person who has had the accident who will pay, but the insurance company.
The person who is compensated will not pay; whoever compensates that person for their injury will pay for the costs of NHS treatment through their liability.
I read that you worked out a sum that you might be able to claw back. How did you work out that sum?
We calculated a percentage of the total United Kingdom estimate.
The estimate was done by economists in the UK Department of Health, who calculated a 10 per cent share of what was assessed to be the UK figure.
It is very much a ball-park figure. I think we said that it would be between £18 million and £25 million, which is between 7 per cent and 10 per cent of what the Department of Health calculates will be recoverable from insurance companies and other sources of compensation.
If I understand the position correctly, insurance companies should have been offering to pay this money all along but, perhaps, have not been doing so.
They are obliged to pay out only for road-traffic accidents. The scheme will widen that to cover all instances in which people receive compensation for personal injury, so it will include workplace accidents as well.
This is probably not related to the issue that we are discussing, but what about travellers who come to this country with medical insurance? Is that a separate issue? Would the money that their insurance companies pay come under a different scheme?
There will be a separate scheme. The person has to be injured before a case arises.
So the issue is really related just to personal injury.
Yes.
Ross Scott said that the money would go
The money would go directly to the board that treated the person; the scheme would not distinguish between hospitals. That board would have mechanisms by which the money could be given to the appropriate hospital.
I assume that the hospital will have the flexibility to use that money however it sees fit.
Yes.
In relation to the powers that you will get when section 153 of the Health and Social Care (Community Health and Standards) Act 2003 is amended, are you content that, in making regulations, you can do so without their being so complex that you will cover several pages when you take into account contributory negligence? Without wishing to anticipate a debate about what will be in the regulations, are you confident that you will be able to produce something that is readily comprehensible rather than something that is a labyrinthine legal impossibility?
The objective is always to make legislation as comprehensible as possible, whether it is primary or secondary legislation. That can be a challenge, especially when it relates to matters of financial compensation for legal liability, but it is a challenge that we will endeavour to meet.
You mentioned workplace accidents. How does the system operate in that regard at the moment? How will it operate in the future? How would you differentiate between a workplace accident, injury and disease?
I will ask Ross Scott to comment on the status quo. I think that the answer is that nothing is in place at the moment and that the scheme is the first of its kind, essentially.
At the moment, an employee who is injured in the workplace will be compensated, but there is no scheme by which we could recover the NHS costs of treating that injury. That is what this scheme will do.
How would the recovery mechanism operate? What would be the impact on the worker who has broken their leg falling from scaffolding and has visited the accident and emergency unit?
The impact would be primarily on the employer's liability insurance company rather than on the worker.
How would we ensure that?
The DWP would recover the cost from the company that provided the insurance cover to the employer. As with road accidents, the recovery is not made from the person who is compensated but from the compensator.
Basically, the money will come from the insurance company that is behind the person who was at fault.
That is exactly it.
On first reading, people assume that the scheme will mean that people who get personal injury compensation will have money taken away from them. However, it does not work like that. The insurer behind the person or body who is at fault will end up paying the NHS costs; the victim of the accident will get their compensation in the normal way and it will not be removed from them.
My only concern is that many such personal injury cases are taken on a no-win, no-cost basis. I am concerned that the situation is not as regulated as that which relates to road-traffic accidents, which involves clear procedures. I am concerned that there is a bit of a difference, but we will have an opportunity to consult on the matter.
Yes.
I think that that has exhausted our questions. I thank the minister and his officials for coming along.
Meeting continued in private until 14:47.
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