Background
The Department of Health announced in June 2005 that four companies - Air Products, the British Oxygen Company (BOC), Allied Oxycare/Medigas and Linde - had won the contracts to provide the home oxygen service in 10 NHS Home Oxygen Service Regions in England.
The DH claimed that the decision they had made for contracting out the service was not about privatisation, or about driving down costs, but about getting better services for patients
As from 1 February 2006 the four new oxygen contractors would be expected to provide an integrated service –cylinder, concentrator and ambulatory oxygen – to patients in their service regions on a 24/7 basis.
In line with DH plans, on 1 Feb 2006 the transfer was implemented for the four private companies to take over the provision of oxygen from local pharmacists, in co-operation with GPs.
However, following the transfer of home oxygen supplies from community pharmacies to these four private oxygen companies, there were severe problems for both patients and pharmacists – resulting in 2 patient fatalities. The initial fatality crisis’ was the death in Cumbria of Mrs Alice Broderick, after waiting more than 6 hours for oxygen ordered from Air Products by an out of hours doctor.
The new providers proved unable to cope with demand – and turned to community pharmacies to continue with the service they had provided for many years.
Events / Issues
In many parts of the country the transfer was utterly chaotic, with the DH claiming that the private suppliers were ‘overwhelmed’ by patient demand – and that a sudden rise in demand resulted in supply shortages.
Air Products and Allied Respiratory suffered the worst supply problems.
Suppliers claimed the DH had led them to believe it would manage the transition – whereas the reality was that supply from the pharmacy network ‘ceased abruptly’.
Wales, which has a high number of elderly patients (many ex-miners) who rely on oxygen therapy, was particularly affected.
The Welsh Health Minister, Brian Gibbons, praised the willingness of community pharmacists to continue to offer the old service after 1 Feb. He said: “I am most grateful to those pharmacists in Wales who have continued to serve their patients in this way. Their professional approach to the problem is to be applauded.”
The issues involved – and the NPA’s position and pharmacy’s concerns – were extensively covered by the national and regional media, and as a result, questions and concerns were raised by Parliamentarians.
- The broadsheets media coverage focussed on the fact that the privatisation of the NHS home oxygen supply service has left thousands of patients at risk – and there were various comments on the issue of patient choice (the ‘mantra’ of DH Ministers) and the impact of outsourcing NHS services to private suppliers (Tony Blair’s views on private suppliers role in h/care provision quoted).
- Some media commentators suggested that oxygen supply had been privatised for 'cost saving' reasons – a view held by the Lib-Dems.
- The Times 20 Feb, published a letter from Health Minister, Caroline Flint, which claimed that ‘the service was always planned to be phased in over a six-month transition period and not ‘suddenly switched’.
NPA Comment
- For many months, prior to the handover of home oxygen services, the NPA had consistently highlighted to all stakeholders its concerns about potential problems with the transition arrangements – and the difficulties associated with maintaining supplies to patients.
- Our priority and concern centred on the crucial issue of patient welfare.
- We highlighted that pharmacists had supplied a robust and timely home oxygen service – and had not wanted to lose it. And we put the case for “patient choice” on oxygen.
Our key messaging highlighted:
- The consistent concerns we have raised about the implications of a ‘big bang’ transition from a pharmacy based to ‘arms length’ oxygen supply for patients
- The risks of giving the supply function to others
- The fact that patients should be given choice
- The value of the community pharmacy network as a supply chain for medicines and medical equipment.
- The value of the community pharmacy network in dealing with an emergency situation.
NPA Press Release 17 Feb : Pharmacists continue to voice grave concerns for patient welfare
Despite the fact that the Home Oxygen Service was taken away from Community Pharmacy, local pharmacies around the country are doing all they can, where possible, to pick up the pieces in this flawed service, to ensure patients get the oxygen they need. Prior to the new arrangements, which came into effect on February 1st 2006, Community pharmacists had been the backbone of home oxygen services for many years. In doing this they provided a responsive and timely service.
The NPA has always been concerned about the possible ‘worst case scenario’ implications, whereby oxygen suppliers would not be able to deliver emergency oxygen in the stated 4 hour response. In the old system there was flexibility: if one community pharmacy could not supply oxygen, arrangements would be made to effect oxygen supplies through another pharmacy. This highlights the difficulties and problems inherent in the new system, when patients have to rely solely on one supplier, covering a large geographic area.
John D’Arcy went on to say: “Unfortunately, the arrangements for home oxygen deliveries from the oxygen suppliers have clearly not been thought through properly. Planning and procedures have not been robust enough to match the demands currently being placed by oxygen patients. Patient welfare is our paramount concern. However, the goodwill and commitment of our pharmacy members is being stretched to the limit, against a backdrop of uncertainty with regards to liability for missing and lost oxygen cylinders.”
Political / Stakeholder comment
Conservatives
- They asked a number of parliamentary questions about the oxygen handover:
Q: Opposition Spokesperson on Health Dr. Andrew Murrison MP (Cons, Westbury): To ask the Secretary of State for Health if she will publish correspondence between her Department and its agencies since January 2005 about the direct supply of domiciliary oxygen for patients by the British Oxygen Company and its subsidiaries
Q: Opposition Health Spokesperson Dr. Andrew Murrison MP (Cons, Westbury):To ask the Secretary of State for Health (1) what guidance her Department has issued to (a) patients and (b) health care professionals on changes in the provision of domiciliary oxygen; and on what dates the guidance was issued; (2) what guidance her Department has issued to pharmacies since January 2005 on the provision of domiciliary oxygen; and on what dates the guidance was issued.
Lib-Dems
- Called for an urgent investigation into home oxygen services – citing the situation a ‘shambles’.
Welsh Assembly
- Labour Minister Kim Howells wrote a very heavy hitting letter to Jane Hutt regarding the difficulties in receiving home oxygen therapy --- a problem prevalent in his Ponypridd constituency where a large number of former miners live. Key comments in his letter “The issue of oxygen therapy is an extremely important one for the many people in Waleswho suffer from lung diseases. On the evidence of your response I fear it is not receiving the attention it warrants. I hope very much that you will consider improving the quality of the response of your department to ANYONE who might offer their co-operation on this – let alone to a Labour Minister in a Labour Government that provides your department with extremely high levels of funding which we hope are being used to best effect.”
- He praised the willingness of community pharmacists to continue to offer the old service after 1 Feb. He said: “I am most grateful to those pharmacists in Waleswho have continued to serve their patients in this way. Their professional approach to the problem is to be applauded.”
DH
- Health Minister with responsibility for pharmacy, Jane Kennedy gave a number of broadcast interviews on oxygen – and in response for the patient death in Cumbria. She accepted there had been "problems" since four private companies took over the provision of oxygen from local pharmacists on 1 Feb
- The key messaging and DH ‘line’ was that private providers had been ‘overwhelmed’ by demand since taking over the contract on1st Feb – and that pharmacists had been told they would continue to be paid for supplying oxygen after that date, but would not be contractually obliged to supply it.
Air Products
- Claimed to have been deluged with calls: 12,500 calls to its helpline in the first 2 days of Feb, when it expected and had planning in place for 3,000 calls a day
- Blamed GPs and patients for contacting their helpline with ‘general queries and future supply orders’
- Claim that 80% of the oxygen forms received had been filled in incorrectly
Allied Respiratory
- Blamed the DH for the way it handled the transition, in cutting off supplies from the pharmacies which had previously supplied oxygen
- Claimed to have received 24,000 unplanned calls in its first week of the contract
- Received 3,000 orders from GPs in the first week
- Majority of information provided by GPs was inaccurate – which compounded demand on resources and rendered its contract ‘unserviceable’
British Lung Foundation
- Acknowledged ‘serious teething problems’ with the new supply system – but continued to support the new system, which they believed ‘would help patients get modern, lightweight oxygen cylinders on the NHS’
NHS Alliance
- Said the oxygen problems were ‘typical of inadequate and inept contract specification in the NHS’
