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Domiciliary Oxygen

Volume 406: debated on Thursday 12 June 2003

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To ask the Secretary of State for Health (1) if he will allow on prescription conserving devices for domiciliary oxygen; [118620](2) when he will announce the results of the review of domiciliary oxygen services initiated in March 2000. [118621]

To ask the Secretary of State for Health (1) what plans he has for the provision of ambulatory oxygen to patients with lung disease; [118818](2) if he will make it his policy to allow

(a) conserving devices for domiciliary oxygen and (b) ambulatory oxygen to be dispensed on prescription; [118819]

(3) what assessment he has made of the benefit to patients of using conserving devices with domiciliary oxygen. [118820]

In 1999, the Department of Health asked the Royal College of Physicians to lead a multidisciplinary working party to devise new clinical guidelines for the use of domiciliary oxygen. Although the working party's terms of reference precluded making specific recommendations about alterations in service provision, a number of the guidelines had implications for the content of the existing domiciliary oxygen service and for the way in which the service is delivered. It was clear, therefore, that this vital resource—that has seen only one significant change, the introduction of oxygen concentrators, in the past 50 years—had become out of date, both in terms of the service offered to patients and its cost effectiveness. It was against this background that the then Under-Secretary of State, my noble Friend Lord Hunt of Kings Heath directed that a review of the domiciliary oxygen service should take place.This review is now complete and we are ready to move forward to create a modernised and integrated service for the provision of domiciliary oxygen.At present, domiciliary oxygen is ordered for patients by general practitioners. The service consists principally of the provision of oxygen either from large cylinders supplied by community pharmacies, or delivered by way of an oxygen concentrator, installed in the patient's home by a contractor.The modern, integrated service that is proposed represents a considerable advance on this organisational and service model.The new model will transfer responsibility for ordering oxygen for long-term oxygen therapy from general practitioners to specialist consultants in hospital. This will relieve general practitioners of the bureaucratic burden of writing prescriptions, effectively on doctors. (Patients who need long-term oxygen will invariably have their needs assessed by hospital staff). The hospital consultant will decide, in discussion with the patient, what the patient's needs for oxygen are. For example, many patients would benefit from having oxygen available in a form that allows then greater freedom of movement both in and outside the home than is possible with large cylinders or oxygen concentrators. General practitioners will continue to be able to prescribe oxygen for patients who need small amounts of oxygen.Once the hospital consultant or general practitioner has discussed and determined the patient's need for oxygen, it will be the responsibility of contractors to work closely with the patient and decide what technology, that is what type and method of oxygen supply, will best suit the patient's therapeutic need, and to provide it. These specialist contractors will be well placed to keep pace with developments in the technical aspects of service delivery, so patients will benefit from advances in technology as they are developed.Thus, the modernised integrated service represents a sensible division of responsibility in the provision of domiciliary oxygen services. It places clinical responsibility for assessing oxygen need with doctors, and places technical decisions on the best and most up to date method of delivery with service contractors. Over the next few months a specification for the provision of the integrated service will be drawn up. Contractors will be invited to tender against this specification and fully operational early in 2005. The current arrangements for the provision of domiciliary oxygen will continue as at present to cover this transitional period.