House of Commons Hansard Debates for 6 Jun 1990

Mr. Turner : I said eye operations.

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Mr. Maples : The hon. Gentleman did not. He said operations in general. The idea that free eye tests were somehow the early diagnosis of all sorts of acute hospital cases is the most awful rubbish.

Dame Jill Knight : A moment or two ago, my hon. Friend said it was not serious to be wandering round wearing the wrong glasses. I assure my hon. Friend that if one is driving a car it is very serious to be wearing the wrong glasses.

Mr. Maples : I do not think that anybody who owns a car will have any difficulty in coming up with £10 for an eye test.

Who are the people who are being asked to pay the £10 or £12 and of what consequence is it to them? We know that the exemptions cover children, pregnant mothers and people on income support and family credit-- about 35 per cent. to 40 per cent. of the population. The other 60 per cent. who are being asked to pay have had amazing increases in their take- home pay over the past 10 years. The cut-off for family credit is about three quarters of average earnings. Somebody on three quarters of average earnings has had an increase in his take-home pay of £2,084 over the past 10 years. If he were on average earnings, he would have had an increase of over £3,000 in his take-home pay, and, even on half average earnings, which is now £7, 500 a year, he would have had an increase of £1,500 in take-home pay.

All levels of earnings at which people might be asked to pay the £10 have had increases in take-home pay of over £1,500 in the past 10 years. In that context, it is palpable nonsense to suggest that £12 every other year is a significant item in a family budget. It cannot feature at all. We are talking about a cost of £6 a year to have an eye test every other year to somebody whose income has increased by at least £1,500 over that period. It is not unreasonable to ask people as they become better off to make some contribution at the margin to their health care. It basically affects only those whose household incomes have increased by more than £1,500 per year. As my hon. Friend the Member for Pembroke (Mr. Bennett) pointed out, the average family spends £10 a week on alcohol. We are suggesting that they should spend £10 every two years on an eye test.

Glaucoma is more serious. Undoubtedly, eye tests show it up early in some cases, but the eye test was never a screening process for glaucoma. If it is thought as a matter of public policy that we should screen for glaucoma, we should do it some other way than through a random eye test, whether it is free or paid for. The Government have acknowleged that by making a special exemption for people who are more likely to have glaucoma or who are related to people who have it--there is a large hereditary element in it. To a substantial extent, that matter is taken care of.

As I have already said, one third, or perhaps even 40 per cent., of the population do not have to pay for the eye test, and the other 60 per cent. have had such substantial increases in income that the charge cannot be a deterrent that could lead to serious consequences. We are going through a time when people are able, willing and prepared to take greater responsibility for themselves and not to expect the state to do everything for them. As their real incomes rise, it is the policy of the Government, which I wholly applaud--it is one reason why I got into politics

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--that they should be left with more of their income in their pockets through less taxation and more of the responsibility for paying for things for themselves where they can. At the very best, it is patronising for the Opposition to suggest that they are not capable or responsible for making that decision and that they are likely to be deterred from taking care of their health by a charge that averages out at £6 a year.

An interesting way of looking at that argument is that, in 1988, the year when the charges were debated and when the legislation was passed the Opposition objected to a 2p income tax cut in the Budget. They said that the money should have been spent on improving the Health Service. That cut in income tax is worth £180 a year to someone on average earnings. The charge for an eye test is £12 every other year. The Opposition suggested that those who would have preferred that additional £180 not to be given back to them but to be spent on the Health Service are so stupid, shortsighted or mean-minded that they will not spend £12 every two years, having had a £180 a year tax saving, on an eye test. It does not add up. If people are willing, as the Opposition argued at the time, for the money to be spent on the Health Service, surely they are willing to spend a fraction of that amount on one item of health care, which is obviously a sensible way to protect the health of their eyes. It is patronising and silly to suggest that people are not responsible for themselves. Clearly they can come up with £10 or £12 a year. The Government need no lectures from the Labour party on the funding and management of the Health Service. Over the past 10 years, the Government have spent £3 for every £1 that the Labour party spent on it--an increase in real terms of 40 per cent. That increase in real terms is £9 billion. We spend more than £40 a week for every family of four on the Health Service. There are thousands more doctors--

Mr. Turner : It is not enough.

Mr. Maples : It will never be enough if the service is free, in the sense that we will never be able to remove all the waiting lists. All that I can say is that it is an awful lot more than the previous Labour Government spent.

We have the largest-ever hospital building programme. We treat more patients as in-patients, out-patients and day cases, and we need no lectures from the Opposition on the funding of the Health Service. It is interesting to look at the Opposition's policy review, which they euphemistically call "Looking to the Future". It seems to be a giant step back to the 1960s. There are no commitments to spend any additional money on health care. However, there is a commitment to "bring back free eye tests and dental checks."

There is also a commitment to abolish competitive tendering. Those three things together will cost £200 million and will not deliver one iota of additional health care. They will not improve health care one little bit. If that £200 million were available, it would build four new district general hospitals every year. The Opposition are saying that they would choose to spend it on removing those three things which are purely political dogma--they are not related to health care at all.

If one extends the logic of the Opposition's argument to prescription charges, which they were going to remove at one time, and to providing free glasses and free dental care which, if the charge for a test is a deterrent, must equally

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be a deterrent, one is talking of a sum well in excess of £1 billion. That sum would add absolutely nothing to the quantity of health care delivered to the public. It is extraordinary that, in the Opposition's document, the future of the Health Service rates one page, half of which is taken up with community care. There are no commitments to additional spending apart from the ones that I have mentioned. Even the ones that are mentioned must be taken with a pinch of salt.

In the public expenditure debate, the hon. Member for Derby, South (Mrs. Beckett), who has some responsibility for the Labour party's attitude to public spending, said :

"What we are promising is an increase for pensioners and an increase in child benefit. Everything else that is regarded as a desirable aim is also listed, quite clearly and specifically, as something that we hope to do as resources allow."--[ Official Report , 13 February 1990 ; Vol. 167, c. 179.]

It is difficult to know whether the hon. Member for Livingston (Mr. Cook) has co-ordinated his policy with that of his hon. Friend. One assumes that he has, but there is a conflict between the commitments made in "Looking to the Future" and what the hon. Member for Derby, South said. The hon. Lady made her statement categorically and reiterated it twice in response to interventions from my right hon. Friend the Chief Secretary to the Treasury. She said that that was all that the Labour party would commit itself to doing if it were to come into government.

If what the hon. Lady said is correct, what the hon. Member for Livingston said about £200 million for abolishing competitive tendering and the charges for eye and dental check-ups is on the wish list. In other words, the Labour party is saying, "These are the things that we should like to do if resources allow." Well, we do that--if resources allow, we increase the resources that are given to the National Health Service, which is why we have been able to spend an additional £9 billion on it. One suspects that those things are not Labour party commitments, and that they are part of the letter to Santa Claus which the hon. Member for Livingston is puffing up the chimney with the smoke and which the hon. Member for Derby, South, who is sitting at the top, is tearing up unless its commitments refer to child benefit or pensions. I hope that I have the attention of the hon. Member for Livingston.

When the hon. Member for Cardiff, South and Penarth (Mr. Michael) replies to the debate, it will be interesting to hear whether those three items-- abolishing competitive tendering and reintroducing free eye and dental check-ups--are absolute commitments on the part of the Labour party when it forms its next Government, and whether they override the equally categorical statement by the hon. Member for Derby, South in the public expenditure debate on 13 February. The Labour party seems to be trying to talk out of both sides of its mouth at the same time. On the one side, the Treasury spokesmen are trying to reassure the City, the markets, the press and the taxpayers that they are not trying to pick their pocket to a large extent to pay for a major public expenditure programme, while on the other side the Labour party is trying to say to the voters, "Of course, we shall spend billions of pounds on transport, education and health." Of course, the only reason for ever electing a Labour Government is that they would raise more money in taxes and spend it on public services.

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However, the Labour party will be rumbled because taxpayers and consumers are exactly the same people and they will realise that the Labour party is delivering two totally different messages. One message says, "We shall spend a lot more money", and the other says, "We shall not spend any more money." It will be interesting to have that contradiction resolved. I repeat that taxpayers and consumers are the same people and they will rumble the con trick that the Labour party is trying to perpetrate on them.

In conclusion, our changes seem a sensible way of ensuring an additional £90 million for the Health Service. If one adds in the dental checks, a total of £140 million is available to be spent on better and more constructive things and on alleviating real suffering and life-threatening conditions. The structure exempts vulnerable people from the charges. Those who are liable to the charges have had enormous increases in their take- home pay in the past 10 years. Those on half average incomes have received a minimum of £1,500. It is not unreasonable to ask those people to pay £12 every two years. The Labour party's opposition to the charges-- just like its opposition to competitive tendering--is pure political dogma. Changing the system would not deliver one iota more health care. It makes absolutely no sense to reverse the change. It is right as a matter of principle to reduce people's taxes and to leave them with more money in their own pockets and more responsibility for taking care of themselves. On the whole, people behave responsibly and it is patronising to suggest that they do not.

6.23 pm

Mr. Ieuan Wyn Jones (Ynys Mo n) : I listened carefully to the hon. Member for Lewisham, West (Mr. Maples). With every speech by a Conservative Member we seem to hear higher figures for the money that the Government have saved as a result of not having free tests. We have heard £70 million, £90 million and even £150 million being quoted. It has even been said that we could have three new general hospitals as a result of the savings. What utter nonsense. Even Ministers have said that the money that is saved will be spent on primary health care--and whoever heard of the building of three new general hospitals being part of any Government's primary health care budget?

I also listened with great care to the Secretary of State. He said that the Government intend to give everyone the service that they require. However, he then spent half an hour telling us why the Government could not give everyone the service that they need. He also said that, even after the introduction of the changes, the Government were still paying for the tests of the third of the population who qualify for income support, and we know that the take-up of income support has been extremely low. Unfortunately, therefore, a number of people who would qualify for free tests if they applied for the income support, to which they are entitled, are not receiving free eye tests.

We all agree that the average charge is between £12 and £15. Although many right hon. and hon. Members can no doubt afford £12 or £15, many people cannot. Unfortunately, the people who will be hit hardest are the most vulnerable in our society.

The decision to abolish free eye tests disproportionately affects the elderly. The hon. Member for Brigg and Cleethorpes (Mr. Brown) said that many elderly people can afford to pay for their eye tests and referred to the

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average income of elderly people. However, the average income of elderly people is skewed by the fact that the income of the top one fifth accounts for a disproportionate amount of the income of all elderly people. The average pensioner's income is less than £100 per week--it is actually £98 per week, but four fifths of elderly people receive substantially less than that. They are therefore hit by charges for eye tests. We know that the cost of the elderly to the Health Service is substantially more than the cost of those who are not of pensionable age. We also know that 78 per cent. of elderly people between the ages of 78 and 85 suffer from severe eye conditions, yet it is precisely that category of vulnerable people that the Government are refusing to assist. That is deplorable. There is no doubt in my mind--if they were honest, there would be no doubt in the minds of Conservative Members either--that substantially fewer people are now attending for eye tests than was the case before 1 April 1989. We all know that evidence from our constituencies. There is also the anecdotal evidence that we hear when speaking to our friends, colleagues and families. If the Government are seeking to rely on one set of statistics to justify their position, and if they refuse to accept any statistics that suggest an opposite point of view, they are a blinkered Government who are refusing to look at all the evidence.

The Secretary of State is a lawyer and, as such, he must look at both sides of the argument. However, he refuses to do so because the evidence does not fit the Government's position. The right hon. and learned Gentleman refuses to accept that anybody who can produce statistics to support a contrary point of view can have a valid argument. In those circumstances, I believe that the survey that the Government have produced is fundamentally flawed. The Government must look at the hard evidence that is produced by the practitioners, rather than relying on people's memories.

I shall conclude, as other hon. Members wish to speak. It is short sighted of the Government to dispense with free eye tests because, as we have heard in many valuable speeches, eye tests can detect other conditions. Ensuring that people have free eye tests actually saves money. Therefore, even if the Government are not prepared tonight to introduce free eye tests for everybody, I urge them to ensure that pensioners are entitled to free eye tests from this day forward. 6.29 pm

Mr. Keith Vaz (Leicester, East) : What an extraordinary speech we have heard from the hon. Member for Lewisham, West (Mr. Maples). Despite the fact that he sits on the Conservative side, I always considered him to be a reasonable person. How extraordinary that he should tell us that he received no representations whatever from his constituents protesting against the imposition of charges for eye tests. I advise him to keep his speech well hidden from his constituents in Lewisham, West.

Even before charges were introduced, some constituents of mine in Leicester felt that charges would have a detrimental effect on their health. On 31 October 1988 a group of pensioners went to Downing street and presented the Prime Minister with a gift. It was an unusual gift--a large pair of wooden spectacles and a large tooth. I do not know whether either of the items fitted the Prime Minister, but they were intended as a symbol of the effect that

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charges would have on people in my constituency. My constituents predicted over one and a half years ago that fewer people would have eye tests, and that is exactly what has happened.

Conservative Members are keen to give us facts and figures about the amount of money that has been spent on the Health Service. I agree entirely with what the hon. Member for Birmingham, Edgbaston (Dame J. Knight) said in her eloquent speech. I, too, believe that the facts are clear. She gave us facts on the national position and spoke of a 30 per cent. reduction in the number of eye tests. The figure for Leicestershire is lower but just as stark. According to the Leicestershire local optical committee, there has been a 25 per cent. reduction in the number of eye tests carried out on people in the county of Leicestershire. Hundreds of thousands of people-- the hon. Lady said millions--nationally have serious eye disorders which will go undetected as a result of the introduction of charges for eye tests.

Contrary to what we were told by Conservative Members, people in my constituency were angry at the introduction of charges for eye tests. There was huge opposition to it. One person who worked hard campaigning against the charges in my constituency was Mr. Edwards who lives at 67 Marston road, Leicester. He was an optician. Shortly after the charges were introduced it was discovered that he had cancer and that it was terminal. Despite his illness, he campaigned vigorously in Leicester against the charges.

Mr. Edwards presented me with a petition signed by 105 people who opposed the scheme. That was all the names that he had time to collect in the limited time available before he died. I presented that petition to Parliament and shortly afterwards Mr. Edwards went into hospital and died there. I hope that that petition was a suitable memorial to the work that he did on behalf of local people to ensure that the voice of local people was raised against charges for eye tests.

Retinitis pigmentosa is an eye disease which affects a fair number of people in Britain. I have been told that one person in every 4,000 has the potential of developing the disease. A Leicester local councillor, Mary Draycott, members of whose family suffer from the disease, brought to my attention the fact that those who suffer from the disease are not exempt from charges for eye tests. Pressure on local doctors has increased greatly since the introduction of charges for eye tests simply because in the past relatives of those who suffer from retinitis pigmentosa were entitled to a free test. They can no longer have a free test. First, they must go to their general practitioner, who must refer them to a hospital doctor, who, in turn, must refer them to an optician for a free eye test. I wrote to a Minister--not the Minister who is at the Dispatch Box but a previous Minister--about that matter urging her to initiate a scheme to exempt such people from paying for eye tests. Unfortunately, her response was negative.

I received a letter from a Mr. Clinton Smith who is the honorary secretary of the Leicestershire local optical committee. He wrote to me on 11 April 1989. In opposing the charges introduced by the regulations, he contrasted the view expressed by the Government about the tests with the way in which people operate according to the family doctor service. He said :

"It is like suggesting that people can accurately decide for themselves what treatment they need from a family doctor and, although the doctor is trained and able to assist with the

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best possible advice in their interest, they are encouraged for commercial reasons to risk their health and happiness, and possibly their life, by demanding only an inferior part of the service should be given."

That is what we are discussing today. An inferior service is being provided because of the introduction of charges for eye tests. Opposition Members are right to draw attention to the whole range of cuts in the National Health Service. One must see charges for eye tests in the context of the cuts affecting our local health services. The hon. Member for Edgbaston wanted to know where it would all end. I can tell her. It will end in the same way as it has ended in America--in a privatised Health Service. I visited America recently and I know that other hon. Members from both sides of the House have done so, too. When I was there it cost £25 to see a doctor. That is exactly what is intended by introducing charges for eye tests. We shall have a more and more privatised Health Service which we regarded as free at the points of entry and of need.

In my constituency and across the county of Leicestershire cuts have bitten into the local Health Service. Hon. Members from both sides of the House recently had a meeting with the Secretary of State about charges for tests and cuts in the Health Service. It was like communicating with a brick wall. If any hon. Members were thinking of seeing the Health Secretary to lobby on behalf of their health authorities, they should not bother simply because the Secretary of State is not interested in providing any assistance either to Labour or Conservative Members.

I shall finish by quoting from a letter that I received on the day of the Third Reading of the Health and Medicines Bill on 1 November 1988. A student came all the way from Leicester and handed me a letter which was as relevant now as it was then. She urged me to vote against the imposition of charges for tests. She said :

"You may be able to eat with false teeth, walk with false legs but you cannot see with a false eye."

That is what we are saying to the Government. We urge them to put away their false eyes and consider the position in a positive and constructive way. We hear a great deal these days about reviewing the poll tax because of enormous opposition to it. I advise Conservative Members that now is the time to review charges for eye tests and abolish them.

6.37 pm

Mr. Tim Devlin (Stockton, South) : I have an obvious interest to declare in that I have worn spectacles since I was 13. Since then, I have seen the eye test develop from a relatively unsophisticated process to the detailed test that is provided now. The last time that I went to the optician to have my eyes tested--last year--it took about 40 minutes to go through all the electronic and other tests, including blowing air into the eye to detect glaucoma. When one visits the optician, as I do every year, one is always faced with a charge.

I remember that when eye tests were free the cost of spectacles was amazing. At the age of 19 I paid about £70 for a pair of spectacles. When I went to buy spectacles last year the cost for certain pairs was as high as £200 or £300. However, since the introduction of greater competition in the supply of spectacles brought about by the

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Government, it has become possible for people to buy spectacles for as little as £25. Taken with the cost of the test, which is only £10 or £12--a reasonable charge for 40 minutes' work--the total charge is reasonable. It is certainly within the reach of many people in Britain to have their eyes tested once a year or once every two years.

When the reforms were first suggested last year I was one of the most sceptical Conservative Members. I went to see the Minister privately to discuss whether they were necessary. I assure the hon. Member for Leicester, East (Mr. Vaz) that I for one have no plans for the privatisation of the Health Service. I can tell the rest of the House that many Conservative Members would fight to the death rather than see that happen. Many, if not all, of us recognise the great value of the NHS. It will long remain so.

I looked up the history of the NHS charges to see what the precedents were for this form of charge and found that they were first introduced by the Labour Government who set up the NHS. I looked further and found that when the then right hon. Member for Ebbw Vale, Mr. Bevan, was Minister for Health, he said that charges in the National Health Service were "not a tax" on the Health Service, but "a readjustment within it". This is just another series of readjustments which were first brought about by the Labour Government.

Last week I returned from the Soviet Union. In that socialist Nirvana, which many Labour Members undoubtedly aspire to establish here, there are Health Service charges for a whole range of items, such as medicines, prescriptions and eye tests.

After careful consideration, I believe that there is much to be said for what the Government are doing. They are releasing a great deal of money for investment elsewhere in the service and I know that the Minister is monitoring the matter all the time.

6.41 pm

The Minister for Health (Mrs. Virginia Bottomley) : We have had a brief and, at times, heated debate on a subject which is of great concern and importance to many.

Frankly, Labour Members cannot have it both ways. Many whinged and groaned about the supposed demise of optical services, questioned our commitment to going ahead with the survey and pressed us for the results. We have undertaken an independent survey and made the results available in full. There is no conspiracy or concealment. The facts speak for themselves. Once again, the doom and gloom mongers have been seen in their true colours. The growth of the uptake of sight tests that took place through the 1980s is continuing. At a time of rising prosperity--after all, the average family has seen an increase in living standards of 34 per cent. over the past 10 years--those who can do so should pay for their sight test. All will agree that the vulnerable, the frail and the needy should have free sight tests. That is why children, students, people on low incomes, the blind, the partially sighted, diabetics and those with glaucoma and their older relatives are eligible for free tests.

Reference has been made to several surveys produced recently, each showing a fall in sight test demand since the introduction of charges. The plain fact is that most surveys have been commissioned either directly or indirectly by the profession or those with a special interest. There is no

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doubt that extensive pre-publicity about charges encouraged many people to bring forward their appointments to avoid the new arrangements. Indeed, my right hon. and learned Friend the Secretary of State mentioned that some opticians even stayed open until midnight to beat the April 1989 deadline.

We estimate that in the 15 months between 1987 and April 1989 about 1.8 million more sight tests were carried out over and above what would normally have been expected. That is a revised figure of an earlier estimate and relates to all of Great Britain. It takes account of the large number of sight tests conducted before 1 April 1989, but which were paid for later.

Hon. Members will be aware that during the passage of the Health and Medicines Bill the Government undertook to monitor the effects of the new system. We have met that undertaking in full. We commissioned the independent market research company, National Opinion Poll, to survey the number of NHS and private sight tests carried out in the first quarter of 1990. As my right hon. and learned Friend made clear, we have acted swiftly to make that information available to the House today.

I want to make it clear, however, that we have in no way sought to conceal the fact that NOP, in undertaking the survey, made a minor error. It altered the wording in the later weeks of the survey. That does not affect the number of tests undertaken, but we are concerned that it affects the interpretation given about whether or not the test was private or on the NHS. This is spelt out fully in the documents without any attempt at concealment. Indeed, NOP takes full responsibility for that error.

The NOP report concludes that an estimated 4.5 million adults--a total of 5 million people if children are included--received a sight test in the first three months of 1990. That compares with 4.4 million in the same quarter of 1989.

As I have made clear, there is no disagreement that the proposed changes resulted in a dramatic increase in the number of those seeking tests. That is why to establish an underlying pattern we need to look at the 1987 figures. In assessing the report we projected forward the expected uptake on the basis of the upward trend established during the decade. If consumers are seeking eye tests at the same rate as that established trend, we would now expect 3.5 million to have come forward in the first quarter of 1990. We recognise and, again, make it clear in the comments on the report that surveys of this kind encourage over-estimation by the interviewee. Our independent survey, even when generous allowance is made for possible over-reporting, suggests that there were an estimated 4.1 million sight tests in the first quarter of 1990--600, 000 more than the trends would reasonably suggest. Even if we assumed a 50 per cent. rate of over-reporting, there would be more tests that in 1987. Therefore, the survey provides firm evidence, which is endorsed by many of the reports available in the optical press, that the market is again on the upturn.

The hon. Members for Livingston (Mr. Cook) and for Ross, Cromarty and Skye (Mr. Kennedy) referred to the Economists Advisory Group. We have never said that our survey is the only one to be believed. Indeed, paragraph 8 of our report suggests that the true figure may be somewhere between the NOP figure and that in the most recent EAG reports.

My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who is a champion of this

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subject and who is well known and respected in this House, made several important points. Her comment, and that of the hon. Member for Halifax (Mrs. Mahon), that patients are being referred to hospitals to obtain an eye test has not been borne out in evidence. I cannot believe that practitioners would follow such a course of action.

Mr. Dalyell : Will the Minister give way?

Mrs. Bottomley : I am afraid that I have little time.

Mr. Dalyell rose --

Mrs. Bottomley : Pensioners have never been automatically exempted from optical charges on the grounds of age rather than income. We heard excellent contributions from my hon. Friends the Members for Brigg and Cleethorpes (Mr. Brown), for Lewisham, West (Mr. Maples) and for Stockton, South (Mr. Devlin). We are confident that eyesight tests are on a stable course. We take seriously the importance of providing a Health Service with a proper emphasis on primary health care and on eye tests. Only recently we made possible domiciliary visits so that pensioners who cannot leave their homes can now receive an NHS sight test at home. That started on 1 June. It is a further recognition of our desire to target resources on those who are vulnerable and to make sure that they can benefit from a test.

Similarly, in April this year when the Government increased the money spent on the value of optical vouchers, we targeted those in greatest need. We redefined voucher band A so that more patients would fall into the higher group and receive more help.

Many hon. Members have spoken about the importance of prevention, and the need for people to understand that their eyes must be cared for and protected. Hon. Members will be aware that, with the new GP contracts, prevention and health promotion are fundamental concepts. Those aged over 75 will receive regular visits and health checks, and sensory perceptions will be part of that assessment : vision will of course be checked. The Government intend to collaborate with GPs to ensure that they have all the relevant information to ensure that their patients receive the care that they need.

I hope that the Government have laid to rest the myths about the take-up of eye tests. We are at the beginning of a new campaign to draw to people's attention the importance of looking after their eyes, and we hope to put the disagreements of the past behind us and work with the profession on a further campaign in the autumn.

An eye test costs less than an MOT, about the same as a haircut--or perhaps two if one shops around--and about the same as reading The Sun or The Daily Mirror one day a week for a year. Free NHS sight tests are available to one in three of the population. We are confident that our policies of providing health care for those who need it, and ensuring that we have a preventive Health Service, are well and truly vindicated. I urge the House to reject the motion. 6.51 pm

Mr. Alun Michael (Cardiff, South and Penarth) : I am saddened by the cheap and dismissive way in which the Minister ended her remarks. Occasionally, when debating the Government's health policies, we succeed in detecting some twisted logic or some vestige of reasoning. However,

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today's debate has confirmed yet again that there is no logic or sense--or any redeeming feature--in the imposition of eye-test charges. As my hon. Friend the Member for Livingston (Mr. Cook) made clear at the beginning of the debate, there is overwhelming evidence that the Government's policy has proved every bit as devastating as we predicted in April 1989.

Today the Secretary of State attempted to bluff his way out of another disaster. His defence was based on a breathtaking dependence on a single opinion poll ; and, by definition, an opinion poll reflects opinions rather than facts. His figures depend on retrospective analysis--which is not an accurate or a dependable method of dealing with this type of question--and on gratuitous insults aimed at an entire profession and at people who have genuinely tried to get at the truth. The hon. Member for Birmingham, Edgbaston (Dame J. Knight) eloquently blasted him out of the water on that point.

The Secretary of State's figures fly in the face of all other available evidence. They were produced in a press release today in a desperate attempt to minimise the effect of this debate. He mentioned them reluctantly at the tail end of his speech, only after I challenged him to do so ; they are no substitute for the proper figures and objective research that he and his colleagues have refused to produce over the past 15 months.

The Minister for Health added nothing except fine sentiments, which are not reflected in the actions of the Government and depend on the same flawed source. However, she contradicted the Secretary of State by acknowledging the validity of other evidence. She tried to re-announce a development implemented on 1 June.

The case is simple. Many people have been deterred by the charges. People are suffering, and some will go blind through serious eye conditions remaining undetected. Businesses are having to close because of the downturn in tests. Even those who are entitled to free tests are being deterred by the system that the Government have introduced.

This is not, as some Conservative Members try to suggest, a peripheral service for which a charge is appropriate : others, such as the hon. Member for Edgbaston, understand that. However, those who took and did not critically examine the brief from Conservative central office clearly do not understand. In today's debate, and over recent months, the ministerial response has been convoluted and the Government have tried to spread doubt and confusion. They have tried to say that we do not know what is happening. We need only read the blocking answers of the Minister for Health during recent months to recognise her single-minded determination not to know what is going on.

The Minister's colleague in another place, Baroness Hooper, was equally unhelpful, but rather more confident. When she was asked on 2 May about people entitled to free eye tests, she stated categorically :

"There is no change in the uptake of eye tests in that proportion of the population."--[ Official Report, House of Lords, 2 May 1990 ; Vol. 518, c. 1039.]

Funnily enough, she did not have the benefit of the information that the Minister is re-using today. She is wrong.

The Minister has managed to cast a cloak of darkness and opinion over the English figures, but the figures in

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Wales were given to me in a parliamentary reply on 8 May. In the six months from 1 April 1989, the numbers almost halved, from 330,000 to 170,000--a truly devastating drop. The Welsh Health Minister tried to say that it might be due to more people's taking private tests, but that is not true : the House has had the facts. An independent survey by the Federation of Ophthalmic and Dispensing Opticians shows a drop of 36 per cent. The other figures referred to by my hon. Friend the Member for Livingston show the extent of the downturn across the country. Against that, the Government's own investigations offer no independent or substantial evidence for their case. The Government say that there was bound to be a drop in the first couple of months after the charges were brought in. In April 1989, the Secretary of State for Scotland tried to suggest that a downturn after 1 April could be explained by people's success in rushing to beat the deadline. Apart from the curious logic of that, if charges will not deter, why should the lack of a charge and the imminence of an imposition cause an upturn? The history of events show that he was wrong. An increase of some 6.3 per cent. in the number of tests before 1 April hardly accounts for the drop of 36 per cent. recorded independently by the FODO, and certainly does nothing to balance the 49 per cent. drop in free tests reported by the Welsh Office. The fact is that fewer people are having tests. Most serious of all is the evidence from Michael Bateman, the chairman of the FODO, who said :

"Since the introduction of the charges there has been an overall drop in the number of people going for eye checks, even amongst those who are still entitled to a free sight test under the NHS such as those on low incomes, diabetics, and relatives of glaucoma sufferers whose own sight could be at risk."

The Government's third attempt to confuse us is the suggestion that the figures produced by optometrists and independent sources may be inaccurate. There is overwhelming evidence that they are accurate. Opposition Members have asked questions--not dependent on those surveys--all round the country, and the evidence has mounted each time we have asked. Let us take referrals of new ophthalmology outpatients. The Welsh figures show a downturn late last year--just when one would expect reduced detection to follow the reduction in the number of eye tests--before the major increase in serious cases of which we are now hearing. In Pembrokeshire, for instance, there was a drop from 424 to 296.

The hon. Member for Pembroke (Mr. Bennett)--who intervened briefly at the beginning of the debate, although he is not here now--may like to know that Mr. Nick Ainger, who will join us on the Labour Benches after the next general election, rang me last night to tell me the views of opticians in his area. One optician told of an elderly lady who went to see him yesterday. She had not had an eye test since 1976 ; she was blind in one eye and losing sight in another. She said that she had been reluctant to come in because of the cost of spectacles, as she is not on income supplement. How many like her have still not reached the point of desperation when they cast aside their financial worries and take a test?

That optician reported a downturn of nearly 25 per cent. since last April. He believes that the Government should give free eye tests to all retired people now. Another optician in Pembroke dock says that pensioners who are not on income support are failing to turn up for appointments because of the charges. The same is true of

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unemployed people who are not on income support--perhaps because a member of the family is working--but whose family financial problems are nevertheless acute.

The Secretary of State claimed earlier that we still pay for one third of the population. He is wrong : one third may be eligible, but they may also be deterred. In Holyhead, near where I was born, an optician confirmed yesterday that he has experienced a downturn of 40 per cent. An independent sample undertaken by HTV Wales showed a drop of 47.5 per cent. in Carmarthen and a drop of 39.8 per cent. in one of the most deprived areas of the country, the Cynon Valley. However, the problems are not limited to poorer areas : similar figures were produced by an independent survey by the Kensington, Chelsea and Westminster family practitioner committee.

After I had illustrated the situation in Wales I received a letter that graphically illustrates what charging means--it is not just about figures. An optician passed to me a letter that he had received from the father of a 19-year-old student who was not exempt from the eyesight charges. The optician told me that she therefore had to pay, which fortunately she could, but that others would be deterred. The letter reads :

"Dear Sir,

On Thursday 22nd February at 12.30 pm my daughter had an appointment to see the optician to have her eyes tested. He noticed that there was something wrong at the back of her eye and told her to go to the doctor. This she did, and was admitted to hospital on the same day and was operated on a few days later for the removal of a brain tumour. I should like to thank the optician for his prompt action--he probably saved my daughter's life."

I am sure that we would all like to thank the professional opticians who detect such conditions. They deserve more respect than was shown to them by the Secretary of State today. I am told that such cases are far from unusual. Far better than thanks would be an announcement from the Minister that the dogmatic experiment of charging for eye tests has proved a disaster and that that dogmatic charging will be abandoned forthwith.

You, Mr. Speaker, will know the prayer :

"Grant me the serenity to accept things I cannot change, the courage to change things I can, and the wisdom to know the difference."

The Government have the power to make the necessary change and the Prime Minister should have the wisdom to revert to the decision not to go ahead with the charges which she justified in a letter of 23 June 1980, saying that it was

"in reponse to strong representations that such a charge, in a service which has a preventative function, would be wrong in principle and could deter patients from seeking professional advice" Those comments apply as strongly today as they did at any other time, but this time she and her Government have pressed ahead against all available advice and evidence. This time the charge has been brought in and that charge has now deterred-- it will go on deterring. It remains wrong in principle and the Government should remove eye test charges now.

Question put, That the original words stand part of the Question :--

The House divided : Ayes 209, Noes 275.

Division No. 224] [7.01 pm

AYES

Abbott, Ms Diane

Adams, Allen (Paisley N)

Allen, Graham

Alton, David

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