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Government conducted a survey. My hon. Friend the Member for Livingston challenged it in a debate after the eye test charges were introduced.The institute states :
"The Government have seized this information to support their argument. We believe the figure is a substantial overestimate. The Government itself accepted that its survey had produced some degree of overestimate. It is also worth comparing what the Government survey claimed to have happened on NHS tests with what actually happened.
2.05 million adults claimed to have had an NHS test in the first quarter of 1990, but the records show the Family Practitioner Committees only paid for 0.624 million tests. Although some of this discrepancy might be explained by confusion as to the difference between NHS and private tests, it casts doubt on the credibility of the Government's survey."
I believe that, too, and I hope that the Minister will seriously consider that forcefully made point.
In the light of the overwhelming evidence from all sources, it is time for the Government to admit that they made a serious mistake in abolishing free eye tests. Abolition is leading to serious diseases going undetected. The Government must accept that thousands are at risk because of the cost deterrent. They are not being given medical care when they need it, and that cannot be in their interests. That makes a cruel nonsense of the purpose of the NHS, and it represents a false economy that can only lead to human misery.
Some of these diseases are very painful, and human beings are suffering needlessly. Some may even suffer early death as a result of their condition not being detected early enough. I urge the Government immediately to restore the free eye tests. It they do not, we can only assume that the impression that we were given when the Government changed their Prime Minister--that we were to have a more caring Government--was only a mirage, and that they are following the tradition of the last Prime Minister and her Administration, in whose hands we could not trust the NHS.
I promise the Minister and anyone who may take note of this debate that we shall keep pressing for free eye tests, which any socially aware and civilised society should provide for its citizens. If the Government do not restore them, on the election of a Labour Government we shall soon restore them. They are vital diagnostic tests which provide an early warning system for serious diseases. I urge the Government not to wait for the next Labour Government and to show that they really do care.
11.12 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : I agree with the hon. Member for Halifax (Mrs. Mahon) thathis is an important subject, and the House therefore has reason to be grateful to her for initiating this Adjournment debate, which allows us once again to test the arguments for the stance that the Opposition have adopted on the issue and the arguments that the Government deploy in defence of their position.
I wish to restate the policy that the Government have pursued and to set it in context. There is no disagreement between the Government and the hon. Member for Halifax, or between the Government and the optometry profession, about the importance of eye tests. The Government remain fully committed, as they have been throughout, to quality eye care and to ensuring that those
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who go to opticians receive a high-quality professional service. That is why, in July 1989, the Government tabled regulations that set out factors that should be taken into account, by law, when a patient has an eye test. The law requires that a patient have a refraction test to measure the degree of correction required for good eyesight, and that patients be given a full examination of their eyes. That requirement was put on the statute book by the Government because we are committed to the principle that a regular eye test is an important part of health care.The hon. Lady is concerned principally not with high-quality eye care but with who pays in most instances for such tests. Experience proves that on average the cost of a test is £12 or £13, and the Government believe that, for the great majority, it is entirely reasonable that the individual citizen should pay that sum for himself or herself. I suggest that it is inconsistent to argue, as many do, that taxpayers, and citizens in general, would be prepared to pay another 1p in the rate of income tax if the proceeds were directed entirely to health care. If the rate of income tax were to be increased by 1p, something in excess of £50 a year would be the yield from a man on average earnings. Yet that same person is not prepared to pay £12 every two years for an eye test.
The Government accept that people are prepared to pay an additional charge to ensure high-quality health care. For those who are in a position to do so, the eye test is a perfect example of an opportunity for people to make a contribution to their health care, recognising as the Government do the importance of a fully qualified person conducting an eye test. That does not detract from the Government's commitment to ensure that there are free eye tests available to those who can establish a need, either on the ground that they are adults with low incomes, or are children or students aged under 19 years, or to those who on health grounds attach an especial importance to regular eye tests. That is why free tests continue to be provided for the blind and partially sighted, for those who suffer from diabetes and for those and their families with a history of glaucoma.
Those who benefit from free eye tests on the ground of low income and those who so benefit on health grounds constitute 40 per cent. of the population. I accept that by and large the public would like to have the opportunity to contribute more to expanding the resources that are available for health care, and the eye test system provides exactly that. It seems entirely consistent with the Government's commitment to improve the quality of health care that is available and to ensure that the maximum value is squeezed out of the budget that is available to the national health service.
It is sometimes suggested that the free facilities amount in some sense to a concession that has been drawn from the Government under protest, but our record gives the lie to that. My hon. Friend the Minister for Health devoted considerable effort in the early spring to promoting the importance of eye tests and the availability of free tests to those who will benefit from them. It is not a matter of 40 per cent. having an entitlement and the Government taking no further steps. We have undertaken a promotion campaign to ensure that those who are entitled to a free test have that fact brought to their attention.
The hon. Lady has said that an incoming Labour Government would restore the universal availability of free eye tests. That commitment, blithely given late on Monday night in the House, would cost such a
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Government more than £100 million a year. The question that the hon. Lady and her hon. Friends must answer is whether an extra £100 million a year available for improving and expanding the resources of the national health service would be best used in the way she described or whether it would be better used to improve the quality and availability of health care elsewhere in the national health service. I find it hard to believe that the highest priority for a marginal £100 million in the national health service is the restoration of free eye tests.The only evidence that the hon. Lady used to substantiate her case this evening--her speech was entirely consistent with speeches made by Opposition Members ever since the change was made--was a series of surveys on which I shall comment briefly. The hon. Lady suggested that I should not get involved in an argument about which survey we embrace, and she sought to argue that there was some doubt about the credibility of one of the surveys that one of my right hon. Friends relied on in the past. I am content with that. I shall take the surveys published on 12 April by the Association of Optometrists on which the hon. Lady placed the greatest weight.
There were two surveys. The first was carried out by MORI which, not surprisingly, concluded that given the choice between paying for eye tests and getting them free, the British people would prefer to have them free. The hon. Lady considered that to be socially aware. I disagree. If someone offered me the choice between having something free and paying for it, I would choose to have it free. That is simply to ignore the reality of the choice and the importance of priorities in the use of resources within the national health service.
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The other survey published on 12 April by the Association of Optometrists was undertaken by the Economists Advisory Group which sought to demonstrate that the take-up of eye tests has been substantially cut since charges were introduced in April 1989. I believe that that survey is subject to severe shortcomings. First, only 56 per cent. of the optometrists to whom it was directed responded to the survey. That leaves me wondering what evidence the other 44 per cent. would have produced. Secondly, the statistics that were quoted compared the period immediately after charges were introduced for the first time with the period immediately before the change--the last period during which they were free. It is not surprising that there was a boom in demand for eye tests just before the charges were brought in, and that there was a slump just after they were introduced.If the hon. Lady reads the press release, she will find one piece of evidence that was not highlighted in the text. In the last two quarters measured by that survey, there was a sharp increase in the take-up of eye tests. In the third quarter of 1990, eye tests were up by 9 per cent. on the equivalent period in the previous year and in the fourth quarter of 1990, take-up was up by 16 per cent. over the same period in the previous year.
I do not accept that the evidence is conclusive that the change in funding has led to a long-term decline in the demand for eye tests. I agree with the hon. Lady about the importance of eye tests and we shall certainly continue to stress that, but I do not accept that her conclusions can be based firmly on the statistical information at her disposal.
Question put and agreed to.
Adjourned at twenty-three minutes past Eleven o'clock.
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