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Mr. Malone: That does not need to be enshrined in primary legislation, because there is already a power to bring it about. If the hon. Gentleman wants an undertaking that we view the role of optometrists as important and ophthalmic services as essential to the provision of a range of primary care services, I am happy to give such an assurance. We intend to give powers to health authorities to regularise existing arrangements such as shared eye schemes through the provisions on NHS contracts in clause 30. The matter is not explicitly covered in the Bill because we do not need to write in such a power.
I give the hon. Gentleman the assurance that I suspect he seeks--that we view the matter as being of great importance. We want to regularise the excellent schemes that are already growing up in the service, such as shared eye schemes. I think that I mentioned that to the hon. Gentleman in Committee.
I do not believe that giving health authorities and health boards powers to extend the criteria for eligibility for free NHS sight tests would be an appropriate use of development funds. We believe that people who can afford it should pay for their sight tests. I have often put that argument to the House. I am glad that it seems to be catching somewhat, at least with Labour Front-Bench spokesmen, if not with the hon. Member for Southwark and Bermondsey.
Any help that is available, especially from development funds, should be concentrated on vulnerable members of the community. When dealing with problems such as this, targeting is important. About 40 per cent. of the population are eligible for NHS sight tests, including people on low incomes and those at special risk of eye disease. The policies are framed precisely to target available resources on those at greater risk.
We estimate that removing all restrictions on eligibility for NHS sight tests would cost about £140 million a year, while making everyone over 60 eligible would cost £32 million a year. As so often with health care, we are talking about proper targeting to bring about the best possible results. That £32 million could pay for about 4,000 cataract operations. Cataract surgery is one of the most effective eye care interventions and leads to
improved visual acuity for more than 80 per cent. of patients treated. That such targeting is effective is shown by the fact that between 1984 and 1995 the number of eye lens operations, which are mainly for cataracts, increased by 174 per cent.
Mr. Simon Hughes:
I am grateful for the opportunity to speak on this group of amendments. I do not take exception to new clause 1, but I would like to speak on the amendments grouped with it. The Minister's evaluation of my reason for tabling new clause 9 and our other new clauses and amendments was right. It is to ensure that we can go back to having, under the NHS, both piloted ophthalmic services and the ability to return to free dental and eye checks.
I understand the debate about targeting and generalising. There is an honest intellectual debate about that--I do not pretend otherwise--and I doubt whether I can persuade the Minister. If I am wrong, I would achieve a significant but slightly unexpected change of Government policy. However, I want to give the serious argument on the other side of the debate to that which the Government espouse and to cite the helpful evidence from answers from the Minister's Department supporting it.
The change in policy in relation to eye and dental checks was controversial. If we could include, as new clause 9 does, pilot schemes under which special ophthalmic services are provided and also, as clarified by amendment No. 79, pilot schemes for sight testing for the over-60s, we would achieve good primary health care. That is what the debate is about.
I would like to go further than the amendments. I do not want someone to say later, "You only included sight testing for the over-60s--what about the rest?" Our policy is to do everyone. However, for the purposes of conciliation and compromise with other parties, I am only putting forward, in amendments Nos. 77 and 79, sight testing for the over-60s. I want to speak specifically about amendment No. 79.
The Department, in timely fashion, gave me yesterday a parliamentary answer with figures for the increase in cataract problems. The crude figure shows that there has been a 57 per cent. rise in treatment for cataracts and a 44 per cent. rise in treatment for glaucoma in the past four years. The figures, which come from the Department of Health, are not disputed.
I shall not speak at length on the figures, which are available in Hansard. However, they are--at least--worrying and, I would say, frightening. Some 58,289 more people received cataract treatment in 1995 than in 1991, and 7,651 more people received treatment for glaucoma. Figures from the Library show that an average cataract removal operation costs £1,800, which means that the total bill to the NHS for cataracts alone is £105 million--a significant sum. Just so that people do not accuse me of being nationalistic or partisan, the Welsh figures for cataract treatment are up by 64 per cent. and the Scottish figures are up by 48 per cent.
There is broad support for the case made to Ministers by the Royal National Institute for the Blind, whose representatives came to me and said that they were off to meet the Secretary of State for Health immediately afterwards. The RNIB produced a report some weeks ago and, in support of that report, there are 100 signatures on an early-day motion on the matter--eight Conservative Members, 71 Labour Members and the remainder from my party. The early-day motion argues for a return to free eye tests for this limited category.
The Minister said that we must target the most vulnerable, and in this context no one will be surprised to learn that those most vulnerable are the elderly. Therefore, this proposal is targeted at reintroducing free eye tests for the over-60s. The Minister has given figures from parliamentary answers which suggest that reinstating free eye tests for everybody would cost £100 million, but that reinstating free eye tests for the over-60s would cost only £32 million.
I believe that there would be huge public support for a return to free dental and eye checks, and the Government and the Labour party are making a mistake in not supporting this. I am disappointed, to say the least, that the Labour party--as confirmed a couple of weeks ago--is not supporting the proposal. If it cannot find £32 million to restore free eye tests for the over-60s, its welfare policies must be even thinner than people imagine.
Early diagnosis is essential in preventing the eventual development of serious eye conditions, and the evidence from the RNIB is clear. I was privileged to open the new lecture theatre at the Institute for Optometry at the Elephant and Castle in my constituency. That profession wants to be able to do additional work, and there are huge amounts of work for qualified optometrists. We need more of them, and this debate should be a plea for more people to come forward to qualify to work in this part of the health and medical services.
I shall not detain the House much longer. The figures make the case and, historically, Members from all parties have made the case. We could do some practical work by passing new clause 10. If the new clause were to be passed, I imagine that the Minister would concede that the other amendments could go through on the nod. We should reinstate as a primary care pilot scheme the ability to give free eye tests to the over-60s. I ask the House to support the new clause enthusiastically.
Ms Tessa Jowell (Dulwich):
We welcome the Minister's support for new clause 1, and we congratulate him on fulfilling his commitment in Committee by moving the clause today. The new clause is welcomed by the Association of Optometrists, and it allows proper professional discretion for optometrists. It is consistent with the spirit of innovation that we supported throughout the Committee. We would argue that those who look most at eyes, and at eyes most of the time, are competent to make judgments about whether patients need a referral for further medical advice.
I shall refer briefly to the amendments tabled by the hon. Member for Southwark and Bermondsey (Mr. Hughes) and his hon. Friends. We do not think that this is the place to raise these issues again. When the Government imposed charges for eye tests, we opposed them and fought hard against the abolition of free tests. But we are sick and tired
of the hon. Gentleman, his hon. Friends and candidates from his party going on public platforms up and down the country making promises that they know they have not the slightest likelihood of ever having to take responsibility for implementing. It is rank hypocrisy, and I shall be perfectly prepared to give way to the hon. Gentleman after I have asked him to confirm whether he joined the Opposition in the last Parliament when this matter was put to the vote.
Mr. Simon Hughes:
I can deal with both matters. We are committed to the Budget figure, and to finding the money. On the question of the votes on this issue, I have been here for all such votes, except one, in the past 14 years.
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