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Ms Jowell: I see. When we had a chance in the last Parliament to defeat the Government on the imposition of charges for eye tests, the hon. Gentleman was absent. That makes my case and suggests how his amendments should be dealt with. We are glad to support new clause 1.

Mr. Malone: The hon. Lady had better tread with care, as I understand that the hon. Member for Southwark and Bermondsey has said in print that in the event of a hung Parliament--which I think is unlikely, in view of our impending victory--he intends to be Minister for Health in a coalition Government. She had better have a care when insulting someone who may be a future colleague.

Ms Jowell: There are two words which deal with that ambition: "Dream on".

Mr. Ieuan Wyn Jones (Ynys Mon): I rise to support the amendments tabled by the hon. Member for Southwark and Bermondsey and his colleagues, as it is important to stress that other parties would like to see the reintroduction of free eye tests generally and, in the context of this debate, for the over-60s. I have not had the benefit of listening to all the debates in Committee, but I have read some of the Minister's comments. One of the issues highlighted is whether the Government have properly assessed the risk of sight loss involved.

The Minister said in Committee on 27 February:

"we believe that it is important to develop policies to ensure, where possible, that resources are targeted to where they are needed--to those sections of the population especially at risk."

However, the RNIB report "Losing Sight of Blindness" clearly shows that despite age being the most significant risk factor in terms of developing eye conditions, older people are not eligible for free eye tests on the ground of age alone. Those at the highest risk ought to be those who get free eye tests.

The Minister went on:

"It is important to meet any proven possibility of providing better care. When we are talking about a limited resource, it is better to look at the principle of targeting care than to re-establish something general that is less easy to prove has a definable result."--[Official Report, Standing Committee D, 27 February 1997; c. 198-99.]

Again, the RNIB makes it clear that people aged 60 and over are the group most at risk of developing eye disease because of their age. It is consequently believed that there is a proven need to target that group as the most high-risk group.

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We all agree that not only is early diagnosis and treatment vital to prevent avoidable sight loss, but it is cheaper when compared with the full health and social care costs for an individual with advanced eye disease. Poor vision and blindness lead to greater reliance on social services, limited mobility and expensive medical interventions. Sight disability imposes additional expenses on the individual that are not adequately compensated for in the benefits system. Poor eyesight is a significant contributory factor to accidents among older people. Although there is an estimated cash saving of £32 million from not providing free eye tests for people aged 60 and over, that will be more than offset by those other costs, especially the costs of looking after elderly people who have lost their sight or whose sight is deteriorating.

6.30 pm

It is important to note that there is a clear and genuine dispute about the Government's figures on the number of people going for eye tests. Research carried out in 1994-95 showed that the number of people going for eye tests was 12.7 million, but the Government's change in the methodology resulted in the figures for that year being 14.6 million--clearly the Government wanted to show an increase. While there is considerable dispute about the figures, there is clearly a disincentive for the elderly in particular to go for tests when they have to pay for them.

It is vital that the quality of the eye tests is ensured. By law, an eye test must include a comprehensive eye examination to check for any disease, injury or abnormality that may be present. I am sure that the Government will want to ensure that the those tests are carried out to the proper standard. In addition, there is widespread misunderstanding about who qualifies for exemption under the current rules. Many people are not aware of the exemptions, which should be more widely promoted.

We know that older people have a far higher level of eye disease than other age groups: 90 per cent. of blind and partially sighted people are aged 60 and over. At just over 1 million people in the United Kingdom, that is a significant number. Given the high incidence of visual impairment among the over-60s, it is of great concern that that high-risk group is not exempt from charges on the ground of age alone. In 1995-96, it was estimated that almost 4.5 million eye tests were carried out on people aged 60 and over, of which only 43 per cent. were done on the national health service; therefore, 57 per cent. paid for the tests. It is clear that the single most significant factor in developing eye disease is age. There is a proven, clear and discrete need and I want the Government to recognise that in the context of the debate on free eye tests.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New clause 8

Employment of pre-registration house officers in medical practices

'.--(1) The Medical Act 1983 is amended as follows.
(2) In subsection (2) of section 10 (experience required for full registration as a medical practitioner), for "approved hospitals or approved institutions," substitute "--
(a) approved hospitals,
(b) approved institutions, or

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(c) approved medical practices,".
(3) In subsection (3) of section 11 (construction of section 10, etc), after the first "where" insert "--
(a) in the case of an approved hospital or an approved institution,",
and at the end insert "; or
(b) in the case of an approved medical practice, the person employed satisfies such conditions as to residence as may be prescribed".
(4) In subsection (4) of section 11--
(a) insert in the appropriate place--
"medical practice" means a prescribed description of practice in which one or more medical practitioners--
(i) provide general medical services under Part II of the National Health Service Act 1977, Part II of the National Health Service (Scotland) Act 1978 or Part VI of the Health and Personal Social Services (Northern Ireland) Order 1972; or
(ii) perform personal medical services in accordance with arrangements made under section 28C of the 1977 Act, section 17C of the 1978 Act or the corresponding provisions of the law in force in Northern Ireland;";
(b) in the definition of "prescribed", after "means" insert "--
(a) in subsection (3)(b) and in the definition of "medical practice", prescribed by regulations made by the Secretary of State; and
(b) in the other provisions of this Part,".
(5) After subsection (4) of section 11 insert--
"(4A) The Education Committee may by regulations provide that the period of employment in a medical practice which may be reckoned towards the completion of any of the periods mentioned in section 10(3)(a) above shall not exceed such period as may be specified in the regulations.
(6) In subsection (5) of section 11, after "under subsection (2) of section 10 above" insert "or under subsection (4A) of this section".
(7) After subsection (6) of section 11 insert--
"(7) Regulations made by the Secretary of State under this section must be made by statutory instrument; and such a statutory instrument shall be subject to annulment in pursuance of a resolution of either House of Parliament." '.--[Mr. Malone.]
Brought up, and read the First time.

Mr. Malone: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker (Dame Janet Fookes): With this, it will be convenient to discuss the following: amendment (a) to the proposed clause, in line 40, at end add--

'(8) Section 12 is omitted.'.

Government amendments Nos. 59, 60, 62, 63, 65, 67 to 72, 74 and 75.

Mr. Malone: During the Second Reading debate I gave an undertaking to meet the concerns of several hon. Members about the limitations in the Medical Act 1983 that prevented pre-registration house officers from taking placements in general practice except in health centres. In Committee, I explained that that was clearly an anomaly that we were happy to address. I am therefore pleased to move new clause 8 and to discuss amendment No. 75, which deliver on my undertaking to the Committee. With those, I want also to speak to the related amendments to clauses 11 and 22 and schedule 2.

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New clause 8 and amendment No. 75 are designed to enable more young doctors in their final year of basic training--the pre-registration house officer year--to undertake part of that training in general practices. The case for the change has been made for many years and it is now quite timely, given that the Bill provides opportunities for more flexible ways of working and providing services. Much of a primary care-led national health service has to do with the training provided in the context of primary care.

It is important that I should set out a number of practical issues that will have to be carefully considered before those placements in general practice are fully introduced. I want there to be no misunderstanding among hon. Members: the measure before the House is an enabling measure and there is considerably more work to be done. We are considering encouraging carefully evaluated pilot schemes in health centres, which will enable us to assess whether any constraints should be placed on the activities of pre-registration house officers in general practice. For example, concerns were raised in Committee about the prescribing of medicines and unaccompanied visits to very young children or, indeed, to any patient.

Those are important issues and we must balance young doctors' training needs with the protection of patients' interests and safety. The education committee of the General Medical Council will need some time for the careful development of regulations and guidance to cover those issues and will need to consult widely. Regulations made by the education committee will be approved in the normal way by the Privy Council. We therefore do not expect the new arrangements in general practices to be in place for some time.

I now turn to amendment (a) to new clause 8. There must have been some misunderstanding that has led to the amendment being tabled, because it removes entirely section 12 of the Medical Act which provides that a health centre cannot be an approved institution for the purpose of pre-registration house officer training, unless it is an NHS centre provided under the National Health Service Act 1977 or the Scotland or Northern Ireland equivalents. Where it is so and if other conditions are satisfied, PRHO training can take place in health centres. In other words, if that part of the Medical Act were removed, it would cast doubt on whether PRHO placements--including some that are now in operation--could take place in health centres. I am sure that that was not what was intended.

I turn finally to the amendments to clauses 11 and 22 and schedule 2. In brief, those replicate provisions that currently exist in general medical services and give the Secretary of State powers to replicate those that operate in the general dental services. They will enable us to ensure that training can take place in the different environments and service settings for which the Bill provides. I assure hon. Members that all the controls that currently underpin training within general medical and dental services will equally be applied to personal medical and dental services, so that training activities can be undertaken with no effect on the quality of the services provided. I commend the amendments to the House.

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