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Dr. Howard Stoate (Dartford) (Lab): I thank my right hon. Friend for her remarks on community pharmacies. I am sure that they will be greatly appreciated by the many thousands of community pharmacists who work so hard to provide front-line health care services. Will my right hon. Friend ensure that, when she relaxes the requirements for pharmacists to be on the premises at all times as they are now, at least one pharmacist will be available so that we avoid the situation in which one pharmacist has, in theory, to manage more than one premises at the same time? I am concerned that that could compromise standards.
Ms Hewitt: My hon. Friend makes an important point, which we will look into carefully when we draw up the detailed regulations to give effect to the provision. In order to ensure that patient safety is in no way compromised, a responsible pharmacist will have to be in charge of every pharmacy. However, because he or she may not have to dispense every item, it will be possible to make much better use of the range of skills within the pharmacy team.
We are also reforming the entry requirements governing the provision of pharmacy services by implementing in England the final elements of the balanced package of reforms that we published in response to the Office of Fair Trading report two years ago. Similarly, in modernising ophthalmic services, we are relaxing the current restrictions on who can provide them.
Helen Jones (Warrington, North) (Lab): As someone who has been using opticians since the age of seven, may I ask my right hon. Friend about the logic behind devolving general ophthalmic services to PCTs? Will she give an assurance that PCTs will not be able to restrict the number of opticians who provide sight tests?
My hon. Friend raises an important point. We want to give PCTs the ability to secure the best services for people in their area, and that is exactly what we are doing by devolving responsibility for dental services[Interruption.] Yes, they will be able to respond to some of the very real problems that we are addressing. On ophthalmic services, PCTs will be able to
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use a wider range of providers to obtain the services that people need. The changes will simplify entry requirements for the provision of NHS services and help to support better service provision.
Mr. Andy Reed (Loughborough) (Lab/Co-op): I accept that PCTs are often well placed to drive up the level of provision in their area, but does my right hon. Friend understand the concerns of optometrists in my constituency, such as David Austen, who provides an excellent service but is fearful that quality may be reduced if the PCT is driven by the need to make economies? The changes should be about driving up standards, not reducing them to a level playing field.
Ms Hewitt: My hon. Friend's final point is right. These changes will help to continue improving the quality of care that opticians are able to provide. My hon. Friend the Minister with responsibility for ophthalmic services has recently met the opticians to reassure them on that point, because it has been raised not only by the constituents of my hon. Friend the Member for Loughborough (Mr. Reed) but by many others.
Ms Hewitt: No. The hon. Gentleman is very persistent, but I have already said that I will not give way, because I wish to make some progress and there are many other issues on which I anticipate hon. Members will wish to make interventions.
The counter fraud service has performed a highly important job since we established it in 1998. By the end of the last financial year, it had produced a financial benefit to the NHS of £675 million, which is a 13:1 return on its total budget since 1999. The service is an important part of ensuring that we get value for money for every additional £1 of taxpayers' money that we put into the NHS.
I come to my final point before I turn to smoking. In part 5 of the Bill, we respond to an important report published in 2003 by the Public Administration Committee, which was called "Government by Appointment", by establishing a new non-departmental public body, the appointments commission, to replace the current NHS Appointments Commission. In the Committee's estimation, the NHS Appointments Commission was working well and the Committee
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recommended that other Departments should be able to use its services. The Bill provides the legal framework to do that and reaffirms our commitment to an independent appointments process.
Mr. Andrew Turner (Isle of Wight) (Con): I am grateful to the Secretary of State for giving way before she discusses smoking. In her responses to interventions by Labour Members, she did not appear to give an assurance that she would not allow PCTs to restrict patients' choice of ophthalmic practitioner. Will she assure the House that she will carry out a full review of general ophthalmic services, in consultation with the profession, so that people in England receive the same quality of treatment as is available in Wales and Scotland?
Ms Hewitt: The measures in the Bill are designed to increase the choice that is available to patients in England. The Bill will enable primary care trusts to contract with a wider range of providers, and indeed, as you would expect, Mr. Speaker, we have been discussing this very closely with the opticians, with the profession, and we shall continue to do so as we bring forward regulations on this matter.
Ms Hewitt: I am not going to take further interventions because I wish to turn to another very important matterpart 1 of the Bill, on smoke-free places. The provisions that we are introducing in part 1, which extend to England and Wales, fulfil the commitment that we made last year, in the "Choosing Health" White Paper, to legislate to shift the balance significantly in favour of smoke-free environments.
Dr. Desmond Turner (Brighton, Kemptown) (Lab): I am sure that my right hon. Friend is aware that many of us see a fatal flaw and contradiction in the Bill[Interruption.]in part 1, which is otherwise admirable in its intent. I am sure that everyone on the Labour Benches would wish to protect workers from being exposed to smoke in their workplaces, and probably all of us in the House would support that aim. Part 1 is fatally undermined, however, by providing exemptions for private clubs for instance, or pubs that do not serve food, where people still have to work and where, in practice, it is impossible to separate those working there from the smoke. My right hon. Friend must be aware that there will be serious moves to amend that part of the Bill.
Ms Hewitt: My hon. Friend has raised early in this debate what the exemptions should be, but I would refer him first to the manifesto on which he and I were both elected earlier this year[Interruption.] Perhaps I may just finish this sentence, which is rather an important one, if I may say so, for all my hon. and right hon. Friends. We were all re-elected this year on a manifesto that promised we would legislate to ensure that
"all enclosed public places and work places other than licensed premises will be smoke-free . . . that all restaurants will be smoke-free, all pubs and bars preparing and serving food will be smoke-free".
The Bill delivers on that promise by introducing a complete ban on smoking in enclosed public spaces and workplaces, but allowing for limited exemptions about which I shall say something more in a moment.
Mr. Jim Devine (Livingston) (Lab): My right hon. Friend will be aware that I was not actually elected on the manifesto, coming in, as I did, in October, and she will be aware that many of us in this place would like us to follow the lead of the Scottish Parliament and the Dail in banning smoking totally in all public places. But I wonder whether she is aware of the British Medical Association report that was produced in October, which compared the respiratory function of bar staff in Northern Ireland and in the Republic, before and after the introduction of the smoking ban. It showed that the respiratory function of bar staff in the south had increased substantially, and the conclusion was that the smoke-free law
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