Examination of Witnesses (Questions 360
- 379)
THURSDAY 9 FEBRUARY 2006
DR LESTER
ELLMAN, DR
MAUREEN BAKER,
MRS LYNN
HANSFORD AND
MR DAVID
CARTWRIGHT
Q360 Mr Campbell: A lot of people
would not wear a budget pair. They may say, "I'm not going
to pay the difference just for a budget pair of glasses, but if
I had a bit more money I would go for a good pair". Even
the poor want to have glasses like my own.
Mrs Hansford: There is plenty
of selection in spectacles.
Q361 Mr Campbell: I do not know about
that. I go to my optician's and I look at the little case with
the budget pairs and there are only about 12 pairs in there.
Mr Cartwright: It is a fact that
two-thirds of practices will provide spectacles of the voucher
value, so at no extra cost at all and with a range of spectacles.
We are not going back to the old NHS days of brown or black glasses
where there was a badge of poverty—
Mr Campbell: There is not a great choice.
I have looked at them when I have been in there. For the best
glasses there are three or four cases.
Q362 Jim Dowd: Go to another optician,
Ronnie!
Mr Cartwright: I beg to differ
because it is a very competitive market and there is choice, so
people will be able to go in and there will be a number of frames
that are available for that person.
Q363 Mr Campbell: I have not got
a problem with that. My point is about the difference between
the voucher they get and the price of the good glasses. I am talking
about poor people on Income Support getting a good pair of glasses.
Mr Cartwright: These would still
be good glasses, they would be good lenses and they would still
be backed by that professional service. There is no difference
in the offering to the patient.
Anne Milton: My child has worn glasses
since he was 18-months old and I have never paid for them. The
choice has been fantastic. I live in Surrey and if there was any
way of going to the opticians where you did not have to pay for
glasses it would be there, but in fact every optician has distributed
them. They are fantastic glasses. You are using the words good
and bad prejudicially and it is not fair. If you want a Giorgio
Armani pair of glasses you are going to have to pay for it like
you would a suit.
Mr Campbell: The voucher system only
applies to some frames.
Anne Milton: And they are absolutely
fine.
Mr Campbell: They should go beyond that.
Q364 Chairman: Maybe you should have
that debate in a private session. Would the issue of the value
of the voucher be the difference in this debate?
Mrs Hansford: There is not any
such thing as free glasses and then the next pair of glasses cost
you £200. You might pay £5, £10 or £15 to
have something a little bit better. We are not talking about huge
amounts of money to have a bigger choice. You can spend a lot
of money on spectacles just the same as you can spend a lot money
on a suit, but you can also get an off-the-peg suit that is perfectly
reasonable, that can be thrown in the washing machine and look
good for years that you do not pay a lot of money for, and you
can have a pair of glasses that you do not pay a lot of money
for that look perfectly good and do the job.
Mr Campbell: A good pair of glasses costs
about £100.
Chairman: This is a very interesting
but anecdotal debate in many ways. I would like to move on now.
Q365 Mr Amess: Chairman, just for
a moment I want to join in the free-for-all and go completely
off the script. About 45 minutes ago we had this interesting exchange
between Dr Ellman and my two colleagues about what happens when
you neglect your teeth, what is the ultimate effect of it and
all the rest of it. Surely you end up with dentures. Not everyone
is successful in wearing dentures. You need teeth to eat and chew
your food. You cannot just sit there sucking boiled sweets all
day. I would have thought you could even die through it. Never
mind your remark about the aesthetic result, I would have thought
it was very, very important that you keep your own teeth.
Dr Ellman: There is no doubt whatsoever
that in today's world more and more and more people wish to retain
their teeth for as long as they live and that is where the additional
expenditure will come in. If their teeth are taken out and they
wear dentures then that will reduce that effect to some extent.
Q366 Mr Amess: Believe it or not,
I am trying to help you with the answers. Dentists no longer pull
out teeth unnecessarily. They do everything they can to save them.
Let us come on to the opticians and the national service framework.
Mrs Hansford: We never pull out
eyes!
Q367 Mr Amess: In your written evidence
you say that General Optical Services are "not underpinned
by a national service framework for improving health in the optical
field". Obviously you feel that this is a big issue. Given
that it is a big issue and given that there are all these different
contractors, there is certainly some resistance as a result of
the charges. Why is it so important, and how could you achieve
this national service framework in practice?
Mrs Hansford: That is all laid
out in this document that I waved around when David was talking.
We did present this document to Rosie Winterton in the autumn
of last year and it does lay out our vision of the future for
primary eye care and David did explain it in quite a lot of detail,
ie the essential service, the additional services and the enhanced
service. It is pretty much the same as we have in Wales. My practice
is in Wales. You are probably aware that we have enhanced primary
eye care in Wales where we provide an acute referral scheme which
is in effect a triaging system and where patients with eye problems
can come to the optometrist. About two-thirds of the practitioners
in Wales are accredited to deliver those charges. There is the
Low Vision Scheme and other things like that. We feel quite strongly
that there ought to be a national service framework and a publicity
campaign so that everybody understands the importance of vision.
If you speak to anybody about the importance of vision and they
think about it for more than 10 seconds, it is obvious that you
cannot function unless you can see properly, but it is never a
thought that is prominent in people's mind. The children's NSF
does not mention eye care for children and the older people's
NSF does not mention eye care for older people and yet when I
say that you think that is mad. If we had an NSF for vision so
that everybody understood the importance of vision, the importance
of eye care, seeing well and detecting eye disease early, then
I think that would be a huge health gain for patients and for
the NHS as a whole.
Q368 Mr Amess: If this were to be
effective you would systematically have to monitor the situation.
How would you get the information across to the public and private
sector? What would be the mechanism to make this national service
framework a reality?
Mr Cartwright: We are currently
about to embark on negotiating the new GOS contract and we would
propose that the essential services, the additional and enhanced
services within that and they should be properly funded. Much
of this information would go through the Department of Health.
We would have payments and all that sort of information would
be there. Is that the sort of things you are thinking of?
Q369 Mr Amess: Given that there is
public and private provision, how would you collect it all? How
would you get everyone to agree? You are suggesting that the Department
controls the thing overall. There seems to be a bit of a contradiction.
Mr Cartwright: If we were thinking
about awareness and if we had a framework—and they do exist
in some areas of the country and Wales is a good example—where
a patient who has an eye problem is going to their GP but then
they no longer go to their GP but to an optometrist locally. That
actually would raise awareness very quickly that if I have got
a problem with my eyes I will go to my optometrist. At a GP's
surgery you would be told to go to see the optometrist. When you
ring up for an appointment and they ask you what it is about,
you would say it is to do with your eyes and you would be referred
to the optometrist. We do not need to talk to every GP, although
that might be a useful thing to do, but if that was a nationally
set framework which was set centrally and then PCTs were picking
that up then that would happen naturally.
Mr Amess: The Committee will reflect
on your evidence. I think Boots is splendid!
Q370 Jim Dowd: It is a German company
that has just bought them!
Mr Cartwright: It is Italian.
Q371 Jim Dowd: I want to raise the
comparatively recent development of people being able to buy glasses
off the rack from supermarkets. I just wondered what your view
of that was.
Mr Cartwright: Supermarkets have
entered the market and it is very competitive. In the supermarkets
it is a registered practice so you will have an optometrist or
a professionally qualified person there to help.
Q372 Jim Dowd: I am not talking about
that, I am talking about the fact they are on the shelves alongside
any other product. What is the percentage of people buying glasses
without professional guidance?
Mr Cartwright: This has been there
for 20 years and I think at the time the profession thought it
was appropriate. There is also unregistered spectacle dispensing.
Both of those have regulation behind them. If it is a readymade
pair of readers and it is to correct presbyopia, that is glasses
for near work, you should not be able to go in and buy them for
driving for instance. There is an age limit set so that children
cannot go and buy these to correct their distance vision. It is
acceptable if there is background regulation. Also, for unregistered
dispensing, so somebody can set up without the professional service,
the regulation says that there has got to be a prescription dated
within two years. There has got to be measurements taken. I think
it is acceptable if there is some background to it.
Q373 Jim Dowd: But there is not.
They are just on racks. People go in and pick up a pair and they
go to the cashier and that is it.
Mrs Hansford: That is why we need
the national service framework.
Q374 Jim Dowd: I was asking your
view about that as a practice.
Mr Cartwright: It certainly has
its dangers but in a lot of places there will be responsible promotional
material with it saying an eye examination is important and you
should do that every two years, so that would be a responsible
way of doing it. There are some places where you can just go and
buy them. You can imagine that for somebody whose sight is failing
they may think, "I'll just go and get myself a slightly stronger
pair of glasses", and actually they have got a medical problem
and they should be going to have their eyes examined to correct
that.
Q375 Jim Dowd: So the supermarkets
should adopt a more responsible and active role, is that what
you are saying?
Mr Cartwright: It would be unfair
to pick on supermarkets. There are some places where you can just
go and buy readymade reading spectacles. The important point is
to raise awareness so that people think, "Okay, I can get
these, but I need to make sure they are right for me and I need
to back that up with an eye examination".
Mrs Hansford: There is a lot of
evidence to show that people who buy "ready readers"
are quite often buying them as a backup pair to their prescription
pair. So they have had their eyes examined and they have bought
their prescription specs. That may not be every case.
Q376 Mike Penning: When you are in
the opticians having your eye test they give you the prescription
and they try and sell you glasses while you are there, but if
you get out the door like I did you can buy them elsewhere for
£10.
Mrs Hansford: As long as you have
had your eye examination and as long as you are buying a pair
of reading glasses that suit you that is not a problem.
Q377 Jim Dowd: I bought a pair in
Sainsbury's largely because I could not read the label on something
I was going to buy and thought they would help.
Mrs Hansford: As long as you went
and had your eyes examined by the optometrist the next day that
would not be a problem.
Q378 Jim Dowd: I have not.
Mrs Hansford: Well, you need to.
How do you know you have not got glaucoma?
Jim Dowd: You are right.
Q379 Dr Taylor: I am going to follow
the rather rumbustious precedent of not sticking to the script
certainly for the moment. I am really quite staggered to hear
that the BDA has not expressed a collective view about the contract
because I really thought it had.[5]
Are local dental committees affiliated to you? They are part of
you, are they not?
Dr Ellman: No, they are not. They
are statutory bodies that represent the profession locally and
present the views and they are there to assist primary care trusts
and the like in formulating policy and dealing with things on
the ground. They are not dissociated from us but they are not
part of the British Dental Association.
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