Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 360 - 379)



  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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