Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 400 - 405)



  Q400  Chairman: I have just one more question to you about the issue of domiciliary eye tests when we were talking earlier about elderly people falling and everything else and sort of the added cost to the NHS for that. What is the current position with domiciliary eye tests?

  Mr Cartwright: Domiciliary eye examinations are available, and there are many practices who do them and some companies which specialise in domiciliary eye care. I believe that one of the issues there is that there is a fee for the first patient and then a lower fee for subsequent patients. There should be a higher fee for the first and second patients and then perhaps a tail-off, whereas it happens at the moment after just one patient.

  Q401  Chairman: If you had this National Service Framework which was mentioned earlier, obviously issues like that would be in there and hopefully would be accepted throughout the UK. Could I move on to Dr Ellman. You advocate an automatic, free oral health risk assessment programme which I would have thought, in terms of last week's White Paper, was something that the Government would be interested in looking at. What are actually the costs and benefits of such an initiative like that? Has it been costed in any way?

  Dr Ellman: Not as far as I am aware, but it has not been developed properly yet either.[9] There is an outline being developed, but there is no IT system to support it currently. A full oral health assessment has been used by other people in private plans, for instance, to give guidance to get a full picture of somebody's oral health, not just the fillings, but the whole picture. That would be beneficial because you could see and again you could do the one thing we have never really done much of in dentistry and that is to measure the health gain, the effects in terms of what we do. We know what the immediate effects are, but we do not know the long-term effects. It would also enable patients to be encouraged along the prevention route by doing oral health scores, so you would know exactly where you were in terms of relationship. This has been trialled outside the NHS by Denplan actually who did it as part of one of their schemes with a fair degree of success, so I think we are not reinventing the wheel from that viewpoint.

  Q402  Chairman: Have you got reports from Denplan on that which perhaps the Committee could look at?

  Dr Ellman: I can try and ask them if they could supply us with some for you. I have not any.

  Q403  Chairman: The other thing I would just like to ask you, Dr Ellman, was not really about NHS charges, but it does come into what you have just said there to some extent. It is this issue of fluoridation of the public water supply. What is the BDA's position on that?

  Dr Ellman: Absolutely solidly in favour. We ran a massive campaign here at Parliament for that some 18 months ago and that was very successful. The BDA is very much in favour of that and the science is very much in favour of that. There are entrenched views in the different directions, but there we are.[10]

  Q404  Chairman: We have heard them over the years, but, with our new regulations in situ now, we do not know when or who is going to operate them. Could I just move back to the opticians. How do you see the   new general ophthalmic services contract developing in the future, not in terms of you would like it set in the National Service Framework and everything else, as I am sure you would, but in terms of charges? Do you think there is going to be any great change?

  Mr Cartwright: I think, in the ideal situation, there would be eligibility, so an eye examination would be something that everybody could access. I think we have to be realistic and say that there are certain groups that are more at risk than others, such as children, elderly people, sufferers of medical conditions and those on low income, so that is absolutely right. Personally, I would then put more effort into extending the role of the optometrist to be able to deal with specific situations that would free up resource elsewhere. We have talked about where, if somebody has red eye or conjunctivitis, that would go into the optometric practice and, perhaps rather than extend eye examination eligibility to absolutely everybody, I would put some money into that side.

  Q405  Chairman: Well, could I thank all of you for coming along this morning. It has been quite an enjoyable session with the little bit of entertainment in the middle of it all! Thank you very much indeed and hopefully it will not be too long before we are actually reporting to Parliament in relation to this. Any further papers you have on these issues we will be more than happy to look at before we come to any firm conclusions.

  Mrs Hansford: Would you like us to send copies of these documents to the Committee?

  Chairman: Yes, indeed we would. I think David would in particular. Thank you.

9   In 2003, the BDA produced a report, Oral Healthcare for Older People: 2020 Vision, which made a number of recommendations in this area. See Ev 137. Back

10   Note by witness: Water fluoridation is the most effective public health measure in reducing dental decay and for tackling oral health inequalities. Tooth decay is a significant problem in the UK and the dental health inequalities are widening. In socially deprived communities as many as one in three children under the age of five will have one or more decayed teeth extracted. As part of the Water Act 2004, MPs voted in favour of local communities being offered the change to decide whether they wanted targeted water fluoridation schemes in their locality. Back

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