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Session 2005 - 06
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Standing Committee Debates
Health Bill

Health Bill

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Standing Committee E

Tuesday 10 January 2006


The Committee consisted of the following Members:

Chairmen: †Mr. Eric Illsley, Mr. Martin Caton, Ann Winterton

Blunt, Mr. Crispin (Reigate) (Con)

†Butler, Ms Dawn (Brent, South) (Lab)

†Dorries, Mrs. Nadine (Mid-Bedfordshire) (Con)

†Engel, Natascha (North-East Derbyshire) (Lab)

†Ennis, Jeff (Barnsley, East and Mexborough) (Lab)

†Flint, Caroline (Parliamentary Under-Secretary of State for Health)

†Hodgson, Mrs. Sharon (Gateshead, East and Washington, West) (Lab)

†Joyce, Mr. Eric (Falkirk) (Lab)

†Kennedy, Jane (Minister of State, Department of Health)

†Kidney, Mr. David (Stafford) (Lab)

†Lansley, Mr. Andrew (South Cambridgeshire) (Con)

†Merron, Gillian (Lord Commissioner of Her Majesty's Treasury)

†Murrison, Dr. Andrew (Westbury) (Con)

†Reed, Mr. Jamie (Copeland) (Lab)

†Webb, Steve (Northavon) (LD)

†Williams, Stephen (Bristol, West) (LD)

†Young, Sir George (North-West Hampshire) (Con)

John Benger, Gordon Clarke, Committee Clerks

†attended the Committee

[Mr. Eric Illsley in the Chair]

Health Bill

Clause 33

Arrangements for dispensing of medicines

Question proposed, That the clause, as amended, stand part of the Bill.

10.35 am

The Minister of State, Department of Health (Jane Kennedy): Just to give the Committee a quick refresher, clause 33 links with earlier provisions in the Bill that relate to the supervision of retail pharmacy businesses and the preparation and supply of medicines. We had a good and useful debate in our closing sittings before the recess and I felt that it was the wish of the Committee that it should stand part of the Bill. I hope that the Committee will give it a fair wind.

Question put and agreed to.

Clause 33, as amended, ordered to stand part of the Bill.

Clause 34

Provision of primary ophthalmic services

Stephen Williams (Bristol, West) (LD): I beg to move amendment No. 79, in clause 34, page 28, line 41, leave out from 'all' to end of line 11 on page 29 and insert 'persons'.

Good morning, Mr. Illsley and may I wish you and all members of the Committee a happy new year. There is a very fraternal atmosphere in my party at the moment, as I am sure you will realise. I did a quick calculation this morning and discovered that we had 47 clauses, four new clauses and five schedules to get through today. I therefore intend to be brief and I hope that other hon. Members will be brief too. The purpose of the amendment is to provoke a discussion on the disparities in access to eye health services for different groups of the population within England, particularly compared with the much enhanced access in Scotland and the different system in Wales under the new devolved arrangements.

The amendment deletes all references to the groups of the population in new section 16CD(2) who currently receive free eye tests: those who are under 16; those who are over 16 but in full-time education; various people who are in receipt of means-tested benefits; and the over–60s. The clauses in this chapter of the Bill deal with the general ophthalmic services contracts and what we would normally describe as eye tests. The significant part of GOS is certainly eye tests.

I had a most useful meeting with optometrists and ophthalmic dispensers in my constituency back in November. I learned a great deal about how the existing service operates. I was quite shocked to
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discover that the NHS eye test fee is currently only £18.39, which for a visit to a well-qualified professional person seems very small. That is rather less than one would expect to pay for a visit to the local garage to have one's car repaired, let alone various other medical services. I was staggered to discover how low the eye test fee is. However, 66 per cent. of the tests currently offered by optometrists are funded by the NHS, albeit at a low rate. The second part of the GOS contract is the voucher system, which contributes towards the cost of children's spectacles.

The purpose of the amendment is to provoke a discussion on access to eye care for all sections of the population of England. The major worry that the eye care profession has about chapter 2 of the Bill relates to the provisions for the existing GOS contract in England. The management will be devolved from the central NHS to the primary care trusts that operate in all our constituencies. They will have discretion over the management of contracts. Several amendments to later clauses will deal with that, so I shall not dwell on the matter now. However, it will be worth hearing from the Minister why in England only the groups specified in new section 16CD(2) in clause 34 have access to a free eye test and eye care, when the devolved Administrations have seen the value of giving all sections of the population free and easy access to an optometrist, not only to detect a defect in natural sight but to look for other health concerns that only a qualified optometrist can identify.

There is an analogy here with dental services. I went to a most useful presentation before Christmas about mouth cancer—I am sure that the Under-Secretary attended it too—where I learnt that, as part of their standard contract with the health service, dentists look for early signs of mouth cancer. The analogy is that, as well as doing the obvious thing of testing somebody's vision, a qualified optometrist will look for other potential defects. The issue involves more than the standard eye test.

Dr. Andrew Murrison (Westbury) (Con): May I wish you, Mr. Illsley, and the Committee a happy new year—especially the hon. Member for Bristol, West (Stephen Williams), given the excitement currently surrounding his party, although I hope that it is not too happy.

I am interested in the amendment. I thought that the Liberal Democrats were going to talk about extending access, and that that was the purpose of removing the qualifying words in new section 16CD(2). However, the hon. Gentleman did not talk about that. The gist of what he had to say related to access. I put it to the Minister that, on access to dispensing opticians and optometry, we do pretty well. One of the defining things about optometrists and dispensing opticians in this country at the moment is that there is fantastic access to them. No other part of our health care system that I can readily think of has no absolutely no waiting lists. One simply wanders in off the high street for an eye test or ophthalmic appliance. There is no waiting whatever. Without being too complacent, access is right there, right now. The Minister will have to explain how these seven clauses relating to optometry will improve the service.
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We shall come back to the matter as we go through the clauses, but she must say why she feels that there is a problem that requires her intervention. Nowhere is that more the case than in respect of access, which is the gist of the hon. Gentleman's amendment.

10.45 am

The hon. Gentleman might have been saying that primary care trusts should be asked to make provision for eye tests and optometry for everyone, without exception. That is a cause of confusion because of the issue of free eyesight tests and vouchers and the provision of optometry services. I hope that PCTs, if they are to be empowered in the way suggested, will act to ensure that access is as good as possible for everyone, whether they are entitled to free services or are among the 34 per cent. who pay for them. That is important; it is what we have at present. I will explain why we are worried about the matter as we go through the proposals. The Government's intervention by virtue of the seven clauses will reduce choice and access. Before we are prepared even to consider supporting the Government on these proposals, the Minister must reassure us in that respect.

The Parliamentary Under-Secretary of State for Health (Caroline Flint): Happy new year to everybody—some are happier than others, I imagine. I hope during our proceedings to be able to reassure my hon. Friends, the hon. Member for Westbury (Dr. Murrison) and his hon. Friends and the hon. Member for Bristol, West, that we have no intention of disrupting what I think is a very good service or unnerving those who provide it. I have been a recipient of opticians' services since I was a child; I am very short-sighted, and I now use glasses and contact lenses. I therefore have a vested interest in the matter.

We recognise that a clearer framework is needed. I will endeavour to reassure those who have a particular interest that access to sight tests and the national negotiating framework for the fee will not be diminished by our proposals. I will come to those matters later, as I want to address the amendment, which would extend eligibility for NHS-funded sight tests to the whole population of England.

Free sight tests on the NHS are already available to priority groups: children under 16, those aged 16 to 18 in full-time education, people on low incomes who might otherwise be deterred by the cost of a private sight test, and defined categories of people at risk of developing eye disease. Before 1 April 1989 there was universal entitlement to free sight tests, but from that date eligibility was restricted to the groups that I mentioned. In April 1999 we extended free sight tests to everyone aged 60 and over because those in advancing years may have associated health problems that can be picked up by opticians. The eligibility criteria for NHS-funded sight tests are designed to ensure that the groups to which I referred are not discouraged from having their sight tested. However, we have to make some tough choices and a further extension would not be the best use of funds available for the development of the NHS.

In 1999, we reviewed the eligibility rules and extended eligibility for sight tests to those over 60,
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and the available evidence suggests that it resulted in a transfer of sight tests from the private sector to the NHS rather than any material increase in the overall number of sight tests undertaken. I have to tell the hon. Member for Bristol, West that that does not suggest that a further extension of eligibility and the associated increase in NHS funding is likely to affect significantly the overall number of sight tests undertaken or the associated health outcomes. The cost of extending free sight tests to all those who currently pay privately would be an additional £92 million, based on the 2005–06 rate of £18.39.

The hon. Gentleman also mentioned his concern about the rate. The rate for the test is negotiated nationally. I understand that negotiations for 2007–08 are about to begin and I would like to reassure the Committee that there is no intention, as part of this legislation, to move away from that national negotiating framework or to undermine in any way access to sight tests, either for those who are eligible for support through the NHS or for those who pay privately. The hon. Member for Westbury mentioned that point.

There are choices to be made in health. As we discuss these clauses, we can also reflect on the opportunities, outside the areas that are part of a nationally provided service, for PCTs to consider, based on local need, what other enhanced services might be suitable in the local community. Contracting for the provision of eye tests in a residential care home is just one example of provision for which PCTs might in future want to contract. The proposals in the Bill, including in the clauses that we shall discuss this morning, provide a greater opportunity for such areas to be thought about in relation not only to eye health but, possibly, to other health issues that may arise out of such contracts.

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Prepared 10 January 2006