Health Bill


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Dr. Murrison: Will the hon. Lady confirm that the legislation as drafted will allow PCTs to negotiate with providers at differing levels of fee for the sight test—in other words, that the matter could be decided at local level?

Caroline Flint: The Bill could possibly allow for that, but I want to make it clear that there is no intention on the part of the Government to allow for a locally or regionally negotiated sight test fee basis. We have given assurances, and the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), met a number of different stakeholders just before Christmas to reassure them that our intention is to continue under the present system, which is to have a nationally negotiated sight test fee. That will be provided for. There is no question of that being varied at local level or of unnecessary lower or upper levels being set for the number of sight tests, with the proviso that if there were a possibility of fraud, a PCT would look into that—but we shall cover that under later clauses. I hope that that answers in a straightforward way the hon. Gentleman's question.

Dr. Murrison: I thank the Minister for that. I take it, therefore, that she will support amendment No. 32.
 
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Caroline Flint: We have not reached that amendment yet, but I shall not support it, for reasons that I shall come to later.

Finally on amendment No. 79, the way in which we provide sight tests at the moment is a tried and trusted system. I am pleased that we were able, within the finances that the Government have, to extend eligibility in 1999. However, I do not believe that there is a case for a further extension. I say to the hon. Member for Bristol, West that whoever is elected as the leader of the Liberal Democrats may want to reflect on the issue as part of their future financial plans if they ever want to be in government.

Stephen Williams: I have listened carefully to the Minister, and essentially she has said that no one should be afraid of the measures proposed in the Bill. There will not be a change to the centrally negotiated NHS fee, which is currently £18.39, and there should not be any worries about the range of services provided in the high street, to which the hon. Member for Westbury also referred. One does wonder, then, what is the point of the legislation. I wonder why the Government did not take the opportunity, as was done in Scotland, to review the entire GOS contract in consultation with the eye care profession and then come forward with proposals to improve eye care in this country.

I was interested to learn that the estimated cost of extending free eye care to all parts of the population, not just the groups specified in the Bill, was £92 million. In the great scheme of things in Government funding that seems rather a small amount. What discussions has the Minister had with her counterpart in the Scottish Executive, who took a different decision from that she proposes for England? Presumably they thought that there was a public health advantage to extending free eye tests to all sections of the population in Scotland.

The Minister mentioned that PCTs may be able to look at the contracts for domiciliary care for when an optometrist visits a care home. That point was made to me at my meeting with practitioners in my constituency. Currently the fee for an optometrist visiting a care home is £50.77 for the first and second persons, but thereafter it is only £10 for each consultation. That seems quite strange. There is scope for PCTs, or the NHS centrally, in negotiation with the profession, to look at that fee structure too.

I listened with interest to what the Minister had to say, and as we will be discussing several other clauses this morning, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

Dr. Murrison: This is the first clause in a series of seven dealing with an important matter. We dealt with the heat and light aspects—smoking—earlier, and given the time that we had to spend on that it is fortunate that we have reached this point. It would have been wrong to have completed the Committee stage without devoting adequate time to these clauses.
 
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I should like to pay tribute to optometrists and dispensing opticians in this country who, by their own admission, tend to be a fairly self-effacing and quiet group. We will all have received their briefing notes in which they point out that in the past they have generally acquiesced in the requirements of the Government of the day, but at this point in their evolution and history they have become quite concerned. They would say that since the war they have provided a fantastic service—a landmark service—in our health services in this country. Who can doubt the quality of the service we get where there are no waiting lists and waiting times? That is unique in our health services.

Very few of us receive complaints from our constituents about the quality of ophthalmic services. I have received none. Indeed, of the 43,000 written complaints received in 2004 by family health services, only five related to ophthalmics. That is quite extraordinary. Given that there does not appear to be a problem, the Minister has to tell us what she has identified in the range of services that she is endeavouring to fix. I do not understand it at all. So far she has not given me the feeling that she has identified a problem. No doubt she will expound at length on the problem and we can then determine whether these clauses are the solution.

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I put it on record that we are not convinced that there is a problem. We pay tribute to these services, which do such brilliant work for our constituents. The providers of the services rightly point out that, every year, they refer 200,000 people whose tests reveal medical conditions such as glaucoma, hypertension, various forms of cancer and the more obvious ocular-related conditions, such as cataracts, which would otherwise would not have been discovered.

Ophthalmic services are a huge benefit to the NHS. Elderly people who have their eyes tested and are found to have defective vision because of conditions such as refractive errors and cataracts can usually have them satisfactorily remedied. There are no figures to support this, but one can only imagine the savings to the NHS when people in advanced years have their sight tested and corrected, as poor vision can lead to problems such as fractured hips and a range of other medical conditions. I feel strongly that, if work is not being done to determine the contribution that opticians make to health care generally, it should be. The figures would be very interesting indeed.

There is a catalogue of good-news stories from the sector. The Minister seems to be providing a solution when there is no identifiable problem. Will she tell us why she has introduced these proposals? Did the Health Bill just happen along and she felt that it would benefit from having something on ophthalmic services bolted on to it? If that is the case, it is pretty extraordinary, because the Government have been talking about holding a review of general ophthalmic services. That is perfectly reasonable, as eye services have been conducted in the same way for a considerable time.
 
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The profession has some problems in the way things have been working—gosh, which profession does not?—and would like some minor changes. In that context, a review would be reasonable. We have all spoken to opticians, not least when we go for an eyesight test, and if they know that we are MPs, they bend our ears. My optician certainly did so about the cross-subsidy between the provision of optical appliances—glasses and so on—and the eyesight test.

A review has long been promised, but nothing has come of it. It is a bit like dentistry; things were promised, but months and years go by and nothing seems to happen, and so it is with general ophthalmic services. All there is this proposal. The Minister does not even bother to wait for the review, she simply promises it, which puts the entire review and the consultation process into the long grass.

I mentioned consultations in earlier clauses and the effect on their validity of the Government putting the cart before the horse. That discredits, degrades and demeans their value and makes people less willing to take them seriously and to contribute to them. If and when the review of general ophthalmic services comes to pass, people will ask what on earth is the point of contributing to the review and taking it seriously because the legislation has pre-empted it.

If the Minister had held the review, come to the House and said, ''These are the results. We have identified these difficulties and this is how we propose to deal with them,'' that would have been all well and good, but it has not happened. She has promised us the review for a long time, but it simply has not happened. Perhaps she can tell us what progress has been made with the review, what its terms of reference are, who sits on the review board, how far they have got, how many meetings they have had and so on. That would be extremely useful.

Perhaps there are even some preliminary conclusions that might inform this discussion. If the Minister can give us some idea about those, we might be a little more favourably inclined towards the proposal, but that has not happened so far. Instead, while promising the review, she has cracked on and drawn up these clauses, which are pocked, like other bits of the Bill, by references to regulation. Presumably that enables her to fill in the gaps. A bit like a child colouring in a stencil, she intends to colour in the Bill at a later stage, because she has allowed the regulations. That seems to be her approach to the Bill and nowhere is that more the case than with these seven clauses.

These clauses are pocked with references to regulation, and we have to assume that, at some later stage, the Minister will tell us what she really wants to do—based on the review, I hope—using those regulations. As we have said before, that would not have been our approach. We would have conducted the review. It is right and proper to hold a review at this stage and for the legislation to be informed by it, but we have not had that. I hope that the Minister will give us some idea of why the review has not happened and what stage she is at with it. Is it still planned to take place at all, or has it been overtaken by events?
 
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Have these clauses superseded any plan that she had to review GOS?

I am concerned about the sight test fee. I have identified the fact that a cross-subsidy applies. The hon. Member for Bristol, West said that the fee was very cheap, and indeed it is. Most of us have experienced various other forms of what amount to compulsory fees when we have had to get our car fixed, our plumbing repaired or whatever. Set against such expenditure, the sight test fee seems ludicrously low. I tend to agree with the hon. Gentleman on that. Particularly when one takes into account the cost of the equipment required to do a proper sight test, the experience and expertise of those who carry out the tests and their need to maintain premises and staff, the fee seems extraordinary, but of course there is a cross-subsidy between the provision of spectacles, for example, and the sight test.

 
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