Health Bill


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Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): I, too, add my good wishes for the new year to everybody.

As people are talking about their own spectacles and giving examples, I should like to show the Committee my beautiful leopard-skin-printed glasses, which I purchased for £9.99 from a local gift shop. Unfortunately, they have not served me well. Last time we sat in the Chamber, I was the butt of a number of jokes, not least those that went, ''Now Nadine, take the glasses off.'' That is not why I am now seeking the help of an optician. I am doing that because I have been squinting. I cannot read the Order Paper. I could not read menus in restaurants over Christmas, and I was in a rather dire state.

This morning, I decided to see an optician. Before the Committee started, I initiated two phone calls: I made one of them, and I got my researcher to make the other after me. I wanted to check whether the service was equitable, easily accessible and fair to all. I rang a local high street chain, pretending to be somebody on benefits, with no money at all, who needed glasses. The shop—I shall not mention its name, but the second word is ''savers''—told me that I could go in tomorrow and have my eye test, and that I would be given a voucher for £39 that I could take to any high street store—a supermarket, pharmacy or anywhere—that I chose in order to have a pair of spectacles dispensed to my prescription.

For me, the disappointing part of the exercise was that the voucher would have been for £39, but the cheapest pair of glasses and lenses that I would have been able to purchase was £79. That left me with a deficit. I said, ''I do not have any money. I am on benefits. How do I go about it?'' but there was no way round it; the cost of the glasses and lenses was going to be more than the value of the voucher.

Then my researcher phoned and pretended to be me, wanting a private eye test and not having any benefits. He was given exactly the same information in that he was told that he could go in tomorrow for an hour for a similar appointment. We have a service that, regardless of one's position—whether one is on benefits or able to pay for an eye test—is fair, accessible to all and of a high quality. One can go in whenever one wants to, and can take the prescription anywhere on the high street. It is a service that works. That is particularly useful for me, because within an hour I can have my prescription dispensed and come out with my glasses. Unlike my hon. Friend the Member for Westbury, I do not have the time to go around looking for better options. I want to go in, get my prescription and get out. It works.

Why are we considering the introduction of legislation that might distort a service that works so well? It might reduce the number of opticians or optometrists on the high street and that would reduce competition, which is also important. We all know that competition, patient choice, is what drives up
 
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quality. The service is of a high quality. Why would we want to bring in legislation that might restrict quality and choice? Why is the Minister proposing legislation that is not needed? The service is not broken; it works adequately—very well, in fact. Why are we trying to repair something that is not broken? What is the reason for the legislation?

Caroline Flint: I should like to emphasise and be upfront about the fact that the clauses mirror the existing obligations on primary care trusts in many respects. However, they put those obligations in a new framework. Several members of the Committee asked why we are making changes at all, so let me point to one example.

At present, primary care trusts can contract for NHS sight tests only with providers who are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council. Businesses owned by dispensing opticians or lay people who employ those whom I mentioned to do eye tests cannot contract with primary care trusts. Several members of the Committee talked about choice, and our approach in the clauses is partly about providing an opportunity to extend contracts with dispensing opticians or lay people much more transparently, provided that they meet quality standards and that clinical provision, particularly the provision of sight tests, is carried out by optometrists or ophthalmic medical practitioners.

That is important because the present arrangements have led to a situation in which businesses have had to restructure, so that they can register with the General Optical Council, or to have an agreement with an employee who is an optometrist or ophthalmic medical practitioner and who is therefore able to contract with PCTs. As a long-term measure, that way of getting round the system—that is what it is, although I am not saying that it has necessarily led to less quality—is not particularly helpful or satisfactory. Indeed, the present measures were introduced when it became clear that there had been failures to comply with the regulations.

We are trying to move to a proper legal framework for the provision of ophthalmic services, and the Bill is the first available vehicle that allows us to do so. The planned changes will enable PCTs to contract directly with optical businesses without the current restrictions on ownership and they reflect the reality of service provision. However, there must be quality assurance when PCTs contract with organisations with which they cannot presently contract directly.

It is ridiculous that we continue to endorse a roundabout way. Let us not forget that, in some places, there are optimists—sorry, optometrists, although optimists as well—who serve several different businesses. If we say that the PCT should contract only with that roving individual, that raises questions about the service that is being provided and about who is responsible for providing it, for the access points and for other issues. A prime aim in the clauses is therefore to provide greater opportunity while recognising that there must be clinical safeguards.
 
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I hope that that answers the questions from the hon. Member for Mid-Bedfordshire (Mrs. Dorries) and others about what is significantly different about the proposals. Their introduction in no way undermines what I acknowledge is a very good service, but it gives us greater opportunities to have a more realistic discussion with those in the business of providing services on the business and clinical sides.

Dr. Murrison: I am grateful to the Minister for giving way, because I do not really understand a lot of what she has said. She talks about providing greater opportunity, but I question for whom one is providing it, because Opposition Members have certainly not had representations from professional bodies or providers about the lack of opportunity. The Minister has not said how providing greater opportunity will improve patient care or access. Will she rewind, and explain things again? It is soon after Christmas and perhaps I am being dim.

Caroline Flint: As the hon. Gentleman is aware, the services are provided by a number of different organisations; there are big corporate bodies and brands such as Specsavers, and smaller opticians. Certain services are already provided in other businesses.

I make it clear that at present primary care trusts can contract with providers for NHS sight tests only if they are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council. That means that businesses owned by dispensing opticians or lay people who employ optometrists or ophthalmic medical practitioners to do sight tests cannot contract with PCTs. In that situation, the contract must be with the employee of a business rather than the business itself.

The Government believe that is a ludicrous situation, because it leads to a convoluted set of arrangements. The oversight of local contracts and discussions on the provision of more and enhanced services are disjointed, as the hon. Gentleman said, as the PCTs do not deal with those who provide the premises and the environment for the clinical services.

This does not apply to other primary medical services, such as dentistry, and we are trying to create a more practical, transparent and legal framework in which dispensing opticians and lay people who employ clinical professionals can be part of and engaged in the contracting process.

Mrs. Dorries: Is the Minister saying that at present if I bought premises and employed an optician to run the business and provide the service, I would not be able to have a contract with the PCT, but that, under the legislation, if an individual wanted to establish a business employing optometrists or ophthalmologists, they could have a contract with the PCT? Is she saying that at present the only people who can have a contract with the PCT are registered optometrists, ophthalmologists or opticians and that if I wanted to set up a business, with people working in that business, I would not be able to have a contract?

Caroline Flint: What I am saying is that there are limitations at present on those individuals within the profession who can contract with a PCT. At the
 
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moment, where a lay person or a dispensing optician has a business, the named person who has the contract with the PCT has to be the employee who is brought in to provide the clinical services. That seems ridiculous, considering that we are talking about businesses with which one may want to discuss providing a range of enhanced services outside of or in addition to the sight test procedures. Later, we will discuss the local committees, on which we want clinical professionals and contractors to be represented.

There is an anomaly at the moment, which the clauses try to address, but at the same time the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central and I have to ensure that the necessary arrangements are clear and that clinical expertise is provided for by whoever is given a contract by the PCT.

 
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