Health Bill


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Dr. Murrison: The Minister is generous in giving way. A bit of a seam has been opened up in this debate, because nothing is explained in the verbiage of the guidance notes. That underscores the obvious need for the proposal to have been subject to a full review before the Bill was introduced. I am most grateful to her for shedding the information at this stage but it is new to us and we will have to give it serious consideration.

The Minister mentioned dentists and pharmacies and I will need time to discover to what extent the proposals marry with the contracts that the Government or their agencies want to establish with those professional groups.

11.45 am

It does not seem to me that the general dental services and personal dental services regulations that were laid before the House late last year bear any resemblance to the arrangements that the Minister is now proposing for optometrists and dispensing opticians. That seems to be a central tenet of the Minister's argument; she is trying to harmonise the arrangements that PCTs enter into with various professional individuals and corporate groups. I am completely at sea as to what the Minister is trying to get at. It is all new material, which we should have been apprised of well before now. The Minister dealt briefly with the issue of quality. That is a serious concern. One does not register with professional organisations for no reason at all.

Caroline Flint: Has the hon. Gentleman finished yet?

Dr. Murrison: Mr. Illsley, I shall return to the matter at a later date; I think that we will cover it at some length.

Caroline Flint: I had not finished my speech, but in answer to the hon. Gentleman's first point, the fact that he has not done his research is down to him, not the Government. Part of the core of the discussions with professional groups was about the opportunity for PCTs to contract with dispensing opticians and lay persons. I have seen the briefings provided by a number of the professional groups because I was sent them as an MP and went through them. I have read a number of things and it is clear, as it is clear from the
 
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discussions, that the extension of the opportunity to contract in a transparent and open way with the individuals I have described is a core part of the reason why we are bringing the clauses forward. Second to that are the issues of fraud and the important role of the PCTs as a watchdog to ensure that it does not take place, whether in the delivery of the sight test or in the provision of vouchers for purchasing optical accessories.

The clause gives primary care trusts a duty to provide a sight-testing service for eligible patients. It mirrors their existing obligations but in a new framework. Eligibility for the service will be maintained through the regulations—that is nothing new—which will be made in respect of all those currently eligible. Primary care trusts will also have a new duty to provide any other primary ophthalmic services that may be prescribed and any further services that they judge necessary to meet reasonable need in their area. Those could be for individuals who are diabetic—we are obviously aware of the issues about sight and diabetes. They could be post-treatment care in the local community for individuals who have had a cataract removed or had glaucoma. I will come on to that when I address the points that have been made about the review process.

PCTs will reimburse opticians and a central budget will reimburse the PCTs. There is no ceiling on that as long as the provision is in line with the standards that we expect and the eligibility requirements. That is the position now and it is what is intended for the future. The sight-testing service will be mandatory under the clause and PCTs will have no scope to reduce it.

A point was made about co-operation. This is a standard provision that mirrors those for dental and medical services. There is a risk of failure to co-operate. It is a slight risk, but there is always such a risk and we have to provide for that. The clause gives the basis for a strategic health authority or the Secretary of State to intervene and remind NHS bodies of their duties. As I said before, there are issues in the legislation that complement the review.

It is desirable for PCTs to provide services should there be an unwillingness to provide them privately in a community, although such unwillingness is most likely to occur in the provision of services other than sight tests. To that end, it is not apparent that the provision would necessarily have to be used by PCTs, but it is important to ensure that it is linked to a duty to provide sight tests. Where sight tests are not provided privately, rare though that may be, it is important to have the provision so that the PCTs may seek to provide that service.

Mr. Andrew Lansley (South Cambridgeshire) (Con): Will the Minister help me to understand the nature of the budgetary arrangements to which she is committing the Government? Is it a central budget to fund sight tests or primary ophthalmic services? The comparison with dentistry, for example, would be of a fund that was centrally distributed but ring-fenced and devolved. What precisely will be held centrally and not cash-limited?
 
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Caroline Flint: My understanding is that the current process and framework for negotiating the sight tests and the reimbursement will continue.

Mr. Lansley: I understand that, but the question then is whether the Government intend there to be global primary ophthalmic services budgets for PCTs, against which the resources for sight tests would be offset, or whether the central budget for sight tests will be completely separate from the devolved budget for primary ophthalmic services, so that an increase in the uptake of sight tests in a PCT will not have the negative consequence of an adverse effect on the additional services that are bought locally.

Caroline Flint: The answer to the last point is yes. An increase in the number of sight tests that are carried out in a certain area and the seeking of reimbursement for those tests will have no relationship to any other services provided for locally. In the same way, we are not setting a minimum or upper limit on the number of sight tests.

The only concern about volume relates to abuse of the system, whether financial or in relation to the quality of the sight tests being carried out. A contractor may employ someone who is qualified to carry out sight tests, but the number of sight tests that they carry out in the hours for which they are contracted may beggar belief, and there may be doubts about whether there is any real quality assurance. I do not, however, want that to be taken as suggesting that such practices are common.

I agree with everything that hon. Members have said about the flexibility and choice that already exists in the system, but it is important to be aware that there is abuse of the system. According to the latest reckoning, some £10 million of fraud is committed every year. That amount has gone down, but we do need more measures to clamp down on it. I hope that that reassures the hon. Gentleman. So far as I am aware, there is no connection between reimbursement for sight tests and any other funding issues for other services that the PCT may wish to provide, although that may of course depend on issues in the local community.

Dr. Murrison: The Minister mentioned £10 million of fraud. It would be useful to know how much the new arrangements will cost, given that avoidance of fraud is one of the important reasons why she wants the seven clauses to be implemented. It is not clear how much the arrangements will cost, but it is self-evident that there will be a cost to the service for PCTs to administer them.

Caroline Flint: I do not believe that there will be a huge additional cost, because we are simply widening the scope of contractors who can be part and parcel of provision locally. The provision therefore simply widens the pool of contractors. PCTs already contract with services locally to provide the facilities available on the NHS. All that we are doing in that respect is widening the pool and making opportunities through the local committee to have the sort of discussions that are currently held, but also opportunities to address local issues as and when they occur. Nothing in these proposals indicates
 
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additional costs of themselves. They are simply to deal with some of the anomalies in the system and make it clearer and more transparent so that everyone knows what they are dealing with.

Mrs. Dorries: The Minister mentioned £10 million worth of fraud. If we are to take on additional costs to put in a new system, what safeguards will there be against fraud? We may go through the process and find that next year the fraud has escalated to £10 million; the new arrangements will do nothing to limit that.

Caroline Flint: We come to that later in the clauses. The 1999–2000 baseline shows that losses through optical patient fraud were measured at £13.25 million per annum. That was reduced in 2001–02 to around £10.17 million. The Counter Fraud and Security Management Service is currently undertaking a further risk measurement exercise in ophthalmic fraud focusing on both patients and contractors in England and Wales and expects to produce statistics by the end of this financial year.

I was not sure what point the hon. Lady was making in her earlier contribution. Obviously, when people ring up and pretend to be something that they are not, there is not a lot that one can do about it over the phone. I thought that she was going to make the point that she then went to the opticians and they did not ask for proof of her status and issued a voucher and so forth. If that was the case, she can see me afterwards with the name of the opticians and we will send the fraud people along to them.

She also seemed to suggest that it was unfair that the voucher for optical equipment did not meet the full price of the glasses themselves. I was not sure whether she was suggesting that we should up the rate for the optical voucher to a price that is consistent with some of the more highly priced commercially available glasses. She might want to look at Hansard. She then asked what it was all about and why were we changing it. I hope that I have managed to explain the wider opportunities for much more direct and straightforward arrangements and contracts with businesses that are providing services.

 
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