Mr. Lansley: Of course, there is a point there. People who are held not to have any money to pay for their sight test get a test subsidised by the NHS, but the subsidy is considerably below the actual cost of providing the test and is cross-subsidised from the sale of spectacles. If those people then go on to receive a voucher that meets only part of the cost of their glasses, in effect they are paying for part of their sight test. That is all theoretical. The question for the Government is whether they intend that the cross-subsidy between the sale of spectacles and sight tests should continue or, as is the case elsewhere in the NHS, that remuneration should much more accurately reflect the cost.
Caroline Flint: That point of view has been expressed by others. There is a claim that the NHS sight test fee does not meet the actual cost of the test and is subsidised by the sale of glasses. Our position is that we negotiate the sight test fee nationally with the representatives of the profession and the sale is a
There are glasses available at a lower cost, but choice is a factor. When I started wearing glasses, one had either the NHS tortoiseshell square ones or the John Lennon metal round ones. That was the basic choice on the NHS; if one wanted to use the voucher to buy one's glasses, those were the glasses one got. People wanted more choice and wanted to add to that, which is why there is now a greater range. Two of my children are short-sighted—I am afraid that I have passed that on—and when I go with them to see what glasses are available, I see that there are ranges of glasses for under £50 and under £100, and lots of deals are available, such as buy a pair of glasses and get sunglasses free; then there are the glasses by Armani and so on. It is about choice.
The alternative, which would deny choice and flexibility, would be to say, ''We will pay for the glasses, but there are only three types that you can have; that is it.'' We could control what is provided in that way. In the provision of other NHS appliances—for want of a better phrase—that is the position, but some people feel that it is far too centralist and restrictive. When budgeting, one must decide whether to give people the opportunity to take their voucher and add to its value or whether to say, ''Right, I'm sorry, if you're going to have the voucher, this is the limited choice of glasses that you can have.'' I think that the former is a better way of giving assistance without creating a sort of Stalinistic system in which NHS patients are given limited choice and flexibility on eyewear, which is important to people. Clearly, the hon. Member for Mid-Bedfordshire is interested in how her glasses look, and there is no reason why anyone else who receives such services should not be similarly concerned by the look of their glasses. However, there is an issue, taking into account the market and the range of costs of glasses, as to what price the taxpayer is prepared to pay. Nothing is perfect, but I think that the current system is about as good as it gets.
I shall touch briefly on the review and give the Committee some information. The review is under way and discussions are continuing. One reason for the review and its terms of reference is the need to emphasise the importance of making better use of primary care resources. For example, undertaking primary care rather than secondary care where appropriate, and developing patient choice.
As I said earlier, the post-treatment care of people who have been in hospital for the treatment of glaucoma or for cataract removal is only provided in hospital settings in some cases, but might better be provided in a community-based setting. As part of the review, we are discussing with the profession and others how we can deliver such services closer to home and develop patient choice. We are currently funding pilot projects that test model pathways in those areas.
The review is also looking at wider development in England, with PCTs being responsible for health services. We decided to extend the review, because we listened to people in the profession who wanted more time to explore such issues, and because of our White Paper, ''Your health, your care, your say'', as there are clearly some overlaps in those areas. The review is likely to finish later, rather than earlier, in 2006. We recognise that this issue links into several areas to do with providing health care outside hospital. However, the provisions in this clause and others do not necessarily have to await the outcome of the review.
These clauses provide a better, more transparent system for the contract arrangements and ensure that primary care trusts have a duty in legislation to provide the NHS sight-testing service for eligible patients. In answer to the question asked by the hon. Member for Westbury, I shall deal in a moment with where people take the test.
Mr. Lansley: The Minister referred to the debate on the White Paper. One of the central debates on the White Paper relates to the extent to which PCTs should provide services in future. The implication of the Government's proposals thus far—although one never quite knows where they are on this issue—is that primary care trusts should not be both purchaser and provider of services. However, the structure of clause 34 expressly allows primary care trusts to be both purchasers and providers of primary ophthalmic services.
Clearly, people in the profession might reasonably worry that PCTs will make the kind of provision that has been seen in dentistry with dental access centres, which they control and which is turning the profession into a salaried, NHS-employed profession, rather than one made up of independent practitioners—unfortunately, at much greater cost than independent provision. That seems perverse to people in the dental profession, and it would certainly be perverse in the profession that we are considering. Will the Minister tell us why, as my hon. Friend the Member for Westbury said, proposed new section 16CD(4)(a) contains provision for a PCT to become a provider?
Caroline Flint: As I outlined earlier, that is to allow for those circumstances in which sight tests are not provided by the private sector. This is about access for individuals. I said earlier that, given the already very good service that is provided in terms of access to sight tests in a variety of settings, it would be rare for PCTs to feel that they had to make such provision, but we felt that there could be circumstances in which it was an issue, and therefore the measure allows what I have described to happen.
On PCTs and the provision of services, my right hon. Friend the Secretary of State for Health has been clear. It is up to PCTs to determine whether they provide services; but in relation to the hon. Gentleman's last point, it is also important for PCTs
The hon. Member for Westbury asked a direct question about whether an individual could go outside their PCT area and still have access to a sight test. The PCT's duty is to provide or secure provision in the area, not for persons in an area. The situation is exactly the same as the current arrangements. The sight-testing service remains catchment-based rather than resident-based. Therefore, if someone is on holiday or working in a different area from where they live, they can have a sight test. There is no change in that regard to the flexibility and choice of service.
I have covered a number of issues that were raised this morning, and I hope that I have reassured members of the Committee and those outside listening to the debate that clause 34 is an attempt not to undermine any existing arrangement, but to build on what I think everyone agrees is a good service by making better sense of some anomalies, which people get around but which do not contribute to a much more open and straightforward contracting relationship and do not allow PCTs to explore with contractors the sort of work that they might want them to do beyond the sight test—the sort of work that they would be responsible for funding and for which they would negotiate based on local need.
Clause 34 ordered to stand part of the Bill.
General ophthalmic services contracts
Dr. Murrison: I beg to move amendment No. 29, in clause 35, page 32, line 47, at end insert—
The Chairman: With this it will be convenient to discuss the following amendments:
No. 30, in clause 35, page 32, line 47, at end insert—
No. 31, in clause 35, page 32, line 47, at end insert—
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