Health Bill


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Dr. Murrison: We had hoped that this would be a group of four amendments, including amendment No. 32 to which I referred earlier, but we have been told that that is legally defective. That shows the disadvantage suffered by the Opposition when it comes to parliamentary draftsmanship in relation to tabling amendments. Nevertheless, I hope that we will be able to cover the intention of the amendment as part of the clause stand part debate, and that the
 
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Minister will address the matter further than she has done so far.

Amendments Nos. 29, 30 and 31 and, by implication, 32 all have to do with choice. They would guarantee that people might continue to enjoy their current level of choice when it comes to ophthalmic optics and the services of opticians and optometrists, particularly on the high street. We fear that that will be damaged as a result of the seven clauses that relate to those important services.

Let me quote a letter about the proposals from an optometrist in Witney in Oxfordshire.

    ''These proposals, if they become law, have the potential to create the same chaos of reducing patient choice and accessibility seen in dentistry, as patients are restricted to a select practice or are denied appointments as the budget for the year has been spent. This is a retrograde step and would affect the more vulnerable members of society (the elderly, partially-sighted, low-income, and children) who at present can choose which practitioner to provide their eye care on the NHS.''

That very succinctly puts our concerns as well. Given our concerns about access, choice and the potential to damage a very good service, we have tabled these three, originally four, amendments. Let me take the Committee through them one at a time.

Amendment No. 29 states:

    ''Regulations under subsection (2) must make provision for all those with entitlement to GOS to retain the right to have that delivered by the provider of his or her choice.'.''

That, effectively, is what happens at the moment. I assume that the Minister wants choice to continue, and I suspect that she wants the Bill to do no harm to that choice. Therefore, the amendment would tally with her thinking. Under our provision, people will be able to choose providers for themselves from the large number available, as they can at the moment. They will be able to make informed choices about which provider to go to, based on past experience, locality and whether they perceive that they are getting good value for money. The danger under the proposed measures is that, to a greater or lesser extent, PCTs will determine their choices for them. Those who wish to seek out a free NHS eyesight test could find that their provider of choice is no longer available to them. They might have been going to a particular provider for many years, but suddenly find that they cannot do so any more.

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Many of us take a fairly eclectic approach to the issue of who we go to for what I hope are our regular eyesight tests, but others do not and regard their practitioner in much the same way as their GP. They wish to build up a long-term relationship, and there are instances in which such a relationship is particularly important—screening for glaucoma, for example, needs to be done regularly. The Minister should not put in place legislation that damages individuals' ability to make such a choice and determine where they go. Indeed, that ability to choose should be held up for other practitioners as a model of how to provide patients—our constituents—with the services of their choice at their behest. Damaging what is almost the jewel in the crown of NHS choice is entirely retrograde, and we tabled amendment No. 29 with that in mind.
 
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In a similar vein, amendment No. 30 would insert the words:

    ''Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.''

That touches on issues with which we dealt earlier, and I suppose that we had the same debate about dentistry, where the same concerns would apply. Once one uses up the units of dental activity that one negotiated with the PCT a year previously, one can, in effect, sit on one's hands and do nothing. Indeed, a practice could structure itself in such a way that it did precisely that; it could lay off staff and profit thereby. However, that is not what we want to see if we are serious about maintaining patient access and patient choice. In the present context, such an arrangement may mean that a patient turns up for an eyesight test in March—at the end of the financial year—and finds that the optometrist is no longer doing NHS eyesight tests because he has used up the entitlement that he negotiated for the year and for which he contracted with the PCT.

The Minister gave us some reassurance on NHS eyesight tests, but she might like to expand a little on her meaning in response to the amendment. However, the situation that I described would also apply to primary ophthalmic services. The worry is that, at the end of the financial year, practitioners might say, ''We've done everything we have contracted to do and we will do no more.'' That would clearly be a very strange and exceptionally wasteful way of operating, although it could be advantageous to the practitioner or business concerned.

Following on from the previous two amendments, amendment No. 31 would insert the words:

    ''Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.''

Later, we shall discuss disqualification, and I shall leave it until then to voice my concerns about what that means in practice. Are we talking about disqualification on the basis of perceived competence, behaviour or registration or on the basis of a business or individual having been found to be, let us say, difficult in contractual terms? The latter would be a slightly sinister situation, with the PCT being able adversely to influence the businesses with which they were contracted; indeed, it might even prejudice the independence of those organisations, and we would be concerned about that.

Taken all in all, the three amendments—I may mention amendment No. 32, which is in a similar vein, on clause stand part—would guarantee an element of choice for individuals seeking primary ophthalmic services. They would also help providers by ensuring that primary care trusts could not shut them out when drawing up contracts. People would be able to use any high-street practitioner, as they can now.

We have covered the question of whether the finance will be cash-limited, and the other clauses
 
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touch on that further. The Minister has given us some assurances, although I remain concerned about whether primary ophthalmic services will be cash-limited and therefore subject to prioritisation by the PCT, which is not necessarily the case now.

I suspect that the Minister will say that she cannot allow the amendments, given her previous explanation. Much of what she said was new, despite her protestation that it was all in the briefing notes. In the context of her earlier remarks, why cannot she incorporate the amendments into the Bill? They will not disestablish the rationale that the Minister rather belatedly gave for the seven clauses of chapter 2.

Caroline Flint: Amendment No. 29 would ensure that eligible patients were able to choose their NHS provider of sight tests. We support the right of patients entitled to a sight test under NHS arrangements to choose which practitioner should test their sight. Nothing in the Bill takes away from the right of individuals to choose when and where they have their sight tested, so long as it is in line with existing regulations. That is why we are inserting new subsection 28WE (5) into the 1977 Act. It states:

    ''Regulations under subsection (1) must make provision as to the right of persons to whom services are to be provided to choose the persons from whom they are to receive them.''

I hope that I have reassured the hon. Gentleman that there is no attempt to limit the range of choice.

Dr. Murrison: Will the Minister give way?

Caroline Flint: May I make a further point? It may answer the hon. Gentleman's question.

Providers of sight tests under the NHS are required to have a contract with the NHS and to be included on a PCT list. That is right and proper. Yes, patients have a right to choose who should test their eyesight, but it is important that those who provide the service, which is funded by the taxpayer, should be legitimate providers; people must be clear that the providers are qualified to provide those services. That is the case now, and we intend it to remain the case.

Dr. Murrison: Will the Minister give way on that point?

Caroline Flint: No, I shall make a little further progress in order to answer the point.

The amendment would result in patients being able to choose a provider who did not have a contract with the NHS and who was not included on a primary care trust list. I cannot accept that. It would mean that the post-Shipman system of lists, whereby PCTs have to be satisfied of the competence and probity of NHS practitioners, would be negated for ophthalmic services. I believe that patients are best protected when NHS services are performed by primary care professionals who are included in a PCT list of performers and who have contracts with the NHS or are employed by others who do. As a consequence, there is a relationship and the primary care trust has the right to ensure that standards are maintained and to cancel a contract if it is not satisfied that that is the case. Should people meet the clinical conditions and
 
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the quality standards, there is no limit on the number of contractors or performers on the list. That provides ample choice for individuals to access services that they can be assured are of a good standard.

 
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