Health Bill


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Dr. Murrison: The burden of what the Minister is saying therefore, is that the only benchmark for deciding whether a provider should be offered a contract is his or her professional competence. Can she confirm that provided that the individual can prove his or her professional competence, which would presumably require registration with the General Optical Council, for example, that person would be offered a contract? If that is not what the Minister is saying, how is a PCT to determine with whom to place the contract?

Caroline Flint: Clearly, the arrangements at present are that only people with required qualifications can carry out the sight tests. That is agreed with the various professional bodies and organisations and it will continue in the future. As is the case now, providers who contract with the PCT must make sure that their organisation has the clinical competence to provide the sight test. There may also be issues such as how the service is provided, and so on. For example, if questions of probity came to the fore, there would be a question whether the PCT wanted a contract with that particular provider.

There is nothing different from that which currently exists in what we are suggesting: the NHS will only pay through PCTs those practitioners and providers who meet the standards of quality and clinical assurance that have already been discussed by professional bodies and are laid down in regulations.

Dr. Murrison: The Minister has side-stepped the point, if I may make so bold. I asked her to confirm that, provided that a professional is competent professionally and in terms of probity, in all respects—that would imply registration with the appropriate body—he or she could, if they asked, be given a contract to provide primary ophthalmic services. That is the burden of what the Minister said previously.

Caroline Flint: My understanding is that if an organisation or individual meets those conditions they are entitled to a contract. Nothing in our proposal—[Interruption.] Well, they can apply for a contract and if they meet the conditions there is very little reason why a PCT would turn them down.

Mr. Lansley: Will the Minister give way?

Caroline Flint: If I can finish, we are not setting limits on the number of providers or, for that matter, on the number of people who are on the performers list to provide services.

Mr. Lansley: Will the Minister give way?

Caroline Flint: No, as I want to make progress on some of the other amendments.

Mr. Lansley: Explain this point.

Caroline Flint: If it was accepted, amendment No. 29 would mean that someone could go to an organisation or an individual who did not have a contract with the PCT or was not on the performers
 
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list. That is not the correct way forward. We are not trying to shut down the number of people who provide services; we are trying to ensure that NHS money is given to those who provide a proper, qualified service. The hon. Member for Westbury may disagree, but the upshot of amendment No. 29 would be that anybody who was not on a PCT performers list or who had a contract with a PCT could seek to be reimbursed through taxpayers' money, and that is not good enough.

12.30 pm

Dr. Murrison: Can the Minister provide evidence that fraudulent dispensing opticians and optometrists are currently operating in this way? That might be helpful. Could she also confirm that there is little evidence of any such thing? If there were, I would tend to agree with her. If individuals were putting themselves up falsely, we would need to take steps to ensure that public money was not provided in such a fashion. Could she also confirm that it would be illegal for individuals to offer themselves as holding such professional qualifications? We do not need further legislation to ensure that public funds are safeguarded in such a way. I resent what she implied about Shipman in that regard; that is entirely a red herring. She should be ashamed for using it.

Caroline Flint: The issue is whether one believes—it is clear that the hon. Gentleman does not—that as a local NHS body provides and funds NHS services, national standards should be inspected locally and dealt with in such a way that we can ensure to the best of our ability that those people who are either contracted to provide services or clinically provide services are fit for purpose. I personally do not think that there is a huge amount of concern about the idea that contract providers or performers should register and be part of a list with the local PCT. If someone was on a performers list in one PCT area, it would apply across the whole of England. They would not be confined to the geographical location of their PCT.

I find it difficult to understand the direction of the hon. Gentleman's argument. He seems to be saying that an individual, as a customer, could go to anybody who was not on the contractors list or the performers list and avail themselves of a sight test that the NHS would pay for with no controls or links back to the locally accountable body that is there to help to ensure that nationally negotiated standards, guidance and conditions are implemented locally. I am not sure how professionals who are on lists now and will be in the future would feel about that. It would undermine the process of creating an environment that tries—not in a bureaucratic way but straightforwardly—to create a check to ensure that people are able to do the job that they seek to do. To go back to our earlier partnership discussion, part of that partnership is about the discussion of the delivery of services locally and the issues of need. I cannot accept amendment No. 29, because it is a bit of a nonsense.

Mr. Lansley: Let me one last time try to express what we are concerned about. Things may have changed slightly as Ministers have accepted in discussions with the profession and in Committee that the sight test will be centrally funded, but there is
 
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a risk that a primary care trust might constrain the local list of providers who were able to offer a sight test in order to secure a better deal in the provision of other primary ophthalmic services. There is no reason why that should happen. On the face of it, if it is centrally funded to a nationally agreed standard, every registered provider with the General Optical Council should be free to offer that service. There is no good reason why the primary care trust should intervene to restrict that. The primary care trust, on the face of it, does not seem better able than the professional regulatory structures to determine whether someone is qualified.

The distinction that we are driving at is that with the sight test, if nothing else, we should be clear that every properly registered provider should be able to provide the sight test to every customer. Nothing should intervene to prevent that from happening.

Caroline Flint: As far as I am aware we intend that, as now, contractors will be able to have an NHS contract for the sight test provided they meet the national criteria, which should be met with local decisions on matters such as quality of service and inspection of premises and equipment. That is the current position, I understand. There is local inspection using national standards before a provider can go on the list for a GOS contract. Nothing about that will change.

There may be some contractors who want to offer other services. That is a separate issue, to be negotiated with the PCTs. It is separate from the national sight test and from optical vouchers and so forth. It does not necessarily mean that if the PCT would like other services to be provided in the area there will be pressure on someone to offer them if they do not want to. As we discussed earlier, one of the strengths of the current system is the opportunity for the public to have sight tests and purchase spectacles in a huge variety of outlets, regardless of whether they need enhanced services, or whether they are having the sight test in the area where they live or where they work.

I hope that I have reassured hon. Members and made things clear. [Interruption.] That is why I am discussing those issues; we cannot put everything in the Bill. My hon. Friend the Minister of State, Department of Health met professionals before Christmas and talked about some of the relevant aspects of the matter.

Dr. Murrison: Will the Minister give way?

Caroline Flint: No.

Dr. Murrison: It is an important point.

Caroline Flint: It is always an important point. I will not give way at this stage. The hon. Gentleman can return to it on clause stand part if he wants to.

Amendment No. 30 would guarantee the rights of eligible patients to NHS-funded sight tests and would provide in statute that there should be no limitations on the number of sight tests for which providers can claim payment. We support the right of patients eligible for sight tests under NHS arrangements to have those sight tests and that is already covered by
 
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the Bill. In proposed new section 16CD(1)(a) we set out the duty of primary care trusts to provide a sight testing service and in new subsection (2) we specify the patients who are eligible for that service. The proposed new section also provides for the power to make regulations to add to the category of those eligible for sight tests under NHS arrangements. We will be making regulations to ensure that all those currently eligible for sight tests under NHS arrangements will continue to be eligible in future.

Dr. Murrison: Will the Minister give way?

Caroline Flint: Perhaps I can start to address the amendment, if the hon. Gentleman will allow me.

It cannot be acceptable for primary legislation to provide that providers should be recompensed for sight tests without any limitation. That could prevent primary care trusts from questioning the appropriateness of sight testing undertaken in volumes apparently far in excess of what any responsible clinician would undertake if they were carrying out sight tests properly.

We do not propose to place limits on the number of sight tests that may be undertaken or to place any cash limit on the budget that reimburses the cost of sight tests provided under NHS arrangements. However, there must be scope for primary care trusts—which, as I said, are responsible for ensuring locally that national standards are implemented—to exercise judgment to ensure that public funds are properly spent. The amendment would remove that safeguard, which I am sure was not the intention of the hon. Member for Westbury.

Amendment No. 31 is intended to ensure that PCTs are unable to limit the number of providers of NHS funded sight tests or of performers who work in their areas. We do not intend that regulations should give powers to primary care trusts to place limits on the number of providers with which they contract for the provision of sight tests under proposed new section 16CD(1)(a), but we see no need for that to be in the Bill. It would be quite inconsistent with the approach taken for other primary care professions, which have maintained the right to establish businesses in their areas and operate contracts with the NHS without an explicit prohibition or any limitations in the relevant primary legislation.

For performers of primary ophthalmic services we are committed to maintaining the right of clinicians who undertake sight tests under NHS arrangements to work in any area in England, provided that they are listed with a primary care trust in England. Restrictions on performers would be inconsistent with the performers list regulations already in force, which prevent movement of the work force in ways that are not in the interests of patients or optical businesses.

Given the fact that sight tests will be centrally funded, I see no reason whatever why a PCT should restrict the numbers on its performers list, as it will not be affected by any budget concerns that it may have locally. For those reasons, I recommend that
 
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amendments Nos. 29 to 31 be rejected. I hope that I have clarified how the Government feel: sight test services should continue to be provided in an open way that maximises flexibility and choice but ensures that existing safeguards continue.

 
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