Health Bill


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Dr. Murrison: We have heard very little from the Minister on how she will guarantee that the choice we have now will continue once these seven clauses pass into law. She has not given us the assurances that we have sought and which our amendments would have cemented into the arrangements that she is introducing. However, she opened up one or two interesting lines of debate, particularly in relation to amendment No. 29. She appears to be exercised about the quality of professionals undertaking ophthalmic services. I share her concerns; we all hope that those who provide NHS services will be high calibre and subject to audit and inspection—indeed, we look to professional bodies that register practitioners largely for that reason. That is why the amendment referred to GOS.

The Minister did not address my question about how many mavericks are out there and why she is so concerned about the possibility that people are performing sight tests who are not qualified or competent to do so, or who do not have the probity. I am not aware of any. If she is aware of any and is concerned about them, she should say so. We might then be more minded to agree with her that the amendment should be withdrawn. I am not sure, however, that she answered that question. Indeed, I am pretty sure that she sidestepped it completely.

So it appears that the PCT will be in the invidious position of determining who is of sufficient quality to undertake the contractual arrangements. That brings us back to the question that I put to the Minister during our debate on clause 34, which dealt with the cost of such arrangements. If PCTs will be expected to assure themselves that those with whom they enter into a contract are of sufficient quality, that clearly implies an inspection regime and an auditing structure, all of which requires people. Replicated across the country, that means cost.

I suspect that the £10 million-worth of fraud, which the Minister says it is so crucial to avoid that she needed to draw up these seven clauses, will be largely overshadowed by the amount of money required by the NHS to ensure that PCTs place contracts for sight tests with appropriate people. We have not heard much about that to date. It is the subject of some of the measures in proposed new section 28WF of the 1977 Act, but only very peripherally. As for GOS and the review that we hoped for, such issues ought to have been explored in the review that we thought would precede the seven clauses.

12.45 pm

Caroline Flint: Is the hon. Gentleman aware that at present all clinicians who perform NHS sight tests are listed with a PCT and that all contractors must be listed with each PCT where they provide that service? That is current practice, to ensure quality and delivery of that service. It is a safeguard to ensure that national standards are met. Why on earth is he suggesting that
 
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we should now open up the situation so that people can be on neither of those lists? I fail to understand why he is suggesting that we change current practice in a way that could open the system to abuse and cause concern about the provision of services. What we are proposing exactly mirrors what already exists.

Dr. Murrison: It is useful to have the Minister's description of the inspection and audit regime that she envisages. As I understand it from what she has just said, things will not change at all. She has not described precisely what the regime will involve and how one will get on the list. Will somebody from the PCT go around every five years making sure that somebody has a slit lamp in place, or is it more involved? I suspect that it might be, because going to the trouble of becoming involved in a contractual arrangement—that is what these seven clauses mean—and placing duties on PCTs to ensure that organisations and individuals are competent and their premises are up to speed implies a more rigorous regime than currently. If the proposals simply mean having a list that is kept on file on a shelf, we will not get too excited. Clearly, that would not cost much more than the piece of A4 paper and the space on the shelf. A contract implies rather more than that.

The Minister seemed to suggest in her attempted demolition of my amendments that some practitioners may not be competent—that there may be some incompetent practitioners whom she might wish to eschew from the system—and that that is the purpose of drawing up contracts with some and not with others. My question is this: how will PCTs determine with whom they do and do not want contracts?

At the moment, GOS registration is a measure of competence of sorts, and we should have some reliance on that. Those involved are professionally registered individuals. I am not aware of much dissatisfaction with the quality of practitioners in the field. I refer to the figures that I gave the Minister in my opening remarks about complaints to family health services, which identified five out of the 44,000 complaints in 2004, the latest year for which figures are available. That tells a very clear story that there is not a problem—but there is clearly a problem in the mind of the Minister. She has invented one, which is why we have these seven clauses that deal with optometry and dispensing opticians.

Caroline Flint: The hon. Gentleman says that I have invented something. What is he referring to? I have suggested to him that arrangements are already in place for ensuring local delivery of national standards, which are discussed with all the professional bodies, organisations and groups, and some require registration with the appropriate council. Clearly there are issues around how PCTs currently carry out their functions in regard to performers entering the list, contractors on the list, inspections and so forth. I would be happy to write to members of the Committee on that point. I have to say that the hon. Gentleman is creating a scare that is totally unnecessary and absolutely irresponsible.

Dr. Murrison: I thought that we would have a fairly quiet morning, but this is getting to be quite a heated
 
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debate, which is great. I am suggesting that the Minister has invented a problem; I said that right at the beginning. I felt that there was no problem with the range of services, but I expressed my surprise that she should try to find solutions to problems that do not exist, particularly without the benefit of a review.

Caroline Flint: Is the hon. Gentleman suggesting that the system under which performers and contractors appear on a registered list with PCTs, which the clauses seek not to change but to reinforce, should be disbanded?

Dr. Murrison: Of course I am not suggesting that for one moment. If the Minister has a list, and it simply reflects whether one is registered with the GOC, I have no beef with that at all. I would expect any arrangement with professionals to be with individuals who are appropriately qualified—we will come to that later—and registered. Such individuals would be not just on the PCT list, but on that of the GOC or whichever appropriate registration body.

The Minister, however, is proposing that PCTs enter into a contractual arrangement with individuals or organisations. I suggest to her that that escalates matters substantially. She made it clear that she expects people to be subject to inspection, but she has not given us much more detail other than that things will simply be as they are at the moment. If so, that is fine, although she has not said what audit and inspection regime currently applies.

Mr. Lansley: I do not understand what the Minister is telling us. As I understand it, up to now, if one is suitably registered, one can be entered on to a list of local practitioners, but one does not have to have a contract with a PCT in order to provide an NHS service. She is proposing that there should be an NHS contract. The question that I do not have an answer to—perhaps my hon. Friend does—is whether it is possible under the Government's proposals for a multiple to be on a PCT list in one place and to be able to offer sight tests across the country without restriction, or whether it would have to have a contract with the PCT in order to do so.

Dr. Murrison: My hon. Friend makes an extremely good point; clearly, he is as bewildered as I am. His question, to which I do not know the answer, deals with a specific point. I hope very much that the Minister will clarify that point, and I am more than happy to take an intervention from her if she wishes to respond. However, I see that she remains in her seat, well ensconced.

Caroline Flint: I was waiting for the hon. Gentleman to finish. My understanding is that in order to provide NHS sight tests, which are reimbursed by taxpayers' money, it is necessary to have a contract with the NHS. Clearly the performers list may include people who have contracts through the PCT to provide that service, but it may also include those who are suitably qualified to carry out the service within an organisation whose business may not be the provision of such a service per se. My understanding is that to provide the services there must be a contract with the NHS. That seems right to me, and nothing in our proposals changes what has
 
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gone before. I presume that at some time there must have been some reason why these lists were thought of in the first place as a way of protecting the public and ensuring good use of public money.

Dr. Murrison: The logic of the Minister's argument must therefore be that there should be some central list, because it appears that the issue is a contractual one between individuals or organisations—to take a chain at random, let us consider Specsavers, which has been mentioned before and has operations across the country—and the NHS. Perhaps she would like to explore the possibility that such an arrangement might be agreed nationally, because having not considered it for very long, I can see that there might be definite advantages in that.

We know that the profession is concerned that PCTs might not be competent to run these contractual arrangements; indeed, the National Audit Office was concerned about the ability of PCTs to run dental contracts. We will have to see whether the NAO was correct in its concerns, which we share, because the fateful hour is rapidly approaching. We shall see on 1 April whether all our worries and those of the NAO were well placed. At a particularly difficult time, therefore, PCTs are being burdened once again by a contract that I suspect they do not fully understand, because they have not previously been intimately involved in the delivery of this particular aspect of health care. Like dentistry, it is a bit new to them. We know, courtesy of the NAO, that financial management accounting and contracts are particularly weak areas with PCTs, so we have to be concerned about their ability to take on such contracts. In view of the Minister's remarks she may wish to consider whether the contractual arrangements should be made nationally so as to remove that burden from PCTs.

 
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