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Health Bill

Health Bill

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Standing Committee E

Tuesday 10 January 2006


The Committee consisted of the following Members:

Chairmen: †Mr. Eric Illsley, Mr. Martin Caton, Ann Winterton

Blunt, Mr. Crispin (Reigate) (Con)

†Butler, Ms Dawn (Brent, South) (Lab)

†Dorries, Mrs. Nadine (Mid-Bedfordshire) (Con)

Engel, Natascha (North-East Derbyshire) (Lab)

†Ennis, Jeff (Barnsley, East and Mexborough) (Lab)

†Flint, Caroline (Parliamentary Under-Secretary of State for Health)

†Hodgson, Mrs. Sharon (Gateshead, East and Washington, West) (Lab)

†Joyce, Mr. Eric (Falkirk) (Lab)

†Kennedy, Jane (Minister of State, Department of Health)

†Kidney, Mr. David (Stafford) (Lab)

†Lansley, Mr. Andrew (South Cambridgeshire) (Con)

†Merron, Gillian (Lord Commissioner of Her Majesty's Treasury)

†Murrison, Dr. Andrew (Westbury) (Con)

†Reed, Mr. Jamie (Copeland) (Lab)

†Webb, Steve (Northavon) (LD)

†Williams, Stephen (Bristol, West) (LD)

†Young, Sir George (North-West Hampshire) (Con)

John Benger, Gordon Clarke, Committee Clerks

†attended the Committee

[Mr. Eric Illsley in the Chair]

Health Bill

Amendment proposed [this day]: No. 29, in clause 35, page 32, line 47, at end insert—

    '( ) 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.'.—[Dr. Murrison.]

3.55 pm

Question again proposed, That the amendment be made.

The Chairman: I remind the Committee that with this we are taking the following amendments: No. 30, in clause 35, page 32, line 47, at end insert—

    '( ) 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.'.

No. 31, in clause 35, page 32, line 47, at end insert—

    '( ) 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.'.

Dr. Andrew Murrison (Westbury) (Con): Your arrival was impeccably timed, Mr. Illsley. We now reach our final sitting, and I do not know about anybody else, but I am certainly exhausted, notwithstanding the Christmas break. However, we still have many clauses to plough our way through. There is plenty of stuff to get stuck into and plenty to entertain us for the next three hours or so.

We have discussed clause 35 at some length, and it is important that we have done so, because it deals with the significant issue of choice in ophthalmic services. As we said, we are most concerned about the choice element in the seven clauses that deal with primary ophthalmic services. Choice is what we have on the high street now, and our concern is that the Bill will impinge on the choice that our constituents have across this particular spectrum. The Minister probably got the impression that I am very much a fan of ophthalmic services as they are currently configured, and I hope that she did, because I am. That part of what I might broadly define as our health services is well worth emulating, and that is nowhere more true than on the crucial issue of choice and people's ability to go wherever they want.

So far, the Minister has offered a pretty good, robust defence of the Bill and particularly of why it is necessary to introduce the seven clauses. If I am correct, the reasons centre on enhancing the opportunity to provide services and on a concern to address fraud within ophthalmic services. We have discussed fraud to some extent and have asked her to compare and contrast the cost of the administration that PCTs will undoubtedly have to shoulder as a result of these seven clauses with the estimated
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£10 million of fraud that she is rightly attempting to eschew from the system—I am not sure where that estimate comes from, but it does not sound unreasonable, given the turnover that we are discussing. It is important that we contrast those figures, because it emerged in our deliberations this morning that counter-fraud is one of the cornerstones on which these seven clauses are based. Even at this stage, I hope that she can give us a greater insight into how, or indeed whether, she has compared the money that she hopes to save by removing fraud from this element of health service transactions with the cost that the clauses will undoubtedly involve—the undefined cost that PCTs will apparently have to bear. That will be translated into employing more people to carry the business forward, to do the contracts and the rest of it.

Towards the end of this morning's deliberations, as we were getting into the debate on the amendments—this is the after-dinner part of it—we discussed whether it might be appropriate to have a national contract and national arrangements at least for the sight test. Earlier today, we managed to tease out the difference between the sight test fee and moneys that might arise as a result of the provision of primary ophthalmic services. I am grateful to the Minister for clarifying what we mean by those two things, because they seem to be different in that one is not cash-limited. It is a centrally identifiable sum of money, although it is handled by PCTs, but it is not cash-limited, and that is quite important. That becomes interesting in the context of the basing of the contracts. We can foresee a situation in which a practice exhausts its contractual obligations for any given year and then, as I said earlier, has to sit on its hands for the rest of the year.

Although it is not their principal aim, our amendments would address that situation, because they would ensure that people could choose which practitioner they went to. That cuts both ways: it would also ensure that people were not sitting on their hands for a whole month at the end of the financial year once their practice had discharged its obligations and they had no more work. We have not really heard much from the Minister on that. It has a parallel with the dental contract in one respect, and that is the margin. Last year, in relation to the dental charging regulation, we debated the margin of error that the dentists will be allowed in relation to their contracts. It is rather tight. Just a small divergence from the contract would result in a penalty. The professions will be interested to know what penalties—

Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): On dental comparisons, many dentists have chosen not to provide NHS services. In my area, one cannot find a dentist who will treat NHS patients. If that situation were allowed to develop and optometrists and opticians found themselves running out of budget and unable to treat patients, having waiting lists, and experiencing difficulty negotiating with PCTs, they, too, might decide to withhold their services and become solely private providers. Then they would not have any contract with the PCT and would
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operate, much as dentists do, as wholly private opticians.

We would then find the situation in relation to optical services the same as the one in relation to dental services. Somebody who needs an eye test but cannot afford one might not be able to have it because the opticians will have opted out of the system.

Dr. Murrison: My hon. Friend makes an interesting point. At the moment, there is no incentive for that to happen, because the fee is remarkably low for a variety of reasons. One of them is the cross-subsidy between the provision of specs and the NHS test. In fact, one of the beauties of the way in which the system has evolved is that there is no real market. There is a sight test that is well respected; people know what they are going to get when they go for a test and they are content to have it. I cannot imagine that people going to see an ophthalmic practitioner in the high street really differentiate between NHS and non-NHS in the way that they most certainly now do in dentistry. To that extent, the two are not directly comparable, but I understand what my hon. Friend means.

Again, I emphasise that ophthalmic services seem to be a model to be emulated by other parts of the service. They have evolved in a way that—I sound like a salesman for the sector, which I do not mean to be—offers value for money and is incredibly accessible. No other part of our health service is quite as accessible as this one. The Minister will no doubt say that there are walk-in centres, and one can always go to an accident and emergency department to get immediate treatment, but that is not the same as obtaining primary ophthalmic services on the high street. One would have to go to continental Europe to find anything remotely similar in the provision of health services, broadly defined.

That is why we are very cautious about anything that will fundamentally change that element of health care. In that, we appear to be joined by the profession, going by the briefing notes to which the Minister referred earlier. Her reading of them is slightly different from mine, but it appears clear that the profession is very concerned about these changes. We also know that from the evidence of our constituency mailbags. In nearly five years of being an MP, I have not had one complaint about primary ophthalmic services, and we know that complaints about such services form a tiny proportion—a fraction of 1 per cent.—of all complaints received by family health services committees. That is set against the very large number of consultations that are going on year in, year out.

The lack of complaints is our assurance of quality and backs up our position. The Minister did a fine job this morning defending these seven clauses, but she will forgive me if I say that Opposition Members have the imperative on this issue and we are backed in that by the profession and by the statistics and figures, which support our contention that this is a high-quality service, providing what people want. We should not be trying to affect it or to change it fundamentally. We should be trying to emulate it elsewhere in the health service.
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Amendment No. 32 was, sadly, not selected, for reasons that I have discussed. However, I am not sure whether I am permitted to mention it in the clause stand part debate. If I may just describe it in general terms—

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