The Parliamentary Under-Secretary of State for Health (Caroline Flint): I will try to deal with those points, but in some respects I shall repeat points that I made earlier on the purpose of the clauses. Nothing in the clauses is seeking to undermine some of the good ways in which the service is currently delivered.
I have to say to the hon. Members for Westbury (Dr. Murrison) and for Mid-Bedfordshire (Mrs. Dorries)—he is a doctor and she is a nurse—that there has been a lack of understanding, in some of their contributions, of the present arrangements by which those providing services locally have to engage with PCTs.
It is important that the present sight testing system is maintained, but we are trying, through widening the opportunity for PCTs to contract with people, to get around an anomaly that currently exists, whereby dispensing opticians and lay members cannot directly contract for services and take a roundabout route by which a qualified optometrist has to be the link person whom they are employing for the contract. We are trying to make a more open, transparent system in that regard.
The following points may cover a number of the points that were made. We envisage the sight testing service operating exactly like the general ophthalmic service that is currently in use. On patients being able to choose their GOS contractor, there is no way that we are trying to limit the opportunities for individuals to have a sight test under proper conditions wherever they want.
The point was made about contractors being able to have a GOS contract, provided that they meet agreed national criteria. That will be subject, as now—I emphasise as now—to local decisions on matters such as quality of service, including inspection of equipment and premises. Clearly, that is more easily done locally, and it is done less bureaucratically by not necessarily having a national body to inspect the premises and equipment to ensure that they are up to standard.
We will also, as I have said repeatedly, continue to have a centrally negotiated sight test fee and access to sight tests will not be constrained locally by individual PCT budgets. I have said that several times, but it does not seem to have been picked up by the hon. Member for Mid-Bedfordshire.
Dr. Murrison: Will the Minister give way?
Caroline Flint: No, the hon. Gentleman made a number of points and I should like an opportunity to answer.
Comments have been made about the level of the fee. National negotiations take place on that matter year in, year out, but there is no way that the centrally provided, nationally negotiated fee for sight tests is connected to local provision by PCTs. The clauses ensure that there is a duty on PCTs regarding sight test provision in their local communities—not on a
Whatever the PCT wishes to do to enhance services or to provide other services—I have given a number of examples of what those services might be—it in no way depends on any link to the fees and reimbursement for the sight tests prescribed in legislation and in regulations and guidelines about who will carry them out and what standard of qualification they should have. I hope that that is clear.
The reality is that at the moment there is no right, per se, for anyone to have the contract—that provision does not exist—so there is clearly some misunderstanding, despite the conversations that Committee members have had with their opticians locally. There is no right, per se, for someone to have a contract to deliver NHS services. On the other hand, there is no right per se, unless the people concerned do not meet standards, for PCTs to deny the contract. That has been explained many times in Committee and I cannot understand why some members of the Committee cannot understand it.
It is important that we deal with the way in which services are to be provided; questions were raised in the previous debate. As to disqualification, regulations, on which we shall consult fully, will set out how that will work. It is likely that possible reasons could be history of fraud and a demonstrated unsuitability to provide a service, such as the use of unqualified staff. There would also be the possibility of an appeal to the Family Health Services Appeal Authority, which is a permanent, quasi-judicial body, with wide experience in the field, to guard against inappropriate application. That should serve as a brake on any PCT in the unlikely event of an attempt to disqualify someone who did not deserve the penalty. As I have said, there will be full discussion of and consultation on that matter before regulations are developed.
As to costs, a regulatory impact assessment is being prepared. There has not been a detailed assessment of costs for the Bill, partly because much of the detail will be in regulations, but, in many respects, the Bill reconfirms the practices that already exist at local level, albeit allowing dispensing opticians and lay members to act directly in the contracting of services. People who currently cannot appear on the contractor list may do so in future, because it will be possible for them to discuss the contracting of services directly, instead of in the roundabout way that has been happening.
I read out the exact figure for optical voucher fraud: about £10 million a year. That relates to patient fraud, not fraud by contractors or opticians. There are, I understand, no figures currently available for the amount of contractor fraud. However, the clauses relating to optical voucher fraud relate to contractor fraud, not patient fraud, and are therefore not directly linked to the £10 million a year. I mentioned earlier that the section or department that considers fraud issues is currently reviewing patient fraud and what more could be done to reduce the figure of £10 million. It has dropped by £3 million since a few years before
Dr. Murrison: Earlier, the Minister made the important point that the seven clauses are largely based on the need to tackle fraud, and she cited the figure of £10 million. Is she now saying that that relates to voucher fraud and would she therefore agree that the seven clauses are unlikely to affect the £10 million? We are now dealing with a sum of money—presumably several million pounds—that we have little handle on. Having identified the fraud and put a figure of £10 million on it, the Minister is now saying that it was not the fraud she was thinking of, but some other kind. I am even more confused than I was.
Caroline Flint: When at the start of our debate I talked about the £10 million of fraud, based on the latest figures, I did refer to patient fraud, because I read it from one of my briefing notes. We also had a discussion about the lists, and the hon. Gentleman spoke, too, about whether a limit would be set on the number of sight tests that could be given. What I said, if I recollect correctly, was that no floor or ceiling has been put on the number of tests that can take place—we will not say that once a certain community has reached 3,000 tests, that will be it. However, if a PCT were suspicious that the number of tests an individual contractor claimed for did not sit with the number of qualified staff able to do those tests—if, basically, the number of tests and the hours available suggested a lack of quality and possibly fraud, because tests were not carried out to a proper standard—it should be able to consider that. If there was some confusion in Committee when the hon. Member for Westbury linked that to the figures I raised earlier, I apologise if I was inadvertently responsible.
If we look back at Hansard I think that we will see that the discussion was about the hon. Gentleman's point on setting any upper limit on the number of tests and why it would be necessary for a PCT to question the number of tests carried out by an individual contractor. It was at that point I gave an example of how somebody could carry out more tests than appropriate for the number of qualified staff, which would link to a concern about the quality of those tests. I hope that I have clarified that matter.
Without discussing amendment No. 32, which was not selected, the principal point that has been made about the NHS sight test fee is whether it should be in the Bill. We do not think that that is necessary, because it is not in present legislation. Everybody is agreed that it is so far, so good, and its not being in legislation has not led to concern about its existence. Hon. Members have said that it is important that Ministers make things clear in Committee and give reassurances. We feel that the fee will continue to be negotiated nationally. It will have a separate budget from anything provided to PCTs and in that sense there will be no change. For that and other reasons it is not necessary to have such a provision in the Bill. It has not been in such legislation before.
To be absolutely clear on the meat of discussions on the clause, at present all clinicians who carry out NHS sight tests are listed with a PCT and all contractors must be listed with each PCT where they provide the service. As now, contractors will be able to have an NHS contract provided that they meet national criteria subject to local decisions on matters such as quality of service and the inspection of premises and equipment. National standards will be inspected locally before a provider can go on the list to have a GOS contract. There could be questions about whether a national contract would ensure quality assurance, because we would have to think about who would carry out that necessary local inspection. I hope that that makes it clear that we are not suggesting a huge leap from where we are now. The debate has allowed us to explore how much more clear and transparent the arrangements should be. A number of members of the Committee are clearly on a learning curve in that respect.
The hon. Member for Westbury raised the question of the payment of the fees and mentioned the NHS Business Services Authority. The Business Services Authority has an established work programme and, clearly, any additions need to be carefully considered. As part of a general discussion we are talking about whether claims for optical payments should be processed by the Business Services Authority, but it would not be appropriate to specify such activity before reaching a conclusion. We are considering the issues alongside our review of which other services could be provided in the community outside of hospitals, closer to where people live.
In drafting the proposal we followed the model provided by medical and dental legislation in relation to essential, additional and enhanced services; the terms appear in regulations but not in primary legislation. We have a duty nationally in what we pay for and provide centrally, which has been the subject of much debate today. The clauses provide the opportunity for PCTs to consider other services that they think are appropriate for the communities that they serve, and it is important that is recognised in the Bill. Alongside that there are discussions on the White Paper on services outside hospital and our review, with the profession and others, of the opportunities and potential for other services to be provided locally, which PCTs might wish to contract.
During the break between our sittings, the hon. Member for South Cambridgeshire (Mr. Lansley) asked me whether a large contractor with a chain of contracts around the country could suggest to PCTs that he would provide other services without any change in the fee. The hon. Gentleman asked whether the PCT would look kindly on that contractor, rather than adding other contractors who could provide on-site services to the list. I hope that reflects the scenario that the hon. Gentleman put to me. My advice is that we would not endorse such a tactic and we would seek to ensure that regulations would prevent that from happening. I was told that it could be illegal, but the hon. Gentleman should not quote me on that; the lawyers will have to look at it. We would not want a
There is no major national chemist or fast-food chain in my mining constituency, or even a major supermarket or bookshop, as hon. Members will see for themselves if they come to Don Valley. Community pharmacies and local stores are very important in such constituencies, as my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) recognises. Many services are amply provided for in some constituencies but in others they do not exist. Therefore, smaller stores and community services are vital, whether or not the health services are involved.
I hope that I have covered most of the points raised, including those mentioned by the hon. Member for South Cambridgeshire. I understand that the sight test will, as now, be provided under the Sight Testing (Examination and Prescription) (No. 2) Regulations 1989. The hon. Gentleman asked whether that could be extended beyond the sight test itself. The powers of the new primary ophthalmic services are to provide services beyond sight tests but there will continue to be an ongoing discussion about the delivery of primary health care and the range of services that can be offered at any one time and—I shall be honest with the Committee—the amount of services that the public purse can afford to provide in a complete package. These discussions will be ongoing in the same way as in 1999 when we decided to extend the free sight test to those over 60, which was removed under the previous Conservative Administration.
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