Health Bill

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Caroline Flint: I hope that that will be the case. There would not be much point in disqualifying someone if they could turn up somewhere else and be able to practise. One would hope that there would be checks and balances in the system such that part of someone's working in an area would involve a reference to the PCT with which they are listed. I cannot explain the detail of how that will happen, but as it is an important point, I will write to the hon. Gentleman about the safeguards that would apply in such a situation.
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Another issue is that of disqualification, which, clearly, is a serious matter. In terms of choice and so on, the PCT would also be mindful of the impact on the provider of a service—and, therefore, of provision of the service—if one of its clinical professionals were disqualified. That is another reason why close relationships with the local contractor are important to deal with what I hope will be the relatively rare occasions when that may happen.

My additional information is that there is provision for the Family Health Services Appeals Authority to disqualify a practitioner throughout England and Wales. Presumably, it has mechanisms for communicating a disqualification, and obviously we want to be reassured that, as far as is practicable, it is adhered to. I hope that members will accept the clause.

Question put and agreed to.

Clause 36 ordered to stand part of the Bill.

Clause 37

Assistance and support

Question proposed, That the clause stand part of the Bill.

Stephen Williams (Bristol, West) (LD): The clause makes primary ophthalmic services alongside primary medical and dental services eligible for the assistance and support that is available under the National Health Service Act 1977. During our deliberations, we have heard several references to the NHS in the high street. Optometrists provide important services—not only basic eye tests but screening for various conditions.

The hon. Member for South Cambridgeshire asked the Minister whether, as part of the eye tests, optometrists should look for such conditions as glaucoma. I think she said that either it was not the case or that she would check. When I met optometrists and other professionals in my constituency, I understood that as part of their professional standards they would at least look for such conditions. Whether it forms part of their contract, I do not know. However, the point is that they do it, and it sends patients on a journey throughout other parts of the national health service to obtain the relevant treatment.

I experienced that journey some time ago when, as part of a routine eye test, the optometrist examining my eyes said that at the back of my eye I had a dark patch that needed to be checked because it could have been something serious. However, she could not refer me directly to the Bristol eye hospital's centre of excellence in my constituency. I had to see my GP and repeat what the optometrist had told me, as my GP did not examine me, although he was able to press the relevant button on his computer and send me down the road to the eye hospital. That procedure is rather strange. It is a shame that in the Government's promised review of the general ophthalmic services contracts, they could not consider such matters. Perhaps they will as part of the consultation.

The Government could take some easy steps to bring the ophthalmic services provided on the high
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street further into the NHS family of operations. We tabled an amendment—amendment No. 120—to help the Minister, but it was not selected for consideration, so I shall refer to it in general. One way of bringing optometrist services into the NHS family would be to put them on, other electronic patient record systems, or on the GP referral system to which I have referred. Provided that the patient gave informed consent, it would help the optometrist to track their patient's progress on their journey through the NHS and enable the eye profession to monitor, for instance, how glaucoma was being treated.

The second part of the amendment referred to payments, suggesting that rather than their being made to and collected by the primary care trust, they should have been collected by the NHS Business Services Authority. I heard the Minister say in her remarks on clause 35 stand part that the Government were thinking about it. However, I should be interested to hear from her whether they have considered bringing optometrist services more closely into the family of NHS services, and particularly IT services, so that optometrists could monitor their patients throughout the different stages of the health service.

Dr. Murrison: The hon. Gentleman has made several interesting points. I am not too clear about how relevant they are to the clause; nevertheless, they were well made. He is absolutely correct about referral by GPs to optometrists and optometrists to specialists. On the back of his comments, does the Minister feel that the seven clauses before us will make the process easier? Were it to be made easier, as it is in Scotland without the intervention of such clauses, we would be doing our constituents a great favour because it would make life a lot easier for them. We would be using the ophthalmic professions a lot better, with a consequent increase in job satisfaction for them in feeling that their services, skills and expertise were being adequately utilised. Also, probably equally important, we would save the system a great deal of resources.

5.15 pm

I gave the example of my experience of having to take my daughter to casualty in Salisbury to have a foreign body removed. That is the kind of thing that I would probably expect that enhanced services might cover. It would have been far more convenient for me to nip down to Warminster and have the thing removed on the high street, as I am sure would have been possible. We have not really heard from the Minister how she feels that the seven clauses will assist people such as me and my daughter in the removal of a foreign body on a Saturday morning.

What do we mean by assistance and support? I do not understand what that means. I confess to the Minister that I have not ploughed through section 28Y of the 1977 Act. Perhaps I should have done so and if I had perhaps I would not need to ask the question, but as I have not it would be helpful if she could tell me what we mean by assistance and support in that context. It sounds like a good thing, so I am certainly not minded to oppose it, but the explanatory note simply does not make that meaning clear and it is not
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clear in the Bill. Some explanation from the Minister would be most welcome.

Caroline Flint: The clause enables primary care trusts to support providers of ophthalmic services on the same footing as they are able to support doctors and dentists. That is a welcome extension to ophthalmic services' role in the family of services provided in local communities. Consistent with our policy of delegating functions to the front line, the clause gives PCTs a directly conferred function to assist and support providers of primary ophthalmic services in their area. Support and assistance could include financial support and the provision of premises on such terms as the PCT thinks fit. That might be important, particularly if the PCT were trying to encourage service providers to locate in areas where provision of the sight test is not as flexible and accessible as we might wish.

The clause will enable PCTs to increase primary ophthalmic services capacity by giving assistance to establish or extend ophthalmic practice premises to see, for example, more NHS patients if that is required. It could also be used if, for example, practices had some temporary problems, such as sickness or a period of maternity leave, that impacted on their ability to maintain a proper level of service for the patients. As I said, the clause is about creating a first-among-equals situation and putting ophthalmic services in the same category as support for doctors and dentists. In that respect, it should be welcome.

The hon. Member for Bristol, West (Stephen Williams) asked about NHS Connecting for Health. That is important. Our policy for the national programme for information technology in the NHS has always been, and remains, that over time it will embrace all the clinical services in and around the NHS. I think that he would acknowledge—I know this from issues raised in the House—how ambitious a programme it is to connect up even just the hospitals with the doctors and so forth, and so we are doing this on a step-by-step basis. The task is enormously complex and we need to ensure that we get it right. Inevitably, the key core services—the NHS care records service, choose and book, the new national broadband network, and the electronic prescriptions service—have demanded and continue to demand the highest priority, but that does not mean that we have lost sight of where we want to get to in the future. There are lots of factors to consider, not least the compatibility of current IT systems among many different providers of ophthalmic services in an overarching NHS IT system. They have not been forgotten, but it is a matter of making sure we get it right, step by step.

Dr. Murrison: The Minister says that they are not forgotten; have they been anticipated? That is important, because we have had a variable assessment of the cost of NHS Connecting for Health—what used to be the NPfIT. I am not sure from what the Minister said whether that need, projected forward a few years, has been factored in
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to the estimates of cost, which, by my recollection, vary from £6 billion over 10 years to £31 billion over 10 years.

Caroline Flint: I can only reiterate what I have said. From the start, it has always been the ambition that once systems are established and the technology is proven to work, all parts of the NHS and the clinical services provided on its behalf should be part and parcel of the same system. At this point, I cannot go into any more detail, but we are cautious to ensure that we carry out the process on a step-by-step basis, and there are a number of priorities in the NHS that we feel we have to deal with first. It is difficult to single out particular practitioner groups within an implementation programme that is developing as we speak.

The hon. Member for Bristol, West was right. I mentioned earlier that consideration is being given to the role of the Business Services Authority in processing payments, but that discussion is still ongoing and has to be weighed up against several other issues. I hope that the Committee will support the clause, as it gives a real opportunity for further engagement with ophthalmic services among the family of health services in our communities.

Question put and agreed to.

Clause 37 ordered to stand part of the Bill.

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