Health Bill


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Clause 38

Local Optical Committees

Dr. Murrison: I beg to move amendment No. 33, in page 34, line 26, at end insert—

    '(c) dispensing opticians, to whom payments are made for meeting or contributing towards the cost incurred for the supply of optical appliances or their replacement or repair.'.

The Chairman: With this it will be convenient to discuss the following amendments: No. 116, in page 34, line 27, after 'every', insert 'dispensing optician or'.

No. 117, in page 34, line 30, after 'optometrist', insert 'or dispensing optician'.

No. 118, in page 34, line 36, leave out paragraph (b).

Dr. Murrison: Amendment No. 33 would add dispensing opticians who supply or repair glasses to the list of persons who will comprise the local optical committee. We are a little bewildered as to why they should be left off, particularly as the Minister has a clear understanding—as evidenced by her previous remarks—of the difference between the various professions that work in ophthalmic services in and around the NHS. However, dispensing opticians seem to be disfranchised in this case.

One cannot draw a line between such professions because they are interdependent and interrelated. Sometimes they can be one and the same thing: individuals working for the same organisation who are mutually dependent on each other's activities. Indeed, there is a cross-subsidy between the eyesight test and the dispensing of optical appliances. To use another smoking analogy, one cannot put a cigarette paper between the two.
 
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It seems entirely appropriate that the dispensing optician arm should be reflected in the local optical committee. That said, I am a little in the dark about local optical committees, because the Bill is not entirely clear about what manner of beast they are or what they will do. The guidance notes are a summary to say the least. All they say is:

    ''Clause 38 inserts new section 45C in the 1977 Act''

to which one is invited to refer, but if hon. Members are like me, they do not have a great deal of time to plough through the Act. The notes continue:

    ''The new section relates to Local Optical Committees.''

I would have thought that that was extremely obvious. The notes are not particularly helpful.

I hope that the Minister will be able to describe the committees in depth because they will be important bodies. More particularly, I hope that she will say why dispensing opticians should be left off the list when they are obviously so integral to the system and the various professions in this field are so interdependent.

Stephen Williams: Our amendments Nos. 116 and 117 essentially make the same points as those made by the hon. Member for Westbury and address the interdependency between optometrists and ophthalmic dispensers. I have mentioned several times the meeting that I had in my constituency with various members of the eye profession. It included optometrists and ophthalmic dispensers, and I learned for the first time the difference between the two. As a layman I had thought that they were all opticians, but I learned a lot at that meeting and I have learned a lot today, as I am sure we all have.

We discussed the key interdependence, particularly the financial one, when considering clause 34. The optometrist is the key professional clinician who carries out the initial health check on people's eyes and the ophthalmic dispenser then fits lenses and matches the prescription to the needs of patients. Clearly, one cannot exist without the other and there are many professional analogies, including in my tax profession. I am a member of the Chartered Institute of Taxation and can give taxation advice to people, but my profession would not exist without the skilled technicians—members of the Association of Taxation Technicians—who do much of the essential work in working out people's tax liability.

The same is true in the eye profession, except perhaps that the value seems to lie with the skilled technicians—the ophthalmic dispensers. I referred earlier to the fee that optometrists receive for an eye test, which is a pathetic £18.39, but the value to their business is the sale and fitting of lenses that are provided by ophthalmic dispensers. It seems strange that when a committee is designed to discuss local services—new section 45C(4) to the 1977 Act refers to it as the ''Local Optical Committee'', not a local optometrist committee—ophthalmic dispensers are not considered eligible and fit to be members of that committee. That is a regrettable omission and should be corrected.

Amendments Nos. 116 and 117 relate to amendment No. 33, which was tabled by the hon.
 
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Member for Westbury, and amendment No. 118 is tagged on. It refers to new section 45C(3)(b) of the 1977 Act, which requires notification. That provision seems to be unnecessary, so will the Minister explain why it is necessary for it to be part of the Bill?

5.30 pm

Caroline Flint: I am afraid that I cannot accept any of the amendments and I hope to explain why they are unnecessary.

Amendment No. 33 seeks to make local optical committees representative of dispensing opticians if they receive payments for the supply, repair or replacement of optical appliances. We accept that some optical businesses are not represented by their local optical committee. The Bill makes it clear that such committees must be representative of all providers with contracts to provide primary ophthalmic services. That allows the membership of the committee to draw from the full range of local expertise and experience and to improve their effectiveness as a local representative committee. The local optical committee provides a body with which PCTs may consult on primary ophthalmic services locally. There are equivalent committees for medicine, dentistry and pharmacy and the provision will provide a formalised body for consultation in those areas.

Dispensing opticians and lay-owned businesses that have contracts as providers of primary ophthalmic services with primary care trusts will be represented by local optical committees, because they have a contract. That relates to the points that we made earlier about allowing dispensing opticians and lay members to contract directly to provide services. A specific reference is not needed to dispensing opticians as providers, as they are included in the general power. However, dispensing opticians and lay-owned businesses that do not have contracts with primary care trusts will not fall within that.

We think it right that the local optical committee should be representative of providers who contract with the PCT and those who perform primary ophthalmic services in that area. However, the committee will be able to co-opt people who are neither providers nor performers of primary ophthalmic services if it wishes to do so. I do not believe that the arrangements that we are suggesting will restrict the range of persons and the expertise that can be brought to the body.

Under amendment No. 116, there would be a specific reference to dispensing opticians as having a right to be represented by the local optical committee if they had a contract to provide primary ophthalmic services. We support the right of providers with general ophthalmic services contracts to be represented by the LOC. However, the Bill already provides, on page 34, line 27, for every person with a contract to provide primary ophthalmic services to be represented by that committee. That general entitlement includes dispensing opticians, so again there is no need for a specific reference.

Amendment No. 117 would include a reference to dispensing opticians as performers of primary ophthalmic services alongside optometrists. However,
 
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individual dispensing opticians do not perform primary ophthalmic services, which is currently only the testing of sight. Dispensing opticians are therefore not appropriate for inclusion in that way. There is no reason to include in the Bill one group that may at some future point provide a prescribed service, but not to include others. It is right that the local optical committee should be representative of providers who contract with the PCT and those who perform primary ophthalmic services in that area. The committee will be able to co-opt people who do not come into those categories if it wishes to do so.

Amendment No. 118 would remove the requirement that performers of primary ophthalmic services who wish to be represented by a local optical committee should notify the committee of that. A number of optometrists will work for a number of different employers in the areas of different PCTs for short periods. We discussed that earlier. The amendment would make it mandatory that those people be represented by a number of different local optical committees. It is more sensible for a performer to be represented by a local optical committee where he works regularly and with which he has an ongoing relationship, rather than somewhere that he or she goes to occasionally. A requirement for the performer to notify the PCT that he wishes to be represented means that the practitioner will be able to consider where he or she would be best represented.

For those reasons, I hope that the amendment will be withdrawn and that I have reassured hon. Members of our intent.

Dr. Murrison: I am grateful for the Minister's clarification. However, she has not said a great deal about the function of a local optical committee. That would have been useful for us to judge whether it was necessary for dispensing opticians to be represented on the body. We are left to deduce what the committee does. From the comparison that the Minister drew with medicine, dentistry and pharmacy, one can have a fairly good idea of what the committee might achieve. In that context, I can see her logic in not including dispensing opticians, although I still regret that.

I note, however, that the committee may include individuals who have entered into a contract, and the Bill will enable primary care trusts to enter into contracts with dispensing opticians and others—lay people, people who are not qualified in this area at all. To that extent, I accept the Minister's reassurance that the committee is unlikely to be an exclusive body that simply represents a small part of the range of professions engaged in primary ophthalmic services. That has to be a good thing. Probably with that in mind, and with the assurances that she has given, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

 
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