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Earl Howe: My Lords, I thank the Minister for his detailed reply, and particularly for providing more detail than he was able to give in Committee. There was much in the reply and I shall need to read it. On first hearing, however, it was very helpful. At this stage, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 60 not moved.]

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6.45 p.m.

Lord Clement-Jones moved Amendment No. 61:

    After Clause 21, insert the following new clause—

(1) It is the duty of—
(a) each local authority in England and Wales; and
(b) each Primary Care Trust in England and local health board in Wales,
jointly to establish and support a Low Vision Committee for the area for which the Primary Care Trust or local health board is established for the purposes of co-ordinating multi-disciplinary low vision services for persons with low vision.
(2) Every Low Vision Committee shall—
(a) identify and log local providers of low vision services and gaps in local provision;
(b) determine ways in which services can be developed to meet local needs;
(c) advise commissioning authorities on priorities and the budgetary implications involved;
(d) develop a user-involvement strategy;
(e) ensure that in hospital eye departments an individual is identified as a point of contact for people who are diagnosed as having a visual impairment;
(f) establish mechanisms for inter-agency referral and information exchange between different service providers to ensure a seamless service;
(g) ensure that services are audited appropriately;
(h) ensure that information about the services is promoted to the community; and
(i) consider provision of low vision services for children, older people, people with learning difficulties, people from ethnic groups and people with multiple impairments such as deafblindness.
(3) The appropriate authority may by regulations make further provision in relation to Low Vision Committees.
(4) The regulations may in particular make provision as to—
(a) the composition of a Low Vision Committee and how members are to be appointed;
(b) the funding of Low Vision Committees;
(c) the payment of travelling and other allowances to members of a Low Vision Committee; and
(d) other functions of Low Vision Committees.
(5) In this section—
"low vision services" relate to rehabilitative or habilitative processes which provide a range of services for persons with low vision to enable them to make use of their eyesight to achieve maximum potential and include assessing the person's visual function and providing aids and training, addressing psychological and emotional needs, and facilitating modification to the home, school and work environments,
"persons with low vision" and "persons with a visual impairment" mean those persons who have an impairment of visual function for whom full remediation is not possible by conventional spectacles, contact lenses or medical intervention and which causes restriction in those persons' everyday life,
"deafblindness" and "dual sensory impairment" mean a combined sight and hearing impairment which causes difficulties with communication, access to information and mobility,

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"the appropriate authority" means—
(a) the Secretary of State in relation to England, and
(b) The National Assembly for Wales in relation to Wales."

The noble Lord said: My Lords, this amendment is very similar to the one on low vision committees that I moved in Committee. I have moved the provision again in an attempt to see whether the Minister might reconsider some of the matters he described in Committee. In Committee, the Minister said:

    "My view is that it would be inappropriate now to impose a requirement for primary care trusts and local authorities effectively to establish statutory low vision services committees. I think that it would make sense to allow the project to continue and for an evaluation of the committees' impact on service provision to be carried out by the implementation group at the end of that 18-month period . . . I assure noble Lords that the department will continue to take a close interest in the progress of the implementation project. I take the view that legislation is not the appropriate route down which we should go, but I hope I have reassured noble Lords that we take a keen interest. I accept that having made progress in the past two or three years, more progress needs to be made".—[Official Report, 21/03/02; col. 1521.]

Those were very welcome words. However, having considered the Minister's words, we on these Benches contend that it does not make sense for the Department of Health to sit back and wait for 18 months. The department needs to take action now. The need is urgent as statutory authorities in many parts of the country are failing people with sight problems, resulting, for example, in 200 accidents in the home every week caused by sight problems which people are not being properly supported in managing. Moreover, many of the low vision services committees need stronger support from statutory authorities now so that they can successfully negotiate the changes in commissioning entailed by the restructuring of health services that we have been debating in relation to this Bill.

Other spheres have seen major injections of public investment, sometimes as part of a national service framework, but low vision has apparently been deemed a low priority and left to the voluntary sector to sort out. Visually impaired people are dismayed at how little support they feel the Government are giving in tackling the lottery in specialist health and social care services.

We suggest that the Department of Health should issue positive guidance now to social services and PCTs in England—to give active support and encouragement to the establishment of local low vision committees; to consult them where appropriate; and to take their recommendations into account in planning, deciding priorities and budgeting. Such guidance could also reaffirm the importance of the national low vision framework and the standards and processes set out in it for meeting existing statutory responsibilities for clinical and rehabilitation services in a cost-effective manner. It could also highlight how local authorities and PCTs can collaborate across boundaries to address unmet needs.

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The key message is that now is precisely the time for the Government to give such a steer, while there is a funded implementation officer to support authorities in this regard. I beg to move.

Earl Howe: My Lords, I rise very briefly to support Amendment No. 61. My understanding is that there are currently only 24 low vision committees, many of which have been established since the implementation group was formed, and many of which are or have been supported by the low vision services implementation officer. Whether they flourish depends on the commitment of local players, especially the statutory commissioning authorities. Whether they become a feature of every local community is effectively being left to chance. Without statutory provision or guidance for low vision committees, services risk remaining extremely patchy and unco-ordinated. I for one am very worried about that.

Lord Filkin: My Lords, the noble Lord, Lord Clement-Jones, referred to the importance of having good eye care services and of doing all that is reasonably practicable to remedy deficiencies. The Government strongly agree with those comments and support them. The Government's action in restoring the free NHS eye test for all those aged 60 and over at a cost of £50 million a year shows the priority that we attach to the eye care of older people. That group is most vulnerable to eye disease and stands to benefit most from regular eye examinations. In 1999-2000 there were more than 2 million extra NHS sight tests following the extension of eligibility for free tests.

We are also taking steps to improve cataract services and have allocated an extra £20 million over two years to fund the capital costs of 60 schemes to improve treatment facilities and reduce waiting times. We believe that this investment will considerably improve the standard of eye care and greatly improve the quality of lives, particularly of older people.

However, there are many people, particularly older people with visual impairment, whose conditions are not treatable. Those patients are deserving of support, as the noble Lord, Lord Clement-Jones, indicated. We all recognise the work that voluntary organisations such as the RNIB, Guide Dogs and The Partially Sighted Society do to improve our understanding of the needs of people with visual handicaps.

Amendment No. 61 would require each PCT in England or local health board in Wales and each local authority in both countries jointly to establish a low vision committee for the area for which that PCT or local health board was established.

A report in 1999 by a consensus group of organisations on the future of low vision services recommended the establishment of local vision committees for the purpose of ensuring that services in the UK are provided in accordance with the report's recommendations.

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The Secretary of State for Health commended the report to the NHS and social services, which is what I believe the noble Lord, Lord Clement-Jones, wished to hear. I am also pleased that the department is contributing a grant of £120,000 over three years to provide an implementation officer from the voluntary sector to help in setting up local committees. I understand that good progress is being made and that, as the noble Earl, Lord Howe, said, 24 committees had been set up by the start of this year and a number of others are under consideration.

The implementation project is set to run for another 18 months. As we indicated previously, the Government think that it would be inappropriate now to impose a requirement for PCTs and local authorities to establish jointly low vision service committees. Those committees are intended as a means of bringing about more effective collaboration between agencies and so improve low vision services. I believe that it will make sense to allow the project to continue and for an evaluation of the committees' impact on service provision to be carried out by the implementation group.

It may be possible to have a good multidisciplinary low vision service without a formal committee. In some areas the PCT may not always cover the area that is sensible in terms of linking and providing low vision services and other models may emerge. Also, under the present arrangements, the committee is not in the ownership of one body and that emphasises joint working which may be important for the successful functioning of the committee.

The department will continue to monitor the progress of the implementation project through participation in the implementation group and the six monthly reports it receives. However, we take the view that it would be inadvisable to legislate for a system which has not yet been evaluated. Indeed, as noble Lords recognise, low vision committees have already been established without the need for legislation. Therefore, in that sense, it is superfluous. Also, for the present there would seem to be considerable advantage in retaining flexibility around the organisation of the committees rather than defining it in the way proposed.

In Wales it is believed that the issues the proposers seek to address are being met informally through the Wales eye care initiative, part of which is the Wales low vision aids scheme. Therefore, we believe that there is no need to impose a statutory requirement to establish low vision committees.

To conclude, if one sees it in the round, PCTs will clearly have the responsibility to improve health outcomes in their areas of which those who are suffering from low vision will form an important part. Low vision committees are one way—they may be a good way—of doing that, but they are not necessarily the only way and they are not necessarily a universal way. The Government believe that they should

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promote and support PCTs to address low vision rather than specifying the particular mechanism advanced through this amendment.

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