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Lord Saatchi: My Lords, this is one of those special parliamentary occasions when a Minister comes to the Dispatch Box and clears up one of the great mysteries of the age. What we all want to know is how the Government have achieved a modern miracle—to raise billions of pounds in extra tax, spend it, and produce results which are invisible to the naked eye.

Perhaps I may offer the noble Lord an explanation which he can shortly say is complete nonsense, and then tell us the real reason. Is not the reason—exactly as my noble friend Lord Tebbit says—that 59 per cent of all the sums spent by the Government on public services is disappearing in wage and cost inflation in the public sector; and that the sum left over is too small to make a difference? If that is not the real reason, will the noble Lord say what is?

Lord McIntosh of Haringey: My Lords, the noble Lord really must get out of the habit of answering his own questions. For the reason I gave in reply to the supplementary question of the noble Lord, Lord Tebbit, measures of output of the simple kind that the noble Lord, Lord Tebbit, and apparently the noble Lord, Lord Saatchi, would wish, do not measure the quality of the public service provided.

Let us stay with education as an example. Is the noble Lord seriously saying that the increase in the number of teachers is not an increase in quality? So far

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as concerns health expenditure, is he saying that the increase in the number of doctors and nurses is not an increase in quality in the provision of health services? If those on the Benches opposite are saying so, let them say it to the teachers, the doctors and the nurses.

Lord Newby: My Lords, does the Minister accept that, in the 1990s, pay in the private sector rose by 51 per cent, whereas in the public sector it rose by only 42 per cent? Will he further accept that, in the year to October 2002, public sector pay rose by 3.8 per cent, compared to a 3.6 per cent rise in private sector pay? Finally, will he accept that if there is a problem in regard to improved outputs in the public sector, it cannot be laid at the door of excessive wage payments?

Lord McIntosh of Haringey: My Lords, I do not have the noble Lord's figures in front of me. I have no reason to doubt them—and, if I do not doubt them, I have no reason to doubt his conclusions.

Baroness Gardner of Parkes: My Lords, will the Minister tell the House whether, in terms of inflation in healthcare, there is a continuing disproportionate increase in the amount having to be set aside by the National Health Service for legal liabilities?

Lord McIntosh of Haringey: My Lords, unfortunately, the noble Baroness is entirely right. The growth in litigious activity in this country is greatly to be regretted. It is costing the public sector a great deal of money and is one factor that is putting a brake on reform alongside the increase in resources, which is the key to our approach to the public services.

Children: Visual Screening

2.56 p.m.

Baroness Knight of Collingtree asked Her Majesty's Government:

    What steps they intend to take following the report by the National Screening Committee on the visual screening of children.

Baroness Andrews: My Lords, the National Screening Committee is awaiting a report from its child health sub-group. On the basis of that report, the committee will make its recommendations to Ministers. We will consider any improvements to visual screening in the context of the national service framework for children.

Baroness Knight of Collingtree: My Lords, will the noble Baroness make urgent inquiries about the report, since there is widespread concern that the draft report recommends that children should have eye tests, not at age three and four, as previously, but at age five? Is the noble Baroness aware that one in five toddlers has semi-severe visual problems; and that if such children do not know what others see, they cannot understand and complain about their own disability? Does the noble Baroness recognise that this

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is a severe educational problem, and that other countries are sticking to eye tests for three and four year-olds, not five year-olds? Will the Government ensure that Britain's children are not disadvantaged by any change?

Baroness Andrews: My Lords, I am in awe of the noble Baroness's reputation in this field, so I am happy to be able to agree with her that the earlier we screen, detect and treat vision defects, the better. I understand that there has been a lively professional debate. One of the reasons why Ministers are still waiting on the report is that there has been a very open consultative process.

I understand that screening at age three is problematic. Although defects such as amblyopia can be picked up more easily, when children are immature, they are less likely to provide a reliable report. Also, there is the problem of take-up. We shall examine all the relative merits of testing at different ages. I can assure the noble Baroness that her concerns will be noted.

Lord Carter: My Lords, on the question of take-up, will a special effort be made to encourage low-income families to take advantage of visual screening?

Baroness Andrews: Yes, my Lords. We are concerned that in the pattern of inequalities in health there are real problems. Children from disadvantaged families often do not get the free eye test to which they are entitled. Within the national service framework for children, we very much want to ensure quality standards and additional information. The Sure Start programme, which was expanded in December last year, is a good setting for young, disadvantaged parents to be directed towards the free eye tests and the screening to which they are entitled.

Lord Addington: My Lords, the Hall report on screening, of which I have managed to obtain a rough copy, suggests that pre-school screening is very difficult because, at that age, children are not gathered together. Will the change in educational practice as regards the pre-school age group—that is, having four year-olds within a school setting—make this the ideal stage at which to begin screening? As the noble Baroness has said, a disability that is not picked up early will lead to far greater on-costs, both for those involved and for the system.

Baroness Andrews: Yes, my Lords, I know that there is a strong case for testing at age four to five, precisely because one has a relatively captive population which one does not have at age three to four. But we need to look more closely at other issues associated with testing at age four to five. We will do that in the context of the national service framework. I hope that the Hall report, the fourth report by the committee, Health for All Children, to which the noble Lord refers, will be finalised within the next month. We will have the advantage of that information.

Lord Jenkin of Roding: My Lords, I hope that I can be reassured by the noble Baroness's statement that

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the Government will consult fully on the report. Some voluntary organisations in this field have told me that they are anxious that there will be a very uneven pattern of service across the country because of the shortage of orthoptists. Is it not the case that such tasks with small children can be done equally well by optometrists and other professionals in the field of visual handicap; and that there should be no excuse for the shortage of specialists, which the report appears to have accepted?

Baroness Andrews: My Lords, the noble Lord asked several questions. First, we are aware that there is uneven service provision in the way services are offered across the country. Secondly, there has been wide consultation on the Hall report, because it has been on the world-wide web for more than six months. It has provoked, as it was designed to, much consultation from across the profession and the voluntary sector. Thirdly, as far as I know, there are no shortages in this field. Unlike other parts of the health service, we are well supplied. In particular, there has been an increase of 14 per cent in optometrists in the past three years. The noble Lord is correct to say that we must be clear that the right people screen children at the right age, and that the pattern is equal across the country so that every child has the same chance.

Baroness Gardner of Parkes: My Lords, when and where will the screenings be carried out? Is simple eye-testing carried out in schools anymore?

Baroness Andrews: My Lords, eye-testing still takes place in schools. There has never been a prescription for a particular eye test, although linear eye tests have been the pattern for many years. The Hall report does not recommend changes to that. When we look at the advice to Ministers in the context of raising standards overall, we might be able to come up with better provision generally.

Congestion Charges

3.2 p.m.

Baroness Miller of Hendon asked Her Majesty's Government:

    Why government Ministers are to have congestion charges in London met by the taxpayer.

The Minister for the Cabinet Office and Chancellor of the Duchy of Lancaster (Lord Macdonald of Tradeston): My Lords, there is no special exemption for government vehicles. The Government Car and Despatch Agency will be responsible for the payment of congestion charges on its vehicles and will recover costs from government departments and other customers.

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