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Grand Committee
The Committee met at two of the clock.
[The Chairman of Committees (LORD BRABAZON OF TARA) in the Chair.]
Health Bill
(Sixth Day)
Links to other Grand Committee Sittings on the Bill
Clause 36 [Provision of primary ophthalmic services]:
Baroness Barker moved Amendment No. 91:
The noble Baroness said: In moving Amendment No. 91, I shall speak also to Amendment No. 94, which is grouped with it. Primary ophthalmic services are perhaps one of the most effective services throughout the NHS. They work extremely well and they are extremely efficient in their role of prevention and early detection. They are also one of the parts of the health service for which there is no waiting list. Access to ophthalmic services is rapid, easy and open to everyone. The amendments that we have tabled reflect in part the concern of optometrists, ophthalmologists and dispensing opticians that their services, which to date have worked extremely well, would be changed and tinkered with in such a way that their overall efficacy would be damaged.
Amendments Nos. 91 and 94 serve as a hook on which to hang a debate about provision of general eye tests. Prior to 1989, eye tests were free for everyone. Thereafter, they have been free only for some exempt categories of the population, such as older people, and others must pay for them. Our concern about the Government's proposed changes to ophthalmic services and the contract to be awarded by PCTs is that the current, on the whole satisfactory, ophthalmic services may become limited and less effective.
I say that not least because other parts of the health service that are also involved in primary eye care seem to have changed. I am given to understand that pre-school children and children entering their first school no longer automatically receive eye tests to detect conditions such as squints. It is against that background that we want to probe the Government's intention on access to the general sight test. We want to make sure that it remains the responsibility of a PCT that there is adequate provision in the area, and we want to make sure that such discretion as the Bill affords it to alter contractual arrangements for primary ophthalmic services will not lead to the introduction of charges by the back door.
Amendment No. 94 deals specifically with glaucoma referral services. It is well known—so I do not need to spend a considerable amount of time explaining to noble Lords—that one of the most important things about the general sight test is that it serves as a means to detect other conditions such as
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tumours, glaucoma, the onset of diabetes, and eye conditions such as macular degeneration. We want to ensure that those services remain within this contract, which PCTs are required to provide. That is the basis of our argument. I beg to move.
The Chairman of Committees (Lord Brabazon of Tara): I should point out that if this amendment is agreed to, I cannot call Amendment No. 92.
Earl Howe: I shall speak to Amendment No. 93 in this group. It has a very special purpose, which is to ensure that all children receive an eye examination before they start school for the first time. Why is that so important? The period just before compulsory school is a particularly crucial time for assessing vision for two reasons. The first is that problems picked up at this stage can be sufficiently corrected while the eye is still malleable. If that happens, it can make a difference to the person that lasts a lifetime. On the other hand, problems ignored at this age can plague that person for life.
The second reason is that we all know stories of children underperforming consistently at school simply because they cannot see the blackboard. It happens all too often and it is entirely preventable if the Government have the will to ensure that children take advantage of the sight tests to which they are already entitled. All children under 16 are entitled to a free NHS sight test. However, official statistics show that only around a quarter of under-16s take up that entitlement. My amendment would require primary care trusts to use the opportunity of the proposed NHS life checks to make what could be a critical difference to many children's lives. It is the most effective change that the Government could make to promote eye health for children, so I hope that the Minister will give the proposal serious thought.
Baroness Royall of Blaisdon: I am grateful to the noble Baroness, Lady Barker, for her very positive comments about the efficiency and effectiveness of ophthalmic services in the NHS. Nothing that we are intending to do is aimed at detracting from that in any way.
Amendment No. 91 seeks to extend eligibility for NHS-funded sight tests to the whole population. As the noble Baroness informed us, prior to 1989 there was universal entitlement to free sight tests, but from 1 April 1989 eligibility was restricted to children, those aged 16 to 18 in full-time education, people on low incomes who might otherwise be deterred by the cost of a private sight test, and people suffering from, or predisposed to, certain eye diseases.
In April 1999, this Government extended free sight tests to all people aged 60 and over. The available evidence suggests that that resulted in a transfer of sight tests from the private sector to the NHS, rather than any material increase in the overall number of sight tests undertaken. This does not suggest that any further extension in eligibility, and the associated increase in NHS funding, is likely to affect significantly the overall number of sight tests undertaken or the associated health outcomes. We
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believe that a further extension would not be the best use of the funds available for the development of the NHS.
Amendment No. 93 would provide a regulation-making power allowing primary care trusts to be required to make eye examinations mandatory before children began compulsory education. The Government entirely agree with the noble Earl about the value and importance of early detection of eye defects in children. That is fully recognised in Health for all Children, edited by David Hall, Professor of Community Paediatrics at the University of Sheffield. This guidance forms the basis for the Child Health Promotion Programme promoted by the Department of Health.
The programme of home visiting and community development makes an important contribution to many areas of child health education and fosters the earliest detection of problems, including those associated with eyesight, in pre-school children. As I mentioned before, children are also eligible for a free, NHS-funded sight test if there is a need. I believe that the needs for children's vision to be examined are already met by these two programmes.
Amendment No. 94 would place a duty on primary care trusts to promote the benefits of regular sight tests for all persons. Information about the extensive arrangements for providing help with NHS optical services and other health costs are publicised in leaflet HC11, Are you entitled to help with health costs? Posters are also available for display in optical practices and hospital out-patient departments. Sight tests allow the opportunity to review all aspects of eye health, including investigations for signs of disease. Those at risk of specific eye disease may be asked to attend regular screening.
Free sight tests are available under the NHS to large parts of the population, including children, those aged 16 to 18 in full-time education, people on benefits, those at particular risk of developing eye disease, people who are registered blind or partially sighted or who have a complex spectacle prescription, and all people aged 60 and over. In addition, we have promoted a system of child health and development checks.
The number of NHS sight tests undertaken continues to increase. In 2004–05, there were 10.1 million NHS sight tests, an increase of 3 per cent on 2003–04. Investment in the NHS will have trebled by 2008, following decades of neglect. However, it is for PCTs, in consultation with local stakeholders, to determine their local priorities and decide how to spend this money.
The noble Baroness expressed some concern that the powers in the Bill might be used in a way that would be detrimental to patients and the services currently provided. We envisage the sight testing service operating like the general ophthalmic service system now—that is, with patients being able to choose their GOS contractor, and contractors being able to have a GOS contract provided that they meet agreed national
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criteria, subject as now to local decisions on matters such as quality of service, inspection of equipment and premises. We also envisage continuing to have a centrally negotiated sight test fee with access to sight tests not being constrained locally by individual PCT budgets. We are content that that will ensure that services remain and indeed improve. I hope that noble Lords will take note of that reassurance.
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