Clause 34 - Provision of primary ophthalmic services
Health Bill
10:45 am
Caroline Flint (Parliamentary Under-Secretary (Health), Department of Health; Don Valley, Labour)
Happy new year to everybody—some are happier than others, I imagine. I hope during our proceedings to be able to reassure my hon. Friends, the hon. Member for Westbury (Dr. Murrison) and his hon. Friends and the hon. Member for Bristol, West, that we have no intention of disrupting what I think is a very good service or unnerving those who provide it. I have been a recipient of opticians' services since I was a child; I am very short-sighted, and I now use glasses and contact lenses. I therefore have a vested interest in the matter.
We recognise that a clearer framework is needed. I will endeavour to reassure those who have a particular interest that access to sight tests and the national negotiating framework for the fee will not be diminished by our proposals. I will come to those matters later, as I want to address the amendment, which would extend eligibility for NHS-funded sight tests to the whole population of England.
Free sight tests on the NHS are already available to priority groups: children under 16, 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 defined categories of people at risk of developing eye disease. Before 1 April 1989 there was universal entitlement to free sight tests, but from that date eligibility was restricted to the groups that I mentioned. In April 1999 we extended free sight tests to everyone aged 60 and over because those in advancing years may have associated health problems that can be picked up by opticians. The eligibility criteria for NHS-funded sight tests are designed to ensure that the groups to which I referred are not discouraged from having their sight tested. However, we have to make some tough choices and a further extension would not be the best use of funds available for the development of the NHS.
In 1999, we reviewed the eligibility rules and extended eligibility for sight tests to those over 60, and the available evidence suggests that it 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. I have to tell the hon. Member for Bristol, West that that does not suggest that a further extension of 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. The cost of extending free sight tests to all those who currently pay privately would be an additional £92 million, based on the 2005–06 rate of £18.39.
The hon. Gentleman also mentioned his concern about the rate. The rate for the test is negotiated nationally. I understand that negotiations for 2007–08 are about to begin and I would like to reassure the Committee that there is no intention, as part of this legislation, to move away from that national negotiating framework or to undermine in any way access to sight tests, either for those who are eligible for support through the NHS or for those who pay privately. The hon. Member for Westbury mentioned that point.
There are choices to be made in health. As we discuss these clauses, we can also reflect on the opportunities, outside the areas that are part of a nationally provided service, for PCTs to consider, based on local need, what other enhanced services might be suitable in the local community. Contracting for the provision of eye tests in a residential care home is just one example of provision for which PCTs might in future want to contract. The proposals in the Bill, including in the clauses that we shall discuss this morning, provide a greater opportunity for such areas to be thought about in relation not only to eye health but, possibly, to other health issues that may arise out of such contracts.