Health Bill
3:55 pm
Andrew Murrison (Shadow Minister, Health; Westbury, Conservative)
Your arrival was impeccably timed, Mr. Illsley. We now reach our final sitting, and I do not know about anybody else, but I am certainly exhausted, notwithstanding the Christmas break. However, we still have many clauses to plough our way through. There is plenty of stuff to get stuck into and plenty to entertain us for the next three hours or so.
We have discussed clause 35 at some length, and it is important that we have done so, because it deals with the significant issue of choice in ophthalmic services. As we said, we are most concerned about the choice element in the seven clauses that deal with primary ophthalmic services. Choice is what we have on the high street now, and our concern is that the Bill will impinge on the choice that our constituents have across this particular spectrum. The Minister probably got the impression that I am very much a fan of ophthalmic services as they are currently configured, and I hope that she did, because I am. That part of what I might broadly define as our health services is well worth emulating, and that is nowhere more true than on the crucial issue of choice and people's ability to go wherever they want.
So far, the Minister has offered a pretty good, robust defence of the Bill and particularly of why it is necessary to introduce the seven clauses. If I am correct, the reasons centre on enhancing the opportunity to provide services and on a concern to address fraud within ophthalmic services. We have discussed fraud to some extent and have asked her to compare and contrast the cost of the administration that PCTs will undoubtedly have to shoulder as a result of these seven clauses with the estimated £10 million of fraud that she is rightly attempting to eschew from the system—I am not sure where that estimate comes from, but it does not sound unreasonable, given the turnover that we are discussing. It is important that we contrast those figures, because it emerged in our deliberations this morning that counter-fraud is one of the cornerstones on which these seven clauses are based. Even at this stage, I hope that she can give us a greater insight into how, or indeed whether, she has compared the money that she hopes to save by removing fraud from this element of health service transactions with the cost that the clauses will undoubtedly involve—the undefined cost that PCTs will apparently have to bear. That will be translated into employing more people to carry the business forward, to do the contracts and the rest of it.
Towards the end of this morning's deliberations, as we were getting into the debate on the amendments—this is the after-dinner part of it—we discussed whether it might be appropriate to have a national contract and national arrangements at least for the sight test. Earlier today, we managed to tease out the difference between the sight test fee and moneys that might arise as a result of the provision of primary ophthalmic services. I am grateful to the Minister for clarifying what we mean by those two things, because they seem to be different in that one is not cash-limited. It is a centrally identifiable sum of money, although it is handled by PCTs, but it is not cash-limited, and that is quite important. That becomes interesting in the context of the basing of the contracts. We can foresee a situation in which a practice exhausts its contractual obligations for any given year and then, as I said earlier, has to sit on its hands for the rest of the year.
Although it is not their principal aim, our amendments would address that situation, because they would ensure that people could choose which practitioner they went to. That cuts both ways: it would also ensure that people were not sitting on their hands for a whole month at the end of the financial year once their practice had discharged its obligations and they had no more work. We have not really heard much from the Minister on that. It has a parallel with the dental contract in one respect, and that is the margin. Last year, in relation to the dental charging regulation, we debated the margin of error that the dentists will be allowed in relation to their contracts. It is rather tight. Just a small divergence from the contract would result in a penalty. The professions will be interested to know what penalties—