Clause 35 - General ophthalmic services contracts

Health Bill – in a Public Bill Committee at 12:00 pm on 10th January 2006.

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Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health) 12:00 pm, 10th January 2006

I beg to move amendment No. 29, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) must make provision for all those with entitlement to GOS to retain the right to have that delivered by the provider of his or her choice.'.

Photo of Eric Illsley Eric Illsley Labour, Barnsley Central

With this it will be convenient to discuss the following amendments:

No. 30, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.'.

No. 31, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.'.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

We had hoped that this would be a group of four amendments, including amendment No. 32 to which I referred earlier, but we have been told that that is legally defective. That shows the disadvantage suffered by the Opposition when it comes to parliamentary draftsmanship in relation to tabling amendments. Nevertheless, I hope that we will be able to cover the intention of the amendment as part of the clause stand part debate, and that the   Minister will address the matter further than she has done so far.

Amendments Nos. 29, 30 and 31 and, by implication, 32 all have to do with choice. They would guarantee that people might continue to enjoy their current level of choice when it comes to ophthalmic optics and the services of opticians and optometrists, particularly on the high street. We fear that that will be damaged as a result of the seven clauses that relate to those important services.

Let me quote a letter about the proposals from an optometrist in Witney in Oxfordshire.

''These proposals, if they become law, have the potential to create the same chaos of reducing patient choice and accessibility seen in dentistry, as patients are restricted to a select practice or are denied appointments as the budget for the year has been spent. This is a retrograde step and would affect the more vulnerable members of society (the elderly, partially-sighted, low-income, and children) who at present can choose which practitioner to provide their eye care on the NHS.''

That very succinctly puts our concerns as well. Given our concerns about access, choice and the potential to damage a very good service, we have tabled these three, originally four, amendments. Let me take the Committee through them one at a time.

Amendment No. 29 states:

''Regulations under subsection (2) must make provision for all those with entitlement to GOS to retain the right to have that delivered by the provider of his or her choice.'.''

That, effectively, is what happens at the moment. I assume that the Minister wants choice to continue, and I suspect that she wants the Bill to do no harm to that choice. Therefore, the amendment would tally with her thinking. Under our provision, people will be able to choose providers for themselves from the large number available, as they can at the moment. They will be able to make informed choices about which provider to go to, based on past experience, locality and whether they perceive that they are getting good value for money. The danger under the proposed measures is that, to a greater or lesser extent, PCTs will determine their choices for them. Those who wish to seek out a free NHS eyesight test could find that their provider of choice is no longer available to them. They might have been going to a particular provider for many years, but suddenly find that they cannot do so any more.

Many of us take a fairly eclectic approach to the issue of who we go to for what I hope are our regular eyesight tests, but others do not and regard their practitioner in much the same way as their GP. They wish to build up a long-term relationship, and there are instances in which such a relationship is particularly important—screening for glaucoma, for example, needs to be done regularly. The Minister should not put in place legislation that damages individuals' ability to make such a choice and determine where they go. Indeed, that ability to choose should be held up for other practitioners as a model of how to provide patients—our constituents—with the services of their choice at their behest. Damaging what is almost the jewel in the crown of NHS choice is entirely retrograde, and we tabled amendment No. 29 with that in mind.  

In a similar vein, amendment No. 30 would insert the words:

''Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.''

That touches on issues with which we dealt earlier, and I suppose that we had the same debate about dentistry, where the same concerns would apply. Once one uses up the units of dental activity that one negotiated with the PCT a year previously, one can, in effect, sit on one's hands and do nothing. Indeed, a practice could structure itself in such a way that it did precisely that; it could lay off staff and profit thereby. However, that is not what we want to see if we are serious about maintaining patient access and patient choice. In the present context, such an arrangement may mean that a patient turns up for an eyesight test in March—at the end of the financial year—and finds that the optometrist is no longer doing NHS eyesight tests because he has used up the entitlement that he negotiated for the year and for which he contracted with the PCT.

The Minister gave us some reassurance on NHS eyesight tests, but she might like to expand a little on her meaning in response to the amendment. However, the situation that I described would also apply to primary ophthalmic services. The worry is that, at the end of the financial year, practitioners might say, ''We've done everything we have contracted to do and we will do no more.'' That would clearly be a very strange and exceptionally wasteful way of operating, although it could be advantageous to the practitioner or business concerned.

Following on from the previous two amendments, amendment No. 31 would insert the words:

''Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.''

Later, we shall discuss disqualification, and I shall leave it until then to voice my concerns about what that means in practice. Are we talking about disqualification on the basis of perceived competence, behaviour or registration or on the basis of a business or individual having been found to be, let us say, difficult in contractual terms? The latter would be a slightly sinister situation, with the PCT being able adversely to influence the businesses with which they were contracted; indeed, it might even prejudice the independence of those organisations, and we would be concerned about that.

Taken all in all, the three amendments—I may mention amendment No. 32, which is in a similar vein, on clause stand part—would guarantee an element of choice for individuals seeking primary ophthalmic services. They would also help providers by ensuring that primary care trusts could not shut them out when drawing up contracts. People would be able to use any high-street practitioner, as they can now.

We have covered the question of whether the finance will be cash-limited, and the other clauses   touch on that further. The Minister has given us some assurances, although I remain concerned about whether primary ophthalmic services will be cash-limited and therefore subject to prioritisation by the PCT, which is not necessarily the case now.

I suspect that the Minister will say that she cannot allow the amendments, given her previous explanation. Much of what she said was new, despite her protestation that it was all in the briefing notes. In the context of her earlier remarks, why cannot she incorporate the amendments into the Bill? They will not disestablish the rationale that the Minister rather belatedly gave for the seven clauses of chapter 2.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health) 12:15 pm, 10th January 2006

Amendment No. 29 would ensure that eligible patients were able to choose their NHS provider of sight tests. We support the right of patients entitled to a sight test under NHS arrangements to choose which practitioner should test their sight. Nothing in the Bill takes away from the right of individuals to choose when and where they have their sight tested, so long as it is in line with existing regulations. That is why we are inserting new subsection 28WE (5) into the 1977 Act. It states:

''Regulations under subsection (1) must make provision as to the right of persons to whom services are to be provided to choose the persons from whom they are to receive them.''

I hope that I have reassured the hon. Gentleman that there is no attempt to limit the range of choice.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

May I make a further point? It may answer the hon. Gentleman's question.

Providers of sight tests under the NHS are required to have a contract with the NHS and to be included on a PCT list. That is right and proper. Yes, patients have a right to choose who should test their eyesight, but it is important that those who provide the service, which is funded by the taxpayer, should be legitimate providers; people must be clear that the providers are qualified to provide those services. That is the case now, and we intend it to remain the case.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

No, I shall make a little further progress in order to answer the point.

The amendment would result in patients being able to choose a provider who did not have a contract with the NHS and who was not included on a primary care trust list. I cannot accept that. It would mean that the post-Shipman system of lists, whereby PCTs have to be satisfied of the competence and probity of NHS practitioners, would be negated for ophthalmic services. I believe that patients are best protected when NHS services are performed by primary care professionals who are included in a PCT list of performers and who have contracts with the NHS or are employed by others who do. As a consequence, there is a relationship and the primary care trust has the right to ensure that standards are maintained and to cancel a contract if it is not satisfied that that is the case. Should people meet the clinical conditions and   the quality standards, there is no limit on the number of contractors or performers on the list. That provides ample choice for individuals to access services that they can be assured are of a good standard.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

The burden of what the Minister is saying therefore, is that the only benchmark for deciding whether a provider should be offered a contract is his or her professional competence. Can she confirm that provided that the individual can prove his or her professional competence, which would presumably require registration with the General Optical Council, for example, that person would be offered a contract? If that is not what the Minister is saying, how is a PCT to determine with whom to place the contract?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Clearly, the arrangements at present are that only people with required qualifications can carry out the sight tests. That is agreed with the various professional bodies and organisations and it will continue in the future. As is the case now, providers who contract with the PCT must make sure that their organisation has the clinical competence to provide the sight test. There may also be issues such as how the service is provided, and so on. For example, if questions of probity came to the fore, there would be a question whether the PCT wanted a contract with that particular provider.

There is nothing different from that which currently exists in what we are suggesting: the NHS will only pay through PCTs those practitioners and providers who meet the standards of quality and clinical assurance that have already been discussed by professional bodies and are laid down in regulations.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

The Minister has side-stepped the point, if I may make so bold. I asked her to confirm that, provided that a professional is competent professionally and in terms of probity, in all respects—that would imply registration with the appropriate body—he or she could, if they asked, be given a contract to provide primary ophthalmic services. That is the burden of what the Minister said previously.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

My understanding is that if an organisation or individual meets those conditions they are entitled to a contract. Nothing in our proposal—[Interruption.] Well, they can apply for a contract and if they meet the conditions there is very little reason why a PCT would turn them down.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

If I can finish, we are not setting limits on the number of providers or, for that matter, on the number of people who are on the performers list to provide services.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

No, as I want to make progress on some of the other amendments.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

If it was accepted, amendment No. 29 would mean that someone could go to an organisation or an individual who did not have a contract with the PCT or was not on the performers   list. That is not the correct way forward. We are not trying to shut down the number of people who provide services; we are trying to ensure that NHS money is given to those who provide a proper, qualified service. The hon. Member for Westbury may disagree, but the upshot of amendment No. 29 would be that anybody who was not on a PCT performers list or who had a contract with a PCT could seek to be reimbursed through taxpayers' money, and that is not good enough.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health) 12:30 pm, 10th January 2006

Can the Minister provide evidence that fraudulent dispensing opticians and optometrists are currently operating in this way? That might be helpful. Could she also confirm that there is little evidence of any such thing? If there were, I would tend to agree with her. If individuals were putting themselves up falsely, we would need to take steps to ensure that public money was not provided in such a fashion. Could she also confirm that it would be illegal for individuals to offer themselves as holding such professional qualifications? We do not need further legislation to ensure that public funds are safeguarded in such a way. I resent what she implied about Shipman in that regard; that is entirely a red herring. She should be ashamed for using it.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

The issue is whether one believes—it is clear that the hon. Gentleman does not—that as a local NHS body provides and funds NHS services, national standards should be inspected locally and dealt with in such a way that we can ensure to the best of our ability that those people who are either contracted to provide services or clinically provide services are fit for purpose. I personally do not think that there is a huge amount of concern about the idea that contract providers or performers should register and be part of a list with the local PCT. If someone was on a performers list in one PCT area, it would apply across the whole of England. They would not be confined to the geographical location of their PCT.

I find it difficult to understand the direction of the hon. Gentleman's argument. He seems to be saying that an individual, as a customer, could go to anybody who was not on the contractors list or the performers list and avail themselves of a sight test that the NHS would pay for with no controls or links back to the locally accountable body that is there to help to ensure that nationally negotiated standards, guidance and conditions are implemented locally. I am not sure how professionals who are on lists now and will be in the future would feel about that. It would undermine the process of creating an environment that tries—not in a bureaucratic way but straightforwardly—to create a check to ensure that people are able to do the job that they seek to do. To go back to our earlier partnership discussion, part of that partnership is about the discussion of the delivery of services locally and the issues of need. I cannot accept amendment No. 29, because it is a bit of a nonsense.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Let me one last time try to express what we are concerned about. Things may have changed slightly as Ministers have accepted in discussions with the profession and in Committee that the sight test will be centrally funded, but there is   a risk that a primary care trust might constrain the local list of providers who were able to offer a sight test in order to secure a better deal in the provision of other primary ophthalmic services. There is no reason why that should happen. On the face of it, if it is centrally funded to a nationally agreed standard, every registered provider with the General Optical Council should be free to offer that service. There is no good reason why the primary care trust should intervene to restrict that. The primary care trust, on the face of it, does not seem better able than the professional regulatory structures to determine whether someone is qualified.

The distinction that we are driving at is that with the sight test, if nothing else, we should be clear that every properly registered provider should be able to provide the sight test to every customer. Nothing should intervene to prevent that from happening.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

As far as I am aware we intend that, as now, contractors will be able to have an NHS contract for the sight test provided they meet the national criteria, which should be met with local decisions on matters such as quality of service and inspection of premises and equipment. That is the current position, I understand. There is local inspection using national standards before a provider can go on the list for a GOS contract. Nothing about that will change.

There may be some contractors who want to offer other services. That is a separate issue, to be negotiated with the PCTs. It is separate from the national sight test and from optical vouchers and so forth. It does not necessarily mean that if the PCT would like other services to be provided in the area there will be pressure on someone to offer them if they do not want to. As we discussed earlier, one of the strengths of the current system is the opportunity for the public to have sight tests and purchase spectacles in a huge variety of outlets, regardless of whether they need enhanced services, or whether they are having the sight test in the area where they live or where they work.

I hope that I have reassured hon. Members and made things clear. [Interruption.] That is why I am discussing those issues; we cannot put everything in the Bill. My hon. Friend the Minister of State, Department of Health met professionals before Christmas and talked about some of the relevant aspects of the matter.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

It is always an important point. I will not give way at this stage. The hon. Gentleman can return to it on clause stand part if he wants to.

Amendment No. 30 would guarantee the rights of eligible patients to NHS-funded sight tests and would provide in statute that there should be no limitations on the number of sight tests for which providers can claim payment. We support the right of patients eligible for sight tests under NHS arrangements to have those sight tests and that is already covered by   the Bill. In proposed new section 16CD(1)(a) we set out the duty of primary care trusts to provide a sight testing service and in new subsection (2) we specify the patients who are eligible for that service. The proposed new section also provides for the power to make regulations to add to the category of those eligible for sight tests under NHS arrangements. We will be making regulations to ensure that all those currently eligible for sight tests under NHS arrangements will continue to be eligible in future.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Perhaps I can start to address the amendment, if the hon. Gentleman will allow me.

It cannot be acceptable for primary legislation to provide that providers should be recompensed for sight tests without any limitation. That could prevent primary care trusts from questioning the appropriateness of sight testing undertaken in volumes apparently far in excess of what any responsible clinician would undertake if they were carrying out sight tests properly.

We do not propose to place limits on the number of sight tests that may be undertaken or to place any cash limit on the budget that reimburses the cost of sight tests provided under NHS arrangements. However, there must be scope for primary care trusts—which, as I said, are responsible for ensuring locally that national standards are implemented—to exercise judgment to ensure that public funds are properly spent. The amendment would remove that safeguard, which I am sure was not the intention of the hon. Member for Westbury.

Amendment No. 31 is intended to ensure that PCTs are unable to limit the number of providers of NHS funded sight tests or of performers who work in their areas. We do not intend that regulations should give powers to primary care trusts to place limits on the number of providers with which they contract for the provision of sight tests under proposed new section 16CD(1)(a), but we see no need for that to be in the Bill. It would be quite inconsistent with the approach taken for other primary care professions, which have maintained the right to establish businesses in their areas and operate contracts with the NHS without an explicit prohibition or any limitations in the relevant primary legislation.

For performers of primary ophthalmic services we are committed to maintaining the right of clinicians who undertake sight tests under NHS arrangements to work in any area in England, provided that they are listed with a primary care trust in England. Restrictions on performers would be inconsistent with the performers list regulations already in force, which prevent movement of the work force in ways that are not in the interests of patients or optical businesses.

Given the fact that sight tests will be centrally funded, I see no reason whatever why a PCT should restrict the numbers on its performers list, as it will not be affected by any budget concerns that it may have locally. For those reasons, I recommend that   amendments Nos. 29 to 31 be rejected. I hope that I have clarified how the Government feel: sight test services should continue to be provided in an open way that maximises flexibility and choice but ensures that existing safeguards continue.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

We have heard very little from the Minister on how she will guarantee that the choice we have now will continue once these seven clauses pass into law. She has not given us the assurances that we have sought and which our amendments would have cemented into the arrangements that she is introducing. However, she opened up one or two interesting lines of debate, particularly in relation to amendment No. 29. She appears to be exercised about the quality of professionals undertaking ophthalmic services. I share her concerns; we all hope that those who provide NHS services will be high calibre and subject to audit and inspection—indeed, we look to professional bodies that register practitioners largely for that reason. That is why the amendment referred to GOS.

The Minister did not address my question about how many mavericks are out there and why she is so concerned about the possibility that people are performing sight tests who are not qualified or competent to do so, or who do not have the probity. I am not aware of any. If she is aware of any and is concerned about them, she should say so. We might then be more minded to agree with her that the amendment should be withdrawn. I am not sure, however, that she answered that question. Indeed, I am pretty sure that she sidestepped it completely.

So it appears that the PCT will be in the invidious position of determining who is of sufficient quality to undertake the contractual arrangements. That brings us back to the question that I put to the Minister during our debate on clause 34, which dealt with the cost of such arrangements. If PCTs will be expected to assure themselves that those with whom they enter into a contract are of sufficient quality, that clearly implies an inspection regime and an auditing structure, all of which requires people. Replicated across the country, that means cost.

I suspect that the £10 million-worth of fraud, which the Minister says it is so crucial to avoid that she needed to draw up these seven clauses, will be largely overshadowed by the amount of money required by the NHS to ensure that PCTs place contracts for sight tests with appropriate people. We have not heard much about that to date. It is the subject of some of the measures in proposed new section 28WF of the 1977 Act, but only very peripherally. As for GOS and the review that we hoped for, such issues ought to have been explored in the review that we thought would precede the seven clauses.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health) 12:45 pm, 10th January 2006

Is the hon. Gentleman aware that at present all clinicians who perform NHS sight tests are listed with a PCT and that all contractors must be listed with each PCT where they provide that service? That is current practice, to ensure quality and delivery of that service. It is a safeguard to ensure that national standards are met. Why on earth is he suggesting that   we should now open up the situation so that people can be on neither of those lists? I fail to understand why he is suggesting that we change current practice in a way that could open the system to abuse and cause concern about the provision of services. What we are proposing exactly mirrors what already exists.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

It is useful to have the Minister's description of the inspection and audit regime that she envisages. As I understand it from what she has just said, things will not change at all. She has not described precisely what the regime will involve and how one will get on the list. Will somebody from the PCT go around every five years making sure that somebody has a slit lamp in place, or is it more involved? I suspect that it might be, because going to the trouble of becoming involved in a contractual arrangement—that is what these seven clauses mean—and placing duties on PCTs to ensure that organisations and individuals are competent and their premises are up to speed implies a more rigorous regime than currently. If the proposals simply mean having a list that is kept on file on a shelf, we will not get too excited. Clearly, that would not cost much more than the piece of A4 paper and the space on the shelf. A contract implies rather more than that.

The Minister seemed to suggest in her attempted demolition of my amendments that some practitioners may not be competent—that there may be some incompetent practitioners whom she might wish to eschew from the system—and that that is the purpose of drawing up contracts with some and not with others. My question is this: how will PCTs determine with whom they do and do not want contracts?

At the moment, GOS registration is a measure of competence of sorts, and we should have some reliance on that. Those involved are professionally registered individuals. I am not aware of much dissatisfaction with the quality of practitioners in the field. I refer to the figures that I gave the Minister in my opening remarks about complaints to family health services, which identified five out of the 44,000 complaints in 2004, the latest year for which figures are available. That tells a very clear story that there is not a problem—but there is clearly a problem in the mind of the Minister. She has invented one, which is why we have these seven clauses that deal with optometry and dispensing opticians.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

The hon. Gentleman says that I have invented something. What is he referring to? I have suggested to him that arrangements are already in place for ensuring local delivery of national standards, which are discussed with all the professional bodies, organisations and groups, and some require registration with the appropriate council. Clearly there are issues around how PCTs currently carry out their functions in regard to performers entering the list, contractors on the list, inspections and so forth. I would be happy to write to members of the Committee on that point. I have to say that the hon. Gentleman is creating a scare that is totally unnecessary and absolutely irresponsible.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

I thought that we would have a fairly quiet morning, but this is getting to be quite a heated   debate, which is great. I am suggesting that the Minister has invented a problem; I said that right at the beginning. I felt that there was no problem with the range of services, but I expressed my surprise that she should try to find solutions to problems that do not exist, particularly without the benefit of a review.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Is the hon. Gentleman suggesting that the system under which performers and contractors appear on a registered list with PCTs, which the clauses seek not to change but to reinforce, should be disbanded?

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

Of course I am not suggesting that for one moment. If the Minister has a list, and it simply reflects whether one is registered with the GOC, I have no beef with that at all. I would expect any arrangement with professionals to be with individuals who are appropriately qualified—we will come to that later—and registered. Such individuals would be not just on the PCT list, but on that of the GOC or whichever appropriate registration body.

The Minister, however, is proposing that PCTs enter into a contractual arrangement with individuals or organisations. I suggest to her that that escalates matters substantially. She made it clear that she expects people to be subject to inspection, but she has not given us much more detail other than that things will simply be as they are at the moment. If so, that is fine, although she has not said what audit and inspection regime currently applies.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I do not understand what the Minister is telling us. As I understand it, up to now, if one is suitably registered, one can be entered on to a list of local practitioners, but one does not have to have a contract with a PCT in order to provide an NHS service. She is proposing that there should be an NHS contract. The question that I do not have an answer to—perhaps my hon. Friend does—is whether it is possible under the Government's proposals for a multiple to be on a PCT list in one place and to be able to offer sight tests across the country without restriction, or whether it would have to have a contract with the PCT in order to do so.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

My hon. Friend makes an extremely good point; clearly, he is as bewildered as I am. His question, to which I do not know the answer, deals with a specific point. I hope very much that the Minister will clarify that point, and I am more than happy to take an intervention from her if she wishes to respond. However, I see that she remains in her seat, well ensconced.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I was waiting for the hon. Gentleman to finish. My understanding is that in order to provide NHS sight tests, which are reimbursed by taxpayers' money, it is necessary to have a contract with the NHS. Clearly the performers list may include people who have contracts through the PCT to provide that service, but it may also include those who are suitably qualified to carry out the service within an organisation whose business may not be the provision of such a service per se. My understanding is that to provide the services there must be a contract with the NHS. That seems right to me, and nothing in our proposals changes what has   gone before. I presume that at some time there must have been some reason why these lists were thought of in the first place as a way of protecting the public and ensuring good use of public money.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

The logic of the Minister's argument must therefore be that there should be some central list, because it appears that the issue is a contractual one between individuals or organisations—to take a chain at random, let us consider Specsavers, which has been mentioned before and has operations across the country—and the NHS. Perhaps she would like to explore the possibility that such an arrangement might be agreed nationally, because having not considered it for very long, I can see that there might be definite advantages in that.

We know that the profession is concerned that PCTs might not be competent to run these contractual arrangements; indeed, the National Audit Office was concerned about the ability of PCTs to run dental contracts. We will have to see whether the NAO was correct in its concerns, which we share, because the fateful hour is rapidly approaching. We shall see on 1 April whether all our worries and those of the NAO were well placed. At a particularly difficult time, therefore, PCTs are being burdened once again by a contract that I suspect they do not fully understand, because they have not previously been intimately involved in the delivery of this particular aspect of health care. Like dentistry, it is a bit new to them. We know, courtesy of the NAO, that financial management accounting and contracts are particularly weak areas with PCTs, so we have to be concerned about their ability to take on such contracts. In view of the Minister's remarks she may wish to consider whether the contractual arrangements should be made nationally so as to remove that burden from PCTs.

Photo of Nadine Dorries Nadine Dorries Conservative, Mid Bedfordshire

Would it not be simpler for PCTs if the Minister found a way for the Bill to say that they would, in effect, carry out just the administrative process—that every ophthalmic practitioner who provides services to the eligible population will continue to do so in the same way? The Minister has not clarified that sufficiently. The PCT would merely carry out the administrative process in the same way as currently happens from a central location; there would be no cash limitation and no limitation on budgets, and funds would go to the same practitioners as previously; there would be no change in service delivery and accessibility for patients and service users, and no change for service providers; there would just be an administrative process.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

I am grateful to my hon. Friend for her remarks. She highlights an important point in   asking whether there is potential for Ministers to meddle. My answer was that the case for the change is not proven. Our position this morning has been that the range of services is actually well provided and access is of high quality, as evidenced by the complaints figures, which I have already highlighted twice. Every element of the service appears to be functioning reasonably well and providers seem to be happy with it, although improvements can always be made around the edges. Yet here is a sledgehammer of seven clauses bolted on to an inelegant Bill, to address a problem that appears to be more or less a figment of the Government's imagination and for which they are scrabbling round to try to find justification.

We shall support everything that the Minister does to improve quality and access to health services for constituents, but we are not keen on chasing down a rabbit hole after a non-existent problem—which, in all candour, is precisely what it appears to be. The Minister's references to fraud show that she is scratching around to find a rationale for the provisions, yet we have not heard sufficient justification of the costs involved, despite the fact that, contrary to what she has said, costs are a relevant consideration in the context of the amendments.

It may not be profitable for me to pursue the issues of audit and inspection any further, but surely the Minister can see that if she insists on imposing contractual arrangements between elements of the NHS and individuals where at present there are none, and on subjecting them to audit, inspection, quality control or whatever one calls it, there will be an onus on contracting parties to ensure that the quality level goes beyond writing down a list of practitioners and keeping it in a dusty office.

I suspect that that would be the case in law, because there may be arguments of vicarious liability in the unlikely event of an individual deciding that he or she was unhappy with a particular service and saying to the PCT, ''Look, you certified this practice as a good one and you gave it a contract and a seal of approval, and it has let me down, so I'm complaining about you as much as about the individuals who gave me the service.'' Unlike the hon. Member for Stafford (Mr. Kidney), I am not—fortunately—blessed with being a lawyer, but I suspect that that would be the case in law. I expect that there will have to be an increase in the audit and inspection regime as a result of these seven clauses.

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at five minutes to Four o'clock.