I beg to move amendment No. 33, in page 34, line 26, at end insert—
'(c) dispensing opticians, to whom payments are made for meeting or contributing towards the cost incurred for the supply of optical appliances or their replacement or repair.'.
With this it will be convenient to discuss the following amendments: No. 116, in page 34, line 27, after 'every', insert 'dispensing optician or'.
No. 117, in page 34, line 30, after 'optometrist', insert 'or dispensing optician'.
No. 118, in page 34, line 36, leave out paragraph (b).
Amendment No. 33 would add dispensing opticians who supply or repair glasses to the list of persons who will comprise the local optical committee. We are a little bewildered as to why they should be left off, particularly as the Minister has a clear understanding—as evidenced by her previous remarks—of the difference between the various professions that work in ophthalmic services in and around the NHS. However, dispensing opticians seem to be disfranchised in this case.
One cannot draw a line between such professions because they are interdependent and interrelated. Sometimes they can be one and the same thing: individuals working for the same organisation who are mutually dependent on each other's activities. Indeed, there is a cross-subsidy between the eyesight test and the dispensing of optical appliances. To use another smoking analogy, one cannot put a cigarette paper between the two.
It seems entirely appropriate that the dispensing optician arm should be reflected in the local optical committee. That said, I am a little in the dark about local optical committees, because the Bill is not entirely clear about what manner of beast they are or what they will do. The guidance notes are a summary to say the least. All they say is:
''Clause 38 inserts new section 45C in the 1977 Act'' to which one is invited to refer, but if hon. Members are like me, they do not have a great deal of time to plough through the Act. The notes continue:
''The new section relates to Local Optical Committees.''
I would have thought that that was extremely obvious. The notes are not particularly helpful.
I hope that the Minister will be able to describe the committees in depth because they will be important bodies. More particularly, I hope that she will say why dispensing opticians should be left off the list when they are obviously so integral to the system and the various professions in this field are so interdependent.
Our amendments Nos. 116 and 117 essentially make the same points as those made by the hon. Member for Westbury and address the interdependency between optometrists and ophthalmic dispensers. I have mentioned several times the meeting that I had in my constituency with various members of the eye profession. It included optometrists and ophthalmic dispensers, and I learned for the first time the difference between the two. As a layman I had thought that they were all opticians, but I learned a lot at that meeting and I have learned a lot today, as I am sure we all have.
We discussed the key interdependence, particularly the financial one, when considering clause 34. The optometrist is the key professional clinician who carries out the initial health check on people's eyes and the ophthalmic dispenser then fits lenses and matches the prescription to the needs of patients. Clearly, one cannot exist without the other and there are many professional analogies, including in my tax profession. I am a member of the Chartered Institute of Taxation and can give taxation advice to people, but my profession would not exist without the skilled technicians—members of the Association of Taxation Technicians—who do much of the essential work in working out people's tax liability.
The same is true in the eye profession, except perhaps that the value seems to lie with the skilled technicians—the ophthalmic dispensers. I referred earlier to the fee that optometrists receive for an eye test, which is a pathetic £18.39, but the value to their business is the sale and fitting of lenses that are provided by ophthalmic dispensers. It seems strange that when a committee is designed to discuss local services—new section 45C(4) to the 1977 Act refers to it as the ''Local Optical Committee'', not a local optometrist committee—ophthalmic dispensers are not considered eligible and fit to be members of that committee. That is a regrettable omission and should be corrected.
Amendments Nos. 116 and 117 relate to amendment No. 33, which was tabled by the hon. Member for Westbury, and amendment No. 118 is tagged on. It refers to new section 45C(3)(b) of the 1977 Act, which requires notification. That provision seems to be unnecessary, so will the Minister explain why it is necessary for it to be part of the Bill?
I am afraid that I cannot accept any of the amendments and I hope to explain why they are unnecessary.
Amendment No. 33 seeks to make local optical committees representative of dispensing opticians if they receive payments for the supply, repair or replacement of optical appliances. We accept that some optical businesses are not represented by their local optical committee. The Bill makes it clear that such committees must be representative of all providers with contracts to provide primary ophthalmic services. That allows the membership of the committee to draw from the full range of local expertise and experience and to improve their effectiveness as a local representative committee. The local optical committee provides a body with which PCTs may consult on primary ophthalmic services locally. There are equivalent committees for medicine, dentistry and pharmacy and the provision will provide a formalised body for consultation in those areas.
Dispensing opticians and lay-owned businesses that have contracts as providers of primary ophthalmic services with primary care trusts will be represented by local optical committees, because they have a contract. That relates to the points that we made earlier about allowing dispensing opticians and lay members to contract directly to provide services. A specific reference is not needed to dispensing opticians as providers, as they are included in the general power. However, dispensing opticians and lay-owned businesses that do not have contracts with primary care trusts will not fall within that.
We think it right that the local optical committee should be representative of providers who contract with the PCT and those who perform primary ophthalmic services in that area. However, the committee will be able to co-opt people who are neither providers nor performers of primary ophthalmic services if it wishes to do so. I do not believe that the arrangements that we are suggesting will restrict the range of persons and the expertise that can be brought to the body.
Under amendment No. 116, there would be a specific reference to dispensing opticians as having a right to be represented by the local optical committee if they had a contract to provide primary ophthalmic services. We support the right of providers with general ophthalmic services contracts to be represented by the LOC. However, the Bill already provides, on page 34, line 27, for every person with a contract to provide primary ophthalmic services to be represented by that committee. That general entitlement includes dispensing opticians, so again there is no need for a specific reference.
Amendment No. 117 would include a reference to dispensing opticians as performers of primary ophthalmic services alongside optometrists. However, individual dispensing opticians do not perform primary ophthalmic services, which is currently only the testing of sight. Dispensing opticians are therefore not appropriate for inclusion in that way. There is no reason to include in the Bill one group that may at some future point provide a prescribed service, but not to include others. It is right that the local optical committee should be representative of providers who contract with the PCT and those who perform primary ophthalmic services in that area. The committee will be able to co-opt people who do not come into those categories if it wishes to do so.
Amendment No. 118 would remove the requirement that performers of primary ophthalmic services who wish to be represented by a local optical committee should notify the committee of that. A number of optometrists will work for a number of different employers in the areas of different PCTs for short periods. We discussed that earlier. The amendment would make it mandatory that those people be represented by a number of different local optical committees. It is more sensible for a performer to be represented by a local optical committee where he works regularly and with which he has an ongoing relationship, rather than somewhere that he or she goes to occasionally. A requirement for the performer to notify the PCT that he wishes to be represented means that the practitioner will be able to consider where he or she would be best represented.
For those reasons, I hope that the amendment will be withdrawn and that I have reassured hon. Members of our intent.
I am grateful for the Minister's clarification. However, she has not said a great deal about the function of a local optical committee. That would have been useful for us to judge whether it was necessary for dispensing opticians to be represented on the body. We are left to deduce what the committee does. From the comparison that the Minister drew with medicine, dentistry and pharmacy, one can have a fairly good idea of what the committee might achieve. In that context, I can see her logic in not including dispensing opticians, although I still regret that.
I note, however, that the committee may include individuals who have entered into a contract, and the Bill will enable primary care trusts to enter into contracts with dispensing opticians and others—lay people, people who are not qualified in this area at all. To that extent, I accept the Minister's reassurance that the committee is unlikely to be an exclusive body that simply represents a small part of the range of professions engaged in primary ophthalmic services. That has to be a good thing. Probably with that in mind, and with the assurances that she has given, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
'the amount of its administrative expenses for that year.
( ) A Primary Care Trust may—
(a) on the request of a committee recognised by it, allot to that committee such sums as it may determine for defraying the committee's administrative expenses; and'.
These two amendments seek to ensure that local optical committees are representative of both local providers and performers by providing a simpler arrangement for the committee. The only money available in general ophthalmic services are the fees paid by primary care trusts for the services for which they contract. Those fees may be paid only to contractors and are not paid direct to performers. As local optical committees are to be representative of both providers and performers of primary ophthalmic services, it seems only right that the fees paid for the provision of the services should meet the total expenses of running the committee.
Requiring performers to make a separate payment would almost certainly be a disincentive to being involved in the local optical committee, which would make it less representative and may lead to primary care trusts not recognising such committees. Therefore, a simple levy against the fees paid is in our view the right approach. It will be simply and easily administered and will help to ensure that local optical committees are representative of performers as well as providers. It continues the present arrangements for funding these committees and therefore I hope that hon. Members will support the amendments.
This is fairly straightforward, but I should be grateful if the Minister told us the anticipated level of the levy. She has assured us that it would not be particularly high, but it would be useful to know what it might be approximately. Presumably, there are parallels with other committees to which she referred earlier.
I do not have those figures to hand, but I can assure the hon. Gentleman that we would want to see that the levy was proportionate and not over-expensive. I will write to him with further information about that.
Amendment agreed to.
Question proposed, That the clause, as amended, stand part of the Bill.
This is a largely uncontroversial clause, so I shall not detain the Committee long on it. It would be good to know what the Minister's intentions are in respect of the function of the committees. I am sure that it is necessary, and common sense suggests that it will not be hugely burdensome on the profession, or the public purse for that matter. However, it would be useful to know exactly what it will achieve.
We have remonstrated with the Minister up to this point about the lack of the review that we were promised. Undoubtedly, the fact that we have not had that review has meant that there have been several holes in this area of debate and several things left unanswered. I suspect that the local optical committees will have a fair amount of work to do in interpreting the Bill and carrying forward its provisions. In particular, the committees may consider things such as enhanced and additional services, which we have not heard a huge amount about in the debate. It is not referred to directly in the Bill or the guidance notes that go with it, but it is referred to in the briefing documents that we received from the profession on the back of discussions that the profession had with Ministers.
I assume that the provision of additional and enhanced services, some of which we have discussed, broadly speaking, would be the stuff of the local optical committees. They would be proactive in making recommendations to the PCT on how its members could improve the health of the PCT's patient base. It would be useful to hear the Minister's thoughts on that, as well as a little more description of exactly what she envisages local optical committees doing.
There is not much that I can add to what I said earlier, which is that the committee would mirror similar committees that are provided for other local services, in that it would form a body of people whom the PCT could consult on a range of issues. As I suggested, those issues could include cases where the PCT wants support in helping providers in different ways. That was covered by an earlier clause. The issues could be about the particular eye health needs of the community, and about sharing information about the changes happening locally with providers and performers.
As I have said, a review is ongoing, and that review addresses what secondary care could be provided in a primary care setting. I imagine that PCTs, in putting their views across to Government, may want to discuss that with others in future. I am sure that that debate will develop over time. I hope that that gives the hon. Gentleman some idea of what we are talking about, but obviously it is difficult to just pull out a list. The committees will not just receive information, I hasten to add; they will be a vehicle for their members to share their expertise, experience and knowledge with the PCT. That will ensure that the sight testing policy, which is centrally funded, and for which the PCT is reimbursed, is working properly. Also, the committees will form part of a discussion about enhanced services.
I do not have the figures for the cost at the moment, but I expect that it will be very low. We are talking about the expenses of the committee, of hiring rooms for meetings and, my officials suggest, of tea and biscuits—we had better knock that off, because that is not very necessary. Is it healthy? Perhaps we should say a plate of fruit instead. We are not talking about a tier of administrative support. The committee is an identified body that can act as a formal sounding board that the PCT can engage in discussion, so that it feels that it has a greater understanding of what is happening in the local area in terms of health needs and other issues. I hope that that reassures the hon. Gentleman.
Question put and agreed to.
Clause 38, as amended, ordered to stand part of the Bill.