Health Bill

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 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 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.