Health Bill

I supporting this amendment and, again, I do so with the intention of lightening the bureaucratic burden on PCTs and, indeed, on individual optometrists. It has occurred to me that I should have declared an interest today, and on the previous occasion when the Committee met, as a vice-president of the Association of Optometrists—unpaid. So, in addition to the general ophthalmic list and the supplementary list, as my noble friend has said, there is a third list: the domiciliary list. As I understand it, the intention was to protect taxpayers’ money from fraud, but instead this somewhat tedious and bureaucratic measure has damaged eye care for elderly people. According to Optometry Today, the complexity of the system has prevented a large number of optometrists providing services in people’s own homes and in residential and nursing homes. This Government are determined to make services more accessible to the population. I strongly applaud that. I fought very long and hard to introduce nurse prescribing to enable patients to receive appropriate medication speedily, a measure which the Government have taken further and which, again, I strongly applaud. The Government have taken it further by ensuring that other associated health professionals, including optometrists, can also prescribe. So optometrists are clearly a trusted profession. Now, according to the General Household Survey in 1996, 20 per cent of people aged 85 and over were unable to leave their house. As these figures are set to increase, more and more people will require a home visit from their optometrist. The current regulations mean that an elderly person who breaks their glasses and needs an eye test cannot get one until the optometrist has given the PCT 48 hours’ notice. The eye test is of course the all-important gateway for further tests, either by an optometrist or by a doctor, which determine the presence or otherwise of a disease such as glaucoma or diabetic retinopathy—conditions which, if untreated, can lead to blindness. So, early detection is critical. In addition, a visiting optometrist can give advice on appropriate risk factors, such as poor lighting, and thereby reduce falls, of which there are 189,000 due to visual impairment, which costs the NHS £269 million a year. The 48-hour notice prevents optometrists working efficiently and fitting in an early appointment when either the next day fortuitously has a free appointment or an appointment is cancelled by a patient leaving a slot. The 48 hours does not include weekends, so an appointment made on Friday afternoon cannot take place on the following Monday. The PCT has the responsibility to check that the service given is appropriate and up to standard. However, the employee of the PCT is very unlikely to be an optometrist and may simply be a member of the admin staff. PCTs are already overwhelmed by getting to grips with payment by results, GP commissioning and the fit-for-purpose form-filling, which will take two full-time members of staff, not to mention mergers and other distractions. I cannot see them scrutinising domiciliary visits as a very high priority. I would like the Minister to consider whether the domiciliary list could be dispensed with, possibly by simply indicating on other lists who is prepared to carry out home visits. In supporting the amendment by my noble friend, I seek to help the Government and those involved in better regulation to streamline unnecessary regulation, which is such a burden on PCTs and clinicians alike. The efforts of PCTs would be better spent on mainstream activities, such as strengthening commissioning and achieving clinical engagement of GPs and others, and ensuring that patients get the right care in the right place at the right time. I ask the Minister to reconsider this issue, to lighten the load on PCTs and give those in need of eye tests and advice a quicker and more responsive service.