Health Bill

I thank the noble Baroness for that clarification, but it is important to note that it is much easier to get replacement glasses, as the lack of them can sometimes have an adverse effect. There is not a separate list of domiciliary providers of sight tests. All such providers must be on the optometrist list, like all other providers. A specific decision is required to assess the suitability of a contractor to provide domiciliary sight tests so that the primary care trust is satisfied about the quality of the service that will be provided and so that there will be no concerns about those carrying out the tests going to the homes of vulnerable people. For example, portable equipment is required to enable a service to be provided in a person’s home, but a contractor working from a fixed premises is not always able to provide that. It is therefore important to ensure that domiciliary services are provided only by contractors who are appropriate to provide such services. However, I take note of the noble Baronesses’ concerns. The noble Earl expressed concern about burdens of regulation. The current regulations were introduced following consultation with the representatives of opticians. There is no evidence that service delivery has been impeded by the regulations introduced in April 2005. Figures for the number of domiciliary eye tests for the period April to September 2005 show a small increase over the comparable period in 2004. The 2005 regulations provided for primary care trusts specifically to assess the suitability of optical providers to provide domiciliary eye tests, which previously they were not able to do. This allows them to ensure that the providers have the necessary equipment to carry out sight tests in people’s homes, and that provides greater assurance of the quality of service that people receive. Amendment No. 96 would include in the Bill an example of a specific service that a primary care trust may provide outside a particular PCT area. The Bill provides powers for a wide range of potential services to be provided but it does not provide examples, so adding that would make no difference either way. Adding that example to the Bill would not require us to provide such a service and, as currently drafted, the Bill does not prohibit us from doing so. As I mentioned, PCTs have a duty to provide a sight testing service for eligible people, including those unable to get to an optician. General ophthalmic services contracts can be entered into, allowing the services to be provided out of the particular PCT’s area. Domiciliary sight tests could be contracted for on that basis. The intention of the provision is to allow PCTs to work together and jointly provide a service, rather than each providing separately, if that is the most effective way to meet patient need. With agreement across a number of PCTs, it would be possible for a provider of domiciliary eye tests to be contracted with one PCT to provide services across a number of PCT areas. However, that would have to be considered very carefully. Each primary care trust involved in such an agreement would need to be satisfied that acceptable standards were maintained when the provider was operating in their area. If such standards were not maintained, the provider could be excluded on the decision of the primary care trusts affected, even if that was not the primary care trust that formally held the contract. We expect to make regulations in this area, and will consult representatives of providers, the NHS and patient groups in doing so. While I support the intentions behind the amendments, they do not add anything to the Bill. PCTs, being aware of the problems of those living at home with failing sight—and their need for glasses if they cannot get out to have their eyes tested—would, I am sure, wish to meet the needs of those people, improving their lives and ensuring that additional costs do not have to be met because people have been falling down in their homes. I trust that the legislation will assist PCTs in their efforts to provide better domiciliary ophthalmic provision for those patients.