Questions in the House

MPs were queuing up to probe the government's proposals on GOS at this week's Health Bill Debate, reports David Challinor

Health secretary Patricia Hewitt certainly knows she has a fight on her hands now.

MPs from all sides of the House delivered their damning criticism of the Government's proposals to hand over powers of the General Ophthalmic Services in England to PCTs during Tuesday's six-hour debate on the Health Bill.

The profession's representatives warned practitioners again this week that the proposals could mean 'PCTs could restrict the NHS sight test by giving contracts to a limited number of practices only'.

And it was clear from the concerns voiced by MPs that many members fear the Government is making moves to take optometry down the dental route, a scenario which may make it harder for their constituents to find an NHS practitioner in future.

In mentioning reforms to pharmacy services, Hewitt said the Government was modernising ophthalmic services, and 'relaxing the current restrictions on who can provide them'. This was the signal for MPs to launch their questions.

Helen Jones, Labour member for Warrington North, asked: 'As someone who has been using opticians since the age of seven, may I askabout the logic behind devolving general ophthalmic services to PCTs? Will she give an assurance that PCTs will not be able to restrict the number of opticians who provide sight tests?'

Hewitt replied: 'We want to give PCTs the ability to secure the best services for people in their area, and that is exactly what we are doing by devolving responsibility for dental services.

'PCTs will be able to use a wider range of providers to obtain the services that people need. The changes will simplify entry requirements for the provision of NHS services and help to support better service provision.'

Unsatisfied by this response Andy Reed, Labour MP for Loughborough, mentioned one of his optometrist constituents in his examination of Hewitt.

'I accept that PCTs are often well placed to drive up the level of provision in their area,' he said, 'but does my right honourable friend understand the concerns of optometrists in my constituency, such as David Austen, who provides an excellent service but is fearful that quality may be reduced if the PCT is driven by the need to make economies?'

He added that the changes should be 'about driving up standards, not reducing them to a level playing field'.

Hewitt responded by stating that Reed's final point was right, and admitted concern was widespread.

'These changes will help to continue improving the quality of care that opticians are able to provide. The minister with responsibility for ophthalmic services [Rosie Winterton] has recently met the opticians to reassure them on that point, because it has been raised not only by the constituents ofthe member for Loughborough but by many others.'

Later in the debate the Conservative member for the Isle of Wight, Andrew Turner, said the Government's aim should be for patients in England to receive as good ophthalmic service as elsewhere in the UK.

'In her responses to interventions by Labour members,' he said, 'she did not appear to give an assurance that she would not allow PCTs to restrict patients' choice of ophthalmic practitioner.

'Will she assure the House that she will carry out a full review of general ophthalmic services, in consultation with the profession, so that people in England receive the same quality of treatment as is available in Wales and Scotland?'

Hewitt told him: 'The measures in the Bill are designed to increase the choice that is available to patients in England. The Bill will enable primary care trusts to contract with a wider range of providers, and indeed, as you would expect, Mr Speaker, we have been discussing this very closely with the opticians, with the profession, and we shall continue to do so as we bring forward regulations on this matter.'

Shortly after she commended the Bill to the House.

However, the questions arising from the ophthalmic proposals went on, notably from shadow health secretary Andrew Lansley. He said that the comparison with dental services was 'exactly what people working in ophthalmic services are afraid of'.

'How many letters of complaint have MPs had in recent years, before the publication of the Bill, about the quality of local ophthalmic services compared with the number of letters about quality of and access to dental services? Those figures tell the story.'

He continued to warn the House about the potential results of the Government's proposals.

'People working in ophthalmic services are rightly worried that the consequence will be a reduction in quality and a reduction in access,' he said.
'From a Government who say that they are about choice, what will we have? A reduction in choice for patients, because it will no longer be true that those who are registered with the GOC will automatically be able to supply services locally to NHS patients; that may be restricted by primary care trusts in ways that we cannot at the moment even anticipate.'

Labour member for Cardiff North Julie Morgan gave a Welsh perspective: 'I visited a community optometrist and a representative of the community optometric committee, at his request, in Pontprennau in my constituency last week,' she said. 'He wanted me to mention the concern felt by opticians and ophthalmologists in Wales about the proposals.

'They will not affect Welsh practitioners as things stand, but he was concerned about devolving the budget to primary care trusts. The opticians think that that will inevitably be capped and allow the PCT to select the people with whom they wish to contract. They fear that that could lead to a restricted service to patients.'

Another Conservative, David Amess (Southend West), said it was essential that the Government continues to consult with the profession on the Bill.

Speaking after the debate, Bob Hughes, chief executive of the AOP, said he was grateful to the health secretary about the opportunity to consult further with the Government about the proposals. However 'there was still some misunderstanding about the way opticians provide choice for patients'.