Health Bill

Public Bill Committee, 10 January 2006.

Standing Committee E

Clause 33 - Arrangements for dispensing of medicines

Jane Kennedy (Labour, Liverpool, Wavertree)

Just to give the Committee a quick refresher, clause 33 links with earlier provisions in the Bill that relate to the supervision of retail pharmacy businesses and the preparation and supply of medicines. We had a good and useful debate in our closing sittings before the recess and I felt that it was the wish of the Committee that it should stand part of the Bill. I hope that the Committee will give it a fair wind.

Question put and agreed to.

Clause 33, as amended, ordered to stand part of the Bill.

Clause 34 - Provision of primary ophthalmic services

Stephen Williams (Liberal Democrat, Bristol West)

I beg to move amendment No. 79, in clause 34, page 28, line 41, leave out from 'all' to end of line 11 on page 29 and insert 'persons'.

Good morning, Mr. Illsley and may I wish you and all members of the Committee a happy new year. There is a very fraternal atmosphere in my party at the moment, as I am sure you will realise. I did a quick calculation this morning and discovered that we had 47 clauses, four new clauses and five schedules to get through today. I therefore intend to be brief and I hope that other hon. Members will be brief too. The purpose of the amendment is to provoke a discussion on the disparities in access to eye health services for different groups of the population within England, particularly compared with the much enhanced access in Scotland and the different system in Wales under the new devolved arrangements.

The amendment deletes all references to the groups of the population in new section 16CD(2) who currently receive free eye tests: those who are under 16; those who are over 16 but in full-time education; various people who are in receipt of means-tested benefits; and the over–60s. The clauses in this chapter of the Bill deal with the general ophthalmic services contracts and what we would normally describe as eye tests. The significant part of GOS is certainly eye tests.

I had a most useful meeting with optometrists and ophthalmic dispensers in my constituency back in November. I learned a great deal about how the existing service operates. I was quite shocked to discover that the NHS eye test fee is currently only £18.39, which for a visit to a well-qualified professional person seems very small. That is rather less than one would expect to pay for a visit to the local garage to have one's car repaired, let alone various other medical services. I was staggered to discover how low the eye test fee is. However, 66 per cent. of the tests currently offered by optometrists are funded by the NHS, albeit at a low rate. The second part of the GOS contract is the voucher system, which contributes towards the cost of children's spectacles.

The purpose of the amendment is to provoke a discussion on access to eye care for all sections of the population of England. The major worry that the eye care profession has about chapter 2 of the Bill relates to the provisions for the existing GOS contract in England. The management will be devolved from the central NHS to the primary care trusts that operate in all our constituencies. They will have discretion over the management of contracts. Several amendments to later clauses will deal with that, so I shall not dwell on the matter now. However, it will be worth hearing from the Minister why in England only the groups specified in new section 16CD(2) in clause 34 have access to a free eye test and eye care, when the devolved Administrations have seen the value of giving all sections of the population free and easy access to an optometrist, not only to detect a defect in natural sight but to look for other health concerns that only a qualified optometrist can identify.

There is an analogy here with dental services. I went to a most useful presentation before Christmas about mouth cancer—I am sure that the Under-Secretary attended it too—where I learnt that, as part of their standard contract with the health service, dentists look for early signs of mouth cancer. The analogy is that, as well as doing the obvious thing of testing somebody's vision, a qualified optometrist will look for other potential defects. The issue involves more than the standard eye test.

Andrew Murrison (Conservative, Westbury)

May I wish you, Mr. Illsley, and the Committee a happy new year—especially the hon. Member for Bristol, West (Stephen Williams), given the excitement currently surrounding his party, although I hope that it is not too happy.

I am interested in the amendment. I thought that the Liberal Democrats were going to talk about extending access, and that that was the purpose of removing the qualifying words in new section 16CD(2). However, the hon. Gentleman did not talk about that. The gist of what he had to say related to access. I put it to the Minister that, on access to dispensing opticians and optometry, we do pretty well. One of the defining things about optometrists and dispensing opticians in this country at the moment is that there is fantastic access to them. No other part of our health care system that I can readily think of has no absolutely no waiting lists. One simply wanders in off the high street for an eye test or ophthalmic appliance. There is no waiting whatever. Without being too complacent, access is right there, right now. The Minister will have to explain how these seven clauses relating to optometry will improve the service. We shall come back to the matter as we go through the clauses, but she must say why she feels that there is a problem that requires her intervention. Nowhere is that more the case than in respect of access, which is the gist of the hon. Gentleman's amendment.

The hon. Gentleman might have been saying that primary care trusts should be asked to make provision for eye tests and optometry for everyone, without exception. That is a cause of confusion because of the issue of free eyesight tests and vouchers and the provision of optometry services. I hope that PCTs, if they are to be empowered in the way suggested, will act to ensure that access is as good as possible for everyone, whether they are entitled to free services or are among the 34 per cent. who pay for them. That is important; it is what we have at present. I will explain why we are worried about the matter as we go through the proposals. The Government's intervention by virtue of the seven clauses will reduce choice and access. Before we are prepared even to consider supporting the Government on these proposals, the Minister must reassure us in that respect.

Caroline Flint (Labour, Don Valley)

Happy new year to everybody—some are happier than others, I imagine. I hope during our proceedings to be able to reassure my hon. Friends, the hon. Member for Westbury (Dr. Murrison) and his hon. Friends and the hon. Member for Bristol, West, that we have no intention of disrupting what I think is a very good service or unnerving those who provide it. I have been a recipient of opticians' services since I was a child; I am very short-sighted, and I now use glasses and contact lenses. I therefore have a vested interest in the matter.

We recognise that a clearer framework is needed. I will endeavour to reassure those who have a particular interest that access to sight tests and the national negotiating framework for the fee will not be diminished by our proposals. I will come to those matters later, as I want to address the amendment, which would extend eligibility for NHS-funded sight tests to the whole population of England.

Free sight tests on the NHS are already available to priority groups: children under 16, 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 defined categories of people at risk of developing eye disease. Before 1 April 1989 there was universal entitlement to free sight tests, but from that date eligibility was restricted to the groups that I mentioned. In April 1999 we extended free sight tests to everyone aged 60 and over because those in advancing years may have associated health problems that can be picked up by opticians. The eligibility criteria for NHS-funded sight tests are designed to ensure that the groups to which I referred are not discouraged from having their sight tested. However, we have to make some tough choices and a further extension would not be the best use of funds available for the development of the NHS.

In 1999, we reviewed the eligibility rules and extended eligibility for sight tests to those over 60, and the available evidence suggests that it 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. I have to tell the hon. Member for Bristol, West that that does not suggest that a further extension of 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. The cost of extending free sight tests to all those who currently pay privately would be an additional £92 million, based on the 2005–06 rate of £18.39.

The hon. Gentleman also mentioned his concern about the rate. The rate for the test is negotiated nationally. I understand that negotiations for 2007–08 are about to begin and I would like to reassure the Committee that there is no intention, as part of this legislation, to move away from that national negotiating framework or to undermine in any way access to sight tests, either for those who are eligible for support through the NHS or for those who pay privately. The hon. Member for Westbury mentioned that point.

There are choices to be made in health. As we discuss these clauses, we can also reflect on the opportunities, outside the areas that are part of a nationally provided service, for PCTs to consider, based on local need, what other enhanced services might be suitable in the local community. Contracting for the provision of eye tests in a residential care home is just one example of provision for which PCTs might in future want to contract. The proposals in the Bill, including in the clauses that we shall discuss this morning, provide a greater opportunity for such areas to be thought about in relation not only to eye health but, possibly, to other health issues that may arise out of such contracts.

Andrew Murrison (Conservative, Westbury)

Will the hon. Lady confirm that the legislation as drafted will allow PCTs to negotiate with providers at differing levels of fee for the sight test—in other words, that the matter could be decided at local level?

Caroline Flint (Labour, Don Valley)

The Bill could possibly allow for that, but I want to make it clear that there is no intention on the part of the Government to allow for a locally or regionally negotiated sight test fee basis. We have given assurances, and the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), met a number of different stakeholders just before Christmas to reassure them that our intention is to continue under the present system, which is to have a nationally negotiated sight test fee. That will be provided for. There is no question of that being varied at local level or of unnecessary lower or upper levels being set for the number of sight tests, with the proviso that if there were a possibility of fraud, a PCT would look into that—but we shall cover that under later clauses. I hope that that answers in a straightforward way the hon. Gentleman's question.

Andrew Murrison (Conservative, Westbury)

I thank the Minister for that. I take it, therefore, that she will support amendment No. 32.

Caroline Flint (Labour, Don Valley)

We have not reached that amendment yet, but I shall not support it, for reasons that I shall come to later.

Finally on amendment No. 79, the way in which we provide sight tests at the moment is a tried and trusted system. I am pleased that we were able, within the finances that the Government have, to extend eligibility in 1999. However, I do not believe that there is a case for a further extension. I say to the hon. Member for Bristol, West that whoever is elected as the leader of the Liberal Democrats may want to reflect on the issue as part of their future financial plans if they ever want to be in government.

Stephen Williams (Liberal Democrat, Bristol West)

I have listened carefully to the Minister, and essentially she has said that no one should be afraid of the measures proposed in the Bill. There will not be a change to the centrally negotiated NHS fee, which is currently £18.39, and there should not be any worries about the range of services provided in the high street, to which the hon. Member for Westbury also referred. One does wonder, then, what is the point of the legislation. I wonder why the Government did not take the opportunity, as was done in Scotland, to review the entire GOS contract in consultation with the eye care profession and then come forward with proposals to improve eye care in this country.

I was interested to learn that the estimated cost of extending free eye care to all parts of the population, not just the groups specified in the Bill, was £92 million. In the great scheme of things in Government funding that seems rather a small amount. What discussions has the Minister had with her counterpart in the Scottish Executive, who took a different decision from that she proposes for England? Presumably they thought that there was a public health advantage to extending free eye tests to all sections of the population in Scotland.

The Minister mentioned that PCTs may be able to look at the contracts for domiciliary care for when an optometrist visits a care home. That point was made to me at my meeting with practitioners in my constituency. Currently the fee for an optometrist visiting a care home is £50.77 for the first and second persons, but thereafter it is only £10 for each consultation. That seems quite strange. There is scope for PCTs, or the NHS centrally, in negotiation with the profession, to look at that fee structure too.

I listened with interest to what the Minister had to say, and as we will be discussing several other clauses this morning, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Andrew Murrison (Conservative, Westbury)

This is the first clause in a series of seven dealing with an important matter. We dealt with the heat and light aspects—smoking—earlier, and given the time that we had to spend on that it is fortunate that we have reached this point. It would have been wrong to have completed the Committee stage without devoting adequate time to these clauses.

I should like to pay tribute to optometrists and dispensing opticians in this country who, by their own admission, tend to be a fairly self-effacing and quiet group. We will all have received their briefing notes in which they point out that in the past they have generally acquiesced in the requirements of the Government of the day, but at this point in their evolution and history they have become quite concerned. They would say that since the war they have provided a fantastic service—a landmark service—in our health services in this country. Who can doubt the quality of the service we get where there are no waiting lists and waiting times? That is unique in our health services.

Very few of us receive complaints from our constituents about the quality of ophthalmic services. I have received none. Indeed, of the 43,000 written complaints received in 2004 by family health services, only five related to ophthalmics. That is quite extraordinary. Given that there does not appear to be a problem, the Minister has to tell us what she has identified in the range of services that she is endeavouring to fix. I do not understand it at all. So far she has not given me the feeling that she has identified a problem. No doubt she will expound at length on the problem and we can then determine whether these clauses are the solution.

I put it on record that we are not convinced that there is a problem. We pay tribute to these services, which do such brilliant work for our constituents. The providers of the services rightly point out that, every year, they refer 200,000 people whose tests reveal medical conditions such as glaucoma, hypertension, various forms of cancer and the more obvious ocular-related conditions, such as cataracts, which would otherwise would not have been discovered.

Ophthalmic services are a huge benefit to the NHS. Elderly people who have their eyes tested and are found to have defective vision because of conditions such as refractive errors and cataracts can usually have them satisfactorily remedied. There are no figures to support this, but one can only imagine the savings to the NHS when people in advanced years have their sight tested and corrected, as poor vision can lead to problems such as fractured hips and a range of other medical conditions. I feel strongly that, if work is not being done to determine the contribution that opticians make to health care generally, it should be. The figures would be very interesting indeed.

There is a catalogue of good-news stories from the sector. The Minister seems to be providing a solution when there is no identifiable problem. Will she tell us why she has introduced these proposals? Did the Health Bill just happen along and she felt that it would benefit from having something on ophthalmic services bolted on to it? If that is the case, it is pretty extraordinary, because the Government have been talking about holding a review of general ophthalmic services. That is perfectly reasonable, as eye services have been conducted in the same way for a considerable time.

The profession has some problems in the way things have been working—gosh, which profession does not?—and would like some minor changes. In that context, a review would be reasonable. We have all spoken to opticians, not least when we go for an eyesight test, and if they know that we are MPs, they bend our ears. My optician certainly did so about the cross-subsidy between the provision of optical appliances—glasses and so on—and the eyesight test.

A review has long been promised, but nothing has come of it. It is a bit like dentistry; things were promised, but months and years go by and nothing seems to happen, and so it is with general ophthalmic services. All there is this proposal. The Minister does not even bother to wait for the review, she simply promises it, which puts the entire review and the consultation process into the long grass.

I mentioned consultations in earlier clauses and the effect on their validity of the Government putting the cart before the horse. That discredits, degrades and demeans their value and makes people less willing to take them seriously and to contribute to them. If and when the review of general ophthalmic services comes to pass, people will ask what on earth is the point of contributing to the review and taking it seriously because the legislation has pre-empted it.

If the Minister had held the review, come to the House and said, ''These are the results. We have identified these difficulties and this is how we propose to deal with them,'' that would have been all well and good, but it has not happened. She has promised us the review for a long time, but it simply has not happened. Perhaps she can tell us what progress has been made with the review, what its terms of reference are, who sits on the review board, how far they have got, how many meetings they have had and so on. That would be extremely useful.

Perhaps there are even some preliminary conclusions that might inform this discussion. If the Minister can give us some idea about those, we might be a little more favourably inclined towards the proposal, but that has not happened so far. Instead, while promising the review, she has cracked on and drawn up these clauses, which are pocked, like other bits of the Bill, by references to regulation. Presumably that enables her to fill in the gaps. A bit like a child colouring in a stencil, she intends to colour in the Bill at a later stage, because she has allowed the regulations. That seems to be her approach to the Bill and nowhere is that more the case than with these seven clauses.

These clauses are pocked with references to regulation, and we have to assume that, at some later stage, the Minister will tell us what she really wants to do—based on the review, I hope—using those regulations. As we have said before, that would not have been our approach. We would have conducted the review. It is right and proper to hold a review at this stage and for the legislation to be informed by it, but we have not had that. I hope that the Minister will give us some idea of why the review has not happened and what stage she is at with it. Is it still planned to take place at all, or has it been overtaken by events? Have these clauses superseded any plan that she had to review GOS?

I am concerned about the sight test fee. I have identified the fact that a cross-subsidy applies. The hon. Member for Bristol, West said that the fee was very cheap, and indeed it is. Most of us have experienced various other forms of what amount to compulsory fees when we have had to get our car fixed, our plumbing repaired or whatever. Set against such expenditure, the sight test fee seems ludicrously low. I tend to agree with the hon. Gentleman on that. Particularly when one takes into account the cost of the equipment required to do a proper sight test, the experience and expertise of those who carry out the tests and their need to maintain premises and staff, the fee seems extraordinary, but of course there is a cross-subsidy between the provision of spectacles, for example, and the sight test.

Stephen Williams (Liberal Democrat, Bristol West)

Another anomaly is that when someone gets their prescription from the optometrist, they can leave the premises and take their prescription somewhere else, where a wider range of spectacles might be available. The cross-subsidy is not guaranteed.

Andrew Murrison (Conservative, Westbury)

The hon. Gentleman makes a good point. The Committee will notice that I am wearing a pretty snappy pair of spectacles. They are the bendy ones, which are particularly good for sport, apparently. I do not do much of that, but nevertheless they are a nice pair of spectacles. I got them from an optician who had better remain nameless, but the scenario described applied to me. I am a guileful sort of individual and, arguably, I can shop around—with plenty of time perhaps—but I suspect that many people do not do so.

Almost certainly, the vast majority of individuals who go for an eyesight test will buy their specs from the establishment where they have had the test, not least because people must usually go through a sort of mall full of specs to get to the optician's room, and in those circumstances, it is difficult to take the prescription and run off down the road to another dispensing optician—if, of course, one is available. We should not necessarily assume that everyone lives in a large urban setting where more than one optician is available. Many small towns are lucky to have one, so choice is restricted.

I entirely agree with the hon. Gentleman. Indeed, the point will probably come up again later. If PCTs are to determine the level of fee for the sight test—

Caroline Flint (Labour, Don Valley)

But they are not.

Andrew Murrison (Conservative, Westbury)

We shall have to explore the matter. The Minister has admitted that, as drafted, the legislation allows that; she should accept an amendment to ensure that it does not happen. I had hoped to debate an amendment to clause 35 that would ensure that the Minister's intentions, of which she has just told us, are carried out.

The Minister admits that, if only in theory, one PCT could set a low fee. If that were to happen, everyone would be piling into that PCT area and getting cheap eyesight tests—those who were unfortunate enough not to have a free test—and then crossing the boundary into another PCT area to buy their spectacles. If one operator realised that that was happening, all sorts of perversities could arise. For instance, some of the larger chains, such as Specsavers, could take advantage of the situation to gain a competitive advantage in what I understand is a cut-throat business. The point is extremely well made, and I hope to return to the subject.

I saw a flurry of activity from the Minister as the subject came up, and I hope for some answers, particularly on why something similar to amendment No. 33 has not been introduced as a Government amendment. If her intentions are genuine—I am sure that they are—she should table an amendment to ensure that the risk that she identifies and admits to can be circumvented. PCTs should not be able to negotiate their own sight test fee, as it would result in all sorts of unhelpful perversities that the profession would not wish to see.

We are a little worried that the provisions might somehow be cash-limited. At the moment, part of the cost of the eyesight test is funded from central sources, and that is not limited. Will the Minister say whether the apportionment of moneys will be done in a way that will prevent PCTs from capping the amount of money provided for the eyesight test fee? It is difficult to see how that could not happen. PCTs have to make judgments on how to assign their priorities; and the worry is that, for whatever reason, they might decide to take money away from eyesight tests.

The Minister may say that it is for PCTs to make their own decisions. However, we have recently seen an outbreak of localism, and both parties agree that as many decisions as possible should be taken locally; but one consequence could be that the eyesight test service is de-prioritised. I would be interested to hear what the Minister thinks the implications might be.

I fear that, in their ignorance, PCTs might be tempted to take the view that there is more scope for private subsidy, particularly as there is an interface between the private and public sectors, but that might lead them to the wrong conclusions. That would be a problem because the ophthalmic services' pick-up rate for medical conditions is probably the tip of the iceberg. It has the important job of picking up illness—and, more importantly, remediable illnesses.

Screening is wonderful, but it is often applied incorrectly: it is applied in areas in which, even if something is picked up, prognosis will not be improved, with not much chance of making a big impact on that condition. The conditions that are screened for day in, day out, by high street opticians and picked up—4 per cent. of eyesight tests result in referral—are remediable. That is vital, and applies to both ophthalmic conditions and general medical conditions that have some sort of ophthalmic manifestation, which is why this is so important.

We had a similar debate in connection with oral health and the screening value of NHS dentistry. I agree with that entirely; it is a valid position for the dental profession to take to say that its services in that respect are highly valuable. In this area, we have the same issues, but they are compounded. Many diseases have some eye manifestation, so I cannot think of any area in which screening is more appropriate. If PCTs decide for some reason, such as deficits, that they must cut back—perhaps through a salami-slice-type cutting back—on optician services, I fear that general health will suffer in their constituent populations. That would be extremely bad for public health.

One hallmark of dispensing opticians and optometry is the huge choice. In what other area of our health services is there so much choice? I cannot think of an example. For two reasons, there is a high level of cross-party consensus at the moment on the importance of choice—certainly between my party and the Minister's; I am not so sure about the Liberal Democrats, who appear to be taking a subtly different approach to health services. Choice is right in principle and it tends to drive up standards across the board. If one embraces the concept of choice, one should surely do nothing that will damage it. I fear that these seven clauses will not improve choice in the range of services that we are discussing, and that they stand a real chance of damaging it. The Minister will have to address that accusation head on, reassure us and tell us how she will ensure that the clauses will not reduce the excellent level of choice that people currently have.

If PCTs can pick and choose, decide who their latest best friend is among high street opticians and exclude the rest, that will restrict people's choices and may, in certain circumstances, remove choice altogether in small market towns such as those that I represent, in which there may be few opticians, or even just one. It may remove such providers altogether, particularly as there will be measures, which we will consider later, that will enable individuals to be excluded from providing the free eyesight test, for reasons that are a little opaque. It seems that a characteristic of the seven clauses is their restriction of that important element of choice. It is impossible to see how choice will be enhanced by the proposals. I hope that the Minister will reassure us about that.

Will patients be able to choose an optician away from their PCT area? I hope that the Minister will tell us that they will. At the moment, people might choose, if they work in London, for example, to go down the road here to have their eyes seen to, and to get any specs or a prescription that they may need, because it is more convenient for them. We know that the Minister is terribly keen on things such as walk-in centres at major London termini, apparently to improve choice for commuters. However, there is a risk that the legislation will mean that people will have to go to a dispensing optician that is local to where they live for their free eyesight test, if they are eligible for it. I do not see why PCTs will not be able to insist that that be the case. I hope that it will not be, and that the Minister can reassure me about that, or at least say that it is not her intention to restrict choice in that way in any locality.

We should know why proposed new section 16CD(4)(b) makes provision for PCTs to take on primary ophthalmic services themselves. That seems a departure from the excellent model that we have had for all time—certainly since the advent of high street opticians—whereby the services are provided on the high street by a private individual, with the provision of a free test for those who are eligible. The Bill suggests that primary care trusts might wish to take primary ophthalmic services on board themselves. Perhaps the Minister has a particular model in mind, such as circumstances in which it would be useful for PCTs to take on that service directly themselves. I am not clear what such circumstances would be. Perhaps it has to do with expanding the role of primary ophthalmic services; I hope that we shall come on to that matter later. Perhaps she has in mind domiciliary services of one sort or another. That would be a departure from the service norm that currently applies, but perhaps that is why she wishes to make provision for PCTs to take on that service directly. That rather cuts against the remarks made last year by Sir Nigel Crisp about PCTs divesting themselves of the direct provision of services, but if that is the Minister's intention, she should say so. We would like some clarification as to why she has brought that item in under proposed new section 16CD(4)(b).

The clause requires co-operation between primary care trusts. It would be useful to hear from the Minister why it requires that. One naturally assumes that there would be co-operation between PCTs. However, it apparently needs to be emphasised in the Bill. Perhaps it is required in the context of the remarks that I made earlier, which I hope she will answer shortly, to do with the potential for a differential in the sight test fee. Co-operation between PCTs would obviously be useful in expunging the possibility of a differential occurring, and for advantages and disadvantages being introduced into the system as a result. It would be interesting to hear from her precisely what is in her mind about that, as well as about what pain and grief there would be if PCTs did not co-operate. What mechanism would there be for ensuring that they did co-operate, and at what level would it take place? Is that provision just a throw-away, in which case perhaps we should consider removing it from the Bill in order not to degrade the currency?

It would be interesting to hear from the Minister what she considers constitutes primary ophthalmic services under the anticipated regulations. Most people are clear about what constitutes general medical practice. I think I am less clear about what constitute primary ophthalmic services. It would be useful to hear what she thinks. Indeed, proposed new sections 16CD(1)(a) and 16CD(7), taken together, suggest that de minimis primary ophthalmic services could be defined as just the sight test. That would be a pity, and it would be interesting to hear whether that is the Minister's understanding of what primary ophthalmic services are. If so—if they are just one element of the service—we should know. Does she, as I hope, have in mind a more comprehensive service from opticians and optometrists? The Bill needs to be a little clearer.

The profession was concerned about the absence of reference to additional and enhanced services. I know that the Minister of State, Department of Health, the hon. Member for Doncaster, Central, has spoken to the profession about that, and it has been given some reassurance about ministerial intentions as to additional and enhanced services, but it is regrettable that there is no direct mention of that in the Bill. We should like to know what is intended for those services.

If we assume that the Bill is all about improving health, an opportunity is being missed. Although we have concerns about many aspects of devolution to Scotland and Wales, we must observe the systems there that work well, and it seems that things have been moving in quite a positive direction for dispensing opticians and optometry in Wales and Scotland. There have been many good examples of the role of such professionals being expanded usefully.

Just as pharmacy expansion has taken place in England and throughout the UK, there is room for optometry and opticians to grow professionally. The Bill is a regrettable missed opportunity for England. It would have been useful for the improvement of health if the Bill mentioned how services could be expanded. I am thinking of such things as a red eye service from high street opticians, pre- and post-operative surveillance for cataracts, which could, theoretically, be carried out by high street opticians, and a referral service from GPs to optometrists; a direct referral service from optometrists to ophthalmologists would be useful and the profession would welcome it.

Perhaps a service for the removal of foreign bodies could be provided. I recently attended accident and emergency in Salisbury with my fourth daughter, who had a foreign body in her eye. I could not remove it myself because I did not have the necessary slit lamp, which I used to use when I was a casualty officer to remove foreign bodies quite easily from people's eyes. That equipment is of course available on the high street, and I am sure that optometrists would be capable—it seems that they would be willing—to assist with procedures of that sort. That would hugely improve the eye care services available to our constituents. Those are examples of provisions that I should have expected to constitute additional and enhanced services. However, they have been mentioned only belatedly, when the professions involved have sought to meet with Ministers following the publication of the Bill. In failing to herald such innovations, the Bill is a missed opportunity.

I have in this clause stand part debate introduced some of our concerns. My list is not exhaustive, although it might have been exhausting to those who have had to listen to it. I have laid out some of our principal concerns about the seven clauses. I shall be grateful if the Minister answers as many of them as she can head on. Where she is unable to do that, will she come back on Report to expunge the clauses—which are flawed, if necessary at all—pending the review that we have been promised for so long, or at least improve them so that they stand no chance of damaging what is currently an excellent service?

Nadine Dorries (Conservative, Mid Bedfordshire)

I, too, add my good wishes for the new year to everybody.

As people are talking about their own spectacles and giving examples, I should like to show the Committee my beautiful leopard-skin-printed glasses, which I purchased for £9.99 from a local gift shop. Unfortunately, they have not served me well. Last time we sat in the Chamber, I was the butt of a number of jokes, not least those that went, ''Now Nadine, take the glasses off.'' That is not why I am now seeking the help of an optician. I am doing that because I have been squinting. I cannot read the Order Paper. I could not read menus in restaurants over Christmas, and I was in a rather dire state.

This morning, I decided to see an optician. Before the Committee started, I initiated two phone calls: I made one of them, and I got my researcher to make the other after me. I wanted to check whether the service was equitable, easily accessible and fair to all. I rang a local high street chain, pretending to be somebody on benefits, with no money at all, who needed glasses. The shop—I shall not mention its name, but the second word is ''savers''—told me that I could go in tomorrow and have my eye test, and that I would be given a voucher for £39 that I could take to any high street store—a supermarket, pharmacy or anywhere—that I chose in order to have a pair of spectacles dispensed to my prescription.

For me, the disappointing part of the exercise was that the voucher would have been for £39, but the cheapest pair of glasses and lenses that I would have been able to purchase was £79. That left me with a deficit. I said, ''I do not have any money. I am on benefits. How do I go about it?'' but there was no way round it; the cost of the glasses and lenses was going to be more than the value of the voucher.

Then my researcher phoned and pretended to be me, wanting a private eye test and not having any benefits. He was given exactly the same information in that he was told that he could go in tomorrow for an hour for a similar appointment. We have a service that, regardless of one's position—whether one is on benefits or able to pay for an eye test—is fair, accessible to all and of a high quality. One can go in whenever one wants to, and can take the prescription anywhere on the high street. It is a service that works. That is particularly useful for me, because within an hour I can have my prescription dispensed and come out with my glasses. Unlike my hon. Friend the Member for Westbury, I do not have the time to go around looking for better options. I want to go in, get my prescription and get out. It works.

Why are we considering the introduction of legislation that might distort a service that works so well? It might reduce the number of opticians or optometrists on the high street and that would reduce competition, which is also important. We all know that competition, patient choice, is what drives up quality. The service is of a high quality. Why would we want to bring in legislation that might restrict quality and choice? Why is the Minister proposing legislation that is not needed? The service is not broken; it works adequately—very well, in fact. Why are we trying to repair something that is not broken? What is the reason for the legislation?

Caroline Flint (Labour, Don Valley)

I should like to emphasise and be upfront about the fact that the clauses mirror the existing obligations on primary care trusts in many respects. However, they put those obligations in a new framework. Several members of the Committee asked why we are making changes at all, so let me point to one example.

At present, primary care trusts can contract for NHS sight tests only with providers who are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council. Businesses owned by dispensing opticians or lay people who employ those whom I mentioned to do eye tests cannot contract with primary care trusts. Several members of the Committee talked about choice, and our approach in the clauses is partly about providing an opportunity to extend contracts with dispensing opticians or lay people much more transparently, provided that they meet quality standards and that clinical provision, particularly the provision of sight tests, is carried out by optometrists or ophthalmic medical practitioners.

That is important because the present arrangements have led to a situation in which businesses have had to restructure, so that they can register with the General Optical Council, or to have an agreement with an employee who is an optometrist or ophthalmic medical practitioner and who is therefore able to contract with PCTs. As a long-term measure, that way of getting round the system—that is what it is, although I am not saying that it has necessarily led to less quality—is not particularly helpful or satisfactory. Indeed, the present measures were introduced when it became clear that there had been failures to comply with the regulations.

We are trying to move to a proper legal framework for the provision of ophthalmic services, and the Bill is the first available vehicle that allows us to do so. The planned changes will enable PCTs to contract directly with optical businesses without the current restrictions on ownership and they reflect the reality of service provision. However, there must be quality assurance when PCTs contract with organisations with which they cannot presently contract directly.

It is ridiculous that we continue to endorse a roundabout way. Let us not forget that, in some places, there are optimists—sorry, optometrists, although optimists as well—who serve several different businesses. If we say that the PCT should contract only with that roving individual, that raises questions about the service that is being provided and about who is responsible for providing it, for the access points and for other issues. A prime aim in the clauses is therefore to provide greater opportunity while recognising that there must be clinical safeguards.

I hope that that answers the questions from the hon. Member for Mid-Bedfordshire (Mrs. Dorries) and others about what is significantly different about the proposals. Their introduction in no way undermines what I acknowledge is a very good service, but it gives us greater opportunities to have a more realistic discussion with those in the business of providing services on the business and clinical sides.

Andrew Murrison (Conservative, Westbury)

I am grateful to the Minister for giving way, because I do not really understand a lot of what she has said. She talks about providing greater opportunity, but I question for whom one is providing it, because Opposition Members have certainly not had representations from professional bodies or providers about the lack of opportunity. The Minister has not said how providing greater opportunity will improve patient care or access. Will she rewind, and explain things again? It is soon after Christmas and perhaps I am being dim.

Caroline Flint (Labour, Don Valley)

As the hon. Gentleman is aware, the services are provided by a number of different organisations; there are big corporate bodies and brands such as Specsavers, and smaller opticians. Certain services are already provided in other businesses.

I make it clear that at present primary care trusts can contract with providers for NHS sight tests only if they are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council. That means that businesses owned by dispensing opticians or lay people who employ optometrists or ophthalmic medical practitioners to do sight tests cannot contract with PCTs. In that situation, the contract must be with the employee of a business rather than the business itself.

The Government believe that is a ludicrous situation, because it leads to a convoluted set of arrangements. The oversight of local contracts and discussions on the provision of more and enhanced services are disjointed, as the hon. Gentleman said, as the PCTs do not deal with those who provide the premises and the environment for the clinical services.

This does not apply to other primary medical services, such as dentistry, and we are trying to create a more practical, transparent and legal framework in which dispensing opticians and lay people who employ clinical professionals can be part of and engaged in the contracting process.

Nadine Dorries (Conservative, Mid Bedfordshire)

Is the Minister saying that at present if I bought premises and employed an optician to run the business and provide the service, I would not be able to have a contract with the PCT, but that, under the legislation, if an individual wanted to establish a business employing optometrists or ophthalmologists, they could have a contract with the PCT? Is she saying that at present the only people who can have a contract with the PCT are registered optometrists, ophthalmologists or opticians and that if I wanted to set up a business, with people working in that business, I would not be able to have a contract?

Caroline Flint (Labour, Don Valley)

What I am saying is that there are limitations at present on those individuals within the profession who can contract with a PCT. At the moment, where a lay person or a dispensing optician has a business, the named person who has the contract with the PCT has to be the employee who is brought in to provide the clinical services. That seems ridiculous, considering that we are talking about businesses with which one may want to discuss providing a range of enhanced services outside of or in addition to the sight test procedures. Later, we will discuss the local committees, on which we want clinical professionals and contractors to be represented.

There is an anomaly at the moment, which the clauses try to address, but at the same time the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central and I have to ensure that the necessary arrangements are clear and that clinical expertise is provided for by whoever is given a contract by the PCT.

Andrew Murrison (Conservative, Westbury)

The Minister is generous in giving way. A bit of a seam has been opened up in this debate, because nothing is explained in the verbiage of the guidance notes. That underscores the obvious need for the proposal to have been subject to a full review before the Bill was introduced. I am most grateful to her for shedding the information at this stage but it is new to us and we will have to give it serious consideration.

The Minister mentioned dentists and pharmacies and I will need time to discover to what extent the proposals marry with the contracts that the Government or their agencies want to establish with those professional groups.

It does not seem to me that the general dental services and personal dental services regulations that were laid before the House late last year bear any resemblance to the arrangements that the Minister is now proposing for optometrists and dispensing opticians. That seems to be a central tenet of the Minister's argument; she is trying to harmonise the arrangements that PCTs enter into with various professional individuals and corporate groups. I am completely at sea as to what the Minister is trying to get at. It is all new material, which we should have been apprised of well before now. The Minister dealt briefly with the issue of quality. That is a serious concern. One does not register with professional organisations for no reason at all.

Caroline Flint (Labour, Don Valley)

Has the hon. Gentleman finished yet?

Andrew Murrison (Conservative, Westbury)

Mr. Illsley, I shall return to the matter at a later date; I think that we will cover it at some length.

Caroline Flint (Labour, Don Valley)

I had not finished my speech, but in answer to the hon. Gentleman's first point, the fact that he has not done his research is down to him, not the Government. Part of the core of the discussions with professional groups was about the opportunity for PCTs to contract with dispensing opticians and lay persons. I have seen the briefings provided by a number of the professional groups because I was sent them as an MP and went through them. I have read a number of things and it is clear, as it is clear from the discussions, that the extension of the opportunity to contract in a transparent and open way with the individuals I have described is a core part of the reason why we are bringing the clauses forward. Second to that are the issues of fraud and the important role of the PCTs as a watchdog to ensure that it does not take place, whether in the delivery of the sight test or in the provision of vouchers for purchasing optical accessories.

The clause gives primary care trusts a duty to provide a sight-testing service for eligible patients. It mirrors their existing obligations but in a new framework. Eligibility for the service will be maintained through the regulations—that is nothing new—which will be made in respect of all those currently eligible. Primary care trusts will also have a new duty to provide any other primary ophthalmic services that may be prescribed and any further services that they judge necessary to meet reasonable need in their area. Those could be for individuals who are diabetic—we are obviously aware of the issues about sight and diabetes. They could be post-treatment care in the local community for individuals who have had a cataract removed or had glaucoma. I will come on to that when I address the points that have been made about the review process.

PCTs will reimburse opticians and a central budget will reimburse the PCTs. There is no ceiling on that as long as the provision is in line with the standards that we expect and the eligibility requirements. That is the position now and it is what is intended for the future. The sight-testing service will be mandatory under the clause and PCTs will have no scope to reduce it.

A point was made about co-operation. This is a standard provision that mirrors those for dental and medical services. There is a risk of failure to co-operate. It is a slight risk, but there is always such a risk and we have to provide for that. The clause gives the basis for a strategic health authority or the Secretary of State to intervene and remind NHS bodies of their duties. As I said before, there are issues in the legislation that complement the review.

It is desirable for PCTs to provide services should there be an unwillingness to provide them privately in a community, although such unwillingness is most likely to occur in the provision of services other than sight tests. To that end, it is not apparent that the provision would necessarily have to be used by PCTs, but it is important to ensure that it is linked to a duty to provide sight tests. Where sight tests are not provided privately, rare though that may be, it is important to have the provision so that the PCTs may seek to provide that service.

Andrew Lansley (Conservative, South Cambridgeshire)

Will the Minister help me to understand the nature of the budgetary arrangements to which she is committing the Government? Is it a central budget to fund sight tests or primary ophthalmic services? The comparison with dentistry, for example, would be of a fund that was centrally distributed but ring-fenced and devolved. What precisely will be held centrally and not cash-limited?

Caroline Flint (Labour, Don Valley)

My understanding is that the current process and framework for negotiating the sight tests and the reimbursement will continue.

Andrew Lansley (Conservative, South Cambridgeshire)

I understand that, but the question then is whether the Government intend there to be global primary ophthalmic services budgets for PCTs, against which the resources for sight tests would be offset, or whether the central budget for sight tests will be completely separate from the devolved budget for primary ophthalmic services, so that an increase in the uptake of sight tests in a PCT will not have the negative consequence of an adverse effect on the additional services that are bought locally.

Caroline Flint (Labour, Don Valley)

The answer to the last point is yes. An increase in the number of sight tests that are carried out in a certain area and the seeking of reimbursement for those tests will have no relationship to any other services provided for locally. In the same way, we are not setting a minimum or upper limit on the number of sight tests.

The only concern about volume relates to abuse of the system, whether financial or in relation to the quality of the sight tests being carried out. A contractor may employ someone who is qualified to carry out sight tests, but the number of sight tests that they carry out in the hours for which they are contracted may beggar belief, and there may be doubts about whether there is any real quality assurance. I do not, however, want that to be taken as suggesting that such practices are common.

I agree with everything that hon. Members have said about the flexibility and choice that already exists in the system, but it is important to be aware that there is abuse of the system. According to the latest reckoning, some £10 million of fraud is committed every year. That amount has gone down, but we do need more measures to clamp down on it. I hope that that reassures the hon. Gentleman. So far as I am aware, there is no connection between reimbursement for sight tests and any other funding issues for other services that the PCT may wish to provide, although that may of course depend on issues in the local community.

Andrew Murrison (Conservative, Westbury)

The Minister mentioned £10 million of fraud. It would be useful to know how much the new arrangements will cost, given that avoidance of fraud is one of the important reasons why she wants the seven clauses to be implemented. It is not clear how much the arrangements will cost, but it is self-evident that there will be a cost to the service for PCTs to administer them.

Caroline Flint (Labour, Don Valley)

I do not believe that there will be a huge additional cost, because we are simply widening the scope of contractors who can be part and parcel of provision locally. The provision therefore simply widens the pool of contractors. PCTs already contract with services locally to provide the facilities available on the NHS. All that we are doing in that respect is widening the pool and making opportunities through the local committee to have the sort of discussions that are currently held, but also opportunities to address local issues as and when they occur. Nothing in these proposals indicates additional costs of themselves. They are simply to deal with some of the anomalies in the system and make it clearer and more transparent so that everyone knows what they are dealing with.

Nadine Dorries (Conservative, Mid Bedfordshire)

The Minister mentioned £10 million worth of fraud. If we are to take on additional costs to put in a new system, what safeguards will there be against fraud? We may go through the process and find that next year the fraud has escalated to £10 million; the new arrangements will do nothing to limit that.

Caroline Flint (Labour, Don Valley)

We come to that later in the clauses. The 1999–2000 baseline shows that losses through optical patient fraud were measured at £13.25 million per annum. That was reduced in 2001–02 to around £10.17 million. The Counter Fraud and Security Management Service is currently undertaking a further risk measurement exercise in ophthalmic fraud focusing on both patients and contractors in England and Wales and expects to produce statistics by the end of this financial year.

I was not sure what point the hon. Lady was making in her earlier contribution. Obviously, when people ring up and pretend to be something that they are not, there is not a lot that one can do about it over the phone. I thought that she was going to make the point that she then went to the opticians and they did not ask for proof of her status and issued a voucher and so forth. If that was the case, she can see me afterwards with the name of the opticians and we will send the fraud people along to them.

She also seemed to suggest that it was unfair that the voucher for optical equipment did not meet the full price of the glasses themselves. I was not sure whether she was suggesting that we should up the rate for the optical voucher to a price that is consistent with some of the more highly priced commercially available glasses. She might want to look at Hansard. She then asked what it was all about and why were we changing it. I hope that I have managed to explain the wider opportunities for much more direct and straightforward arrangements and contracts with businesses that are providing services.

Andrew Lansley (Conservative, South Cambridgeshire)

Of course, there is a point there. People who are held not to have any money to pay for their sight test get a test subsidised by the NHS, but the subsidy is considerably below the actual cost of providing the test and is cross-subsidised from the sale of spectacles. If those people then go on to receive a voucher that meets only part of the cost of their glasses, in effect they are paying for part of their sight test. That is all theoretical. The question for the Government is whether they intend that the cross-subsidy between the sale of spectacles and sight tests should continue or, as is the case elsewhere in the NHS, that remuneration should much more accurately reflect the cost.

Caroline Flint (Labour, Don Valley)

That point of view has been expressed by others. There is a claim that the NHS sight test fee does not meet the actual cost of the test and is subsidised by the sale of glasses. Our position is that we negotiate the sight test fee nationally with the representatives of the profession and the sale is a private matter for them to determine. But the fact is that we have national negotiations for the level at which the price should be set for the sight test. I do not accept that there is a cross-subsidy. [Interruption.] That is their view. Negotiations will begin for 2007–08 and I have no doubt that those issues will be raised there.

There are glasses available at a lower cost, but choice is a factor. When I started wearing glasses, one had either the NHS tortoiseshell square ones or the John Lennon metal round ones. That was the basic choice on the NHS; if one wanted to use the voucher to buy one's glasses, those were the glasses one got. People wanted more choice and wanted to add to that, which is why there is now a greater range. Two of my children are short-sighted—I am afraid that I have passed that on—and when I go with them to see what glasses are available, I see that there are ranges of glasses for under £50 and under £100, and lots of deals are available, such as buy a pair of glasses and get sunglasses free; then there are the glasses by Armani and so on. It is about choice.

The alternative, which would deny choice and flexibility, would be to say, ''We will pay for the glasses, but there are only three types that you can have; that is it.'' We could control what is provided in that way. In the provision of other NHS appliances—for want of a better phrase—that is the position, but some people feel that it is far too centralist and restrictive. When budgeting, one must decide whether to give people the opportunity to take their voucher and add to its value or whether to say, ''Right, I'm sorry, if you're going to have the voucher, this is the limited choice of glasses that you can have.'' I think that the former is a better way of giving assistance without creating a sort of Stalinistic system in which NHS patients are given limited choice and flexibility on eyewear, which is important to people. Clearly, the hon. Member for Mid-Bedfordshire is interested in how her glasses look, and there is no reason why anyone else who receives such services should not be similarly concerned by the look of their glasses. However, there is an issue, taking into account the market and the range of costs of glasses, as to what price the taxpayer is prepared to pay. Nothing is perfect, but I think that the current system is about as good as it gets.

I shall touch briefly on the review and give the Committee some information. The review is under way and discussions are continuing. One reason for the review and its terms of reference is the need to emphasise the importance of making better use of primary care resources. For example, undertaking primary care rather than secondary care where appropriate, and developing patient choice.

As I said earlier, the post-treatment care of people who have been in hospital for the treatment of glaucoma or for cataract removal is only provided in hospital settings in some cases, but might better be provided in a community-based setting. As part of the review, we are discussing with the profession and others how we can deliver such services closer to home and develop patient choice. We are currently funding pilot projects that test model pathways in those areas. I am happy to write to the Committee with information about those pilots.

The review is also looking at wider development in England, with PCTs being responsible for health services. We decided to extend the review, because we listened to people in the profession who wanted more time to explore such issues, and because of our White Paper, ''Your health, your care, your say'', as there are clearly some overlaps in those areas. The review is likely to finish later, rather than earlier, in 2006. We recognise that this issue links into several areas to do with providing health care outside hospital. However, the provisions in this clause and others do not necessarily have to await the outcome of the review.

These clauses provide a better, more transparent system for the contract arrangements and ensure that primary care trusts have a duty in legislation to provide the NHS sight-testing service for eligible patients. In answer to the question asked by the hon. Member for Westbury, I shall deal in a moment with where people take the test.

Andrew Lansley (Conservative, South Cambridgeshire)

The Minister referred to the debate on the White Paper. One of the central debates on the White Paper relates to the extent to which PCTs should provide services in future. The implication of the Government's proposals thus far—although one never quite knows where they are on this issue—is that primary care trusts should not be both purchaser and provider of services. However, the structure of clause 34 expressly allows primary care trusts to be both purchasers and providers of primary ophthalmic services.

Clearly, people in the profession might reasonably worry that PCTs will make the kind of provision that has been seen in dentistry with dental access centres, which they control and which is turning the profession into a salaried, NHS-employed profession, rather than one made up of independent practitioners—unfortunately, at much greater cost than independent provision. That seems perverse to people in the dental profession, and it would certainly be perverse in the profession that we are considering. Will the Minister tell us why, as my hon. Friend the Member for Westbury said, proposed new section 16CD(4)(a) contains provision for a PCT to become a provider?

Caroline Flint (Labour, Don Valley)

As I outlined earlier, that is to allow for those circumstances in which sight tests are not provided by the private sector. This is about access for individuals. I said earlier that, given the already very good service that is provided in terms of access to sight tests in a variety of settings, it would be rare for PCTs to feel that they had to make such provision, but we felt that there could be circumstances in which it was an issue, and therefore the measure allows what I have described to happen.

On PCTs and the provision of services, my right hon. Friend the Secretary of State for Health has been clear. It is up to PCTs to determine whether they provide services; but in relation to the hon. Gentleman's last point, it is also important for PCTs to demonstrate that the services that they pay for provide the necessary outcomes and value for money, particularly if they are commissioning those services and run them themselves. That is a role for the strategic health authorities to oversee, too.

The hon. Member for Westbury asked a direct question about whether an individual could go outside their PCT area and still have access to a sight test. The PCT's duty is to provide or secure provision in the area, not for persons in an area. The situation is exactly the same as the current arrangements. The sight-testing service remains catchment-based rather than resident-based. Therefore, if someone is on holiday or working in a different area from where they live, they can have a sight test. There is no change in that regard to the flexibility and choice of service.

I have covered a number of issues that were raised this morning, and I hope that I have reassured members of the Committee and those outside listening to the debate that clause 34 is an attempt not to undermine any existing arrangement, but to build on what I think everyone agrees is a good service by making better sense of some anomalies, which people get around but which do not contribute to a much more open and straightforward contracting relationship and do not allow PCTs to explore with contractors the sort of work that they might want them to do beyond the sight test—the sort of work that they would be responsible for funding and for which they would negotiate based on local need.

Clause 34 ordered to stand part of the Bill.

Clause 35 - General ophthalmic services contracts

Andrew Murrison (Conservative, Westbury)

I beg to move amendment No. 29, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) must make provision for all those with entitlement to GOS to retain the right to have that delivered by the provider of his or her choice.'.

Eric Illsley (Labour, Barnsley Central)

With this it will be convenient to discuss the following amendments:

No. 30, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.'.

No. 31, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.'.

Andrew Murrison (Conservative, Westbury)

We had hoped that this would be a group of four amendments, including amendment No. 32 to which I referred earlier, but we have been told that that is legally defective. That shows the disadvantage suffered by the Opposition when it comes to parliamentary draftsmanship in relation to tabling amendments. Nevertheless, I hope that we will be able to cover the intention of the amendment as part of the clause stand part debate, and that the Minister will address the matter further than she has done so far.

Amendments Nos. 29, 30 and 31 and, by implication, 32 all have to do with choice. They would guarantee that people might continue to enjoy their current level of choice when it comes to ophthalmic optics and the services of opticians and optometrists, particularly on the high street. We fear that that will be damaged as a result of the seven clauses that relate to those important services.

Let me quote a letter about the proposals from an optometrist in Witney in Oxfordshire.

''These proposals, if they become law, have the potential to create the same chaos of reducing patient choice and accessibility seen in dentistry, as patients are restricted to a select practice or are denied appointments as the budget for the year has been spent. This is a retrograde step and would affect the more vulnerable members of society (the elderly, partially-sighted, low-income, and children) who at present can choose which practitioner to provide their eye care on the NHS.''

That very succinctly puts our concerns as well. Given our concerns about access, choice and the potential to damage a very good service, we have tabled these three, originally four, amendments. Let me take the Committee through them one at a time.

Amendment No. 29 states:

''Regulations under subsection (2) must make provision for all those with entitlement to GOS to retain the right to have that delivered by the provider of his or her choice.'.''

That, effectively, is what happens at the moment. I assume that the Minister wants choice to continue, and I suspect that she wants the Bill to do no harm to that choice. Therefore, the amendment would tally with her thinking. Under our provision, people will be able to choose providers for themselves from the large number available, as they can at the moment. They will be able to make informed choices about which provider to go to, based on past experience, locality and whether they perceive that they are getting good value for money. The danger under the proposed measures is that, to a greater or lesser extent, PCTs will determine their choices for them. Those who wish to seek out a free NHS eyesight test could find that their provider of choice is no longer available to them. They might have been going to a particular provider for many years, but suddenly find that they cannot do so any more.

Many of us take a fairly eclectic approach to the issue of who we go to for what I hope are our regular eyesight tests, but others do not and regard their practitioner in much the same way as their GP. They wish to build up a long-term relationship, and there are instances in which such a relationship is particularly important—screening for glaucoma, for example, needs to be done regularly. The Minister should not put in place legislation that damages individuals' ability to make such a choice and determine where they go. Indeed, that ability to choose should be held up for other practitioners as a model of how to provide patients—our constituents—with the services of their choice at their behest. Damaging what is almost the jewel in the crown of NHS choice is entirely retrograde, and we tabled amendment No. 29 with that in mind.

In a similar vein, amendment No. 30 would insert the words:

''Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.''

That touches on issues with which we dealt earlier, and I suppose that we had the same debate about dentistry, where the same concerns would apply. Once one uses up the units of dental activity that one negotiated with the PCT a year previously, one can, in effect, sit on one's hands and do nothing. Indeed, a practice could structure itself in such a way that it did precisely that; it could lay off staff and profit thereby. However, that is not what we want to see if we are serious about maintaining patient access and patient choice. In the present context, such an arrangement may mean that a patient turns up for an eyesight test in March—at the end of the financial year—and finds that the optometrist is no longer doing NHS eyesight tests because he has used up the entitlement that he negotiated for the year and for which he contracted with the PCT.

The Minister gave us some reassurance on NHS eyesight tests, but she might like to expand a little on her meaning in response to the amendment. However, the situation that I described would also apply to primary ophthalmic services. The worry is that, at the end of the financial year, practitioners might say, ''We've done everything we have contracted to do and we will do no more.'' That would clearly be a very strange and exceptionally wasteful way of operating, although it could be advantageous to the practitioner or business concerned.

Following on from the previous two amendments, amendment No. 31 would insert the words:

''Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.''

Later, we shall discuss disqualification, and I shall leave it until then to voice my concerns about what that means in practice. Are we talking about disqualification on the basis of perceived competence, behaviour or registration or on the basis of a business or individual having been found to be, let us say, difficult in contractual terms? The latter would be a slightly sinister situation, with the PCT being able adversely to influence the businesses with which they were contracted; indeed, it might even prejudice the independence of those organisations, and we would be concerned about that.

Taken all in all, the three amendments—I may mention amendment No. 32, which is in a similar vein, on clause stand part—would guarantee an element of choice for individuals seeking primary ophthalmic services. They would also help providers by ensuring that primary care trusts could not shut them out when drawing up contracts. People would be able to use any high-street practitioner, as they can now.

We have covered the question of whether the finance will be cash-limited, and the other clauses touch on that further. The Minister has given us some assurances, although I remain concerned about whether primary ophthalmic services will be cash-limited and therefore subject to prioritisation by the PCT, which is not necessarily the case now.

I suspect that the Minister will say that she cannot allow the amendments, given her previous explanation. Much of what she said was new, despite her protestation that it was all in the briefing notes. In the context of her earlier remarks, why cannot she incorporate the amendments into the Bill? They will not disestablish the rationale that the Minister rather belatedly gave for the seven clauses of chapter 2.

Caroline Flint (Labour, Don Valley)

Amendment No. 29 would ensure that eligible patients were able to choose their NHS provider of sight tests. We support the right of patients entitled to a sight test under NHS arrangements to choose which practitioner should test their sight. Nothing in the Bill takes away from the right of individuals to choose when and where they have their sight tested, so long as it is in line with existing regulations. That is why we are inserting new subsection 28WE (5) into the 1977 Act. It states:

''Regulations under subsection (1) must make provision as to the right of persons to whom services are to be provided to choose the persons from whom they are to receive them.''

I hope that I have reassured the hon. Gentleman that there is no attempt to limit the range of choice.

Andrew Murrison (Conservative, Westbury)

Will the Minister give way?

Caroline Flint (Labour, Don Valley)

May I make a further point? It may answer the hon. Gentleman's question.

Providers of sight tests under the NHS are required to have a contract with the NHS and to be included on a PCT list. That is right and proper. Yes, patients have a right to choose who should test their eyesight, but it is important that those who provide the service, which is funded by the taxpayer, should be legitimate providers; people must be clear that the providers are qualified to provide those services. That is the case now, and we intend it to remain the case.

Andrew Murrison (Conservative, Westbury)

Will the Minister give way on that point?

Caroline Flint (Labour, Don Valley)

No, I shall make a little further progress in order to answer the point.

The amendment would result in patients being able to choose a provider who did not have a contract with the NHS and who was not included on a primary care trust list. I cannot accept that. It would mean that the post-Shipman system of lists, whereby PCTs have to be satisfied of the competence and probity of NHS practitioners, would be negated for ophthalmic services. I believe that patients are best protected when NHS services are performed by primary care professionals who are included in a PCT list of performers and who have contracts with the NHS or are employed by others who do. As a consequence, there is a relationship and the primary care trust has the right to ensure that standards are maintained and to cancel a contract if it is not satisfied that that is the case. Should people meet the clinical conditions and the quality standards, there is no limit on the number of contractors or performers on the list. That provides ample choice for individuals to access services that they can be assured are of a good standard.

Andrew Murrison (Conservative, Westbury)

The burden of what the Minister is saying therefore, is that the only benchmark for deciding whether a provider should be offered a contract is his or her professional competence. Can she confirm that provided that the individual can prove his or her professional competence, which would presumably require registration with the General Optical Council, for example, that person would be offered a contract? If that is not what the Minister is saying, how is a PCT to determine with whom to place the contract?

Caroline Flint (Labour, Don Valley)

Clearly, the arrangements at present are that only people with required qualifications can carry out the sight tests. That is agreed with the various professional bodies and organisations and it will continue in the future. As is the case now, providers who contract with the PCT must make sure that their organisation has the clinical competence to provide the sight test. There may also be issues such as how the service is provided, and so on. For example, if questions of probity came to the fore, there would be a question whether the PCT wanted a contract with that particular provider.

There is nothing different from that which currently exists in what we are suggesting: the NHS will only pay through PCTs those practitioners and providers who meet the standards of quality and clinical assurance that have already been discussed by professional bodies and are laid down in regulations.

Andrew Murrison (Conservative, Westbury)

The Minister has side-stepped the point, if I may make so bold. I asked her to confirm that, provided that a professional is competent professionally and in terms of probity, in all respects—that would imply registration with the appropriate body—he or she could, if they asked, be given a contract to provide primary ophthalmic services. That is the burden of what the Minister said previously.

Caroline Flint (Labour, Don Valley)

My understanding is that if an organisation or individual meets those conditions they are entitled to a contract. Nothing in our proposal—[Interruption.] Well, they can apply for a contract and if they meet the conditions there is very little reason why a PCT would turn them down.

Andrew Lansley (Conservative, South Cambridgeshire)

Will the Minister give way?

Caroline Flint (Labour, Don Valley)

If I can finish, we are not setting limits on the number of providers or, for that matter, on the number of people who are on the performers list to provide services.

Andrew Lansley (Conservative, South Cambridgeshire)

Will the Minister give way?

Caroline Flint (Labour, Don Valley)

No, as I want to make progress on some of the other amendments.

Andrew Lansley (Conservative, South Cambridgeshire)

Explain this point.

Caroline Flint (Labour, Don Valley)

If it was accepted, amendment No. 29 would mean that someone could go to an organisation or an individual who did not have a contract with the PCT or was not on the performers list. That is not the correct way forward. We are not trying to shut down the number of people who provide services; we are trying to ensure that NHS money is given to those who provide a proper, qualified service. The hon. Member for Westbury may disagree, but the upshot of amendment No. 29 would be that anybody who was not on a PCT performers list or who had a contract with a PCT could seek to be reimbursed through taxpayers' money, and that is not good enough.

Andrew Murrison (Conservative, Westbury)

Can the Minister provide evidence that fraudulent dispensing opticians and optometrists are currently operating in this way? That might be helpful. Could she also confirm that there is little evidence of any such thing? If there were, I would tend to agree with her. If individuals were putting themselves up falsely, we would need to take steps to ensure that public money was not provided in such a fashion. Could she also confirm that it would be illegal for individuals to offer themselves as holding such professional qualifications? We do not need further legislation to ensure that public funds are safeguarded in such a way. I resent what she implied about Shipman in that regard; that is entirely a red herring. She should be ashamed for using it.

Caroline Flint (Labour, Don Valley)

The issue is whether one believes—it is clear that the hon. Gentleman does not—that as a local NHS body provides and funds NHS services, national standards should be inspected locally and dealt with in such a way that we can ensure to the best of our ability that those people who are either contracted to provide services or clinically provide services are fit for purpose. I personally do not think that there is a huge amount of concern about the idea that contract providers or performers should register and be part of a list with the local PCT. If someone was on a performers list in one PCT area, it would apply across the whole of England. They would not be confined to the geographical location of their PCT.

I find it difficult to understand the direction of the hon. Gentleman's argument. He seems to be saying that an individual, as a customer, could go to anybody who was not on the contractors list or the performers list and avail themselves of a sight test that the NHS would pay for with no controls or links back to the locally accountable body that is there to help to ensure that nationally negotiated standards, guidance and conditions are implemented locally. I am not sure how professionals who are on lists now and will be in the future would feel about that. It would undermine the process of creating an environment that tries—not in a bureaucratic way but straightforwardly—to create a check to ensure that people are able to do the job that they seek to do. To go back to our earlier partnership discussion, part of that partnership is about the discussion of the delivery of services locally and the issues of need. I cannot accept amendment No. 29, because it is a bit of a nonsense.

Andrew Lansley (Conservative, South Cambridgeshire)

Let me one last time try to express what we are concerned about. Things may have changed slightly as Ministers have accepted in discussions with the profession and in Committee that the sight test will be centrally funded, but there is a risk that a primary care trust might constrain the local list of providers who were able to offer a sight test in order to secure a better deal in the provision of other primary ophthalmic services. There is no reason why that should happen. On the face of it, if it is centrally funded to a nationally agreed standard, every registered provider with the General Optical Council should be free to offer that service. There is no good reason why the primary care trust should intervene to restrict that. The primary care trust, on the face of it, does not seem better able than the professional regulatory structures to determine whether someone is qualified.

The distinction that we are driving at is that with the sight test, if nothing else, we should be clear that every properly registered provider should be able to provide the sight test to every customer. Nothing should intervene to prevent that from happening.

Caroline Flint (Labour, Don Valley)

As far as I am aware we intend that, as now, contractors will be able to have an NHS contract for the sight test provided they meet the national criteria, which should be met with local decisions on matters such as quality of service and inspection of premises and equipment. That is the current position, I understand. There is local inspection using national standards before a provider can go on the list for a GOS contract. Nothing about that will change.

There may be some contractors who want to offer other services. That is a separate issue, to be negotiated with the PCTs. It is separate from the national sight test and from optical vouchers and so forth. It does not necessarily mean that if the PCT would like other services to be provided in the area there will be pressure on someone to offer them if they do not want to. As we discussed earlier, one of the strengths of the current system is the opportunity for the public to have sight tests and purchase spectacles in a huge variety of outlets, regardless of whether they need enhanced services, or whether they are having the sight test in the area where they live or where they work.

I hope that I have reassured hon. Members and made things clear. [Interruption.] That is why I am discussing those issues; we cannot put everything in the Bill. My hon. Friend the Minister of State, Department of Health met professionals before Christmas and talked about some of the relevant aspects of the matter.

Andrew Murrison (Conservative, Westbury)

Will the Minister give way?

Caroline Flint (Labour, Don Valley)

No.

Andrew Murrison (Conservative, Westbury)

It is an important point.

Caroline Flint (Labour, Don Valley)

It is always an important point. I will not give way at this stage. The hon. Gentleman can return to it on clause stand part if he wants to.

Amendment No. 30 would guarantee the rights of eligible patients to NHS-funded sight tests and would provide in statute that there should be no limitations on the number of sight tests for which providers can claim payment. We support the right of patients eligible for sight tests under NHS arrangements to have those sight tests and that is already covered by the Bill. In proposed new section 16CD(1)(a) we set out the duty of primary care trusts to provide a sight testing service and in new subsection (2) we specify the patients who are eligible for that service. The proposed new section also provides for the power to make regulations to add to the category of those eligible for sight tests under NHS arrangements. We will be making regulations to ensure that all those currently eligible for sight tests under NHS arrangements will continue to be eligible in future.

Andrew Murrison (Conservative, Westbury)

Will the Minister give way?

Caroline Flint (Labour, Don Valley)

Perhaps I can start to address the amendment, if the hon. Gentleman will allow me.

It cannot be acceptable for primary legislation to provide that providers should be recompensed for sight tests without any limitation. That could prevent primary care trusts from questioning the appropriateness of sight testing undertaken in volumes apparently far in excess of what any responsible clinician would undertake if they were carrying out sight tests properly.

We do not propose to place limits on the number of sight tests that may be undertaken or to place any cash limit on the budget that reimburses the cost of sight tests provided under NHS arrangements. However, there must be scope for primary care trusts—which, as I said, are responsible for ensuring locally that national standards are implemented—to exercise judgment to ensure that public funds are properly spent. The amendment would remove that safeguard, which I am sure was not the intention of the hon. Member for Westbury.

Amendment No. 31 is intended to ensure that PCTs are unable to limit the number of providers of NHS funded sight tests or of performers who work in their areas. We do not intend that regulations should give powers to primary care trusts to place limits on the number of providers with which they contract for the provision of sight tests under proposed new section 16CD(1)(a), but we see no need for that to be in the Bill. It would be quite inconsistent with the approach taken for other primary care professions, which have maintained the right to establish businesses in their areas and operate contracts with the NHS without an explicit prohibition or any limitations in the relevant primary legislation.

For performers of primary ophthalmic services we are committed to maintaining the right of clinicians who undertake sight tests under NHS arrangements to work in any area in England, provided that they are listed with a primary care trust in England. Restrictions on performers would be inconsistent with the performers list regulations already in force, which prevent movement of the work force in ways that are not in the interests of patients or optical businesses.

Given the fact that sight tests will be centrally funded, I see no reason whatever why a PCT should restrict the numbers on its performers list, as it will not be affected by any budget concerns that it may have locally. For those reasons, I recommend that amendments Nos. 29 to 31 be rejected. I hope that I have clarified how the Government feel: sight test services should continue to be provided in an open way that maximises flexibility and choice but ensures that existing safeguards continue.

Andrew Murrison (Conservative, Westbury)

We have heard very little from the Minister on how she will guarantee that the choice we have now will continue once these seven clauses pass into law. She has not given us the assurances that we have sought and which our amendments would have cemented into the arrangements that she is introducing. However, she opened up one or two interesting lines of debate, particularly in relation to amendment No. 29. She appears to be exercised about the quality of professionals undertaking ophthalmic services. I share her concerns; we all hope that those who provide NHS services will be high calibre and subject to audit and inspection—indeed, we look to professional bodies that register practitioners largely for that reason. That is why the amendment referred to GOS.

The Minister did not address my question about how many mavericks are out there and why she is so concerned about the possibility that people are performing sight tests who are not qualified or competent to do so, or who do not have the probity. I am not aware of any. If she is aware of any and is concerned about them, she should say so. We might then be more minded to agree with her that the amendment should be withdrawn. I am not sure, however, that she answered that question. Indeed, I am pretty sure that she sidestepped it completely.

So it appears that the PCT will be in the invidious position of determining who is of sufficient quality to undertake the contractual arrangements. That brings us back to the question that I put to the Minister during our debate on clause 34, which dealt with the cost of such arrangements. If PCTs will be expected to assure themselves that those with whom they enter into a contract are of sufficient quality, that clearly implies an inspection regime and an auditing structure, all of which requires people. Replicated across the country, that means cost.

I suspect that the £10 million-worth of fraud, which the Minister says it is so crucial to avoid that she needed to draw up these seven clauses, will be largely overshadowed by the amount of money required by the NHS to ensure that PCTs place contracts for sight tests with appropriate people. We have not heard much about that to date. It is the subject of some of the measures in proposed new section 28WF of the 1977 Act, but only very peripherally. As for GOS and the review that we hoped for, such issues ought to have been explored in the review that we thought would precede the seven clauses.

Caroline Flint (Labour, Don Valley)

Is the hon. Gentleman aware that at present all clinicians who perform NHS sight tests are listed with a PCT and that all contractors must be listed with each PCT where they provide that service? That is current practice, to ensure quality and delivery of that service. It is a safeguard to ensure that national standards are met. Why on earth is he suggesting that we should now open up the situation so that people can be on neither of those lists? I fail to understand why he is suggesting that we change current practice in a way that could open the system to abuse and cause concern about the provision of services. What we are proposing exactly mirrors what already exists.

Andrew Murrison (Conservative, Westbury)

It is useful to have the Minister's description of the inspection and audit regime that she envisages. As I understand it from what she has just said, things will not change at all. She has not described precisely what the regime will involve and how one will get on the list. Will somebody from the PCT go around every five years making sure that somebody has a slit lamp in place, or is it more involved? I suspect that it might be, because going to the trouble of becoming involved in a contractual arrangement—that is what these seven clauses mean—and placing duties on PCTs to ensure that organisations and individuals are competent and their premises are up to speed implies a more rigorous regime than currently. If the proposals simply mean having a list that is kept on file on a shelf, we will not get too excited. Clearly, that would not cost much more than the piece of A4 paper and the space on the shelf. A contract implies rather more than that.

The Minister seemed to suggest in her attempted demolition of my amendments that some practitioners may not be competent—that there may be some incompetent practitioners whom she might wish to eschew from the system—and that that is the purpose of drawing up contracts with some and not with others. My question is this: how will PCTs determine with whom they do and do not want contracts?

At the moment, GOS registration is a measure of competence of sorts, and we should have some reliance on that. Those involved are professionally registered individuals. I am not aware of much dissatisfaction with the quality of practitioners in the field. I refer to the figures that I gave the Minister in my opening remarks about complaints to family health services, which identified five out of the 44,000 complaints in 2004, the latest year for which figures are available. That tells a very clear story that there is not a problem—but there is clearly a problem in the mind of the Minister. She has invented one, which is why we have these seven clauses that deal with optometry and dispensing opticians.

Caroline Flint (Labour, Don Valley)

The hon. Gentleman says that I have invented something. What is he referring to? I have suggested to him that arrangements are already in place for ensuring local delivery of national standards, which are discussed with all the professional bodies, organisations and groups, and some require registration with the appropriate council. Clearly there are issues around how PCTs currently carry out their functions in regard to performers entering the list, contractors on the list, inspections and so forth. I would be happy to write to members of the Committee on that point. I have to say that the hon. Gentleman is creating a scare that is totally unnecessary and absolutely irresponsible.

Andrew Murrison (Conservative, Westbury)

I thought that we would have a fairly quiet morning, but this is getting to be quite a heated debate, which is great. I am suggesting that the Minister has invented a problem; I said that right at the beginning. I felt that there was no problem with the range of services, but I expressed my surprise that she should try to find solutions to problems that do not exist, particularly without the benefit of a review.

Caroline Flint (Labour, Don Valley)

Is the hon. Gentleman suggesting that the system under which performers and contractors appear on a registered list with PCTs, which the clauses seek not to change but to reinforce, should be disbanded?

Andrew Murrison (Conservative, Westbury)

Of course I am not suggesting that for one moment. If the Minister has a list, and it simply reflects whether one is registered with the GOC, I have no beef with that at all. I would expect any arrangement with professionals to be with individuals who are appropriately qualified—we will come to that later—and registered. Such individuals would be not just on the PCT list, but on that of the GOC or whichever appropriate registration body.

The Minister, however, is proposing that PCTs enter into a contractual arrangement with individuals or organisations. I suggest to her that that escalates matters substantially. She made it clear that she expects people to be subject to inspection, but she has not given us much more detail other than that things will simply be as they are at the moment. If so, that is fine, although she has not said what audit and inspection regime currently applies.

Andrew Lansley (Conservative, South Cambridgeshire)

I do not understand what the Minister is telling us. As I understand it, up to now, if one is suitably registered, one can be entered on to a list of local practitioners, but one does not have to have a contract with a PCT in order to provide an NHS service. She is proposing that there should be an NHS contract. The question that I do not have an answer to—perhaps my hon. Friend does—is whether it is possible under the Government's proposals for a multiple to be on a PCT list in one place and to be able to offer sight tests across the country without restriction, or whether it would have to have a contract with the PCT in order to do so.

Andrew Murrison (Conservative, Westbury)

My hon. Friend makes an extremely good point; clearly, he is as bewildered as I am. His question, to which I do not know the answer, deals with a specific point. I hope very much that the Minister will clarify that point, and I am more than happy to take an intervention from her if she wishes to respond. However, I see that she remains in her seat, well ensconced.

Caroline Flint (Labour, Don Valley)

I was waiting for the hon. Gentleman to finish. My understanding is that in order to provide NHS sight tests, which are reimbursed by taxpayers' money, it is necessary to have a contract with the NHS. Clearly the performers list may include people who have contracts through the PCT to provide that service, but it may also include those who are suitably qualified to carry out the service within an organisation whose business may not be the provision of such a service per se. My understanding is that to provide the services there must be a contract with the NHS. That seems right to me, and nothing in our proposals changes what has gone before. I presume that at some time there must have been some reason why these lists were thought of in the first place as a way of protecting the public and ensuring good use of public money.

Andrew Murrison (Conservative, Westbury)

The logic of the Minister's argument must therefore be that there should be some central list, because it appears that the issue is a contractual one between individuals or organisations—to take a chain at random, let us consider Specsavers, which has been mentioned before and has operations across the country—and the NHS. Perhaps she would like to explore the possibility that such an arrangement might be agreed nationally, because having not considered it for very long, I can see that there might be definite advantages in that.

We know that the profession is concerned that PCTs might not be competent to run these contractual arrangements; indeed, the National Audit Office was concerned about the ability of PCTs to run dental contracts. We will have to see whether the NAO was correct in its concerns, which we share, because the fateful hour is rapidly approaching. We shall see on 1 April whether all our worries and those of the NAO were well placed. At a particularly difficult time, therefore, PCTs are being burdened once again by a contract that I suspect they do not fully understand, because they have not previously been intimately involved in the delivery of this particular aspect of health care. Like dentistry, it is a bit new to them. We know, courtesy of the NAO, that financial management accounting and contracts are particularly weak areas with PCTs, so we have to be concerned about their ability to take on such contracts. In view of the Minister's remarks she may wish to consider whether the contractual arrangements should be made nationally so as to remove that burden from PCTs.

Nadine Dorries (Conservative, Mid Bedfordshire)

Would it not be simpler for PCTs if the Minister found a way for the Bill to say that they would, in effect, carry out just the administrative process—that every ophthalmic practitioner who provides services to the eligible population will continue to do so in the same way? The Minister has not clarified that sufficiently. The PCT would merely carry out the administrative process in the same way as currently happens from a central location; there would be no cash limitation and no limitation on budgets, and funds would go to the same practitioners as previously; there would be no change in service delivery and accessibility for patients and service users, and no change for service providers; there would just be an administrative process.

Andrew Murrison (Conservative, Westbury)

I am grateful to my hon. Friend for her remarks. She highlights an important point in asking whether there is potential for Ministers to meddle. My answer was that the case for the change is not proven. Our position this morning has been that the range of services is actually well provided and access is of high quality, as evidenced by the complaints figures, which I have already highlighted twice. Every element of the service appears to be functioning reasonably well and providers seem to be happy with it, although improvements can always be made around the edges. Yet here is a sledgehammer of seven clauses bolted on to an inelegant Bill, to address a problem that appears to be more or less a figment of the Government's imagination and for which they are scrabbling round to try to find justification.

We shall support everything that the Minister does to improve quality and access to health services for constituents, but we are not keen on chasing down a rabbit hole after a non-existent problem—which, in all candour, is precisely what it appears to be. The Minister's references to fraud show that she is scratching around to find a rationale for the provisions, yet we have not heard sufficient justification of the costs involved, despite the fact that, contrary to what she has said, costs are a relevant consideration in the context of the amendments.

It may not be profitable for me to pursue the issues of audit and inspection any further, but surely the Minister can see that if she insists on imposing contractual arrangements between elements of the NHS and individuals where at present there are none, and on subjecting them to audit, inspection, quality control or whatever one calls it, there will be an onus on contracting parties to ensure that the quality level goes beyond writing down a list of practitioners and keeping it in a dusty office.

I suspect that that would be the case in law, because there may be arguments of vicarious liability in the unlikely event of an individual deciding that he or she was unhappy with a particular service and saying to the PCT, ''Look, you certified this practice as a good one and you gave it a contract and a seal of approval, and it has let me down, so I'm complaining about you as much as about the individuals who gave me the service.'' Unlike the hon. Member for Stafford (Mr. Kidney), I am not—fortunately—blessed with being a lawyer, but I suspect that that would be the case in law. I expect that there will have to be an increase in the audit and inspection regime as a result of these seven clauses.

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at five minutes to Four o'clock.

Standing Committee E

Health Bill

Eric Illsley (Labour, Barnsley Central)

I remind the Committee that with this we are taking the following amendments: No. 30, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.'.

No. 31, in clause 35, page 32, line 47, at end insert—

'( ) Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.'.

Andrew Murrison (Conservative, Westbury)

Your arrival was impeccably timed, Mr. Illsley. We now reach our final sitting, and I do not know about anybody else, but I am certainly exhausted, notwithstanding the Christmas break. However, we still have many clauses to plough our way through. There is plenty of stuff to get stuck into and plenty to entertain us for the next three hours or so.

We have discussed clause 35 at some length, and it is important that we have done so, because it deals with the significant issue of choice in ophthalmic services. As we said, we are most concerned about the choice element in the seven clauses that deal with primary ophthalmic services. Choice is what we have on the high street now, and our concern is that the Bill will impinge on the choice that our constituents have across this particular spectrum. The Minister probably got the impression that I am very much a fan of ophthalmic services as they are currently configured, and I hope that she did, because I am. That part of what I might broadly define as our health services is well worth emulating, and that is nowhere more true than on the crucial issue of choice and people's ability to go wherever they want.

So far, the Minister has offered a pretty good, robust defence of the Bill and particularly of why it is necessary to introduce the seven clauses. If I am correct, the reasons centre on enhancing the opportunity to provide services and on a concern to address fraud within ophthalmic services. We have discussed fraud to some extent and have asked her to compare and contrast the cost of the administration that PCTs will undoubtedly have to shoulder as a result of these seven clauses with the estimated £10 million of fraud that she is rightly attempting to eschew from the system—I am not sure where that estimate comes from, but it does not sound unreasonable, given the turnover that we are discussing. It is important that we contrast those figures, because it emerged in our deliberations this morning that counter-fraud is one of the cornerstones on which these seven clauses are based. Even at this stage, I hope that she can give us a greater insight into how, or indeed whether, she has compared the money that she hopes to save by removing fraud from this element of health service transactions with the cost that the clauses will undoubtedly involve—the undefined cost that PCTs will apparently have to bear. That will be translated into employing more people to carry the business forward, to do the contracts and the rest of it.

Towards the end of this morning's deliberations, as we were getting into the debate on the amendments—this is the after-dinner part of it—we discussed whether it might be appropriate to have a national contract and national arrangements at least for the sight test. Earlier today, we managed to tease out the difference between the sight test fee and moneys that might arise as a result of the provision of primary ophthalmic services. I am grateful to the Minister for clarifying what we mean by those two things, because they seem to be different in that one is not cash-limited. It is a centrally identifiable sum of money, although it is handled by PCTs, but it is not cash-limited, and that is quite important. That becomes interesting in the context of the basing of the contracts. We can foresee a situation in which a practice exhausts its contractual obligations for any given year and then, as I said earlier, has to sit on its hands for the rest of the year.

Although it is not their principal aim, our amendments would address that situation, because they would ensure that people could choose which practitioner they went to. That cuts both ways: it would also ensure that people were not sitting on their hands for a whole month at the end of the financial year once their practice had discharged its obligations and they had no more work. We have not really heard much from the Minister on that. It has a parallel with the dental contract in one respect, and that is the margin. Last year, in relation to the dental charging regulation, we debated the margin of error that the dentists will be allowed in relation to their contracts. It is rather tight. Just a small divergence from the contract would result in a penalty. The professions will be interested to know what penalties—

Nadine Dorries (Conservative, Mid Bedfordshire)

On dental comparisons, many dentists have chosen not to provide NHS services. In my area, one cannot find a dentist who will treat NHS patients. If that situation were allowed to develop and optometrists and opticians found themselves running out of budget and unable to treat patients, having waiting lists, and experiencing difficulty negotiating with PCTs, they, too, might decide to withhold their services and become solely private providers. Then they would not have any contract with the PCT and would operate, much as dentists do, as wholly private opticians.

We would then find the situation in relation to optical services the same as the one in relation to dental services. Somebody who needs an eye test but cannot afford one might not be able to have it because the opticians will have opted out of the system.

Andrew Murrison (Conservative, Westbury)

My hon. Friend makes an interesting point. At the moment, there is no incentive for that to happen, because the fee is remarkably low for a variety of reasons. One of them is the cross-subsidy between the provision of specs and the NHS test. In fact, one of the beauties of the way in which the system has evolved is that there is no real market. There is a sight test that is well respected; people know what they are going to get when they go for a test and they are content to have it. I cannot imagine that people going to see an ophthalmic practitioner in the high street really differentiate between NHS and non-NHS in the way that they most certainly now do in dentistry. To that extent, the two are not directly comparable, but I understand what my hon. Friend means.

Again, I emphasise that ophthalmic services seem to be a model to be emulated by other parts of the service. They have evolved in a way that—I sound like a salesman for the sector, which I do not mean to be—offers value for money and is incredibly accessible. No other part of our health service is quite as accessible as this one. The Minister will no doubt say that there are walk-in centres, and one can always go to an accident and emergency department to get immediate treatment, but that is not the same as obtaining primary ophthalmic services on the high street. One would have to go to continental Europe to find anything remotely similar in the provision of health services, broadly defined.

That is why we are very cautious about anything that will fundamentally change that element of health care. In that, we appear to be joined by the profession, going by the briefing notes to which the Minister referred earlier. Her reading of them is slightly different from mine, but it appears clear that the profession is very concerned about these changes. We also know that from the evidence of our constituency mailbags. In nearly five years of being an MP, I have not had one complaint about primary ophthalmic services, and we know that complaints about such services form a tiny proportion—a fraction of 1 per cent.—of all complaints received by family health services committees. That is set against the very large number of consultations that are going on year in, year out.

The lack of complaints is our assurance of quality and backs up our position. The Minister did a fine job this morning defending these seven clauses, but she will forgive me if I say that Opposition Members have the imperative on this issue and we are backed in that by the profession and by the statistics and figures, which support our contention that this is a high-quality service, providing what people want. We should not be trying to affect it or to change it fundamentally. We should be trying to emulate it elsewhere in the health service.

Amendment No. 32 was, sadly, not selected, for reasons that I have discussed. However, I am not sure whether I am permitted to mention it in the clause stand part debate. If I may just describe it in general terms—

Eric Illsley (Labour, Barnsley Central)

Order. The amendment has been ruled out of order and not selected. If the hon. Gentleman wants to raise the issues that he intended to raise in relation to that amendment, he will have to wait for a clause stand part debate.

Andrew Murrison (Conservative, Westbury)

Thank you for that clarification, Mr. Illsley. I will raise the amendment as part of the clause stand part debate and I am grateful for your willingness to hear comments on it in that debate, because it is quite important.

May I deal with what I am enjoined to discuss: the three amendments in this group? I hope even now that the Minister may be able to smile favourably on the amendments, which relate entirely to choice. I hope that she will reconsider her remarks about audit and inspection, because she seemed to be quite dismissive of the cost that may be involved, through the PCT, in overseeing her arrangements to do with the contract. It seems counterintuitive to suppose that, if someone enters into a contractual arrangement with a provider, they will not have any obligation to check the arrangement more thoroughly than if they simply have somebody on a list.

I think that we deal with the list in a little more depth later in the Bill and I would be grateful to know what it means in terms of primary care trusts. We maintain that such a list would perhaps be better held centrally, by which we mean nationally. That might be a way of getting around some of the expense that I identified earlier. With that, all that I need to do at this juncture is to withdraw amendment No. 29 and look forward to the clause stand part debate, which I am sure will be exhaustive. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Several hon. Members rose—

Andrew Murrison (Conservative, Westbury)

We are all leaping to our feet. We now come to the bit that I thought we were at. My apologies, Mr. Illsley: my lunch was obviously rather better than I planned and I got ahead of myself in my enthusiasm to get to amendment No. 32. You will recall that that amendment was ruled out of order for technical reasons that are slightly lost on me because I do not have the abilities of the parliamentary draftsmen available to the Minister, or the paraphernalia that supports her performance in this Committee. Essentially, the amendment would insert the following:

''Regulations under section 16CD(4) shall direct that the remuneration paid to providers for each sight test shall be a nationally negotiated fee as agreed from time to time by the Secretary of State.''

The Minister might say, ''Well, that is funny, because the Conservatives are keen on deciding things locally.'' Indeed, there is cross-party consensus that we should, where possible, negotiate things locally. That is right and proper, and it is nice that we should have such consensus, but it might seem a little odd that we should insist on a national fee.

It seemed to me, although I am not entirely sure, that the Minister suggested in her remarks earlier today that, de facto, that is what will happen. I hope so, for a raft of reasons, which we have dealt with to some extent, such as that such a system would get around the problem of different fees being negotiated in different primary care trusts. The Minister said that it was her intention that that should not happen, but admitted that it might. She is vastly more experienced than I am, but it seems to me that it would be strange to rely on her assurance in this Committee that there is a theoretical possibility that a particular outcome might happen, but that it is not her intention that it should. That is unacceptable. We must close such loopholes. That is why we spend hours and days going through the Bill bit by bit, clause by clause, and comma by comma.

In the light of the Minister's earlier remarks, I should have thought that she welcomed the amendment, which you, Mr. Illsley, disallowed for technical reasons. Nevertheless, I recommend to her the burden of what it says. I am sure that she and her parliamentary draftsmen colleagues could craft a form of words that got around that apparent technical difficulty and ensure that the figure is negotiated centrally and will apply to all PCTs, thus getting away from the possibility of competitive advantage and disadvantage applying from one place to another. It would prevent guileful people such as me from getting tests more cheaply in one part of the country and going to another part for their specs, and would prevent the big providers from acting in a similar perverse fashion. I am sure that it is not the Minister's intention that such situations should arise. More particularly, for the public service, it would mean a saving for PCTs. This morning, we rehearsed the argument, which I do not want to go over again too much, that PCTs are overburdened with administrative cost and bureaucracy. They have the dental contract coming in a few weeks. It will be interesting to see what happens with that. The National Audit Office is rather concerned about PCTs' capacities for managing those contracts, and here is another one on which they have to negotiate—potentially on individual terms.

Before I withdraw the amendment that was not selected and which I did not move, if I may make that tautology, will the Minister give some assurance that she hears what I say, that it is categorically not her intention that the fee should be different from one PCT to another and that she will, in some way that she can describe, make sure that that illogicality is not built into the Bill? It seems to us that a central contract administered through the Business Services Authority might be a more appropriate and cheaper way of doing things. It would certainly be a lot more cost-effective in terms of PCTs and in the context of trying to save money. The Minister admitted that she wants to save money on fraud. We need to find savings where we can. We must not, in the course of that, burden organisations with more bureaucracy and cost, thereby diluting any efficiency savings that might be achieved. I am sure that we are all singing from the same hymn sheet on this issue, and I commend our general thinking to the Minister.

There are a few technical points relating to the clause that it was not appropriate to deal with through amendments, but I hope that the Minister will expand on them. Proposed new section 28WB contains no reference to qualifications or registration levels for practitioners, which seems a bit strange. Clause 36, which we will come to shortly, deals with the issue in a little more depth but is really not that specific. This morning, we talked about entering into contracts with various people and the Minister talked about expanding the opportunity for various organisations to provide services. It is important to know about the qualifications and registration of those operating the services, and to know what the Minister is expecting to see.

Across the whole range of medical health services we rely on qualifications and registration, yet these seven clauses seem to be fairly qualification-light. We have not talked much about the differences between the various practitioners, except to get tongue-tied over some of them. It would be interesting to know why the Minister has not felt it necessary to stipulate the qualifications of the various persons who may be involved with the contracts. As far as I recollect, that stands in contrast to the Government's changes in relation to pharmacies. I recall spending a considerable time talking about qualifications in that context. Some comment on that from the Minister would be most welcome.

Proposed new section 28WC refers to the disqualification of persons from entering into a GOS contract, but it does not really tell us much about the grounds for those disqualifications. Are they professional? Are they to do with probity, which the Minister mentioned earlier; with negligence, although the incidence of complaints is very low, so I suspect that that issue would not come up often; or with contractual disputes? If the latter, that is when the provision potentially becomes a little more sinister, because applications for disqualification could be based on organisations that are perceived as being a little difficult. For example, a high street single-handed practitioner might be regarded as more difficult to work with than Specsavers. We seek reassurance about what the Minister means with regard to disqualification, and what the grounds might be for disqualification.

We know that there is an appeals mechanism through a committee set up by the Secretary of State for Health, and that is right and proper, but such a committee would, of course, involve considerable outlay by the appellant, and would mean time, effort, anxiety, uncertainty, and potentially lost trade. It is important to understand the grounds for disqualification, so perhaps a little detail from the Minister might be appropriate.

We have not talked at great length about the cost of the contract. That is strange, because in general when we discuss legislation we are used to having a regulatory impact assessment that goes into that subject in some detail. The Minister has assured us that she does not think that the new arrangements will involve a great cost. The more I think about it, the more I think the costs will be considerable. We are breaking down the contract into a myriad little bits that will have to be individually negotiated and worked through by primary care trusts. It will be new for the PCTs, which will have to set up new structures as a result. That will take manpower time. We all know what happens in such circumstances. Before anyone is appointed, the position has to be advertised. The PCT—the trust in my area is quite small—will suddenly have to take on additional staff to deal with ophthalmic services. That will represent a significant increase in the overheads that PCTs will be expected to shoulder.

Blithely to say that the proposals will be cost-neutral—that it will be a zero cost venture—is somewhat disingenuous. Considerable costs will be involved, and it is appropriate to set them against the £12 million identified as fraudulent, especially as the Minister gave that as the cornerstone for these seven clauses, and one of two reasons identified this morning. If it is so very important to save that £12 million, we need to consider setting it against the costs resulting from the implementation of chapter 2. My ''back of a cigarette packet'' calculations—if I may use such a phrase, given our earlier deliberations—suggest that the cost of the provisions might start to approach that sum. A more reflective assessment by the Minister of the cost of implementing the GOS contract through the continuing myriad of PCTs would be appreciated.

I am grateful, Mr. Illsley, for your indulgence in allowing me to expound at length on the clause. It deals with a number of important issues and I look forward to the Minister's assurances on the points that I have raised.

Nadine Dorries (Conservative, Mid Bedfordshire)

During the break, I had to go to Boots to buy another pair of glasses, because my old ones were not working. The new ones are not working terribly well, either. Frankly, I think I am better off without them. I shall try my best.

Clause 35 empowers the Secretary of State to rewrite the contract between the NHS and ophthalmic practitioners for the provision of general ophthalmic services. It opens up the real possibility of a PCT refusing to enter into a contract with an optometrist, or to vary the contract in such a way as to exclude those optometrists who the PCT feels are not needed. Nothing in the Bill would prevent that from happening.

The Minister has failed to assure us that any qualified optometrist or optician who meets the necessary criteria and who has the appropriate qualifications will be able to provide ophthalmic services on the high street for all those in the local community who wish to use their services. I am concerned about the responsibility of PCTs for commissioning general ophthalmic services. My PCT is running a £20 million deficit. In order to recover that deficit, it is restricting emergency services, which is almost a complete contradiction.

Given those deficits, one cannot help but put oneself in the shoes of a PCT chief executive and wonder how the trust would cope with the additional responsibilities of handling the GOS contract. In the face of increasing demand for ophthalmic services in the community, I doubt whether the PCT would honour the contractual rights of every optometrist and optician. The very nature of the Bill means that, at some time, cash will be limited, and that will enable the PCT to decide to whom it wants to award a contract. I know that the Minister gave some verbal reassurances this morning, but the wording of the Bill will not prevent that from happening.

Taking that one step further, were we a PCT we would try to get the best value for the budget that we were awarded because, if we limited the number of providers the flow of people would be restricted and we would have to start a waiting list. The PCT would not want to have to deal with the possibility of waiting lists for eye care services, so it could be tempted to negotiate the best deal possible with the bigger providers. We could even see the bigger players strategically planning new development and future growth based on such PCT-negotiated deals. I again ask the Minister to give the categorical reassurance that the eligible population will retain access to NHS sight tests at the practice of their choosing in their community—not at the choosing of the PCT, but still that of the patient.

A PCT could make such a choice because it felt that from an administrative point of view handling the process of a small number of claims from a small number of outlets would be easier and far cheaper, and that could be presented to the PCT as an advance in clinical governance and therefore become a quality issue. As we discussed this morning, and I think agreed, patient choice is the driver of quality.

The PCT could decide to put the general ophthalmic service contract out to competitive tender in order to save money and to acquire less volume. Every PCT we know is cash-strapped, almost all are running a deficit and it is easy to see how PCTs could choose to ignore or reprioritise patient choice in the face of financial pressure. After all, they have to take much tougher measures with arguably more vital services. As I said, my PCT is restricting emergency services. The prospect of having to restrict ophthalmic services would be a walk in the park; it would not even break into a sweat faced with that option. It would be easy for a PCT to decide that there were sufficient practitioners in a particular town or high street and that they simply did not need to award contracts to any more. We have not heard anything in Committee today from the Minister that would prevent that from happening. In fact, there is nothing in the language of the Bill to prevent such a scenario.

Were a large provider to be commissioned by a PCT, a similar fate could affect our opticians as has affected post offices or high street pharmacies. As we know, the people who feel the effects of closing post offices and high street pharmacies are the elderly, those in rural locations, the house-bound or those of restricted means. High street optometrists are of significant importance to those groups of people, as are post offices and high street pharmacists.

Optometrists and opticians are not a group of people that one would normally describe as radical or political. They are well behaved caring professionals, carrying out a vital role. However, as my mother-in-law frequently used to say, even a worm can turn. If the budget became cash-limited, if PCTs restricted budgets to optometrists, if not every optometrist and optician could obtain a contract, as they have a right to do now, one could foresee, as I described in my earlier intervention, their finding a way to withdraw their services, as dentists have done. Then, very much like dentists, people would see optometrists and opticians as a political punch-bag, as politically motivated or affected.

At the end of this debate we need to hear from the Minister a guarantee that every practising optometrist, ophthalmologist and optician will be able to practise in future; that they will have a right to the contract, as they have at the moment and have always had; that the budget will not be cash-limited; and that anybody in the community will have access to services, as they have now.

Andrew Lansley (Conservative, South Cambridgeshire)

I want to ask a couple of questions under clause 35, which I do not think we have quite touched on.

Under the general ophthalmic services contract, the primary care trust will be able to contract with providers to provide not only the sight test but other services. There is a relationship between those, in so far as many practitioners offer a range of additional examinations attendant upon a sight test. Dependent upon who is doing the sight test, it varies from a minimum examination to something that is looking for pathology.

My first question is about the extent to which the Government are expecting to specify what the sight test is, using the powers in clause 35. To what extent are they open to looking again in the current consultation at the sight test and, with the Scottish example of an eye examination in mind, at whether it would be appropriate for it to tend more toward pathology, rather than being concerned simply with examining the qualities of somebody's sight?

Secondly, on the structure of payments, what are the Government expecting? If we look at these changes and those for GPs and dentists, the nature of the contracts has varied. All these contracts are concerned to varying degrees with quality, volume and cost. Concerning GPs, they have essentially been about quality and volume. With dentists, they have substantially been about volume. With ophthalmic services, there is a risk that they could be substantially about cost. What is the Government's intention in that respect? How far are they expecting to extend payment by results and the tariff into the determination of contracts for ophthalmic services? To the extent that the Government propose that, it diminishes the opportunity for primary care trusts to negotiate contracts by reference to costs. Can we have some idea about that, or are we simply legislating with no idea of what the regulations will be?

Steve Webb (Liberal Democrat, Northavon)

I want to give the Minister a brief opportunity to place on the record certain assurances regarding the ophthalmic services covered by this clause, which I understand have been given by the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), who is not with us today. Those assurances were about what the contracts cover, and they are headed in a briefing which Committee members may have seen from the Association of British Dispensing Opticians, the Association of Optometrists and the Federation of Ophthalmic and Dispensing Opticians.

I am sure that the Minister is familiar with the meeting that took place between her colleague and that group on 27 October, subsequent to which a letter was written on 8 November by a Mr. Derek Busby, Ophthalmic Services, Department of Health. Sometimes, where assurances are given by officials to professional bodies on behalf of the Government, it is worth ensuring that they are placed on the official record, so that they have greater weight, as it were. The gist of it was that, under clause 35, the new general ophthalmic services contracts will cover three things; essential, additional and enhanced services.

To ensure that my understanding, and indeed that of the professional bodies, is correct, can the Minister confirm, first, that there are essential services that all PCTs—and anyone holding a GOS contract—have to provide? The example given was of sight tests for eligible NHS patients. Secondly, can she confirm that there will be additional services that all PCTs, but not all contractors will have to provide? The PCT must ensure that someone is providing those services, but not all contractors will have to do so. Thirdly, might there be enhanced services? The professional bodies are recommending that those should, again, be covered within the contractual framework. Particular PCTs might judge that those are needed in their area.

Mr. Busby says, of what I have just described,

''This provides a framework for future service development . . . building on the success of the current GOS system . . . ensuring that PCTs have a duty to make sight tests available to meet the needs of their eligible populations on a similar basis to the GOS now''.

I would be grateful if the Minister confirmed that the assurances given to the professional bodies are also her understanding. To quote from one further sentence by Mr. Busby,

''the Bill enables the Secretary of State to define''—

those things that I have just talked about, but it then says:

''(in substance, although these terms are not in the Bill)''.

One is always wary when an official writes to a professional body, saying ''This is what the Bill means, but we don't use those words in the Bill.''

Can the Minister clarify whether these are informal equivalents of what is actually in the Bill, or are there reasons why that language was not used in the Bill and it was not felt necessary to specify that there? Clearly, the professional bodies have been reassured by that letter. I hope that the Minister can reiterate those reassurances and clarify how those things arose.

Caroline Flint (Labour, Don Valley)

I will try to deal with those points, but in some respects I shall repeat points that I made earlier on the purpose of the clauses. Nothing in the clauses is seeking to undermine some of the good ways in which the service is currently delivered.

I have to say to the hon. Members for Westbury (Dr. Murrison) and for Mid-Bedfordshire (Mrs. Dorries)—he is a doctor and she is a nurse—that there has been a lack of understanding, in some of their contributions, of the present arrangements by which those providing services locally have to engage with PCTs.

It is important that the present sight testing system is maintained, but we are trying, through widening the opportunity for PCTs to contract with people, to get around an anomaly that currently exists, whereby dispensing opticians and lay members cannot directly contract for services and take a roundabout route by which a qualified optometrist has to be the link person whom they are employing for the contract. We are trying to make a more open, transparent system in that regard.

The following points may cover a number of the points that were made. We envisage the sight testing service operating exactly like the general ophthalmic service that is currently in use. On patients being able to choose their GOS contractor, there is no way that we are trying to limit the opportunities for individuals to have a sight test under proper conditions wherever they want.

The point was made about contractors being able to have a GOS contract, provided that they meet agreed national criteria. That will be subject, as now—I emphasise as now—to local decisions on matters such as quality of service, including inspection of equipment and premises. Clearly, that is more easily done locally, and it is done less bureaucratically by not necessarily having a national body to inspect the premises and equipment to ensure that they are up to standard.

We will also, as I have said repeatedly, continue to have a centrally negotiated sight test fee and access to sight tests will not be constrained locally by individual PCT budgets. I have said that several times, but it does not seem to have been picked up by the hon. Member for Mid-Bedfordshire.

Andrew Murrison (Conservative, Westbury)

Will the Minister give way?

Caroline Flint (Labour, Don Valley)

No, the hon. Gentleman made a number of points and I should like an opportunity to answer.

Comments have been made about the level of the fee. National negotiations take place on that matter year in, year out, but there is no way that the centrally provided, nationally negotiated fee for sight tests is connected to local provision by PCTs. The clauses ensure that there is a duty on PCTs regarding sight test provision in their local communities—not on a residence basis, enabling someone to go out of their residential area to have a sight test, but on a catchment basis.

Whatever the PCT wishes to do to enhance services or to provide other services—I have given a number of examples of what those services might be—it in no way depends on any link to the fees and reimbursement for the sight tests prescribed in legislation and in regulations and guidelines about who will carry them out and what standard of qualification they should have. I hope that that is clear.

The reality is that at the moment there is no right, per se, for anyone to have the contract—that provision does not exist—so there is clearly some misunderstanding, despite the conversations that Committee members have had with their opticians locally. There is no right, per se, for someone to have a contract to deliver NHS services. On the other hand, there is no right per se, unless the people concerned do not meet standards, for PCTs to deny the contract. That has been explained many times in Committee and I cannot understand why some members of the Committee cannot understand it.

It is important that we deal with the way in which services are to be provided; questions were raised in the previous debate. As to disqualification, regulations, on which we shall consult fully, will set out how that will work. It is likely that possible reasons could be history of fraud and a demonstrated unsuitability to provide a service, such as the use of unqualified staff. There would also be the possibility of an appeal to the Family Health Services Appeal Authority, which is a permanent, quasi-judicial body, with wide experience in the field, to guard against inappropriate application. That should serve as a brake on any PCT in the unlikely event of an attempt to disqualify someone who did not deserve the penalty. As I have said, there will be full discussion of and consultation on that matter before regulations are developed.

As to costs, a regulatory impact assessment is being prepared. There has not been a detailed assessment of costs for the Bill, partly because much of the detail will be in regulations, but, in many respects, the Bill reconfirms the practices that already exist at local level, albeit allowing dispensing opticians and lay members to act directly in the contracting of services. People who currently cannot appear on the contractor list may do so in future, because it will be possible for them to discuss the contracting of services directly, instead of in the roundabout way that has been happening.

I read out the exact figure for optical voucher fraud: about £10 million a year. That relates to patient fraud, not fraud by contractors or opticians. There are, I understand, no figures currently available for the amount of contractor fraud. However, the clauses relating to optical voucher fraud relate to contractor fraud, not patient fraud, and are therefore not directly linked to the £10 million a year. I mentioned earlier that the section or department that considers fraud issues is currently reviewing patient fraud and what more could be done to reduce the figure of £10 million. It has dropped by £3 million since a few years before 2001, but clearly we should like it to be reduced even further.

Andrew Murrison (Conservative, Westbury)

Earlier, the Minister made the important point that the seven clauses are largely based on the need to tackle fraud, and she cited the figure of £10 million. Is she now saying that that relates to voucher fraud and would she therefore agree that the seven clauses are unlikely to affect the £10 million? We are now dealing with a sum of money—presumably several million pounds—that we have little handle on. Having identified the fraud and put a figure of £10 million on it, the Minister is now saying that it was not the fraud she was thinking of, but some other kind. I am even more confused than I was.

Caroline Flint (Labour, Don Valley)

When at the start of our debate I talked about the £10 million of fraud, based on the latest figures, I did refer to patient fraud, because I read it from one of my briefing notes. We also had a discussion about the lists, and the hon. Gentleman spoke, too, about whether a limit would be set on the number of sight tests that could be given. What I said, if I recollect correctly, was that no floor or ceiling has been put on the number of tests that can take place—we will not say that once a certain community has reached 3,000 tests, that will be it. However, if a PCT were suspicious that the number of tests an individual contractor claimed for did not sit with the number of qualified staff able to do those tests—if, basically, the number of tests and the hours available suggested a lack of quality and possibly fraud, because tests were not carried out to a proper standard—it should be able to consider that. If there was some confusion in Committee when the hon. Member for Westbury linked that to the figures I raised earlier, I apologise if I was inadvertently responsible.

If we look back at Hansard I think that we will see that the discussion was about the hon. Gentleman's point on setting any upper limit on the number of tests and why it would be necessary for a PCT to question the number of tests carried out by an individual contractor. It was at that point I gave an example of how somebody could carry out more tests than appropriate for the number of qualified staff, which would link to a concern about the quality of those tests. I hope that I have clarified that matter.

Without discussing amendment No. 32, which was not selected, the principal point that has been made about the NHS sight test fee is whether it should be in the Bill. We do not think that that is necessary, because it is not in present legislation. Everybody is agreed that it is so far, so good, and its not being in legislation has not led to concern about its existence. Hon. Members have said that it is important that Ministers make things clear in Committee and give reassurances. We feel that the fee will continue to be negotiated nationally. It will have a separate budget from anything provided to PCTs and in that sense there will be no change. For that and other reasons it is not necessary to have such a provision in the Bill. It has not been in such legislation before.

To be absolutely clear on the meat of discussions on the clause, at present all clinicians who carry out NHS sight tests are listed with a PCT and all contractors must be listed with each PCT where they provide the service. As now, contractors will be able to have an NHS contract provided that they meet national criteria subject to local decisions on matters such as quality of service and the inspection of premises and equipment. National standards will be inspected locally before a provider can go on the list to have a GOS contract. There could be questions about whether a national contract would ensure quality assurance, because we would have to think about who would carry out that necessary local inspection. I hope that that makes it clear that we are not suggesting a huge leap from where we are now. The debate has allowed us to explore how much more clear and transparent the arrangements should be. A number of members of the Committee are clearly on a learning curve in that respect.

The hon. Member for Westbury raised the question of the payment of the fees and mentioned the NHS Business Services Authority. The Business Services Authority has an established work programme and, clearly, any additions need to be carefully considered. As part of a general discussion we are talking about whether claims for optical payments should be processed by the Business Services Authority, but it would not be appropriate to specify such activity before reaching a conclusion. We are considering the issues alongside our review of which other services could be provided in the community outside of hospitals, closer to where people live.

In drafting the proposal we followed the model provided by medical and dental legislation in relation to essential, additional and enhanced services; the terms appear in regulations but not in primary legislation. We have a duty nationally in what we pay for and provide centrally, which has been the subject of much debate today. The clauses provide the opportunity for PCTs to consider other services that they think are appropriate for the communities that they serve, and it is important that is recognised in the Bill. Alongside that there are discussions on the White Paper on services outside hospital and our review, with the profession and others, of the opportunities and potential for other services to be provided locally, which PCTs might wish to contract.

During the break between our sittings, the hon. Member for South Cambridgeshire (Mr. Lansley) asked me whether a large contractor with a chain of contracts around the country could suggest to PCTs that he would provide other services without any change in the fee. The hon. Gentleman asked whether the PCT would look kindly on that contractor, rather than adding other contractors who could provide on-site services to the list. I hope that reflects the scenario that the hon. Gentleman put to me. My advice is that we would not endorse such a tactic and we would seek to ensure that regulations would prevent that from happening. I was told that it could be illegal, but the hon. Gentleman should not quote me on that; the lawyers will have to look at it. We would not want a large organisation to enter into such an arrangement, which would cause difficulties.

There is no major national chemist or fast-food chain in my mining constituency, or even a major supermarket or bookshop, as hon. Members will see for themselves if they come to Don Valley. Community pharmacies and local stores are very important in such constituencies, as my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) recognises. Many services are amply provided for in some constituencies but in others they do not exist. Therefore, smaller stores and community services are vital, whether or not the health services are involved.

I hope that I have covered most of the points raised, including those mentioned by the hon. Member for South Cambridgeshire. I understand that the sight test will, as now, be provided under the Sight Testing (Examination and Prescription) (No. 2) Regulations 1989. The hon. Gentleman asked whether that could be extended beyond the sight test itself. The powers of the new primary ophthalmic services are to provide services beyond sight tests but there will continue to be an ongoing discussion about the delivery of primary health care and the range of services that can be offered at any one time and—I shall be honest with the Committee—the amount of services that the public purse can afford to provide in a complete package. These discussions will be ongoing in the same way as in 1999 when we decided to extend the free sight test to those over 60, which was removed under the previous Conservative Administration.

Andrew Murrison (Conservative, Westbury)

I am particularly pleased to intervene, because it seems that the Minister was about to make a political point, and we would not want that, would we? As a matter of interest, do the sight test regulations include the need to screen for, say, glaucoma? Perhaps I should know the answer, but I do not. This is important, because most opticians carry out such a test as a matter of course, and I suspect that the Minister, who has referred to the sight test regulations, will know whether the regulations in fact include that need.

Caroline Flint (Labour, Don Valley)

I do not think that they do, but I am happy to write to the Committee on exactly what the sight test regulations cover, if that would be helpful. I think that that is all.

Andrew Lansley (Conservative, South Cambridgeshire)

Tariff?

Caroline Flint (Labour, Don Valley)

On the tariff point, I do not know whether payment by results would apply to these services, but some issues are totally separate. The dental contract, for example, is totally different from the payment by results service. My hon. Friend the Minister of State, Department of Health, has been very forward-looking in getting dentists away from the old system of payment simply for drill and fill rather than considering people's real dental health needs. That will contribute hugely to preventing unnecessary drilling and filling, and will give dentists more of an opportunity to provide a full service. I will write to the hon. Gentleman about that if there are any issues that connect those two areas.

Question put and agreed to.

Clause 35 ordered to stand part of the Bill.

Clause 36 - Persons performing primary ophthalmic services

Andrew Murrison (Conservative, Westbury)

The clause should not detain us for too long. I know that I have said that before, but I really mean it this time.

I am very grateful for the Minister's lengthy exposition of the list held by the PCTs. She said that members of the Committee needed to be educated about the list, and I am very grateful for her attempts to do so. I believe, however, that we are really talking about two lists—I refer to the lists suggested in new subsection (2A).

Lists are obviously important to the clause. The first is a list of practitioners who are qualified, and the second is a list of contractors. Given the importance that the Minister places on lists, it would be useful if she outlined what she means by a list, how one becomes a member of that list, and whether there are indeed two lists, one of which is of contractors who may not be qualified to provide ophthalmic services in the way that I understand the Minister to mean, and the other of which is of persons who are qualified to provide those services as dispensing opticians, as ophthalmic medical practitioners and so on. That is important, because we have spent some time discussing how one might become a member of that list and how one might be disqualified from it, and we need to know which list we are dealing with.

In that context, it would also be useful to have the Minister's clarification of what is driving all this, as she seems to be concerned about the current level of opportunity for dispensing opticians and what she calls lay members to provide those services. Apart from the fraud issue, which we discussed earlier, much of this part of the legislation appears to be driven by the need to enhance the opportunity for the category of people who are lay members or dispensing opticians.

In the context of our discussion on the possibility of opening up the provision of enhanced and additional services to a range of providers, it seems that the Minister is exercised about potential providers that do not have someone who is currently qualified to provide primary ophthalmic services.

If that is the case, the Minister should say so categorically. Perhaps she should also say what representations she has received from organisations that have a lay member or a dispensing optician who may wish to apply for contracts. The whole thing has been driven by their needs rather than by those of the rest of the professions who might deliver primary ophthalmic contracts or by those of patients in particular.

The clause makes reference to medical practitioners who might apply for inclusion in a list and to the fact that regulations may prescribe their qualifications and experience. I could find no reference to regulations that may prescribe the qualifications and experience of dispensing opticians and optometrists; none of that is laid out in the clause or elsewhere in the Bill.

That is strange and I wonder why ophthalmic medical practitioners, which I would understand to mean doctors who are qualified in ophthalmology and who are qualified to carry out primary ophthalmic services, are singled out to have their experience and qualifications defined whereas other professionals in the field are not. I am not making a judgment about whether that is a good or bad thing; I am merely intrigued to know why a difference is being established between those two groups: the ophthalmic medical practitioner, who is essentially a doctor who is additionally qualified, and dispensing opticians, optometrists and so on. It would be interesting to hear the Minister's rationale for that. I am sure that there is a good explanation in addition to her comments about the list.

Caroline Flint (Labour, Don Valley)

As I said earlier, at present PCTs can contract with providers for NHS sight tests only if they are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council.

On the hon. Gentleman's other point, currently there are cases where dispensing opticians employ a qualified optometrist or someone else who is suitably qualified, and PCTs have to contract with individual clinicians. Lay people are in exactly the same situation. All we are doing is making sense of a situation that is already occurring. I gave examples earlier: a qualified optometrist might often provide services at a number of different business service providers. There are issues in relation to the roving person and the contract.

Clause 36 is entitled ''Persons performing primary ophthalmic services''. It aims to ensure that, as occurs in relation to medicine and dentistry, only practitioners on PCT performers lists will be able to undertake sight tests under NHS arrangements. That is because it is important that those who are performing the ophthalmic, clinical service meet the necessary clinical standards and that only professionals who are registered with the appropriate regulatory body and are otherwise fit and appropriate persons can undertake sight testing under NHS arrangements. It is important that that is clear and that we ensure that the regulations, on which there will be full consultation, are clear about it as well.

I come now to the qualifications that will be prescribed for practitioners on the performers list. As now, sight-test practitioners must be registered with either the General Optical Council or the General Medical Council. In the latter case, they must also meet prescribed requirements on qualifications and experience. The qualifications required to carry out either additional or enhanced services will be set out in regulations when the services are determined. The General Optical Council already has powers to establish specialists lists of practitioners who have an interest in a particular area and who have undertaken the necessary additional training, and we anticipate that those lists will provide the basis for the standards required.

The qualifications required of clinicians providing primary ophthalmic services other than the sight test will also be set out in regulations. PCTs must ensure that they contract with people who will be employing appropriately qualified professionals. The General Optical Council has powers, as I said, to establish specialists lists of optometrists or dispensing opticians who have undertaken additional training in particular areas, and we anticipate that optometrists and dispensing opticians undertaking additional or enhanced services would be drawn from the practitioners on those lists.

The clause is about those persons who perform clinical services, and ensuring through regulations and discussions with the appropriate councils and professional bodies that there is rigour in the system to protect public safety and the interests of patients. I hope that deals with the hon. Gentleman's points.

Andrew Murrison (Conservative, Westbury)

I am interested in how the list will cope with locums. Optometrists often do locums. A requirement for them to be on the list will build into the system an inflexibility that may make it difficult to employ locums.

Caroline Flint (Labour, Don Valley)

I am not sure why that would be the case. For example, once an individual is on the performers list of one of the PCTs in Doncaster, they could practise in any part of England. They are not limited in that respect. All things being equal, this one step covers the whole picture. A situation in which a clinical professional had to sign up on every performers list around the country would be ridiculous.

The difference between the performers list and the contractors list is that the contractors have to contract with each PCT area that they cover. In some cases, PCTs work across two PCT areas—that is a separate issue. However, once a clinical professional is on a performers list—whether with the hon. Gentleman's PCT, with your PCT, Mr. Illsley, or with my PCT—they would be eligible to perform services anywhere in England. I hope that that reassures the hon. Gentleman.

Andrew Murrison (Conservative, Westbury)

Indeed it does, but another issue occurs to me in connection with the Minister's elegant explanation of the situation. Can the Minister assure me that a person's disqualification will be articulated throughout the whole of the PCT network, as an optometrist who is disqualified by one PCT could seek to get on the list of some other PCT?

Caroline Flint (Labour, Don Valley)

I hope that that will be the case. There would not be much point in disqualifying someone if they could turn up somewhere else and be able to practise. One would hope that there would be checks and balances in the system such that part of someone's working in an area would involve a reference to the PCT with which they are listed. I cannot explain the detail of how that will happen, but as it is an important point, I will write to the hon. Gentleman about the safeguards that would apply in such a situation.

Another issue is that of disqualification, which, clearly, is a serious matter. In terms of choice and so on, the PCT would also be mindful of the impact on the provider of a service—and, therefore, of provision of the service—if one of its clinical professionals were disqualified. That is another reason why close relationships with the local contractor are important to deal with what I hope will be the relatively rare occasions when that may happen.

My additional information is that there is provision for the Family Health Services Appeals Authority to disqualify a practitioner throughout England and Wales. Presumably, it has mechanisms for communicating a disqualification, and obviously we want to be reassured that, as far as is practicable, it is adhered to. I hope that members will accept the clause.

Question put and agreed to.

Clause 36 ordered to stand part of the Bill.

Clause 37 - Assistance and support

Stephen Williams (Liberal Democrat, Bristol West)

The clause makes primary ophthalmic services alongside primary medical and dental services eligible for the assistance and support that is available under the National Health Service Act 1977. During our deliberations, we have heard several references to the NHS in the high street. Optometrists provide important services—not only basic eye tests but screening for various conditions.

The hon. Member for South Cambridgeshire asked the Minister whether, as part of the eye tests, optometrists should look for such conditions as glaucoma. I think she said that either it was not the case or that she would check. When I met optometrists and other professionals in my constituency, I understood that as part of their professional standards they would at least look for such conditions. Whether it forms part of their contract, I do not know. However, the point is that they do it, and it sends patients on a journey throughout other parts of the national health service to obtain the relevant treatment.

I experienced that journey some time ago when, as part of a routine eye test, the optometrist examining my eyes said that at the back of my eye I had a dark patch that needed to be checked because it could have been something serious. However, she could not refer me directly to the Bristol eye hospital's centre of excellence in my constituency. I had to see my GP and repeat what the optometrist had told me, as my GP did not examine me, although he was able to press the relevant button on his computer and send me down the road to the eye hospital. That procedure is rather strange. It is a shame that in the Government's promised review of the general ophthalmic services contracts, they could not consider such matters. Perhaps they will as part of the consultation.

The Government could take some easy steps to bring the ophthalmic services provided on the high street further into the NHS family of operations. We tabled an amendment—amendment No. 120—to help the Minister, but it was not selected for consideration, so I shall refer to it in general. One way of bringing optometrist services into the NHS family would be to put them on NHSOnline.net, other electronic patient record systems, or on the GP referral system to which I have referred. Provided that the patient gave informed consent, it would help the optometrist to track their patient's progress on their journey through the NHS and enable the eye profession to monitor, for instance, how glaucoma was being treated.

The second part of the amendment referred to payments, suggesting that rather than their being made to and collected by the primary care trust, they should have been collected by the NHS Business Services Authority. I heard the Minister say in her remarks on clause 35 stand part that the Government were thinking about it. However, I should be interested to hear from her whether they have considered bringing optometrist services more closely into the family of NHS services, and particularly IT services, so that optometrists could monitor their patients throughout the different stages of the health service.

Andrew Murrison (Conservative, Westbury)

The hon. Gentleman has made several interesting points. I am not too clear about how relevant they are to the clause; nevertheless, they were well made. He is absolutely correct about referral by GPs to optometrists and optometrists to specialists. On the back of his comments, does the Minister feel that the seven clauses before us will make the process easier? Were it to be made easier, as it is in Scotland without the intervention of such clauses, we would be doing our constituents a great favour because it would make life a lot easier for them. We would be using the ophthalmic professions a lot better, with a consequent increase in job satisfaction for them in feeling that their services, skills and expertise were being adequately utilised. Also, probably equally important, we would save the system a great deal of resources.

I gave the example of my experience of having to take my daughter to casualty in Salisbury to have a foreign body removed. That is the kind of thing that I would probably expect that enhanced services might cover. It would have been far more convenient for me to nip down to Warminster and have the thing removed on the high street, as I am sure would have been possible. We have not really heard from the Minister how she feels that the seven clauses will assist people such as me and my daughter in the removal of a foreign body on a Saturday morning.

What do we mean by assistance and support? I do not understand what that means. I confess to the Minister that I have not ploughed through section 28Y of the 1977 Act. Perhaps I should have done so and if I had perhaps I would not need to ask the question, but as I have not it would be helpful if she could tell me what we mean by assistance and support in that context. It sounds like a good thing, so I am certainly not minded to oppose it, but the explanatory note simply does not make that meaning clear and it is not clear in the Bill. Some explanation from the Minister would be most welcome.

Caroline Flint (Labour, Don Valley)

The clause enables primary care trusts to support providers of ophthalmic services on the same footing as they are able to support doctors and dentists. That is a welcome extension to ophthalmic services' role in the family of services provided in local communities. Consistent with our policy of delegating functions to the front line, the clause gives PCTs a directly conferred function to assist and support providers of primary ophthalmic services in their area. Support and assistance could include financial support and the provision of premises on such terms as the PCT thinks fit. That might be important, particularly if the PCT were trying to encourage service providers to locate in areas where provision of the sight test is not as flexible and accessible as we might wish.

The clause will enable PCTs to increase primary ophthalmic services capacity by giving assistance to establish or extend ophthalmic practice premises to see, for example, more NHS patients if that is required. It could also be used if, for example, practices had some temporary problems, such as sickness or a period of maternity leave, that impacted on their ability to maintain a proper level of service for the patients. As I said, the clause is about creating a first-among-equals situation and putting ophthalmic services in the same category as support for doctors and dentists. In that respect, it should be welcome.

The hon. Member for Bristol, West (Stephen Williams) asked about NHS Connecting for Health. That is important. Our policy for the national programme for information technology in the NHS has always been, and remains, that over time it will embrace all the clinical services in and around the NHS. I think that he would acknowledge—I know this from issues raised in the House—how ambitious a programme it is to connect up even just the hospitals with the doctors and so forth, and so we are doing this on a step-by-step basis. The task is enormously complex and we need to ensure that we get it right. Inevitably, the key core services—the NHS care records service, choose and book, the new national broadband network, and the electronic prescriptions service—have demanded and continue to demand the highest priority, but that does not mean that we have lost sight of where we want to get to in the future. There are lots of factors to consider, not least the compatibility of current IT systems among many different providers of ophthalmic services in an overarching NHS IT system. They have not been forgotten, but it is a matter of making sure we get it right, step by step.

Andrew Murrison (Conservative, Westbury)

The Minister says that they are not forgotten; have they been anticipated? That is important, because we have had a variable assessment of the cost of NHS Connecting for Health—what used to be the NPfIT. I am not sure from what the Minister said whether that need, projected forward a few years, has been factored in to the estimates of cost, which, by my recollection, vary from £6 billion over 10 years to £31 billion over 10 years.

Caroline Flint (Labour, Don Valley)

I can only reiterate what I have said. From the start, it has always been the ambition that once systems are established and the technology is proven to work, all parts of the NHS and the clinical services provided on its behalf should be part and parcel of the same system. At this point, I cannot go into any more detail, but we are cautious to ensure that we carry out the process on a step-by-step basis, and there are a number of priorities in the NHS that we feel we have to deal with first. It is difficult to single out particular practitioner groups within an implementation programme that is developing as we speak.

The hon. Member for Bristol, West was right. I mentioned earlier that consideration is being given to the role of the Business Services Authority in processing payments, but that discussion is still ongoing and has to be weighed up against several other issues. I hope that the Committee will support the clause, as it gives a real opportunity for further engagement with ophthalmic services among the family of health services in our communities.

Question put and agreed to.

Clause 37 ordered to stand part of the Bill.

Clause 38 - Local Optical Committees

Andrew Murrison (Conservative, Westbury)

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.'.

Eric Illsley (Labour, Barnsley Central)

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).

Andrew Murrison (Conservative, Westbury)

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.

Stephen Williams (Liberal Democrat, Bristol West)

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?

Caroline Flint (Labour, Don Valley)

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.

Andrew Murrison (Conservative, Westbury)

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.

Caroline Flint (Labour, Don Valley)

I beg to move amendment No. 112, in clause 38, page 35, line 10, leave out from 'determine' to end of line 22 and insert

'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'.

Eric Illsley (Labour, Barnsley Central)

With this it will be convenient to consider Government amendment No. 113.

Caroline Flint (Labour, Don Valley)

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.

Andrew Murrison (Conservative, Westbury)

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.

Caroline Flint (Labour, Don Valley)

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.

Amendment made: No. 113, in clause 38, page 35, leave out lines 27 to 32.—[Caroline Flint.]

Question proposed, That the clause, as amended, stand part of the Bill.

Andrew Murrison (Conservative, Westbury)

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.

Caroline Flint (Labour, Don Valley)

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.

Clause 39 - Payments in respect of optical appliances

Stephen Williams (Liberal Democrat, Bristol West)

I beg to move amendment No. 80, in clause 39, page 36, line 7, at end insert—

'( ) A description set out under subsection (2) shall include any person unqualified to dispense optical appliances to persons under the age of 16.'.

Eric Illsley (Labour, Barnsley Central)

With this it will be convenient to discuss amendment No. 119, in clause 39, page 36, line 7, at end insert

'which may include persons unqualified to dispense optical appliances to persons under the age of 16.'.

Stephen Williams (Liberal Democrat, Bristol West)

The clause is to be welcomed. We have heard several references today to the need to address fraud in the system, although there have been disputes about the extent of that fraud. The clause is a welcome step towards making sure that PCTs have added powers to put checks in place to make sure that the voucher system is not abused in any way. We have heard from the hon. Member for Mid-Bedfordshire, who has on display an array of spectacles from a variety of outlets. I am sure that they are all bona fide outlets, but I understand that the profession has concerns about unscrupulous providers who may abuse the system, particularly in relation to spectacles that may be bought over the internet.

The purpose of the amendment is to strengthen the clause slightly to make it clear that the only people who are allowed to dispense spectacles to children are optometrists, qualified ophthalmic dispensers and doctors. That builds in a further safeguard that would not only protect children's health, but make sure that the voucher system—it is frequently children who have vouchers for glasses—is not open to further abuse. That is the purpose of the amendment.

Caroline Flint (Labour, Don Valley)

The amendments are alternatives, both of which seek to restrict to registered opticians or medical practitioners those who might receive payment for the supply, repair or replacement of optical appliances. Amendment No. 80 seeks to make it mandatory and amendment No. 119 would create a regulation-making power. I support the hon. Gentleman's general intention. We are committed to ensuring that payments for optical appliances are made appropriately when work has been carried out properly and legally. The law already requires that sales of optical appliances for children and most such sales to adults be made under the supervision of a registered optician or medical practitioner. Our view is that the supervision of sales of optical appliances by a registered dispensing optician, optometrist or medical practitioner offers adequate protection.

As we discussed earlier, businesses might be owned by people who are not members of one of those three clinical professions. So long as they employ qualified professionals to supervise sales, those sales are proper and optical vouchers may be used to make the purchases. I therefore suggest that amendments Nos. 80 and 119 be rejected. However, I understand the concern, which has been rightly voiced, that we should reconfirm the importance of ensuring that qualified practitioners are involved in the sale of those accessories.

Stephen Williams (Liberal Democrat, Bristol West)

I have listened carefully to the Minister. She was fairly conciliatory, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Caroline Flint (Labour, Don Valley)

We intend to make it a condition of receiving payments for optical vouchers that individuals or companies make available records relating to the transaction when required to do so by a PCT. Failure to comply with that condition would be sufficient reason for a PCT to refuse to make payments, as it could give grounds for concern that the money could not be accounted for and that there was, therefore, a clear risk that public funds were being misused. That is an important aspect of ensuring that the vouchers are used in a way that is above board and that the scheme is implemented properly.

Question put and agreed to.

Clause 39 ordered to stand part of the Bill.

Eric Illsley (Labour, Barnsley Central)

There is now a long list of clauses without any amendments, so I shall announce the clause stand part and take them in a group. If any hon. Member wishes to speak to clause stand part on any of them, he should stand so that I can be aware of that, and we will take the preceding group. I hope that that is clear.

Clause 40 ordered to stand part of the Bill.

Clause 41 - Compulsory disclosure of documents for purposes of counter fraud or security management functions

Andrew Murrison (Conservative, Westbury)

I am rather confused. We are nearly there and can tick off the minutes until 7 o'clock, draw a deep breath and go for the final furlong. There is not a great deal in chapter 3 with which we would take issue. Nobody can possibly object to the protection of any part of the service from fraud and unlawful activities. We would certainly support the Government's intention to ensure that lawfulness obtains to the NHS and that we remove fraud wherever we find it. That said, the devil is always in the detail.

When eschewing unlawful activity, there is a danger that we trample over sensitivities that are important, particularly matters to do with confidentiality. As we go through the list of clauses, I will be pressing the Minister to assure the Committee that confidentiality is maintained as a high priority, while respecting the need on occasion to divulge information to appropriate bodies. Where that happens, it needs to be done in a controlled and measured way.

We know from various bits of the public service that when the reins are loosened, sooner or later, because of the size of the public service, we lose control to an extent over that information. That is wrong in itself, but it also gives the public the impression that the system is not copper-bottomed, not—to use another metaphor—watertight. That is to be regretted.

We can think of the incident regarding the Driver and Vehicle Licensing Agency, reported some two or three years ago now, when a rogue individual was able to put information into the public domain and the difficulty that that caused. There have been many other episodes, fortunately mostly minor. That of course was by commission. If we loosen the reins, mistakes will be made. That is inevitable, and material will get to where it should not be, by default. That seems likely as a result of the measures because they give us less of a hold over sensitive information than we had previously. We have to make a judgment as to whether that is acceptable, given our need to ensure that what goes on in the national health service and elsewhere in the public sector is lawful, and to clamp down on fraud, which we understand to be substantial. I would like to hear from the Minister a brief exposition on the extent of the problem that she has identified and requires addressing in chapter 3.

We have just dealt with a chapter in which we suggested that the Government had identified a problem that did not exist and had come up with seven clauses to solve that problem. I am not going to level that accusation at the Government here—broadly, clauses 41 to 52—because we are content that there is fraud within the NHS. We hope that fraud is not rampant, but we accept that there is some in the system. The Government, as a responsible one, will wish to reduce that and to ensure that we get efficiency from our service and that those who are miscreants are brought to book. We will support the Government in that, in a way that we would not necessarily support them in the clauses discussed hitherto. What is important is that we have an assessment of the scale of the problem before we consider whether the remedy proposed, in terms of disclosure, is worth the cost, to put it bluntly.

There are a number of ways in which confidentiality in the NHS is being challenged and threatened all the time. Briefly, we mentioned Connecting for Health—what used to be called NPfIT—and the potential that that has for challenging a guarantee of patient confidentiality. I imagine that the use of Connecting for Health would be considered as part of the measures that the Minister will bring forward to combat fraud and unlawful activities within the NHS. What would be useful in the course of the discussion of the clauses is if the Minister gave us a description of how NPfIT or Connecting for Health might be used or abused in the course of such activities.

In summary, although I broadly welcome the intention behind this set of clauses, I sound a cautionary note. I hope that the Minister will be able to tell us what the problem is and the extent of it, and how by addressing that problem we will not unacceptably damage confidentiality in respect of how sensitive patient records are dealt with.

Jane Kennedy (Labour, Liverpool, Wavertree)

I hope that by having a brief debate on these issues we can answer some of the legitimate concerns that the hon. Gentleman has raised. He has rightly asked us to demonstrate why it is necessary to extend the range of criminal offences and to give major powers to officers of the Counter Fraud and Security Management Service of the NHS in order to counteract the problems that we face.

In general terms, in order to continue to counter fraud in the NHS, and to enable us to continue to take steps to make it a safer organisation to work in, authorised counter-fraud and security management specialists require relevant information to be produced when undertaking investigations. The hon. Gentleman has generously accepted that that is clearly necessary. In the most serious cases, those specialists will work with the police, who may use their powers of entry, search, seizure and arrest. However, it is not always possible to make use of police powers, because of resource issues. In any event, that is often a drain on valuable police time. The proposed powers will be exercised only by highly trained and accredited NHS counter-fraud and security management specialists. They will be able to apply all of their NHS knowledge and expertise to ensure that only material relevant to a particular investigation is obtained by them and that it is retained within the NHS. All obtaining of documents in that way will be supervised by senior officers in the service.

Later clauses introduce specific criminal offences, such as failure to produce a document on the part of those being investigated. Because we take patient confidentiality extremely seriously, we are introducing an offence of the wrongful disclosure or misuse of information obtained in that way, so that it is clearly reinforced to those involved in the process precisely how seriously we take the role that they will play.

Let me describe the extent and nature of the problem. In the brief period of seven years since the CFSMS was created in 1998, the NHS has benefited from an additional £675 million for better patient care, thanks to the work of that service. That highlights the fact that we face a big problem. If that funding is spent wisely, it could be used to pay for five new hospitals—perhaps not some of the private finance initiative projects that are around, but a number of smaller ones—27,000 heart transplants or 170,000 hip replacements. Let me mention some of the types of cases where this wonderful service is having a big impact. It has an annual budget of £14 million. In just one case in the last year—where it detected, intercepted and prosecuted a cartel that was operating in generic drugs—it recovered £16 million from the company involved. Therefore, in just one case it paid for the running of its own service. However, it has been operating in a number of areas. Overall losses in patient fraud have been cut as a result of the work of the service by 54 per cent. from £171 million to £78 million. That comprises an estimated fall in pharmaceutical patient fraud, which is basically prescription fraud. Dental patient fraud has fallen by 48 per cent. and optical patient fraud by 23 per cent. The hon. Gentleman and other Committee members may be interested to learn that fraud committed by health professionals generally has also fallen.

One reason why we probably do not make more of the work of the counter-fraud service is that we acknowledge that the vast majority of health professionals work quite properly and that the thought of committing fraud does not even come into their heads. Sadly, some health professionals do consider committing fraud, but there has been a reduction in losses caused by health professional fraud of between 43 per cent. and 54 per cent.

Dentistry is one example of the way in which the service might change as a result of understanding how fraud has been committed and acting on suggestions. The amount of money claimed for the recalled attendance allowance has fallen from £14.3 million to £6.6 million almost overnight as a result of changing the form by which dentists made claims for that allowance.

This is a very important area of work. I am intensely proud of the work that staff are doing, and I believe that the measures in these clauses are important in enabling them to continue and to develop that work.

The hon. Member for Westbury expressed specific concerns about patient confidentiality. It is important to reiterate how strongly we all share his view. It is essential that any information obtained through the use of these powers is used appropriately. A new criminal offence is to be introduced in later clauses to cover the unlikely event in which information is disclosed inappropriately, thereby adding another tier of protection to ensure patient confidentiality. For example, a counter fraud and security management specialist commits an offence if they wrongly disclose information in an investigation. If they are found guilty of that offence as a result of the changes that will be made later in the Bill, they could be sentenced to a maximum of two years' imprisonment, or fined, or both. Patient record confidentiality is paramount, so inappropriately disclosing information will not be tolerated. The offence will apply to a range of people, including the person to whom the information is disclosed.

The Bill also contains provisions for certain information in certain cases to be required under court order under the supervision of a court, and there are further provisions to enable us to work with the courts to ensure that, where information important to a fraud case is to be presented to the court but where the detail of the information, although anonymised, may lead to a patient being identified, a court may meet in private in a closed session so that evidence can be presented to it but in a way that protects the identity of the patients involved.

I appreciate the concerns that the hon. Member for Westbury has expressed and the way in which he expressed them. He asked me how the national programme for information technology fitted in with the counter fraud work. Many safeguards are in place, but he will have to forgive me in this instance, as I will have to write to him and to other members of the Committee after I have looked into the matter in more detail, because I simply do not have a detailed answer for him now. I will consider specific concerns, and discuss the query with my officials after our considerations today. I hope that I can reassure him about NPfIT in writing after the sitting.

With that rather quick but, I hope, useful broad-brush explanation about why we believe that the powers are important, I hope that members of the Committee will be content to give these clauses a fair wind.

Clause 41 ordered to stand part of the Bill.

Clause 42 ordered to stand part of the Bill.

Clause 43 - Notice requiring production of documents

Jane Kennedy (Labour, Liverpool, Wavertree)

The clause deals with the notice requiring the production of documents and, generally speaking, with disclosure. The crux of our concerns is that this and the next couple of clauses might cause a problem as regards confidentiality and the handling of sensitive data. I am particularly worried by the obligation that the clause places on NHS contractors to disclose. That obligation is important because, under this Government, health services are being used in a more catholic way and without regard necessarily being given to the boundaries between the NHS and the private sector. I welcome that because it is a good thing, but it self-evidently causes difficulties in contractual arrangements.

One difficulty is that we are introducing legislation that might require retrospection. There is currently a large number of contracts with various partners in the private sector, which lay out terms and conditions fairly clearly, and, I imagine, deal with issues such as disclosure. I also imagine that most independent sector providers regard their records as their business and would want to protect their patients' confidentiality as closely as they can—I certainly hope that that would be the case. However, the Bill places obligations on such providers, and my question to the Minister is whether those will be deemed to be retrospective. In other words, will the Bill alter the contractual arrangement that the NHS has with those who provide services in the independent sector or is it simply prospective?

If the Bill is retrospective, that clearly introduces a range of interesting conundrums. Prospectively, it might well alter the way in which independent sector providers view the NHS. Many such providers deal with highly sensitive material on individuals and would clearly want to be absolutely sure that any information that they divulged was suitably anonymised. I would be grateful if the Minister commented on the measures that she will take to ensure that providers are given the confidence that they require to take forward contract negotiations with the NHS. However, I am particularly concerned about any possible element of retrospection.

Jane Kennedy (Labour, Liverpool, Wavertree)

On retrospection, the counter fraud service already has powers to recover losses—even going back over time—where it uncovers fraud and can demonstrate that it has taken place. Where there is evidence that the contractor has abused contracts that have been agreed, the counter fraud service already has powers to recover funds from the organisation that has been defrauding the NHS. Those powers will apply to records—including those created before the legislation—that might be relevant to counter-fraud work. There would need to be clear evidence of fraud, and the vast majority of people engaging in contracts with the NHS have nothing to be concerned about in these powers. However, as I have said, there are already powers to take action. They have been used on many occasions and hundreds of thousands, if not millions, of pounds have been recovered for the NHS through being able to demonstrate that fraud had been taking place.

The new powers will apply to all those who are directly employed and, equally, to all of those contracted to provide medical services to the NHS. By that, I do not just mean the independent sector. All of those who are contracted but whom we do not normally think of as working in the private sector—GPs, for example, opticians, dentists and others—would be counted as such contractors.

I hope that I have given the hon. Gentleman the reassurance that he sought in raising those concerns.

Question put and agreed to.

Clause 43 ordered to stand part of the Bill.

Clauses 44 to 46 ordered to stand part of the Bill..

Clause 47 - Disclosure of information

Andrew Murrison (Conservative, Westbury)

The clause is not particularly controversial. However, I am drawn to subsection 3(d), which refers to ''relevant disciplinary proceedings'' in relation to disclosure of information. I am not sure what that means. Does it mean what one would understand as professional disciplinary proceedings, or does it mean internal disciplinary proceedings related, for example, to some managerial function? Also, at what level are we talking? Is it relatively trivial disciplinary proceedings, or matters that are more serious?

Disciplinary issues may range from relatively low-key stuff, such as stealing a paper clip, to far more heinous crimes of the sort that the Minister described in trying to tell us how much fraud goes on in the NHS. That is obviously big-ticket stuff, so we need to know what is really meant by ''relevant disciplinary proceedings''. In particular, some clarification of the word ''relevant'' would be useful.

Jane Kennedy (Labour, Liverpool, Wavertree)

The hon. Gentleman needs to remember the context within which we expect these powers to be used, because use of the powers will be supervised by senior staff. He may wish to know that the Counter Fraud and Security Management Service already considers the full range of available sanctions as an investigation into a suspicion of fraud, a security incident or a breach commences and as it proceeds. Its objective in approaching the investigation would be to consider the full range of sanctions available to it in the event that the fraud is proven. Disciplinary proceedings clearly fit into that. The bodies referred to could include professional disciplinary proceedings, the General Medical Council, the General Dental Council and others.

Therefore, the hon. Gentleman is right to think that the full range would be considered. However, it is hard to imagine the counter fraud service using such powers in the event of a relatively small case such as the theft of a paper clip. I realise that he used that to illustrate the range, but I seek to reassure him that the expertise and professional approach that the service adopts in bringing cases will inform the nature, scope and range of the documents that it seeks to access and the amount of information available. The information required to be disclosed will only be that which is absolutely relevant and necessary for the case of fraud to be proven.

Question put and agreed to

Clause 47 ordered to stand part of the Bill.

Clause 48 - Special protection for personal records

Andrew Murrison (Conservative, Westbury)

The title of the clause is ''Special protection for personal records''. My understanding is that patient identifiable records would be disclosed only on receipt of a court order. I seek the Minister's assurance that that is correct. I think that she gave such an assurance in her initial remarks. The purpose in my discussing the clause briefly is to seek her confirmation that she shares that understanding of the matter.

Jane Kennedy (Labour, Liverpool, Wavertree)

It is useful to have the opportunity to clarify things. This is so important that it bears repetition—just the once, hon. Members will be pleased to learn. There may be circumstances in which information from personal records obtained under these powers will enable a person to be identified either from that piece of information or if it is combined with other information. In such cases, I acknowledge that special care has to be taken.

Where the information is disclosed for the purposes of any court or disciplinary proceedings, the person disclosing it must take steps to ensure that unless there is a court order the information is not disclosed to any member of the public. However, a party to legal proceedings may apply to the court for the information to be used as evidence in a case. Such a party would have to apply to the court and it would be a decision for the court. The court may agree to this, but to safeguard the identity of the individual, because there is the risk of identification, it may require all or some of the proceedings of that court case to be held in private. I hope that that gives the hon. Gentleman a bit more clarity on the point.

Andrew Lansley (Conservative, South Cambridgeshire)

To be sure about things, may I inquire about two points. The first relates to the inclusion of the words a ''member of the public''. Surely the point is not so much that information should not be disclosed to any member of the public but, from an individual's point of view, that it should not be disclosed to any person for whom it is not essential to the court proceedings. I am unsure what a ''member of the public'' means in this context. Does it mean anyone who is not related to the court proceedings in any way, including NHS staff for example?

I may have missed the answer to my second point, but this seems to be the appropriate point at which to ask the question. Where information from somebody's personal records is produced in connection with such a case, where are the obligations on the counter-fraud service to ensure that it is aware of that? Will it be unaware of that or will there be some provision to ensure that it is aware that the information is being used, and aware of to whom it is being disclosed and for what purposes?

Jane Kennedy (Labour, Liverpool, Wavertree)

The hon. Gentleman asks me to define more clearly what we mean by ''the public''. I want to reflect on the points that have been made because I want things to be right. We mean those not engaged in the case. The information will be anonymised, as I was describing earlier. I am unsure whether he was present then. The information will be anonymised and only that which is absolutely relevant and necessary for the case to be demonstrated will be disclosed.

We are creating a criminal offence of misuse of the information, so that when the officers of the counter-fraud service have the information, there will be a heavy duty on them to ensure that it is dealt with properly and only disclosed appropriately. We are concerned with giving special protection for those who might be identified even if the information is anonymised. We are saying to those involved in prosecuting and hearing cases that they have a duty on disclosure, even if we are talking about anonymous information put together with other information. We think of somebody not directly involved with the case—a court reporter or a journalist in particular—but the provision refers to any member of the public. It is right that we should give the utmost, stringent protection possible in relation to the information. If it is possible that someone will be identified, that is the responsibility of those managing and hearing the case. The court will be invited to consider the circumstances in which the evidence should be presented, with the concerns that the hon. Gentleman has just raised specifically in mind. I hope that that answer gives him the reassurance he seeks. I will reflect on the points raised in order to reassure myself that we have got this absolutely right. I think that we have, but I will consider those points to be absolutely sure.

Question put and agreed to.

Clause 48 ordered to stand part of the Bill.

Clause 49 ordered to stand part of the Bill.

Clause 50 - Offences relating to disclosure or use of information

Andrew Lansley (Conservative, South Cambridgeshire)

I did not have the opportunity to ask this earlier, but I am keen that we should, in each case, ask about the basis for decisions about the level of penalties associated with particular offences under the legislation. Will the Minister explain the choice of penalties used here and whether that decision relates directly to any previous precedent?

Jane Kennedy (Labour, Liverpool, Wavertree)

I am grateful to the hon. Gentleman for asking that question, because I asked the same question. I know that the offences of and penalties for failing to produce documents and wrongful disclosure have been reviewed and approved by the Home Office. Comparable powers to require the production of documents are held by the Audit Commission, Healthcare Commission and Government Departments such as the Department for Work and Pensions, and the respective penalties are broadly comparable, so we think that we have got the balance about right. They are all appropriate for the circumstances to which they apply. The penalties for wrongful disclosure in Healthcare Commission and Audit Commission legislation are broadly similar, and the maximum penalty is the same. I am sure that that is the absolute response that the hon. Gentleman seeks.

Question put and agreed to.

Clause 50 ordered to stand part of the Bill.

Clause 51 ordered to stand part of the Bill.

Clause 52 - Interpretation

Andrew Lansley (Conservative, South Cambridgeshire)

I am sorry, but I have a quick question, which I might have asked earlier, regarding subsection (5). I want to ask about the nature of the special health authorities and to whom the functions are likely to be delegated. The provision further defines who within those special health authorities are the appropriate officers to exercise those functions—this is particularly to do with disclosure and the execution of notices to produce documents and the like. Are we talking about the Healthcare Commission alone or a range of authorities? Perhaps we could have some sense of who they are.

Jane Kennedy (Labour, Liverpool, Wavertree)

I sought to say this in my opening comments. The only officers who will be able to discharge those powers will be officers of the Counter Fraud and Security Management Service, which is a special health authority at the moment, but which will merge with other organisations in the Business Services Authority, but only officers of the CFSMS within the BSA of the NHS will have those powers. As I sought to reassure the Committee earlier, they are highly trained individuals and the use of the powers will be supervised by senior officers in the service. I hope that I have reassured the hon. Gentleman that we take seriously the concerns that he and the hon. Member for Westbury raised this afternoon. I, too, want to be sure that we are taking forward and awarding powers that are appropriate to the nature of the problem, and I hope that I have demonstrated that this afternoon.

Question put and agreed to.

Clause 52 ordered to stand part of the Bill.

Clause 54 - The Appointments Commission

Andrew Lansley (Conservative, South Cambridgeshire)

I do not want to engage in a long discussion about the Appointments Commission. I understand, to a limited extent, what is intended, and I welcome it. It should establish greater independence as to appointments across many NHS functions. However, I want to be sure, as we begin consideration of the next few clauses, about the nature of the process that the Government are entering into.

In particular, I am looking for a sense of the basis on which the Government will appoint the Appointments Commission, as it were—what sort of criteria they are looking for, and when and how they propose to go about the task. There is also the matter of foundation trusts, but that is in a separate clause and it might be simpler to leave it until later. At present I am really interested in the process of transfer between the NHS Appointments Commission and the new Appointments Commission, as well as the opportunities that that will give Ministers for recasting the membership of the Appointments Commission, or alternatively the extent to which the existing NHS Appointments Commission structure may continue into the new body.

Caroline Flint (Labour, Don Valley)

This and the other clauses are relatively uncontroversial, but in some ways they reflect the current workings of the NHS Appointments Commission. Hon. Members may be aware that in its 2003 report the Public Administration Committee said that other Government Departments could benefit from its skills and expertise. Therefore, the clause establishes a new body, the Appointments Commission, as an executive non-departmental public body and abolishes the NHS Appointments Commission, which the new body will replace.

The Secretary of State will appoint the chairman and non-executive members of the board. The chief executive and executive members will be appointed by the chairman and non-executive members. The members themselves will appoint a vice-chairman. At least one, but not more than four, of the non-executive members must be appointed to the health and social care appointments committee. I shall write to the hon. Gentleman in more detail about the different transitional arrangements, if that will help.

Obviously, the appointments by the Secretary of State must be made in a transparent and open way that is fully in line with appointments by Secretaries of State in other Departments. However, the setting up of the new body provides scope for other organisations across Whitehall, but also the foundation trusts, to which we shall come later, to use its services. I hope that that reassures the hon. Gentleman. I shall write to him in more detail about transitional arrangements.

Schedule 4 - The Appointments Commission: Supplementary

Clause 57 - Commission to exercise Privy Council's appointment functions

Andrew Lansley (Conservative, South Cambridgeshire)

I just want to ask whether the bodies to which the appointment function particularly refers, which are those listed in schedule 6, have made any representations in relation to the transfer of the appointment functions to an Appointments Commission. I must confess that from my recollection of such matters in the Cabinet Office, the Privy Council appointments process is not necessarily one to which I would wish to have myself subjected as one of the bodies. However, they might have an attachment to it born of a sense of the independence of the Privy Council office as distinct from governmental appointments. I would be surprised if they had any objections, but it would be useful to know whether there were any objections to the transfer of the long-standing arrangement.

Caroline Flint (Labour, Don Valley)

To clarify the situation for the hon. Gentleman, the Privy Council has powers to direct the NHS Appointments Commission to exercise all or part of its functions relating to specified appointments to the health profession's regulatory bodies. In directions of 10 February 2005, the Privy Council directed the NHS Appointments Commission to exercise all its appointment functions relating to the General Chiropractic Council, the General Osteopathic Council, the Health Professions Council, and the Nursing and Midwifery Council. The directions also specified particular appointment functions for the General Medical Council, the General Dental Council, the General Optical Council and the Royal Pharmaceutical Society of Great Britain. The clause gives the Privy Council the same powers to direct the new appointments commission to exercise all or part of the powers that it previously directed the NHS Appointments Commission to provide for. I am not aware of any concerns from any of the bodies that I have mentioned about that function being carried out. If I am wrong about that, I will ask my officials to check and will get back to the hon. Gentleman.

Question put and agreed to.

Clause 57 ordered to stand part of the Bill.

Schedule 6 agreed to.

Clauses 58 and 59 ordered to stand part of the Bill.

Clause 60 - Commission to assist other bodies with appointments

Andrew Lansley (Conservative, South Cambridgeshire)

I am quite interested in this matter, not least because Papworth hospital foundation trust is in the throes of appointing a new chairman. In discussion about the process, I was interested to learn that the trust was not in a position to use the NHS Appointments Commission as a structure to assist it. From that point of view, it would have been helpful if the provision had already been in place to allow that to happen. I do not know what is available on an informal basis to help.

Can I take it that in the not-distant future hospitals across the country will be able to use the commission in the appointment of chairmen and other non-executive directors, although they will be under no obligation to do so? If they use the commission, will they be able to do so on the basis that it will be able to undertake such advisory and other arrangements as they determine? Will it have to delegate the functions or will it be simply advisory? If they use the commission, how will the financing work? We have just approved the schedule that allows the commission to be funded by the Government. Does that extend to the commission being able to undertake advisory activities and support the appointments of foundation trusts in a way that is subsidised from the support to the commission, or will such activities be rechargeable back to foundation trusts?

I take it that the fact that foundation trusts can use the commission does not mean that they will be required to do so. Can we have it on the record that the boards of governors of foundation trusts will have the discretion whether or not to use the commission to make such appointments?

Stephen Williams (Liberal Democrat, Bristol West)

The title of the clause is ''Commission to assist other bodies with appointments'', and something occurred to me while we were cantering through. We all subscribe, I am sure, to patient involvement in the NHS. I regularly receive from various bodies the minutes of the two patients forums that scrutinise the work of the two primary care trusts that cover my constituency as well as the two acute trusts. Often those meetings discuss important matters and are seen as valid consultation of the community, but they are sometimes thinly attended. Clearly, the chair of the organisation is a lay person and has important role in the community. It is not clear how such chairs are selected or screened. Is it envisaged that the new NHS Appointments Commission will have a role in making sure that the chairs of the various patients forums that undertake such important work have gone through a process? Perhaps the Minister will write to me. Will the patients forums receive advice to make sure that they recruit their chairs openly so that anyone from the community can apply and take part?

Caroline Flint (Labour, Don Valley)

I hope that I can clarify the position. Under clause 60, the commission can in future enter into arrangements, contractual or otherwise, to provide boards of governors of foundation trusts with such assistance or support as they may request when appointing chairmen and non-executive directors. The board of governors of the foundation trusts will continue to make the appointment. Such matters have arisen from recent discussions when, for example, the NHS Appointments Commission has sometimes been asked to provide recruitment and other advice not only to organisations such as Monitor but to Government Departments. The facility will give powers to the commission to provide such services, but it will be up to the foundation trust to decide whether it wants an assessment of the services that it provides.

The facility will be on a cost-recovery basis, so the foundation trust, for example, would be charged. However, providing the service will be non-profit making.

Andrew Lansley (Conservative, South Cambridgeshire)

I wish to satisfy my curiosity. The Minister will recall that, under the 2003 legislation, there are circumstances in which Monitor, the independent regulator of foundation trusts, can step in and replace executive directors. If I recall correctly, other members of the board of directors of a foundation trust may be chairmen or non-executive directors. If Monitor steps in, is it required to use the commission or could it exercise the powers of the board of governors under its special measures regime?

Caroline Flint (Labour, Don Valley)

I understand that it is not a requirement for Monitor to use the NHS Appointments Commission, but it can seek its support and advice. Clearly, in its own right it has its own rules and responsibilities as a regulator for NHS foundation trusts and powers to enable it to carry out such work.

I shall write to the hon. Gentleman about the governance of boards of foundation trusts rather than prolong this afternoon's proceedings.

Stephen Williams (Liberal Democrat, Bristol West)

Patients forums.

Caroline Flint (Labour, Don Valley)

Sorry; patients forums. I shall check Hansard to make sure that the hon. Gentleman receives the accurate information that he requested.

Question put and agreed to.

Clause 60 ordered to stand part of the Bill.

Clauses 61 to 66 ordered to stand part of the Bill.

Schedule 7 agreed to.

Clauses 67 to 69 ordered to stand part of the Bill.

Clause 70 - NHS costs recovery

Andrew Lansley (Conservative, South Cambridgeshire)

We have shifted to a different subject. The Minister will no doubt have text that explains the clause better than I can. I recall the discussion that we had on the 2003 legislation about the extension of NHS costs recovery, which has not been brought into effect. If I remember correctly, the previous provision, which was for the recovery of costs when road traffic accidents gave rise to NHS treatment and there was an insurance policy in place that enabled a liability to be met by the insurers, was to be extended in the 2003 legislation to personal injury claims. In effect, it was likely to apply mainly to occupational health-related claims and the like.

My memory is that the Government legislated for that cost recovery in 2003 and subsequently consulted on the nature of it. In the course of that consultation, problems emerged about the precise circumstances in which costs could be recovered. The explanatory notes help us by stating

''contributory negligence to be taken into account''.

The previous legislation simply would not have enabled the recovery amount to be varied.

We expressed concern once about the extent of the liability that was likely to emerge for businesses more than once in the course of the discussion on the 2003 legislation. It has not been my responsibility since, but I am aware that since 2003, and particularly during 2004, there were substantial increases in the cost of employers' compulsory liability insurance. In fact, many insurers found that they were doubling or tripling it. I shall not rehearse the ways in which the Government have tried to respond to that, not least because I do not precisely remember them all. They have intervened since the 2003 legislation through such things as the Office of Fair Trading investigation to determine whether there were any difficulties in the marketplace. Also, the Department for Work and Pensions had a review, the purpose of which was to work with the industry to try to offset the rising costs.

All of that is slightly by the way. The point is that the Minister with responsibility for small business, who is one of the relevant Ministers in the Department of Trade and Industry—the Minister knows who I mean—made it clear that the Department would not introduce this additional imposition on businesses until such time as the problems associated with the rise in employers' compulsory liability insurance and the cost that that would impose on businesses had been resolved. I believe that it was the hon. Member for Edinburgh, South (Nigel Griffiths), who is now the Deputy Leader of the House of Commons, who said that. I do not think for a minute that those problems have been resolved.

I know enough about my friends in business representative organisations, whether it be the Federation of Small Businesses or the British Chambers of Commerce—I declare a past and current interest—or others. They would tell us that employers' compulsory liability insurance continues to rise. The market is much more difficult for businesses than it used to be and, notwithstanding the fact that this part of the Bill will somewhat ameliorate the total extent of the increase in costs that businesses have to bear, we are looking at a substantial further increase in the charges that will have to be met through personal liability insurance. That will have an upward impact on premiums.

I do not have the regulatory impact assessment in front of me, but I am sure it will say that that is not a problem because the Bill reduces the amount that is recovered overall from businesses. However, it is a problem, because we have been holding off—I say ''we'' advisedly. The Government have held off introducing this additional cost recovery scheme because of the problems that business is experiencing. I want to know why they are not continuing to do that. It is clear from what the Minister said that they propose to introduce the measure in 2006. She might be able to confirm the date, but I thought that it was fairly soon. I reiterate our concern that it should not be introduced, with the resulting additional increase in premiums, unless and until the problems in the business sector about access and the cost of employers' compulsory liability insurance have been resolved.

Caroline Flint (Labour, Don Valley)

In relation to the hon. Gentleman's detailed points, and the comments that he ascribed to one of my ministerial colleagues, I will seek guidance on the issue and on its relevance and impact—

Andrew Lansley (Conservative, South Cambridgeshire)

To avoid uncertainty, may I say that the Minister of State, Department of Health, the hon. Member for Doncaster, Central may even have said herself that she would not introduce the proposal until these matters had been resolved in consultation with the Department for Trade and Industry.

Caroline Flint (Labour, Don Valley)

I will seek to verify the situation in that respect. In relation to the clause, it was proposed because, following the 2003 Act there was still considerable discussion and consultation about whether it provided adequately for contributory negligence to be taken into account in a wider range of cases, which did not just involve court processes.

The proposal will retain option A of section 153 of the 2003 Act, but will expand option B so that any form of non-court based negotiated settlement, which has formal recognition of contributory negligence, can qualify for a similar reduction in independent complaints reviewer charges, not just mediation. For example, arbitration or a settlement negotiated by solicitors or insurers without recourse to the courts, or even just agreed between the parties themselves rather than their representatives, will be acceptable. That is important because I understand that more than 90 per cent. of personal injury claims are resolved without going to court. The proposal will greatly increase the number of cases in which contributory negligence can be taken into account. The hon. Gentleman took the words out of my mouth.

Contributory negligence recognises that the individuals themselves played a part in the injury that they sustained and thus should be welcomed by business interests since it would, I hope, logically result in compensators having to pay less in NHS charges in many more cases in which contributory negligence is accepted as a factor in the primary compensation claim.

As I said, I will verify the other issues that the hon. Gentleman raised. Rather than re-open the 2003 discussions, which led to the Act, the proposals tackle areas that should have been tackled earlier.

Question put and agreed to.

Clause 70 ordered to stand part of the Bill.

Clause 71 - Transfer of criminal liabilities of certain

Andrew Murrison (Conservative, Westbury)

I beg to move amendment No. 23, in clause 71, page 54, line 17, leave out 'which may be' and insert 'that will be'.

Eric Illsley (Labour, Barnsley Central)

With this it will be convenient to discuss the following amendments:

No. 24, in clause 71, page 54, line 28, leave out 'which may be' and insert 'that will be'.

No. 25, in clause 71, page 55, line 2, leave out 'which may be' and insert 'that will be'.

No. 26, in clause 71, page 55, line 9, leave out 'which may be' and insert 'that will be'.

No. 27, in clause 71, page 55, line 14, leave out 'which may be' and insert 'that will be'.

No. 28, in clause 71, page 55, line 19, leave out 'which may be' and insert 'that will be'.

Andrew Murrison (Conservative, Westbury)

We now enter the final furlong of the Committee stage. The clause is particularly welcome; the amendments simply beef up the wording, which places obligations on organisations to have their liabilities transferred. The wording seems to me to be permissive rather than obligatory. The amendments would beef up the wording so that the liabilities were transferred.

We are discussing criminal liabilities in the context of NHS bodies, but it is worth pointing out that the Government establish, disestablish and merge NHS bodies at a phenomenal rate and it is particularly welcome that they should ensure that when they do so, the bodies' liabilities are transferred to successor organisations.

Many of us who have witnessed the demise of various health authorities in the past few years will bear witness to the fact that once the bodies are dissolved, their sins of omission and commission often dissolve with them. I have had a five-year quest to find out why certain things have gone wrong with my own local health care economy. The common factor appears to be a health authority that has long since dissolved and the persons associated with it dispersed. To be perfectly honest, trying to pin anything on the authority is a bit like trying to nail jelly to the wall. Any measure that helps us to transfer liabilities of any sort from one NHS body to another is to be warmly welcomed. The case in question is clearly a criminal matter.

It would be nice to hear the Minister say that liabilities in general should be properly transferred when bodies disestablish, merge or close down. Given the rate at which such bodies appear to be doing just that, it is important to retain the audit trail so that we can attribute things when they go wrong. That goes for bodies and, in the context of proper management, individuals. Since I have been a Member of Parliament, dealing with my local health care economy has been a source of great frustration. I welcome the clause to the extent that it helps us attribute things properly. I hope that in that spirit, the Minister will accept our amendments.

Caroline Flint (Labour, Don Valley)

The need for clause 71 arose following a Court of Appeal ruling in the case of R v. The Pennine Acute Hospitals NHS Trust, formerly Rochdale Health Care NHS Trust. In that case, the Court held that the general power in paragraph 30 of schedule 2 to the NHS and Community Care Act 1990 to transfer property rights and liabilities on the dissolution of an NHS trust did not include the power to transfer criminal liabilities. The Court stated that if it was the intention to transfer criminal liability, the legislation should explicitly say so.

There were clearly issues surrounding the perception that the powers transferred criminal liabilities. In a test case the judge decided that they did not, and that is why we have brought forward this clause. I have had discussions with officials about its wording, and when we were considering the issue and addressing the problem highlighted by the Court of Appeal, we thought that it might be necessary to provide a power to transfer criminal liabilities only for those NHS bodies that deliver front-line services—those bodies that could realistically face criminal prosecution in connection with the front-line services that they deliver to patients.

In the case of a strategic health authority, for example, it was difficult to envisage a case in which it might face criminal proceedings about patient care. However, as our thinking developed, we thought that it might be necessary to transfer the criminal liabilities of a front-line body to a strategic health authority when there was no logical or obvious successor to which the powers could be transferred. It means that in the course of natural justice for individuals, any such liabilities that might be transferred to a strategic health authority are similarly transferred onwards in case of its own abolition or dissolution, thereby ensuring that the liabilities are always retained in the NHS.

If the Committee has managed to follow me, it would not normally be necessary to transfer a strategic health authority's criminal liabilities on its abolition, hence it is right to make the provision a power rather than a duty. When an SHA has inherited criminal liabilities from another NHS body delivering front-line services, the power can be used to transfer them onwards in the event of the SHA's abolition.

It has always been the Department's intention to transfer the criminal liabilities of NHS bodies on their abolition or dissolution, because we want to ensure that public accountability for any criminal offence is retained in the NHS. I hope that the hon. Member for Westbury agrees that the very fact that we have brought forward the clause shows our intention to transfer such liabilities. That is the Department's intention.

The second reason why the provision should be framed as a power rather than a duty is that it falls in line with various pieces of health legislation that provide the Secretary of State or the National Assembly for Wales with a power to transfer the property rights and liabilities of an NHS body to another NHS body on the former's dissolution or abolition.

The slightly unusual nature of the liability in question means that it is sensible to have a power rather than a duty. The Court of Appeal made it clear in its ruling that criminal liabilities were somewhat different in nature to other, general liabilities. However, I think that we are all agreed that we certainly do not want to create a situation in which people who are the victims of criminal offences lose out on justice just because an organisation is dissolved or reorganised into a different body.

Andrew Murrison (Conservative, Westbury)

I thank the Minister for that. Of course, I accept that criminal liabilities are very different from general liabilities. I have no doubt that that is the case. I accept the explanation that she has given and I hope that she will accept my more general point about the transfer of general liabilities, because it is important. With her reassurance, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 71 ordered to stand part of the Bill.

New Clause 8 - Amendments relating to Local Health Boards and abolition of Welsh health authorities

Caroline Flint (Labour, Don Valley)

I beg to move, That the clause be read a Second time formally.

Eric Illsley (Labour, Barnsley Central)

With this it will be convenient to discuss Government amendments Nos. 138 to 140.

Andrew Murrison (Conservative, Westbury)

I am slightly surprised that the Minister did not speak to the new clause because these are Government changes and I thought that the Minister might like to explain why she is introducing them at this stage. I would have liked her to do so.

Caroline Flint (Labour, Don Valley)

New clause 8 and related minor amendments Nos. 138, 139 and 140 allow the Secretary of State or the National Assembly for Wales to make orders by statutory instrument to deal with out-of-date references to health authorities in legislation. Since the establishment of PCTs in England and local health boards in Wales, there are no longer any health service bodies called health authorities. The order-making power will enable statutory references to be updated. Such an order could be used to reflect the fact that, since the abolition of health authorities in Wales, most of their former functions have been delegated to local health boards. If the Assembly were to decide to withdraw that delegation in future, the order could substitute a reference to the Assembly in place of a reference to a local health board. These are technical changes to update the language used.

Andrew Lansley (Conservative, South Cambridgeshire)

Did the Government consider using the Government of Wales Bill for that purpose, rather than this Bill? It seems slightly odd to bring the matter forward at this stage when there is another legislative vehicle available.

Caroline Flint (Labour, Don Valley)

Section 27 of the Government of Wales Act 1998, contained an order-making power that enabled the National Assembly for Wales to make consequential amendments to legislation when health authorities were abolished in Wales. The power was not used when that occurred, and I am advised that it can no longer be used: it is spent. I hope that that adequately answers the hon. Gentleman's question.

Andrew Lansley (Conservative, South Cambridgeshire)

It only reinforces the question. Since there is a Government of Wales Bill being considered on the Floor of the House and Government of Wales legislation previously seems to have been appropriate for this purpose, it seems that it would have been more appropriate to use that legislative vehicle, thereby giving greater notice of the measure, rather than introducing it in the Committee on this Bill.

Caroline Flint (Labour, Don Valley)

The opportunity was taken to deal with the matter in the Health Bill. As I say, it is technical matter and just refers to changing the terminology relating to health boards. We need to do that now in the context of the consolidation Bills currently being prepared.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

Clause 53 - Accounts and Audit

Andrew Lansley (Conservative, South Cambridgeshire)

I have one question. I understand that NHS bodies can establish non-charitable trusts to hold property assets. However, paragraph 11 of schedule 8 makes it clear that they are not to be included in summarised accounts. It is not inconceivable that the property assets of non-charitable trusts of NHS bodies could in future have such a volume of assets that it would be necessary to understand the overall balance sheet position of an NHS trust.

It being Seven o'clock, The Chairman proceeded, pursuant to Standing Order 83D and the Order of the Committee [6 December] to put forthwith the Question already proposed from the Chair.

Question put and agreed to.

Clause 53 ordered to stand part of the Bill.

The Chairman then proceeded to put forthwith the Questions necessary to dispose of the business to be concluded at that time.

Schedule 3 - New Schedule 12B to 1977 Act

Clause 75 - Orders and regulations

Clause 76 - Amendments, repeals and revocations

Schedule 8 - Minor and consequential amendments

Schedule 9 - Repeals and revocations

Clause 79 - Commencement

Clause 80 - Short title and extent etc.

Andrew Lansley (Conservative, South Cambridgeshire)

On a point of order, Mr. Illsley. May I express our appreciation to you and your fellow Chairmen for the manner in which you have conducted our proceedings? We on the Opposition Benches appreciate the manner in which the Committee has discussed the Bill's provisions—it seems to have been more for elucidation than for argument's sake. We have exposed a range of important issues. In fact, we discussed nearly all the issues in the Bill—about 10 of them—and although one or two may have had greater prominence, I hope that they all will make a contribution to the management of the NHS—and more particularly to the health of the people of this country.

We appreciate the support from which we occasionally benefited that the Minister received from parliamentary counsel and departmental officials. Once again, all members of the Committee are very much in debt to the Clerks, and to the attendants and the police who look after us.

Personally speaking, I should like to express my appreciation to my hon. Friend the Member for Westbury (Dr. Murrison). I may have come and gone from time to time, but I value his work immensely; whenever I have heard it, I appreciated his heavy lifting on the Bill. I say thank you to him, and I conclude my point of order on that note.

Stephen Williams (Liberal Democrat, Bristol West)

Further to that point of order, Mr. Illsley. I also thank you for your friendly chairmanship of the Committee and particularly for your liberal attitude to dress code. I wish that gentlemen did not have to wear their jackets at all times in other parts of the House of Commons.

We have had 12 sittings. The smoking part of the Bill occupied us and perhaps involved our most lively discussions, and we shall look for further changes when the Bill comes back to the Floor of the House. None the less, the infection control issue and other aspects of the Bill turned out to be more interesting than I had expected; I have certainly learned a lot in my new role as I have helped the passage of the Bill.

This is the second Standing Committee on which I have served. As I have mentioned a couple of times, my professional background before I came here was in tax, so the Liberal Democrat Whips put me on the Finance (No. 2) Bill Committee within two weeks of my arrival at the House of Commons. That was certainly a baptism of fire. However, despite my former profession and my interest in tax, this Committee was much more interesting. Perhaps that will not surprise those who have had or will have the joy of sitting on Finance Bills.

When there have been lapses in concentration—not necessarily during the heavy lifting by the hon. Member for Westbury; maybe at other times as well—I noticed that some Committee members were able to address copious amounts of Christmas cards. One managed to address an entire suitcase-full. Some did crosswords and Sudoku.

Appropriately, I have chosen to wear my glasses today so that I can take one last look at the fine painting of Gladstone's first Cabinet. That was the subject of my undergraduate dissertation, a copy of which I have had at home for the past 17 years. Every time I go home, I shall now be reminded of my enjoyment of my time on this Committee.

Caroline Flint (Labour, Don Valley)

Further to that point of order, Mr. Illsley. I thank you, Mr. Caton and Lady Winterton for your services to this Committee. There have been occasions on which the rota has been in disarray and we have had to look for our Chairman—you have always come to the fore, Mr. Illsley.

I thank the Clerks, the attendants and the police officers for their management and support of the proceedings and my own officials from the Department, who have been very supportive on a number of occasions. I also thank my hon. Friends who have acted as Parliamentary Private Secretaries. They have passed me many notes, as and when I have needed them. I also thank my right hon. Friend my fellow Minister for her support.

In this Committee, I have crossed swords with the hon. Member for Westbury for the first time. I was not in the Room at the time—my right hon. Friend was involved in the proceedings—but I believe that once, when the hon. Gentleman was making a contribution, he turned round to see whether there were any Committee members on his side, only to find that absolutely nobody was there.

It has been an interesting Committee. One party leader has been anointed, while another—I cannot see any knives in Gladstone's back in the painting mentioned by the hon. Member for Bristol, West—has been given the heave-ho. The Committee has not been without its moments.

We were working very hard on the last day before the Christmas recess. My right hon. Friend and I tried to bring a bit of flavour to the Committee with our lapel decorations, borrowed, I have to say, from the Christmas tree in the Members' Tea Room—and sent back afterwards. I was disappointed that the flashing Christmas tree badge brought in by my hon. Friend the Member for Lincoln (Gillian Merron) did not work when required to do so. However, I thank her for all she has done to support all Labour Committee members and for making sure that proceedings have run properly.

We have covered a huge number of areas. We have had some incisive discussions and debates; I have certainly been put on the spot and challenged, as is right. We have gone through the right process to make sure that all areas are given the scrutiny that they deserve. The Bill covers many aspects of health care, each of which is important in its own right, and it will add to the development of health services in England. I thank all members of the Committee for their contributions.

We learned a lot about individuals. We learned that the hon. Member for Bristol, West is single—I do not know whether he is still single after Christmas—

Stephen Williams (Liberal Democrat, Bristol West)

Sadly so.

Caroline Flint (Labour, Don Valley)

Sadly so, but a Committee always offers an interesting opportunity to get to know hon. Members just a little better than we sometimes do on the Floor of the House. I thank everybody for that.

Eric Illsley (Labour, Barnsley Central)

On behalf of my fellow Chairmen, I thank hon. Members for their kind comments. In relation to the comments of the hon. Member for Bristol, West, I did not see anybody signing any Christmas cards. I could well need the optician that the hon. Member for Mid-Bedfordshire visited during today's break.

Let me quickly add my thanks to the Clerk, John Benger, who has done my heavy lifting throughout the Committee, and to his assistant, to the Hansard writers, to the attendants and, of course, to the police for their assistance during the Committee stage of the Bill.

Bill, as amended, to be reported.

Committee rose at eleven minutes past Seven o'clock.