Children: Visual Screening (Hansard, 15 January 2003)

§ Baroness Andrews
My Lords, the National Screening Committee is awaiting a report from its child health sub-group. On the basis of that report, the committee will make its recommendations to Ministers. We will consider any improvements to visual screening in the context of the national service framework for children.

§ Baroness Knight of Collingtree
My Lords, will the noble Baroness make urgent inquiries about the report, since there is widespread concern that the draft report recommends that children should have eye tests, not at age three and four, as previously, but at age five? Is the noble Baroness aware that one in five toddlers has semi-severe visual problems; and that if such children do not know what others see, they cannot understand and complain about their own disability? Does the noble Baroness recognise that this 204 is a severe educational problem, and that other countries are sticking to eye tests for three and four year-olds, not five year-olds? Will the Government ensure that Britain's children are not disadvantaged by any change?

§ Baroness Andrews
My Lords, I am in awe of the noble Baroness's reputation in this field, so I am happy to be able to agree with her that the earlier we screen, detect and treat vision defects, the better. I understand that there has been a lively professional debate. One of the reasons why Ministers are still waiting on the report is that there has been a very open consultative process.
I understand that screening at age three is problematic. Although defects such as amblyopia can be picked up more easily, when children are immature, they are less likely to provide a reliable report. Also, there is the problem of take-up. We shall examine all the relative merits of testing at different ages. I can assure the noble Baroness that her concerns will be noted.

§ Lord Carter
My Lords, on the question of take-up, will a special effort be made to encourage low-income families to take advantage of visual screening?

§ Baroness Andrews
Yes, my Lords. We are concerned that in the pattern of inequalities in health there are real problems. Children from disadvantaged families often do not get the free eye test to which they are entitled. Within the national service framework for children, we very much want to ensure quality standards and additional information. The Sure Start programme, which was expanded in December last year, is a good setting for young, disadvantaged parents to be directed towards the free eye tests and the screening to which they are entitled.

§ Lord Addington
My Lords, the Hall report on screening, of which I have managed to obtain a rough copy, suggests that pre-school screening is very difficult because, at that age, children are not gathered together. Will the change in educational practice as regards the pre-school age group—that is, having four year-olds within a school setting—make this the ideal stage at which to begin screening? As the noble Baroness has said, a disability that is not picked up early will lead to far greater on-costs, both for those involved and for the system.

§ Baroness Andrews
Yes, my Lords, I know that there is a strong case for testing at age four to five, precisely because one has a relatively captive population which one does not have at age three to four, But we need to look more closely at other issues associated with testing at age four to five. We will do that in the context of the national service framework. I hope that the Hall report, the fourth report by the committee, Health for All Children, to which the noble Lord refers, will be finalised within the next month. We will have the advantage of that information.

§ Lord Jenkin of Roding
My Lords, I hope that I can be reassured by the noble Baroness's statement that 205 the Government will consult fully on the report. Some voluntary organisations in this field have told me that they are anxious that there will be a very uneven pattern of service across the country because of the shortage of orthoptists. Is it not the case that such tasks with small children can be done equally well by optometrists and other professionals in the field of visual handicap; and that there should be no excuse for the shortage of specialists, which the report appears to have accepted?

§ Baroness Andrews
My Lords, the noble Lord asked several questions. First, we are aware that there is uneven service provision in the way services are offered across the country. Secondly, there has been wide consultation on the Hall report, because it has been on the world-wide web for more than six months. It has provoked, as it was designed to, much consultation from across the profession and the voluntary sector. Thirdly, as far as I know, there are no shortages in this field. Unlike other parts of the health service, we are well supplied. In particular, there has been an increase of 14 per cent in optometrists in the past three years. The noble Lord is correct to say that we must be clear that the right people screen children at the right age, and that the pattern is equal across the country so that every child has the same chance.

§ Baroness Gardner of Parkes
My Lords, when and where will the screenings be carried out? Is simple eye-testing carried out in schools anymore?

§ Baroness Andrews
My Lords, eye-testing still takes place in schools. There has never been a prescription for a particular eye test, although linear eye tests have been the pattern for many years. The Hall report does not recommend changes to that. When we look at the advice to Ministers in the context of raising standards overall, we might be able to come up with better provision generally.