Eye Tests

HC Deb 06 June 1990 vol 173 cc636-87

Mr. Speaker

I have selected the amendment in the name of the Prime Minister.

3.43 pm

Mr. Robin Cook (Livingston)

I beg to move, That this House records its alarm that since Her Majesty's Government ended the provision of free eye examinations the number of eye tests has fallen by over two million; notes that Her Majesty's Government's policy of leaving charges for eye tests to be settled by the market has resulted in a typical charge of £12.00; concludes that charges are deterring many members of the public from seeking eye tests, thereby putting their sight and health at risk; and calls upon Her Majesty's Government to restore a free preventive service for eye examinations. The Secretary of State will recall that his first reappearance at the Dispatch Box in his current role was to defend the abolition of the free eye test in a debate on a Lords amendment to the Health and Medicines Bill. In the patois of sketch writers, he made a speech which would normally be described as "robust". I remember that he was jolly cross with the rest of us for defending the Lords amendment.

The right hon. and learned Gentleman accused right hon. and hon. Members in all parts of the House who disagreed with him of crying wolf. He said that the idea that people will be deterred from coming forward for an eye test because of a charge was contrary to common sense as well as the evidence … We must ask how many people, if any, will be deterred from going to the optician by the prospect—and it is no more than a prospect—that many opticians will charge £10."—[Official Report, 1 November 1988; Vol. 139, c. 923.] I appreciate that the Secretary of State was asking a rhetorical question, and I apologise for the fact that the rhetorical pause that followed it has lasted 18 months. However, we can now answer the right hon. and learned Gentleman's question. The answer to his question of how many people would be deterred from taking an eye test is 3 million. That is the number who have been deterred from undergoing an eye test as a result of the charge. The Secretary of State appears surprised. That figure has been available from quarterly surveys since charges were introduced.

The figure of 3 million is one which we can quote with confidence because it has been prepared by Professor Hart, professor of statistics at Reading university, using two sources. The first was a survey by the Association of Optometrists, drawing on 400 branches, with data collected from those branches by the Economists Advisory Group. The second was a survey also based on data collected from 1,200 branches of multiples, with data collected by Touche Ross.

I stress that both surveys had a very large base, and were based on work by independent agencies, not professional organisations. The conclusion reached in those surveys, and by Professor Hart, is that, in the year to April 1990, the number of eye tests performed totalled 8.9 million, compared with a figure in the year to April 1989 of 13.2 million—a drop of more than 4 million.

I want to be fair to the Secretary of State. The figures are so dramatic that I can afford to be fair to him. I concede that, in the year to April 1989, probably an extra 1 million people underwent eye tests in anticipation of the introduction of charges. In fact, the Minister of State made a precise estimate of their number. He provided a figure to the Select Committee suggesting that 1.4 million tests were performed in 1987–88 in anticipation of charges and resulted in an unduly high figure for those years. I think that the figure of 1.4 million is rather high, but I shall not quibble. I concede every single one of them. Even if that number is deducted from the fall in the number of tests last year over the previous year, one is still left with a dramatic decline in eye tests of 2.9 million—effectively, a 3 million drop in the number of people going for an eye test last year.

One has to go back to 1981 to find a year in which the number of eye tests was that low. Effectively, the Government have wiped out a whole decade of advance in the eye service.

Mr. Neil Hamilton (Tatton)

The line of argument that the hon. Gentleman is now adopting seems rather different from that which he used in the debate on the Health and Medicines Bill on 1 November 1988, when he said: I predict, with confidence, that the Secretary of State will not save that sum, for two reasons … Eye hospitals will be swamped by references from general practitioners who will no longer be able to refer their patients to optometrists for free examinations."—[Official Report, 1 November 1988; Vol. 142, c. 933.] Can the hon. Gentleman say whether that has happened, and whether the difference in the two figures that he quoted is accounted for by that factor?

Mr. Cook

If the eye hospitals had received 3 million additional referrals for free examinations, I assure the hon. Gentleman that he would have spotted the queues in the street. My point is that since charges were introduced 3 million people have not undergone eye tests who would otherwise have done so. That is perfectly consistent with the fact that the number of people going to eye hospitals who previously would not have done so is significantly up. That increase will be matched by the reduction in the number of referrals of people with secondary symptoms who would obviously have been referred there by optometrists had they seen that large a number.

The Secretary of State for Health (Mr. Kenneth Clarke)

If the hon. Gentleman is going to rely on the surveys published so far, will he agree that he is relying heavily on surveys of opticians, who I have no doubt were trying to be helpful but who have a vested interest in the replies that they give? Is he also going to refer to the survey carried out by the Association of Optometrists using a MORI poll of the general public or to the Royal National Institute for the Blind survey of the public, which show that there is no apparent decrease in the number of tests carried out?

Mr. Cook

The survey carried out by the Royal National Institute for the Blind gave an estimated 2.7 million reduction, which is substantial—I am sorry to have to tell the Secretary of State that I have seen it and it shows precisely that reduction. I can assure him that I will be referring to the survey carried out by MORI because I believe that it is a prime part of his case.

I must pick up on the way that the Secretary of State has immediately sought to cast doubt on the figures that I gave because they came from opticians. I repeat that the statistics I quoted were derived by a professor of statistics, who is putting his scientific reputation on the line, from data collected by the Economists Advisory Group and by Touche Ross, the chartered accountants. The Secretary of State is suggesting that all those are part of a conspiracy to distort the figures. Is he telling the House that every one of those 400 independent optometrists and 1,200 branches of the multiples is part of a conspiracy to practise a statistical lie—that they are all together in a conspiracy to co-ordinate the same statistical lie?

Mr. Kenneth Clarke

I am pointing out that the figures that the hon. Gentleman has relied on, quite mistakenly, are all derived from independent opticians and multiple chains. Figures obtained from the general public—surveys of patients, including, contrary to what he has just asserted, questions asked by the Royal National Institute for the Blind—do not support his thesis.

Mr. Cook

Perhaps my naivety and innocence made me conclude that the people most likely to be able to assist us on the numbers of people coming forward for eye tests are the opticians who carry out such tests. If the Secretary of State is really telling the House—if he is, it will be badly received outside—that that scientific profession is capable of practising a lie for financial gain, I have a simple solution to offer him. In the past year, the profession has offered time and again to agree on a system of independent monitoring with the Secretary of State in which they could both participate. However, the Secretary of State has resisted and rebuffed every one of those overtures. There can be only one conclusion—it is perfectly simple—which is that the Secretary of State does not want their help to monitor the drop because he does not want to know how big the drop is.

Since the Secretary of State advises me to do so, I shall refer to the survey carried out by MORI on behalf of the Association of Optometrists. I assume that it is that survey, and the parallel survey which the Secretary of State has carried out, that have prompted the Government amendment to state that charges will not deter those who need sight tests from seeking them. I do not see where the "will" in the sentence comes from. It is not a question of what will happen in the future: as the Secretary of State knows, we have had a whole year of charges, and the evidence of deterrence is already there.

I understand that the Secretary of State has carried out a survey of his own, similar to the one that the Association of Optometrists commissioned from MORI. I presume that it is those data that the Secretary of State will deploy in his speech—a speech which his junior Minister yesterday assured the House would blow me out of the water. That would be an exhilarating experience, which I look forward to with excitement. The Secretary of State will have to find much more than the market research survey to which he has just referred if he is to succeed in blowing me out of the water.

Faced with the problem, the Government, typically, have opted for market research. Instead of going to the opticians for data, they have asked people in the street whether they can remember when they last had an eye test. The question that the Government have been asking is, "Have you had a sight test at an optician since Christmas?" The problem with that approach—to me, at least, it is a problem, although I suspect that the Secretary of State sees it as a solution—is that it invites over-reporting. It is not just this year that the Association of Optometrists has carried out market research; it has carried out similar market research surveys in each of the last five years, which have resulted in an over-reporting of the number of eye tests by 15 to 25 per cent.

Knowing that he would be asked this question, the Secretary of State commissioned an identical survey from MORI, which put to a sample 1,000 people exactly the question that the Secretary of State devised for his survey: "Have you had a sight test at an optician since Christmas?" The result of the survey, if the answers were correct and if all those who said that they had been to an optician since Christmas had done so, would have been that, in the last financial year, there were not 9 million eye tests but 16 million eye tests.

The only problem that the profession would have had in the last financial year would have been to get all those coming in for an eye test to form orderly queues at the door. Such an approach merely tests popular perceptions; it does not test the reality of those who go to opticians for eye tests.

Mr. Kenneth Clarke

The hon. Gentleman says that a public survey will plainly lead to over-reporting. I am prepared to agree with him, as a matter of argument. He believes that in the past there has been over-reporting of between 15 and 25 per cent. Does the hon. Gentleman not realise that a 15 to 25 per cent. allowance can be made and that there will still be no fall in the number of eye tests? The hon. Gentleman's proposition is based on the absurd argument that, so long as one surveys only opticians, one can show that there has been a drop, but every time one surveys the public, one finds that there has been no drop in the number of eye tests. I prefer the second approach.

Mr. Cook

The House will have observed that the Secretary of State is backing himself into a position from which he is successfully protecting himself against any opportunity of obtaining the correct data. From the moment that he says that opticians cannot be included in the survey, he is precluded from finding out how many people are going to opticians.

Let me try to impress upon the Secretary of State the invitation that opticians have been making to him for a year. If he does not trust them, he is casting a major slur on a scientific profession by saying that they are prepared, in conspiracy with Touche Ross, the Economists Advisory Group and Professor Peter Hart, professor of statistics at Reading, to conceal the figures and deceive the House. If that is what he is saying, I invite him to nominate any independent body that he and the Association of Optometrists can together instruct to collect the data. That invitation has been made to the Secretary of State each month for the past year. I ask him again whether he has the courage to accept the challenge.

Mr. Kenneth Clarke

There is absolutely nothing new to say in this tired old debate between the two sides, except to discuss these surveys. The hon. Gentleman says that we must go only to opticians for our information. He is unaware of any survey of the general public that shows any reduction at all in the number of eye tests. He has seen a survey of the general public which shows that there has been no reduction in demand, but he dismisses it by using the absurd argument that people do not remember correctly when they last had an eye test. Does he not accept that it is sensible to have a survey of the general public, or is he prepared to say that the only source of information on which he will rely is people with a professional, vested interest in the results?

Mr. Cook

Once again, the Secretary of State's most revealing comment was the last line—that because, as he perceives it, they have a vested interest, he is not prepared to believe what the opticians are saying to him. I find that a breathtaking slur which, by implication, would be applicable not just to optometrists, and could be used to rebut pretty well any medical research one cares to name, all of which is based on scientific research of people no doubt with a vested interest in promoting their own profession.

Over the years, the accountancy profession has developed modest and sometimes quite sophisticated tools for accounting the books. The accountancy profession, can, from time to time, detect fraud, particularly when that fraud is practised on the ginormous scale that the Secretary of State has alleged. I put it to the Secretary of State that all those optometrists who have been charging for eye tests for the past year have accounts and have to make annual returns. Will the Secretary of State accept any independent audit of their books to find out what has happened to their accounts and the numbers treated in the past year, or will he say that the accountants also cannot be trusted because they have some vested interest? It is perfectly clear that the Secretary of State is determined on one point—he will not ask the optometrists how many they are treating, because he dare not do so.

Dame Jill Knight (Birmingham, Edgbaston)

Is it not also true that, if the ophthalmic opticians and the medical practitioners are faking their books, that is a matter of fraud for the Inland Revenue?

Mr. Cook

I wholly agree with the hon. Lady, who has first-hand knowledge on which to make that assertion. There is a way in which the Secretary of State could assist the hon. Lady and myself. He could repeat his allegations outside the cloak of privilege. Were he to go public and assert that those 400 optometrists who made returns were seeking to practise fraud on the public, on the Department and on the House, the courts might take a considerable interest in the matter.

Mr. Kenneth Clarke

I have at no stage made any such allegation—[HON. MEMBERS: "Yes, you have.") The hon. Gentleman has such a narrow statistical base for his case that every time I doubt it, he keeps trying to say that I am accusing people of fraud. Obviously, different practices fare to different extents. Some of the multiples have lost out rather badly to independents in the curious market of the past year. All I am saying, and the hon. Gentleman has not denied it, is that nobody has carried out a survey of the general public which shows any fall in demand whatsoever. The hon. Gentleman's entire case is a palpable myth and he should confess that he has based it on an inadequate and narrow survey and allow the House to spend its time on a more serious subject.

Mr. Cook

I am sorry to detain the House so long on the matter, but the Secretary of State has intervened five times to make exactly the same point. Quite patently, he rests his entire defence on his belief, which I am sorry to assure him is mistaken, that market research has revealed no reduction in the number of those coming forward for eye tests.

I have two responses. First, the figures that I am quoting are not on a narrow base. They include one third of all the multiple branches and more than 10 per cent. of independent optometrists. That is a perfectly adequate large base. Secondly, it is not the case that all market research shows no reduction. I have here an RNIB survey and an RNIB press release. The first paragraph of that press release states that the survey indicates that about 2.25 million people have not taken sight tests in the past 12 months because they would have had to pay.

The very research that the Secretary of State is asking us to believe shows exactly the deterrent effect to which I have referred. The press release goes on to say, as we would expect, that the very people who are most deterred are those on lower incomes. That market research which the Secretary of State is prepared to believe—the Secretary of State will no doubt accept it—will show that those on lower incomes are twice as likely to be deterred and that those on the lowest incomes are three times as likely to be deterred.

The Government's amendment invites the House to congratulate the Government on its policy that sight tests paid for by the National Health Service should continue to be available to those on low income". There are two reasons why that assurance should not persuade the House. First, there is the problem which is familiar with mean-tested benefits and which makes entirely predictable the result when applied to eye tests. Many of those who qualify do not know that they qualify and therefore never come forward to claim the benefits. Secondly, the means test used is a mean means test. It is the same means test that is used to test entitlement for free prescriptions. Anyone with an income that is £10 or £15 above income support levels will be excluded. Anyone with an income of £60 a week is unlikely to qualify for help with eye tests.

To find out whether he or she qualifies, a person must first wade his or her way through form AG I, which comes in 17 pages and 19 parts. One will need good eyesight to get through it in the first place. I was recently sent a form by the Halifax building society inviting me to apply for a £5,000 loan. The form sent to test my entitlement ran to two pages, not 17. At the bottom there was an invitation to phone Tamsin if I had difficulty in filling in the form, and there was a photograph of Tamsin with her headphones on and plugged in, smiling and eager to respond to my queries.

There is no Tamsin to help a person to read the 17 pages of AG1. Moreover, the first thing one reads at the top of the form is the reference to help with NHS charges and the cost of travel to hospital or to visit someone in prison. I have challenged that unfortunate opening statement before and have suggested that the Departments of Health and of Social Security should revise this opening gambit. The only change is that the reference to visiting someone in prison now appears in even bolder type. Thousands of pensioners who are confronted with that opening line will go no further. They are precisely the people whom we should be encouraging to come forward for an eye test and precisely the people whose eyesight may be deteriorating.

The medical consequences of those people being deterred and not coming forward can be predicted accurately from the figures prepared by the British College of Optometrists—not a trade organisation but the scientific and examining body for the profession. The college has prepared figures on the expected referrals from eye tests, from which we can predict the reduction in the number of referrals that is likely to result from a reduction of 3 million in the number of eye tests.

The number of referrals for medical examination will fall by 160,000 cases. Those are the people with disturbing symptoms who are now being missed, members of the public who are unaware that their sight and perhaps health are at risk. Using the figures prepared by the college, we can predict their conditions. Among the 160,000 cases, there will be 26,000 cases of cataracts, probably 25,000 cases of glaucoma, 9,000 cases of macular degeneration, 11,000 cases of hypertension and 13,000 cases of diabetes.

I come to the final absurdity. If only a third of those who are putting their sight at risk fail to come forward in time to avert blindness, the cost to the Government of supporting them will be about £50 million a year. I regret that I have expressed this personal tragedy as a cash figure, but I am trying to find an argument that can connect with the Treasury argument.

What savings do the Government expect from charges for eye tests? The answer is £90 million. That saving would be halved by the cost of those who may go blind as a result of being deterred in one year from coming forward. Those savings will be wiped out in two years. The Government's amendment invites us to congratulate them on having made economies by introducing charges for eye tests, but there are no savings from those charges; there will only be in the longer run extra costs to the health budget for coping with those whose condition is not detected.

Why did the Government get it so wrong? For the answer to that, we need look no further than the speech made by the Secretary of State in November 1988. When Opposition Members and even some Conservative Back Benchers told him that optometrists warned that they would be obliged to charge more than £10 for tests, the Secretary of State said that he did not believe that. He went on to say: the charge for the eye test will steadily disappear, that is my strong personal opinion."—[Official Report, 1 November 1988; Vol. 139, c. 927] Quite why the Secretary of State imagined that optometrists would offer a free eye test once he had stopped paying them is a mystery that he did not explain to the House. The income to the optometrists' profession from test fees is equivalent to the entire profits of the profession. How they were expected to absorb such a major loss is a mystery, the answer to which the Secretary of State did not share with the House.

A year after the introduction of charges for tests, the average charge is £12. A common charge is £15, and a charge of £30 has been recorded. When I challenged the Secretary of State six months ago to produce an optometrist who was providing an eye test free of charge, he cited an optometrist in Dover. On inquiry, all was not what it seemed in Dover. The optometrist there offered a free eye test only if someone bought a pair of spectacles after the test. If someone simply wanted an eye test, he had to pay for it.

I do not deny that it is possible to find the odd isolated case of an optometrist who provides a free eye test. However, those cases are so few as to be of curiosity value. There is not the slightest evidence that, by their competition, optometrists in Dover or anywhere else are having the slightest effect on the market price of tests in the big cities. On the contrary, the quarterly surveys of the Association of Optometrists showed that the price charged over the past year has tended to increase, not decrease.

Mr. Nicholas Bennett (Pembroke)

With regard to the £12 charge, we should get the figures into perspective. Will the hon. Member comment on the family expenditure survey for 1988, which shows that the average family spends £13.64 a week on tobacco and alcohol? In that context, is £12 every two years a large sum of money for a test? Is not the hon. Gentleman insulting the British public when he suggests that £12 will deter them from looking after their health?

Mr. Alun Michael (Cardiff, South and Penarth)

That was a Labour gain.

Mr. Cook

I am grateful for the intervention made by the hon. Member for Pembroke (Mr. Bennett), which my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) very astutely described as a Labour gain.

The hon. Member for Pembroke has illuminated the mists of ignorance and darkness with which we are trying to reason. We are not discussing the average family. Two thirds of those who visit optometrists do not constitute average families. They are pensioners, and four fifths of pensioners have incomes below £98 a week. We are concerned with people who must find £12 or £15 from a weekly income of perhaps £60, £70, £80 or even £90. While £12 or £15 might be a small sum to the hon. Member for Pembroke, it is not a small sum for that four fifths of pensioners. It is a tragedy for those pensioners that they find the conduct of the social policy of their nation in the hands of people who cannot comprehend what it is like to live on that sum of money.

Mr. Nicholas Bennett

rose——

Mr. Cook

No, I will not give way to the hon. Gentleman again. He had his chance. I will not give him another opportunity to destroy the Secretary of State's case.

I have one question above all others to which I should like the Secretary of State to reply. Is it still his strong opinion that the eye test charge will steadily disappear? Also, is he still prepared to tell the House that charges of £12 by independent optometrists and of £11.20 in Boots and in Dollond and Aitchisons, which have survived over the past year, will steadily disappear? If so, when will they disappear? How long must we wait until the market works its miracle?

I pause to reflect on the wider lessons to be drawn from the fact that the Secretary of State has been so spectacularly wrong in his predictions to the House. Those predictions were based on the same dogma on which he rests his dramatic proposals for the rest of the Health Service. In 1988 he promised that, by introducing the market, there would be greater efficiency, because competition would drive down prices and widen choice. What has actually happened in the eye service is that the introduction of the market has increased the price and dramatically reduced productivity. It has also reduced the choice available to the public, because 250 branches of independent optometrists have closed.

I noted last month in Ellesmere that an optometrist business that had been operating since 1897 and had survived two world wars and a depression has been driven out of business by the first 18 months of this Secretary of State. Now the public of Ellesmere, if they wish to visit an optometrist, must travel to Oswestry.

The lessons are clear—they are revealing. Competition in health care, in the case of the eye service, has resulted in higher prices, a reduction in the numbers treated, and a reduction in the number of places at which to be treated. Heaven help the Secretary of State if, next April, his new market in hospital care has exactly the same results for the public.

The difference between the two Front Benches is neatly expressed in a letter from the recent junior Minister at the Department of Health who has now departed to the Department of Transport—a man for whom I had high regard until yesterday, when I discovered whom he had appointed as his Parliamentary Private Secretary. I therefore have no compunction about quoting the letter that he wrote to optometrists, in which he himself made the remarkably revealing observation: The Government does not have a policy regarding the price of private sight test fees. Private sight tests are commercial transactions between the optician and his or her patient. I hope this clarifies the situation. It certainly clarifies it. I regard it as an appalling statement by any Health Minister that his Government have no policy on the cost of an eye test. I cannot accept that that important matter of health policy should be left as a commercial transaction. It should be one of the first priorities of health policy that anyone who needs an eye test should be able to get one irrespective of whether he or she can afford the commercial transaction.

In a spirit of charity, I put to the Secretary of State the thought that we all make mistakes. I have made mistakes in my time—one day when we are both retired, I shall tell him what they were. The Secretary of State can be forgiven for being wrong, but he cannot be forgiven for stubbornly refusing to face up to the fact that he has been wrong. Those who loudly deny their mistakes do not prove the strength of their convictions; they only establish their lack of courage.

I have an example for the Government. The state of Alberta also ended free eye tests in July 1987. Twelve months later, it was found that there had been a 30 per cent. fall in the number of eye tests—a perfect parallel with our experience, but there the parallels diverge. The state Government of Alberta had the sense to recognise reality and the courage to recognise that they were wrong. They brought back the free eye test.

It is now the Secretary of State's turn. I wait to hear whether he has the same good sense and the same courage to restore the free eye test that he took away 18 months ago. In the event that he is unable to do so, I end my remarks by correcting yet another of the mistakes in that speech of November 1988. At the end of his speech, the Secretary of State said: I do not believe that any future Labour Government will withdraw this charge".—[Official Report, 1 November 1988; Vol. 139, c. 930.] He was wrong again. It will be one of the first priorities of the next Labour Government to abolish charges for eye tests and to ensure that no one is deterred from getting an eye test because he or she cannot afford it.

4.18 pm

The Secretary of State for Health (Mr. Kenneth Clarke)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: supports the Government in its view that those who can afford to pay for sight tests should do so and that the money which was previously spent by the National Health Service on free sight tests for those who could afford to pay is better spent in other ways in improving health care; believes that this will not lead to the nation's health or sight being put at risk nor deter those from seeking sight tests who need them; and fully supports the Government's policy that sight tests paid for by the National Health Service should continue to be available to those on low income, children and those most at risk of blindness from diabetes and glaucoma.". Care of the eyes is an extremely important part of any health care system and it is important that we do our utmost to ensure that we maintain a high standard of optical services and give everybody the service that they require to protect themselves against glaucoma and the consequences of diabetes, and to preserve good eyesight. That remains the Government's intention, and will be so.

However, with the greatest respect, that argument is stale. It relates to the extent to which we should allow opticians to charge for the eye test that is made before spectacles are dispensed to people who are not in the exempt category and entitled to National Health Service spectacles. The argument is merely a re-run of one that we had last year. Since then there has been no evidence to change the position that I have described. It is a serious mistake for the hon. Member for Livingston (Mr. Cook) to rely so heavily on that point when, for example, committing a future Labour Government—if we should have one—to spending money on this subject. That is a serious misjudgment of priorities which, if ever carried out, would not serve any worthwhile health purpose.

I begin by reminding the House of the effect of the Government's changes. We continued to pay for the eye test for about one third of the population. The major exempt categories were those on low incomes, children, and people susceptible to certain diseases. The remaining two thirds of the population are no longer entitled to go to an optician for an eye test for which the NHS will pay a fee.

The effect of that change was obviously uncomfortable for opticians. When I refer to their vested interest, I am not referring to an illegitimate vested interest—like the rest of us, they are entitled to lobby from time to time in the interest of their cause. However, our change has put the opticians—the multiple chains and the independents—in the position of deciding whether to charge people who are no longer entitled to an NHS sight test and, if so, how much to charge them. We have now had a year of that so we can see where we are when discussing the possible consequences of the change.

I accept that any reputable optician will prefer the previous system—if I were an optician, I expect that I would. Opticians used to have little cards in the window which read "NHS sight tests free to all." That was a perfectly proper, not unprofessional attraction to people to go in and contemplate buying spectacles. It meant that the optician had a guaranteed income from the public purse for every test carried out, at a fee set by the National Health Service and not, therefore, subject to competition for patients among the different outlets. The change has meant that each optician now has to decide whether, and to what extent, to charge. Opticians no longer have those little cards in the window——

Mr. Eddie Loyden (Liverpool, Garston)

rose——

Mr. Clarke

I shall give way to the hon. Gentleman in a moment.

A variety of charges has been imposed. I accept that the average is roughly that which the hon. Member for Livingston described. The hon. Gentleman conceded, fairly, that some opticians are offering the sight test free. I cite Duncan and Todd, Hendrys and Lannies. There are other examples across the country——

Mr. Robin Cook

As the Secretary of State has specifically mentioned Duncan and Todd, I remind him and place on record the fact that Duncan and Todd introduced the free eye test in Scotland after writing to me to seek an assurance that the next Labour Government will abolish the charge for the eye test, on the basis that it could afford the experiment only until the next general election. If the Secretary of State is citing Duncan and Todd, he should remember that the free eye test will not survive the election unless a Labour Government are elected.

Mr. Clarke

That shows that those opticians are worried about weakening the effect of the opticians' lobby on the Labour party. With the greatest respect, the hon. Gentleman's approach to this issue is extremely naive—which is unusual for him. I recommend that he reads the optical press of 12 months ago when the change was made, when many opticians were contemplating much lower charges and free tests. Immense pressure was brought to bear on opticians. I remember a letter that urged them not to play the Government's game. The hon. Gentleman obviously thinks that it is a coincidence that opticians are still charging roughly the same as the NHS fee, except in the cases that I have cited, where free eye tests have already been introduced. Many opticians regard charging the patients who come into their practice less than others legitimately think to be the going rate for carrying out that work to be somehow letting the side down.

Mr. Loyden

When the Secretary of State evaluates the benefits of free eye tests, he seems to ignore the fact that they are very much a part of preventive medicine. Indeed, as one who has experienced being diagnosed as suffering from glaucoma by an optician, I am convinced that that aspect of the eye test is vital. The Secretary of State appears to overlook that completely.

Mr. Clarke

No. I acknowledge it. I urge everyone to have a regular eye test if there is any reason to believe that they need one. I accept that some diseases can be detected by eye tests. We are arguing about whether it is wrong for people outside the exempt categories to pay—most of them—about £10 to £11 once every two years for an important part of their health care. We are debating the consequences of most opticians having decided in practice to continue to charge a fee such as I have described.

I shall respond to the challenge put to me about when competition will become more widespread. I think that it will become more widespread if the Labour party stops supporting the campaign for free eye tests. Opticians are travelling in hope that sooner or later there will be a Government who will give them back the assured income without competition that they used to have. They are extremely reluctant to allow a competitive market to break out when Her Majesty's official Opposition promises, as far as I can see, no explicit extra expenditure on the Health Service except in this unlikely area and on dental checks, which are about the only items of NHS spending to which the Labour party is committed.

I have studied the policy document of the hon. Member for Livingston and I seriously believe that the Labour party is in difficulties. The party is almost bereft of any health policy and is in danger of giving way to professional and sometimes even commercial lobbying when choosing its priorities.

Mr. Charles Kennedy (Ross, Cromarty and Skye)

Listening to the Secretary of State on this point, I am reminded of a gentleman whom I and the hon. Member for Livingston (Mr. Cook) came across last night at a public meeting on health. He was a Conservative-appointed general manager who was talking about NHS consultants in a health debate in a different context. Precisely the same thing struck both the hon. Gentleman and me last night as probably strikes the hon. Gentleman about the Secretary of State now. Cannot the Secretary of State realise that, at least in health, and in many other areas of social policy, too, professionals sometimes react to events and seek assurances out of not commercial self-interest but general care about health standards and their patients? Will he acknowledge that for once, instead of accusing experts or professional groups within the Health Service of commercial, mean-minded motives every time they seek to disagree with him when the best interests of preventive health care and preventive medicine might be their priority?

Mr. Clarke

I do not regard accusing people of having, among other things, commercial motives as necessarily a wicked attack on them. Of course, opticians are skilled professional people upon whose care we all depend. Their prime motive is the care of their patients. But by and large spectacles and eye tests in Britain are provided by commercial chains and organisations as well as independent practices. Outfits such as Dollond and Aitchison and Boots Opticians, with which I have had some contact in my constituency, are perfectly legitimate commercial organisations which have a wholly respectable but commercial interest in the outcome of this discussion.

We should all be worried about—indeed, I believe that we all have the same genuine concern, and that the hon. Member for Livingston is mistaken in choosing this cause for that reason—the consequence for health care and preventive medicine to which the hon. Member for Liverpool, Garston (Mr. Loyden) referred. That is where we must turn to surveys. The whole case of the Opposition that we are threatening the eye care of the nation is based on the proposition that the ending of NHS tests for two thirds of the population led to a reduction in the number of eye tests. I shall seek to demonstrate that that is untrue. There is no evidence to support it. It is wrong. The Opposition's case is based on a total myth.

Mr. John Marshall (Hendon, South)

Will my right hon. and learned Friend also tell the House how much revenue comes from the charges and what would be the impact of their abolition on, for example, the number of hip replacement operations?

Mr. Clarke

The cost of restoring free NHS eye tests to two thirds of the population—including everyone in this Chamber who at present faces the wicked burden of paying £10 for an eye test—would be £90 million. The Labour party wants to spend more than the entire budget of a reasonable-sized, English district health authority on giving everyone in this Chamber a free eye test. That is an absurd choice of priorities, considering all the demands that come piling in on the NHS. It is urged because it is said that the number of people having eye tests has fallen since charges were introduced, but that is not the case.

There have been various surveys. The hon. Member for Livingston correctly cited the surveys that are based on information collected from some, but not all, opticians. I do not doubt the bona fides of those who collected it, but the figures are derived from a section of the profession and some of the chains. I suspect that the tendency to respond to surveys is strongest for opticians who lost out in the extremely turbulent market which was created over the past 18 months.

I believe that the profession and some of the chains created that turbulent market. It was also unavoidable. We had a controversial debate about the change. It was flagged up all over the place that charges were to be introduced in April 1989, with the result that a huge number of people were attracted to come for a free eye test while it lasted. Those who campaigned against us while we were contemplating the changes did not point out that many people would continue to be exempt. As we all know and as the profession concedes, the result was a huge increase in the number of people who had their eyes tested before April 1989. The obvious result was a huge drop in the number of people who had their eyes tested thereafter, if only in the short term. A wave effect was created. I remember that some branches of Dollond and Aitchison stayed open till midnight in the last few days while free eye tests were available to encourage people to rush in. As a result, the first quarter of 1989 saw a big increase in the number of tests while the next quarter saw a big decrease.

Some practices were hit by that. It depended on the business acumen and position of those involved. Clearly, if the market is so transformed in the short term, some businesses lose out, some prosper and others are bought up by chains. Considerable turbulence was created in the market, partly by our changes, but greatly aggravated by the reaction of the profession in response to them. Now, after an interval, attempts are being made to establish the level of demand for eye tests as we return to normality.

The hon. Gentleman relies wholly on figures obtained from some opticians which, I am sure, have been subjected to expert analysis. He has ignored the surveys of the public. It is no good saying that it is all market research. If one wants to discover how many people are having their eyes tested, the only way to produce a reliable estimate is to take an independent sample of the public.

The Royal National Institute for the Blind carried out one survey, but the hon. Gentleman did not appear to have read beyond its press release. It carried out a telephone survey of a small sample. The first question was: Have you paid for a sight test in the last 12 months? That question is not referred to in the press release because the answer made it clear that there was no apparent reduction in the number of people whom one would expect to give the affirmative answer. The RNIB then further questioned those people who said that they had not paid for an eye test in a series of leading questions about why they had not had a sight test. Most people who do not have an eye rest usually do not have one because they have not thought about it. I have had an eye test in the past 12 months, but in the past when I have not, that has been why. The questions heavily suggested that cost was a reason for not having a test. Yet the survey shows that the number who said that they had had an eye test was in line with past trends.

The other survey—which has already been mentioned—was carried out for the Association of Optometrists by MORI. No doubt trying to anticipate the results of our survey, the association had asked MORI to carry out a survey using similar methods, asking people whether they had been given a sight test by the optician—not the hospital or the doctor—since Christmas. Then, like the hon. Member for Livingston, it tried to ridicule the results.

I regret to say that the MORI poll showed that, if anything, the number of people who had had sight tests had gone up since the charges were introduced. Ten per cent. of those polled—equivalent to more than 4 million people—said that they had had a sight test since Christmas. I agree with the hon. Gentleman that that is a startling figure; he is probably right when he says that there was over-reporting, and that we must take off 15 or 25 per cent. to obtain an accurate figure. However, what he did not add was that the figure is so high that, even if that were done, there would still be no apparent drop in the number of people who had had eye tests.

The Association of Optometrists tried to dismiss the results of what was the best survey so far carried out. It said: The Association of Optometrists believe that the phrase `since Christmas' is very loose. Christmas conjures up memories of the festive season, which for most people starts in November. I do not think that most people think that Christmas is in November. When testing the recollection of the general public, it is best to choose some occasion that they may remember, and the phrase "since Christmas" is probably the best way of prompting memory: most people remember what they did before and after Christmas. The idea that "since Christmas" could be thought to include November is—with the greatest respect—a fatuous attempt to discredit the evidence. Even if people's recollections are incorrect and a proportion of respondents are discounted, there is still no evidence of any decline in demand.

Mr. Kennedy

As the Secretary of State has quoted the Association of Optometrists directly, will he do two things? First, will he note that the views with which he takes issue were not obtained by means of amateurish opinion polling, but have been verified by MORI—I hope that he would agree that MORI probably knows more about opinion polling than any of us—and the Association of Optometrists? Secondly, will he respond to another point in the press release to which he referred? The Association of Optometrists and MORI argue that, to focus the question directly, the phrase should have been "since December 31". What does the right hon. and learned Gentleman think?

Mr. Clarke

I have not yet had a chance to contact Bob Worcester of MORI to ask whether he agrees with the phrase "since November". As for the second part of the hon. Gentleman's question, asking people to remember whether something happened after 31 December is less likely to produce an accurate answer than asking them about what happened "since Christmas". Most of us cannot remember exact months or dates. Even if we allow for over-reporting, the survey does not demonstrate any evidence of a reduction in the number of sight tests; quite the reverse.

Mr. Michael

As the Secretary of State seems to be spending all his speech denigrating those who have sought to reach the truth, will he in the next few minutes give any fresh information that he has perhaps sought himself?

Mr. Clarke

It will be my pleasure to do so. The Government—fulfilling an undertaking that was given when the original Bill was being discussed—have carried out their own survey, which we delayed until the market had settled down and the wave effect had shown some signs of coming out.

We asked NOP to conduct a survey on behalf of the Department into the number of NHS and private sight tests during the first three months of this year. We released the results of that survey today and the details have been placed in the Library. Five sets of surveys were carried out in March and in April and 10,000 adults responded to the NOP questions. It is quite the best sample survey to have been carried out so far and it is adequate for any statistical purposes. The results have been made available together with wholly independent comment on the surveys by the Government statistical service.

The survey asked whether a person had had a sight test since Christmas and, on the basis of the response to that question, some 5 million people had their sight tested in the first three months of this year. That is a startlingly high result. If one extrapolated from previous trends up to 1987, only 3.5 million people should have had their eyes tested in that time. The result implies a substantial increase in the number of people having eye tests compared with the years up to 1989.

The results of the survey are startlingly high. Almost certainly it contained an element of over-reporting and therefore one must discount the results to some extent. The hon. Member for Livingston said that there had been between 15 and 25 per cent. over-reporting and attempted to demonstrate that that rubbished the MORI poll. I pointed out that even that level of over-reporting does not rubbish the poll as it still gets one back to the trend in the number of eye tests that existed before 1987.

If one discounts the figures in the NOP poll by 15 per cent. it still means there has been a great increase in the number of people having sight tests. If one makes the ludicrous assumption that half the people involved in the survey were wrong about when they had their sight test, one still gets back to the trend that existed before 1987. On any view the survey shows that the number of sight tests in the first three months of the year is at least well in line with the increases in the 10 years to 1987.

The past 15 months have been entirely consistent with what any reasonable person might have expected. Before the changes were introduced there was a rush and an abnormally high number of people had a sight test in the first three months of 1989. There was then an inevitable dip, after which the number of sight tests has recovered to its former normal level. I intervened in the speech of the hon. Member for Livingston to say that I did not believe that he has a shred of evidence to contradict the surveys that have been carried out. To date three surveys have been conducted and they all show that the number of sight tests undertaken remain about the same. The hon. Gentleman's case is based on an absurd mistake in response to lobbying from the profession.

Mr. Tam Dalyell (Linlithgow)

On a point of order, Mr. Deputy Speaker. The Minister said that the documents relating to the NOP survey are in the Library. I went there because I wanted to have a look at that survey, but it is not available.

Mr. Max Madden (Bradford, West)

Further to that point of order, Mr. Deputy Speaker. You were not in the Chair at the beginning of the debate, but had you been, you would have seen the Parliamentary Private Secretary to the Secretary of State scurrying round the Chamber handing out the documents to a number of Conservative Members. Could it be that those documents include the report on the NOP poll to which the Secretary of State referred? If so, information is being given to Conservative Members which has been denied to the rest of the House.

Mr. Deputy Speaker (Mr. Harold Walker)

I deprecate hon. Members scurrying round the Chamber slipping out pieces of paper, but I have no knowledge of their contents—they might have been betting slips for all I know. I am sure that the Secretary of State is ready to comment on the point made by the hon. Member for Linlithgow (Mr. Dalyell).

Mr. Clarke

One hundred copies of the report are available in the Vote Office. My advisers intended to place them there at the end of my speech, but they will put them there now if hon. Members want that.

Mr. Michael

Let us have a look at them.

Mr. Clarke

I do not mind that. The hon. Gentleman will have an opportunity to speak later and I shall look forward to hearing how he can dismiss the evidence of three public surveys to show that there has been no fall in demand. Presumably he will say that he prefers the returns from 10 per cent. of opticians. I shall greatly look forward to hearing what the hon. Gentleman has to say.

It is total nonsense to keep asserting that people are not having eye tests, but that is the basis upon which the Labour party is committed to spending £90 million of public money, for no worthwhile health advantage.

Mr. Robin Cook

The Secretary of State has repeatedly said that we have produced no evidence, but he knows perfectly well that we have produced voluminous evidence collected by people of impeccable independence and with statistical experience. He chooses to say that all that evidence is worthless because it stems from optometrists, all of whom are in a grand conspiracy to distort the figures. I have produced figures from 1,600 outlets of optometrists who carry out eye tests and they consistently report a decline in demand. As the right hon. and learned Gentleman has waved aside all those 1,600, can he produce a single optometrist whom he has consulted and a single set of figures from any batch that he can reconcile with the wholly incredible results of his opinion polls?

Mr. Clarke

I have already dealt with the evidence, upon which the hon. Gentleman is relying, that comes from some sections of the profession which have responded to the poll. The hon. Gentleman is rendered speechless by the accounts I have given of the surveys—two of which he knew about—of the public which show that there is no evidence to support his case. The hon. Gentleman has again repeated his commitment that a future Labour Government will spend £90 million on eye tests. In terms of the NHS that sum is a staggering resource as it greatly exceeds the total budget of many district health authorities.

The NHS is well financed now—better than it has ever been—and I expect more to be spent on it. If I had £90 million more at my disposal eye tests would not figure on the first several pages of my priorities for expenditure. The hon. Gentleman has a problem because he cannot get his colleagues to agree to a commitment to spend more on the NHS. The shadow Treasury team is to be congratulated for showing common sense. I do not normally congratulate them, but they realise that following a period when cash spending has gone up by 20 per cent. in two years it is not possible for any Government of any party to contemplate increasing spending at a faster rate than that.

The hon. Member for Livingston has been trying to wriggle out of that problem and I think that he has been in trouble with his colleagues from time to time. Until recently he kept on trotting out a figure of £3 billion that might be produced during the lifetime of a Parliament. Obviously he has lost that argument because when one looks at the Labour party policy document no figure of any kind appears. There is a vague reference to underfunding, but it might take more than the lifetime of a Parliament to put that right. The Labour party is not promising to spend more on health. With the greatest respect to the hon. Gentleman, all that he manages to get in a vague, short and lightweight passage on health is a promise to restore free eye tests and free dental checks. That represents an astonishing set of priorities. I should imagine that the hon. Gentleman got that past his Treasury colleagues with his argument that one can save about £50 million by restoring the free eye test. This afternoon we have exposed that argument as wrong. On that occasion the shadow Treasury team showed a lapse in concentration.

There is no evidence to suggest that the restoration of free eye tests would increase the number of tests undertaken. Therefore, one would increase the number of tests undertaken. Therefore, one would not detect any disease quicker and there would be no saving to hospitals, but that is the argument that the hon. Gentleman appears to have swung across his hon. Friends when drafting the policy document. I hope that the hon. Gentleman will go away and decide whether it is wise for the one and only spending commitment of the Labour party to be devoted to saving £11 every two years for at least a comparatively better-off section of society.

Mr. Nicholas Bennett

The commitment given by the hon. Member for Livingston (Mr. Cook) is in direct contradiction to the statement of the hon. Member for Derby, South (Mrs. Beckett) a couple of months ago that there were only two spending commitments by the Labour party, and the restoration of free eye tests was not one of them. Surely this is just like the promise to abolish prescription charges in 1965; those charges were abolished in 1965, but they were brought back in 1968 and were set 25 per cent. higher than in 1965.

Mr. Clarke

I am grateful to my hon. Friend for reminding me of the speech of the hon. Member for Derby, South (Mrs. Beckett). If my hon. Friend continues to scrutinise the speeches of Labour's Treasury spokesmen, he will see that they do not mention health at all. There is no commitment by the Labour party because it would not be possible to exceed our spending plans. The hon. Member for Derby, South must have had a momentary lapse when she allowed this commitment to pass. I hope that when she sees the results of the various surveys she will reconsider her position.

Our priorities are to make a better National Health Service, to expand services generally and to devote money to the cause of better patient care, including eye care. Labour's campaign is stale. It is based on a false premise and should be abandoned. Now that we have become used to free eye tests only for those who need the support of the Government, any sensible level of priority should tell us that that is where we should leave the matter.

4.52 pm

Mr. Gerry Steinberg (City of Durham)

I propose to be brief and mainly to confine my remarks to my constituency. Charging for sight tests has placed a financial restriction on public access to a primary health measure. The imposition of the charge has deterred people from taking early steps in perhaps preventing the need for more treatment later and in the early detection of more serious conditions such as hypertension, one of the most common predisposing causes of a stroke, and glaucoma, which is a potentially blinding disease but often treatable. We are told that prevention is better than cure, but paying for access to preventive health care has deterred many and they run the risk of having treatable medical conditions go undetected at an early stage.

I carried out a survey, but perhaps I should have gone to dentists and asked them for information because what the Secretary of State said suggested that information given by opticians cannot be trusted. I went to opticians in Durham and carried out a small survey. I found that at its worst 60 per cent. fewer people were attending for eye examinations than in the year before the charges were introduced. Most disturbingly, the figure proved to be higher for old-age pensioners, especially for those who were not in receipt of income support. Those people have had their right to a free eye test withdrawn and are most likely to suffer the consequences of developing sight-threatening conditions through being discouraged from attending for routine eye examinations. To discourage such people is monstrous, given that many sight-threatening conditions are treatable after early detection.

The Secretary of State does not seem to take any notice of or accept any information supplied by opticians. Letters that I have received from opticians in my constituency show that they are deeply worried. I wrote to every optician in my constituency and they all expressed misgivings. A Mr. Grundy, who has two practices in my constituency, wrote to me saying: I am very concerned that because these people are now discouraged from attending for routine eye examinations by charges, they are at much greater risk of developing sight threatening conditions which would in the past have been prevented by early detection and treatment. I accept that the Secretary of State does not place much credence in that, because it is only a letter from an optician, but it is a damning comment on the situation.

Figures from a practice in my constituency show that 170 old-age pensioners who were not in receipt of income support attended for eye tests in the three months leading up to the introduction of charges. In the three months after the introduction of charges the number had dropped to 63. Even taking into account the distortion of the statistics caused by people rushing to get a free eye test before the charges were introduced, there is undoubtedly a marked drop in that practice's normal testing figures.

A worrying aspect of the survey was that a large proportion of the missing numbers were people who received income support but apparently did not realise that they were entitled to a free eye examination. Obviously, that can be serious for pensioners. At one practice the number of old-age pensioners receiving income support had dropped from 86 in the months leading up to charging to 56 after the introduction of charges. I was told by another practice that the receptionist was spending a great deal of her time trying to allay the fears of worried pensioners who did not know their entitlement and for whom the £11.20 is far beyond their means. Unfortunately, only a proportion of those worried pensioners found that they could have a free sight test. The rest, those not in receipt of income support but nevertheless without the means to pay, had to face the decision that they would have to do without the much-needed sight test.

Mr. Keith Bradley (Manchester, Withington)

I earned out a similar survey in my constituency and it produced exactly the same results. It showed a reduction of up to 30 per cent. in the number of people going for eye tests. The Secretary of State does not accept the evidence of opticians, but one optician referred to me the case of an 83-year-old woman who thought that she was not entitled to a free eye test. When she realised that she was, the optician examined her and found a tumour in her eye. She was referred to the eye hospital in Manchester and was told that the tumour was so large, because of the delay in having the eye test, that she would probably have to have the eye removed. Is that the sort of health care that we can expect from the Government? Pensioners are scared to go for eye tests because they cannot afford the cost.

Mr. Steinberg

I thank my hon. Friend for his intervention. He gives an example of what can happen if an old-age pensioner or anybody else does not get an eye test in time. There are hundreds of such cases throughout the country, and unless the Government recognise what is happening such stories will become all too familiar.

The figures that I have quoted cover the six months from January to June 1989. When the figures are broken down month by month, it is seen that, in the months before charging, the average number of pensioners attending for routine eye tests ranged from 11 to 29. In April, the month in which charges were introduced, the number attending fell to just one or two pensioners. That was true for every practice that supplied me with information. In the following months of May and June, the figure rose to an average of six or seven. While the initial refusal or inability to pay for sight tests waned slightly, the fact remains that the number of people attending for sight tests has halved. The situation today has hardly improved.

It is an inescapable fact that a sizeable proportion of people, mainly pensioners, no longer attend their optician for a routine eye test. There is no doubt among opticians with whom I have been in contact that there has been no improvement in the past 12 months. While charges remain and while pensioners have to set aside part of their income for the poll tax, there will not be a full return to the pre-April 1989 figures. If nothing else, the Government must consider making all pensioners exempt. Out of a small income, pensioners cannot pay their proportion of the poll tax and pay for a sight test. They will have to make a choice and, as they have to pay the poll tax, they will have to do without the sight test.

Mr. Grundy told me that one of his practices used to rely entirely on pensioners. Now he does not see one pensioner at the practice and has had to reduce the opening times to two days a week. Regular patients at that practice no longer attend, and he attributes the loss purely to the charge for eye tests.

So that I cannot be accused of distorting the statistics by quoting figures for the three months before charging was introduced, I shall quote figures given to me yesterday by Mr. Grundy which leave no doubt about the destructive nature of the charge for eye tests. In January 1988 and January 1989, before the charge was introduced, there were 108 and 118 sight tests respectively. In January 1990, after the charge was introduced, there were 80 sight tests. In February 1988 and February 1989, the figures were 120 and 112 respectively and in February 1990 the number was 68. In March 1988 and March 1989, the figures were 102 and 135 respectively, while in March 1990 the total had dropped to 77.

The figures speak for themselves. In each instance there has been a monthly reduction of between 40 and 60 sight tests following the introduction of charges. That is proof, if proof were needed, of inability and reluctance to pay for a service which should never have been costed. In my constituency—I am sure that it is not unique—there has been a 30 per cent. fall in the number of sight tests. Primary health care is all about prevention and it is imperative that people and prevention are put before pounds.

It is clear from my research and the evidence that has been given to me that the eye-test charge has had a serious effect on the number of people attending opticians. The argument used by some Conservative Members, including, the Secretary of State—I remember clearly the occasion on which he first advanced it—was that market forces would result in so much competition between opticians that charges would be eliminated. That has not happened yet and we wait for evidence that it will. In effect, opticians got together and set the charge for their area. That is not meant to be a criticism of opticians. It is a matter of fact and a natural thing for them to do. They had to do it because there was no alternative.

The criticism must be directed to where the blame lies, and that is with the Secretary of State and the Government generally. There can be no justification for charging for a primary health care measure, especially for one which is able to detect serious medical conditions at an early stage.

It is an especially important test. Even in terms of the Government's philosophy, the charges are not cost effective. It can be said only that the charge is vindictive and that it hits old people in particular. It should be abolished forthwith.

5.2 pm

Dame Jill Knight (Birmingham, Edgbaston)

There are few things that I like less than speaking and voting against the Government. I am happy to say that it is a rare occurrence when I have to do either of those things. For about 99 per cent. of the time I agree entirely with what they do and I support them in Divisions with great enthusiasm and faithfulness. I believe profoundly, however, in following my convictions, and one of my convictions is that one serves the party better by putting convictions above the diktats, arm twisting or threats of the Whips. As I have said on every occasion when charges for eye tests have been debated, the Government are wrong, and for at least seven reasons.

First, charges for eye tests breach the basic principle, which was adhered to for over 40 years, that whatever else is chargeable within the National Health Service, a check or test should be free. I have no objection to charges when a check or test has revealed that glasses or other appliances are necessary, so long as the individual can afford to pay. It is very much to our advantage to know as soon as we can if a person needs attention. It is cheaper to remedy the defect at an early stage and it is very much easier to deal with it. It is also much more likely to be cured.

Secondly, eye-test charges are extremely discriminatory. There are no charges for blood tests, cancer checks, heart scans, barium meals or X-rays. It has been suggested that anyone can afford to pay £12 for a test because some people spend that much on cigarettes, but that argument could just as easily be applied to all other vital tests. It is odd that the Government seem not to understand that eye tests will often reveal the early signs of cancer, blood pressure or diabetes. It is strange that a block should suddently be imposed on one preventive test while other such tests romp along without interference. I do not know whether this means that eventually we are to have charges for other checks. I should like to know whether they are to be introduced.

Thirdly, the money that is saved is not to be spent on projects for which greater need is claimed. It has—[ Interruption.] I hope that my right hon. and learned Friend the Secretary of State will listen, because I am speaking with great conviction. It has been made clear in earlier debates that the money that is saved—it had been estimated that it will be about £70 million per annum—will be spent on preventive medicine. It seems that it will not be spent on hip replacements or anything of that sort. Ministers have said that the money saved will be spent on preventive medicine. But eye tests are preventive medicine. It seems that the Government are saying, "We are saving money on food to spend it on food", or, "We are saving money on clothes to spend it on clothes." I am prepared to admit that there are different and more valuable types of food, or types of clothing, but surely there is no suggestion that eye tests are an inferior form of preventive care and do not amount to important primary health care. It is nonsensical to say that we are saving money on preventive care in the form of eye tests so that we can spend it on other forms of preventive care.

Fourthly, it has been recognised and accepted—my right hon. and learned Friend the Secretary of State has not suggested otherwise—that eye tests can reveal the first signs of many serious diseases. There is no doubt about that. It seems absurd that we should be denying ourselves the ability to spot the first signs of important diseases such as heart disease and cancer by introducing charges. That action has led undoubtedly to a reduction in the number of people seeking eye tests. My right hon. and learned Friend has argued that there has been no reduction, but I must tell him that there are signs that he is wrong. Indeed, the signs cannot be doubted. It worries me that the evidence has been discounted because some of the data have been obtained from opticians. The survey of the Association of Optometrists and the Federation of Ophthalmic and Dispensing Opticians revealed a 32.4 per cent. reduction in the number of eye tests being carried out. The Government's statistics are not suspect—they are plainly inaccurate.

I tabled a question in which I asked my hon. Friend the Minister for Health whether she would ensure that the survey, which has been referred to by my right hon. and learned Friend the Secretary of State, of the number of tests carried out during the first quarter of 1990 would be based on information obtained from the records of ophthalmic opticians instead of the recollection of patients. My hon. Friend replied that the information would be obtained from patients to ensure that the results were clearly independent. Any medical practitioner in any area of medicine will cheerfully tell my right hon. and learned Friend the Secretary of State that memories are notoriously fallible when determining when a test or check was carried out. It is not uncommon for a doctor to ask a patient when he or she last came to the surgery and to be told that it was two years ago, when in fact it was four years ago. And when a patient says that it was four years since he last came to see the doctor, sometimes it is really eight years. People cannot remember accurately. It seems extraordinary to reach important conclusions on the basis of people's memories.

I could understand my right hon. and learned Friend discounting the statistics given by opticians if they had relied on their memories, but they had not. They relied on their records. I strongly resent any suggestion that ophthalmic opticians—professional medical men—would falsify their records for the purpose of the survey.

Mr. Kenneth Clarke

indicated dissent.

Dame Jill Knight

It is a question not just of falsifying statistics for the purpose of this debate but of defrauding the Inland Revenue. If it is true that ophthalmic opticians are deliberately altering their records, something is seriously wrong.

Mr. Dalyell

Did the hon. Lady notice that the Secretary of State shook his head vigorously when she made her point about opticians' records? Perhaps she will ask the right hon. and learned Gentleman whether he thinks that opticians are doing something that borders on the deceitful. Are their records sincerely and accurately kept, or are they not?

Dame Jill Knight

My right hon. and learned Friend's speech will be read with great interest outside this House. He said that the profession was honourable but that he discounted its statistics because the profession itself had produced them. Surely that is the same as saying that the opticians falsified their records. That is the only possible interpretation that one can place on his remarks.

Mr. Kenneth Clarke

Three public surveys have shown that the opticians' figures are wrong. We are debating why they are wrong. It is not for me to comment, because I have not even seen the full results of the survey, but it was not based on records from all opticians. It was based on returns from some opticians. I offered as the most likely explanation for the discrepancy that the opticians most likely to respond to the survey were those who had lost out in the competitiveness of the past two years. The country is full of newly opened opticians' shops.

My hon. Friend the Member for Nottingham, South (Mr. Brandon-Bravo) reminded me that one has just opened in the centre of Nottingham. I do not know to what extent those new businesses responded to the surveys, but they are responsible for the loss of trade by one practice in Durham, which now opens only two days a week. I am making the point that there were three excellent public surveys showing the level of the public's use of outlets, and showing also that the figures produced by the Association of Optometrists were inaccurate.

Dame Jill Knight

The "excellent" surveys to which my right hon. and learned Friend refers were all based on memory. I make the point that memories can be fallible, whereas the records of a practice set down in black and white cannot possibly be challenged.

Mr. Kenneth Clarke

Does my hon. Friend agree, as the hon. Member for the City of Durham (Mr. Steinberg) ought to do, that whereas the records of one practice provide an accurate picture of the number of people who have had their eyes tested there, the best way of identifying how many members of the general public have had eye tests is to question the general public? Opticians' practices are opening and closing all the time. One only has to walk down the high streets of England to see that the nature of optical practice is dramatically changing.

Dame Jill Knight

My right hon. and learned Friend may believe that opticians' practices open and close as easily as that, but I assure him that the ones with which I have been connected have been in business since the very beginning of the profession.

Mr. Steinberg

The Secretary of State suggests that I wrote to only one practice. In fact, I wrote to virtually every practice in my constituency, and I received a similar reply from them all. I cited one practice as an example, but I could have cited half a dozen more.

Mr. David Lightbown (Lords Commissioner to tlhe Treasury)

indicated dissent.

Dame Jill Knight

I believe that the hon. Member for the City of Durham (Mr. Steinberg) also mentioned that there were slight differences between the responses that he received, which is something that my hon. Friend the Member for Staffordshire, South-East (Mr. Lightbown) will be pleased to hear. He imagined that the responses were all exactly the same, and I am glad to have confirmation that they were not.

Another point of significance in view of my right hon. and learned Friend's remarks is that 10,000 people were involved in the Government survey whereas the AOP survey covered 4 million people. I cannot believe that—surprise, surprise—they all just happened to say much the same thing.

I again draw the attention of my right hon. and learned Friend to the Economists Advisory Group report. The hon. Member for Livingston (Mr. Cook) made mention of Professor Peter Hart, who is surely a reputable man, and one who works, as a statistician, in an honourable profession. He is emeritus professor of statistics at Reading university, and a man of his calibre who produces a report on behalf of the Economists Advisory Group can surely be relied upon to give an honest answer.

Professor Hart reported that the number of people undergoing tests since charges were introduced has declined by 32.4 per cent. The hon. Member for Livingston conceded that there was a sharp increase in the number of tests when the public knew that they would shortly be charged. Even so, that jump is estimated to have accounted for fewer than 1 million additional tests. Therefore, whereas the number of eye tests in 1988–89 was 13.2 million, the usual number was 12.2 million annually. Presumably it is fair to say that the extra 1 million tests are accounted for by people trying to beat the charges. In any event, in 1989–90 the number of tests fell to 8.9 million. That must be a source of worry and concern to my right hon. and learned Friend. That is hard data—3.3 million people, more or less, have been deterred from having eye tests.

Fifthly, it is untrue to say that people who are not eligible for free tests can easily afford the £12 fee. My right hon. and learned Friend argued today that it is likely that tests will eventually be free—but that cannot happen, for two reasons. One is that, as a result of laws passed by our Government, anyone is entitled to go to an optician, undergo a test and be given a prescription—and then take it down the road to a spectacle bar and have it made up there. It is breaking the law for an optician to say, "I will test your eyes provided that you buy your spectacles from us." First, opticians may not get any return or any possibility of a return when they have spent time and professional expertise on testing someone's eyes. Secondly, some 20 to 25 per cent. of all people who go to have their eyes tested do not need glasses, and therefore opticians would not be able to recoup any funds. A figure approaching 50 per cent. of ophthalmic opticians' time could be spent on such people, and if they did tests for nothing they would get no return. How on earth can professional people who have trained for some four years, and who know what they are about, open a practice and keep it open and pay receptionists and all the other charges involved if they get no return for 45 or 50 per cent. of the time that they work? It is not feasible.

I must tell my right hon. and learned Friend that it is highly unlikely that eye tests will ever be free. I do not understand why he said so, unless, perhaps—this thought just struck me—he is saying that people who need glasses would pay extra to make up for other people having tests free who did not need them. There is no other way of achieving free tests.

Sometimes I think that we do not all understand how difficult some people find it to make ends meet. We should always be sympathetic to that. People are being pressurised by mortgage costs and have all sorts of other difficulties to meet in their financial lives. Not everyone who is not entitled to a free eye test has no problem in finding £12 and we have to recognise that. It is not even a case of tests once every two years, because some people need them every six months. A woman who wrote to me recently was in that position because of a congenital eye problem, but she was not eligible for free tests.

I have always worried about the problems of parents, who put their young and growing children first. I wonder how many of us know what it is to keep a young child in shoes, never mind anything else. I am quite sure that many parents will say that there might not be anything wrong with their eyes this time, and "Johnny needs new shoes".

The other category of people who worry me are the elderly. There is no doubt that they are up to five times more likely to suffer from eye disease or degeneration than younger people. While it is perfectly true that not all elderly people need help from the Government, why do we give elderly people free prescriptions? If they are old-age pensioners they get free prescriptions whatever their income. Yet it would be fair to say that many prescriptions are not as important as having an eye test. Why have free prescriptions but make people pay for eye tests? Many old persons may well go blind if they cannot afford an eye test and that worries me greatly.

People can have free eye tests at hospitals, and more and more people outside this place will recognise that and ask their doctors to give them a chit to get such tests at the hospital. We shall be in trouble because the cost of a hospital eye test to the Government is somewhere between £25 and £50. I have checked that and there is no doubt about it; it is true. Where is the economic sense of paying up to £50 for someone to have an eye test in a hospital, but failing to pay £12 to a trained ophthalmic optician to do the test instead? Pretty soon, pressure on eye departments will cause problems, because people will wake up to the fact that they can have free tests there. I do not believe that they have realised that.

My final point knocks on the head for ever my right hon. and learned Friend's obviously sincere belief that there has been no drop in the number of eye tests. Practice closures can be seen all over the country. Some 250 practices closed this year and many rural areas will be without an optometrist. I must warn hon. Members about that. There seems to be a general disinclination in this place to love opticians. I sometimes wonder how many hon. Members, or their mothers, were frightened by an ophthalmic optician. There has been a sustained campaign against opticians. However, it is true that if the closures, which are now inevitable, take place in rural areas, many people who desperately need health care, and who are entitled to get it for nothing, will not be able to get that care. That also worries me.

I predict that there will probably be a loss of some 10 per cent. of ophthalmic practices within the next year because many of them are now working from hand to mouth. However much my right hon. and learned Friend tries to deny it, it is true that many ophthalmic opticians are going out of business. That is neither wise nor right. I beg my right hon. Friends in the Government to consider the possibility of helping the aged, who are in far greater danger than anyone else. If they cannot do anything else, for goodness' sake will they give special help to pensioners?

5.27 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye)

The hon. Member for Birmingham, Edgbaston (Dame J. Knight), as is traditionally the case, speaks on this subject with detailed insight and common sense. However, perhaps what is most significant is that, as the first speaker from the Conservative Back Benches, she spoke not one word of support for her own Secretary of State. Not that that is liable to sway him, as he does not seem to be a Secretary of State who wants to listen to information or to consult individuals or organisations in various fields of health care. Indeed, he has something of a track record, and clearly delights in the way that he does not consult those people with knowledge within the field of his ministerial responsibility whom common sense would suggest that he should consult.

If one wants to buy a car, it is likely that one will want to ask friends who drive motor vehicles how they find different cars, and to discover the consumer and public view. The chances are that one will also speak to a car salesman or a mechanic. Similarly, the Secretary of State today laid weight upon a survey which has just been published at last. I find it a completely frustrating feature of this institution that, on the day that we are debating the issue, the information on which the conclusions in the Secretary of State's speech are based becomes available only when his backside hits the green leather at the end of his speech. That does not make for well-informed debate from Conservative Members or from the Opposition.

In the latter stages of his speech, the Secretary of State was like a drowning man clutching at the one piece of flotsam floating past.

Mr. Kenneth Clarke

Let me explain, in case it is thought that publishing it today was a device, that we intended to publish the survey next week. The hon. Gentleman knows that at the last minute the Labour party decided to table this motion. As my enemies had delivered themselves into my hands by returning to this corny old subject, I was unable to resist the temptation to bring it forward today. It contains the best and the most accurate information that anybody has to hand about the number of people having eye tests.

Mr. Kennedy

There is a veneer of plausibility about that, but it contains a number of extremely contentious points. I concede that the topic for debate was changed at short notice, but even if it had been known that the debate would be held at the end of this year, the Secretary of State would not have made the information available until the end of his speech on that occasion.

Mr. Michael

Does not the hon. Gentleman at least welcome the fact that the debate was brought forward because of widespread and serious concern about the topic?

Mr. Kennedy

I agree with the hon. Gentleman.

The Secretary of State is unwilling to consult those who are most affected and those with the best knowledge—the opticians. The Secretary of State's report, published today, refers to the survey of over 1,700 opticians that was carried out by the Liberal Democrats some months ago. On 17 May 1990, the Under-Secretary of State for Health wrote to me thanking me for enclosing the results of the Liberal Democrat optical survey, but he echoed the Secretary of State's argument that there is no point in consulting the professionals because they have an axe to grind. The only people whom the Government want to consult are the consumers; that is the only way to get the answers that the Government want. The Under-Secretary went on to say: It would, therefore, be wrong to rely entirely on information supplied by providers alone. According to the survey that we have heard about this afternoon, it is quite all right for the Secretary of State to rely entirely on information provided only by consumers. The sense of that, both in the English language and in terms of the Government's health policy, is that the Secretary of State is trying to get a judicial blend in order to inform his actions concerning what both the professionals—the optometrists—and patients have found out for themselves. The optometrist surveys that have been referred to in the debate unanimously gave a thumbs down to the Secretary of State's policy. The Secretary of State's survey of consumers alone provides different information and he bases his entire argument on that information.

That is in complete contrast to the logic of the statement made to me on 17 May by the Under-Secretary of State for Health. Dismissing all the surveys that had been made before the Department of Health survey, which has floated down, like manna from heaven, on to the Secretary of State's lap today, the Under-Secretary of State for Health said on 17 May about all the previous surveys: They cannot at this stage be taken as a serious indicator of future trend. By 6 June, the one survey that the Secretary of State has come out with is the definitive indicator of future trend. It is the one to end all arguments and all debate. That is the kind of nonsense with which we are being entertained by the Secretary of State and his colleagues in the Department of Health.

The Secretary of State quoted selectively from today's so-called definitive five-star results. According to the summary on the front page: Whilst there is a disparity between NOP's results for NHS sight testing and the known number of NHS sight tests paid for in the first quarter of 1990, there is no evidence, from this survey, of a fall in sight testing in the first quarter of 1990. A little more detail about the disparity is to be found in paragraph 6.2: The disparity between NOP's results for NHS sight testing and the known number of NHS sight tests paid for casts some doubt on the credibility of the results. I am happy to let those who devised and carried out the survey speak for themselves.

The Secretary of State has ignored the Association of Optometrists, the British Medical Association's ophthalmic committee and the Royal National Institute for the Blind. He bases his entire argument on the survey that has just come into his hands. However, the hon. Member for Edgbaston made the forceful point that many of the questions asked in the survey were unlikely to elicit an accurate response because they depended on human memory rather than on factual information provided from the records of optometrists and opticians.

Mr. Churchill (Davyhulme)

The hon. Gentleman rightly draws attention to the fact that the Secretary of State's NOP survey shows that there is a clear discrepancy. What he has failed to allude to is the scale of that discrepancy, which appears to be quite colossal. Perhaps the Secretary of State, or the Minister of State who is to wind up the debate, will comment on it. According to paragraph 6.1 of the NOP survey: The estimate of NHS sight tests derived from the NOP survey can be compared with data collected from FPCs and Health Boards. 1.058 million were paid for by FPCs in England and Wales and Health Boards in Scotland in the first quarter of 1990. Of these, 0.624 million were adults aged 16 or over; this represents 1.4 per cent. of the adult population. The first two surveys conducted by the NOP suggest that 4.5 per cent… of the adult population had an NHS sight test in the period. In other words, the NOP survey shows more than three times as many people saying that they remember having a sight test since Christmas than the Secretary of State's own figures suggest. Therefore, I query what value can be placed on the document.

Mr. Kennedy

The hon. Gentleman ought to be given a knighthood. I very much welcome his intervention. The Secretary of State is uncharacteristically silent. I have read the speech that the hon. Gentleman made on the subject in a previous debate. I believe that he has touched on a pertinent point. Whether we shall receive a pertinent answer remains to be seen.

Mr. Kenneth Clarke

I had not realised that my interventions were so popular, which is why I remained silent. The explanation is contained in the report. Many people think that the sight test that they pay for is an NHS sight test. The survey is not reliable in terms of the figures that it publishes about how many people have had NHS or private eye tests. We are concerned with the total number of eye tests. As I said in my speech, one could knock off 50 per cent. for errors. We could find every reason that we liked for error, and we should still come up with a figure that showed no decline in the number of eye tests, compared with the expected trend.

Mr. Churchill

But this is a 400 per cent. error.

Mr. Kennedy

As I am sure the hon. Gentleman appreciates, inflation and interest rates are going up, so why should not the margin of error here go up by a similar amount? That is a feature of the running of the country by this Government.

The hon. Member for Edgbaston made a legitimate case, but the Secretary of State has not responded to it. He has produced a fail-safe survey. It does not purport to be fail-safe, but it is based on individual human memory as opposed to facts held on record by opticians. There can be no doubt which survey is more accurate.

I would concede that simply to consult opticians, as we did in our survey, does not give as good a result as consulting a proper statistical blend of customers and opticians as it is reasonable to draw on customers' impressions as well. However, the input of opticians is critical to any set of findings, whatever proportion of those findings they represent.

The simple truth is that the opticians provide the only reliable facts available. Statistics drawn from the public are bound to include impressions, whereas the opticians provide hard evidence. If the Secretary of State is seriously questioning the accuracy or veracity of the facts provided by opticians, as he did in his speech in reply to the hon.

Member for Livingston (Mr. Cook), he is bound to be casting some aspertions on the opticians. There are no two ways about it, and he cannot get away from it.

I adhere to the view that, whatever one may say about the various surveys that have been carried out, including our own, to base his entire argument, as the Secretary of State has done today, on one survey in preference to or in complete opposition to all the other surveys is surely bizarre and wrong-headed in the extreme.

Given the Secretary of State's track record and the way he goes about things in the Department of Health, I suspect that he did that simply because it is the only survey so far that has given him a fig leaf against the warnings uttered to him by his own Back Benchers and from the Opposition. I suspect that, yet again, as he did with the nurses and the ambulance men in the past and as he continues to do with family doctors, he has now picked another group of professionals in the Health Service and offended and alienated them by the tenor of his remarks today. He will live to regret it, as preventive health regrets the decision to introduce these wrong-headed charges on 1 April 1989.

5.41 pm

Mr. Michael Brown (Brigg and Cleethorpes)

I shall not detain the House for long, but I want to make it absolutely clear that I reject what has been said by the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and by my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight). I have always believed that it is right in principle to charge those who can afford it relatively small amounts of money at the periphery of the National Health Service. That policy was started not by the present Government nor the last Labour Government but by the post-war Labour Government. That Government recognised that it was important to raise additional funds which could not be sustained out of general taxation because of the bottomless pit with which the Health Service is sometimes faced, and successive Governments have followed that principle.

My right hon. and learned Friend the Secretary of State has courageously and correctly faced up to the fact that the Department of Health can raise an additional £70 million of expenditure for primary health care from people like me.

I have been wearing glasses for the past two years. I came to the House in 1979, and at the age of 27 I had the good fortune of not needing to wear glasses. By pure coincidence in 1988 I was driving my car through Lincolnshire when I heard on my car radio that Lincolnshire police were planning to conduct spot sight tests for drivers. I was frightened and worried and decided to have my eyes tested. My right hon. and learned Friend the Secretary of State paid for me to have a free sight test, notwithstanding the fact that I cheerfully paid £98 for my glasses.

The hon. Member for City of Durham (Mr. Steinberg) mentioned various statistics. In 1988 an individual from the constituency of Brigg and Cleethorpes went to an optician in Pimlico for a free eye test. I have not had my eyes tested since; I was issued with these glasses two years ago and no doubt I shall receive a card from the optician inviting me back for a periodic eye test. I am a classic example of somebody who has no business to be receiving taxpayers' money for an eye test. I went to have my eyes tested in 1988 and I have not had them tested since. That is why statistics in Durham are producing those results.

Mr. Churchill

I am sure that, on reflection, my hon. Friend will appreciate that his free eye test was paid for not by the Secretary of State but by the taxpayer. While he and the House will accept that no one is arguing today that those on above average earnings, such as himself or the printers in Wapping and what is left of Fleet street, should get taxpayers' money to pay for their eye tests, would he regard it as reasonable and right that one of my constituents who is earning less than a quarter of average earnings should be required to pay the full cost of a sight test? I cannot accept that. That individual should be entitled to a free eye test.

Mr. Brown

Plainly, my hon. Friend has not read the motion that we are debating. I am opposing a motion which calls upon Her Majesty's Government to restore a free preventive service for eye examinations. In 1988, quite wrongly, the taxpayer—my hon. Friend is absolutely right about that—paid for me to benefit from such a service. So, with great respect to my hon. Friend, unless we amend it the motion is inviting us to do that and that is why I believe that it should be opposed.

My hon. Friend the Member for Edgbaston argued wrongly for free eye tests for all pensioners. I know that my hon. Friend looks very youthful, but I believe that she would be entitled to such a free eye test. I know that one should not discuss an hon. Lady's age in the Chamber, but we all know from Vacher's when my hon. Friend the Member for Edgbaston was born. I am sure that she would be the first to acknowledge that she and many pensioners in the United Kingdom are on above average earnings and should not receive free eye tests.

Mr. Dennis Turner (Wolverhampton, South-East)

Will the hon. Gentleman give way?

Mr. Brown

I apologise to the hon. Gentleman, but I have given way already and I do not wish to detain the House as other hon. Members want to speak.

The Government's proposals which were put into effect last year enable 20 million people, or nearly 40 per cent. of the population, to receive free eye tests. Those 20 million people consist of all children under 16, those on low incomes, the blind and partially sighted, students under 19 and people suffering from glaucoma. That is not unreasonable bearing in mind the fact that money is being released as a result of the peripheral charge which Opposition Members accepted, when they were in government and when they created the National Health Service, it was right and proper for the Health Service to raise from the taxpayer.

A not too dissimilar argument is whether those of us who can afford to pay prescription charges should do so. I shudder to think of the "ceaseless cascade" of medicine that is pouring down British throats. The Opposition should remember who said that.

Dame Elaine Kellett-Bowman (Lancaster)

Bevan.

Mr. Brown

My hon. Friend is nearly right. Because free medicine was available indiscriminately, that comment was made by the right hon. Member for Ebbw Vale in 1949, the great defender of the National Health Service.

Dame Elaine Kellett-Bowman

It was Bevan.

Mr. Brown

The right hon. Member recognised in 1949 that funds were distributed indiscriminately across the board to people who could afford to pay.

Dame Elaine Kellett-Bowman

My hon. Friend is wrong. It was Bevan.

Mr. Brown

My hon. Friend says that it was Aneurin Bevan, but I have a quote from the right hon. Member for Ebbw Vale.

Dame Elaine Kellett-Bowman

Bevan was the Member for Ebbw Vale.

Mr. Brown

No less a person than Aneurin Bevan made that statement. The right hon. Member for Blaenau Gwent (Mr. Foot) and the former Member for Ebbw Vale, who both served in the 1945 to 1950 Parliament, recognised that there was a case for having peripheral charges for those able to pay, just like many Members and people outside the Chamber.

Dame Elaine Kellett-Bowman

Will my hon. Friend give way?

Mr. Brown

I would give way were it not for the fact that this is a short debate and I have promised to be brief.

Dame Elaine Kellett-Bowman

Be a sport.

Mr. Brown

I give way, briefly.

Dame Elaine Kellett-Bowman

Is it not significant that Aneurin Bevan, who was supposed to be the father of the Health Service, complained about the "ceaseless cascade"? He was the Member for Ebbw Vale.

Mr. Brown

I entirely accept what my hon. Friend says. My hon. Friend and I would agree that that Labour Government established a principle followed by all successive Governments, notwithstanding the fact that, as my hon. Friend the Member for Pembroke (Mr. Bennett) said, for three years the Labour Government abolished prescription charges, only to restore them in 1968 at a rate 25 per cent. higher. All Governments have recognised the principle of charging for those peripheral services, and I include eye tests, for the reason that I described.

The Government have honoured their commitment in last year's debate. The fact that 40 per cent. of the population—20 million people—receive free eye tests shows that this is a properly targeted measure. The Government are right to ensure that an additional £70 million is available for the primary health care services. I shall have no hesitation in throwing out the Opposition's motion.

5.52 pm

Mrs. Alice Mahon (Halifax)

What appals me most about the Government's attitude to health is that they have blatantly and unashamedly politicised pain and suffering. This is another deliberate policy that is designed to damage the National Health Service. The performance of the Secretary of State will find great favour with the Prime Minister, because it is business as usual, despite the massive amount of factual evidence that the ending of free eye examinations has led to a dramatic fall in the number of eye tests, with dangerous results for the health of millions of people.

I agree with the hon. Member for Birmingham, Edgbaston (Dame J. Knight) that evidence is available if the Government choose to seek it—in the audited records of opticians to which ophthalmic committees have access and which community health councils could monitor. Means-tested benefits carry a stigma, as is shown by the low take-up. If the Prime Minister or the Secretary of State had an elderly relative on a low income who needed an eye test but was deterred because of cost or because he or she did not wish to fill in a lengthy form or take part in means-testing, and that person were in danger of developing glaucoma or a tumour that could be cured if found in time, they would have to explain that they were against any collective provision for individual need at the time of need and paid for through taxation, whatever the pain or suffering caused. They would have to say sorry but, as the amendment states, those who can afford to pay for sight tests should do so". That would be their message, without any regard to a person's ability to pay and to choice.

My hon. Friend the Member for Livingston (Mr. Cook) talked about the dramatic fall in the number of people receiving eye tests. The Secretary of State said that there had been no fall-off in eye testing and that there was an opinion poll to prove it, yet he does not believe in the poll results. The right hon. and learned Gentleman could look at the audited records in every practice and collect the data if he wanted that information, but I suspect that he does not want it.

Like my hon. Friends in their constituencies, I have been keeping an eye on the position in mine. I checked today with the local ophthalmic committee, the community health council and some local opticians who were worried, and I saw the latest survey which had been conducted by the ophthalmic committee, monitored and overseen by the CHC. The first survey, for the six months from April 1989 to October 1989, showed that the number of tests had fallen by 34 per cent. The second survey, from October 1989 to April 1990, showed that the number was still down by 32 per cent., which appears now to be the permanent level. That figure is the same as the one arrived at by the professor of statistics at Reading university. I would argue that that is a more realistic figure than the ones used by the Secretary of State.

It will come as no surprise to my hon. Friends to hear that 32 per cent. is just an average; sometimes it is more than 40 per cent. in more deprived areas in my constituency. That is a fair measure of what is happening locally. Conservative Members should look at the surveys carried out in their constituencies and then argue in the House about the pathetic attempt by the Secretary of State to use the NOP survey. Despite all the facts, we are still subjected to the self-righteous ranting of the right hon. and learned Gentleman, and the self-righteousness shown in the amendment tabled by the Prime Minister. Neither the Secretary of State nor the Prime Minister is deaf. They know exactly what is happening and that the 32 per cent. fall-off is nearer the truth than their figures.

The hon. Member for Edgbaston made a point, which is worth repeating, about the costs that will result when people cotton on to the fact that they can have an eye test carried out free at an ophthalmic clinic. I asked about the local cost and the hon. Lady said that it would be between £25 and £50, an average of £35 in my constituency, for referral by a general practitioner compared with £11.20 for referral by an optician.

There is no legal argument for abolishing free eye tests. If people cotton on to going to hospitals for tests, it will cost the NHS a great deal of money. While preparing for this debate, I discovered that there is a seven-month waiting list at the ophthalmic clinic in my constituency. That is tragic. However, Ministers, and those who support the Government and their onslaught on the NHS, will not be found in those tragic queues because, like the Prime Minister, they can buy their way to the top.

The current crisis in the National Health Service and the Government's policy on eye tests have been created deliberately because the Prime Minister loathes the NHS. The ending of free eye tests is part of the Prime Minister's determination to dismantle the whole structure of post-war social provision and end what she sees as the hated socialist ideal. She deliberately seeks to lower standards of patient care and to produce a two-tier system. That system exists now. If someone has some money and is okay financially, he can have a test and benefit from it. However, if someone is on a low income and worried about a budget or concerned about water bills for which there is no rebate, and the poll tax, he will lose out.

I have a message for the Government from Mr. Bruce, who is the director-general of the Royal National Institute for the Blind. He referred to people missing out on eye tests and the possible subsequent identification of medical conditions. He said: Unnecessary blindness is not something to be proud of. I believe that political myopia is something to be downright ashamed of, and that is what the Government are suffering from with regard to eye testing.

6.1 pm

Mr. John Maples (Lewisham, West)

If the hon. Member for Halifax (Mrs. Mahon) believes that the Government are deliberately embarked on a policy of destroying the Health Service, she must consider why expenditure on the Health Service has risen by 40 per cent. in real terms under this Government while it fell in one year under the last Labour Government when they slashed hospital building programme capital allocations by 30 per cent. If we consider the statistics which show who has done what for the Health Service, there is no contest.

The hon. Member for Halifax became bogged down in the statistical argument which, to some extent, has sidetracked our debate. We have moved away from the basic principles. We should all be suspicious about statistics because politicians have a predilection for picking the statistics that suit their arguments. I was surprised by the readiness with which the Opposition swallowed the propaganda from professional organisations about the Health Service reforms. They swallowed the British Medical Assocition's propaganda hook, line and sinker.

We all remember the lawyers objecting to reforms in the legal profession and we viewed those objections with healthy scepticism. We said to ourselves, "The lawyers know a lot about it and they are worth listening to, but they are talking their book." It is amazing that the Opposition do not say the same thing about doctors and opticians. We need to know more about the survey of opticians because there might, as my right hon. and learned Friend the Secretary of State said, be some self-selection in the sample. If that is the case, the survey is biased in that it has answers from opticians whose business has fallen off over the past year.

I have some evidence that I would like to adduce. I believe that a foolproof indication of whether there are problems with matters such as charges for eye tests is the constituency mail bag. I have received not one complaint about charges for eye or dental tests. If things are free, people are more likely to use them out of interest or from a need to feel secure. I suspect that many people probably had one eye test a year when tests were free while the general reckoning is that a test every two years is necessary. Many of those unnecessary tests have dropped out of the total.

Another adjustment to the statistics arises from the fact that when a charge is to be introduced, many people rush in and have a test for free. A figure of 1 million has been used with regard to eye tests. However, the adjustment is not 1 million; it is 2 million. One million people who would have had a test in the year after charges were introduced had a test the year before. The adjustment to be made in the discrepancy in the figures is not 1 million, but 2 million. If that adjustment is made, the figures look more realistic. Having said that, it would be useful in the context of this debate to have accurate figures to show the results of the change in charges for eye tests.

One of the basic principles is that we are talking about a large amount of money. Introducing the charge saves £90 million. To that we must add the £50 million which would be the cost for reintroducing free dental checks. That total of nearly £150 million a year is the cost of three district general hospitals. I cannot believe that any responsible Secretary of State for Health, were he Labour or Conservative, would choose free eye and dental checks instead of three new district general hospitals. I would not choose free tests and I cannot believe that any of my hon. Friends would either.

Mr. Keith Vaz (Leicester, East)

Is that the choice?

Mr. Maples

Of course it is. If we reinstate free tests, the £150 million must come from somewhere.

The only substantial argument against charges is that of deterrence. Do charges deter people from having tests? The Opposition constantly cause scares when charges are introduced. When the voucher scheme for spectacles was introduced in 1983, the hon. Member for Oldham, West (Mr. Meacher), as usual, went over the top. He said: The result for the public will be eye strain and headaches at best. At worst, it will be inability to see clearly so that they are at risk in their work, a hazard on the road or otherwise may injure themselves".—[Official Report, 20 December 1983; Vol. 51, c. 306.] That was his prediction. However, the opticians' business did not fall off; instead, the price of spectacles fell and that is exactly what the Government predicted.

We hear these scares from the Opposition time and again. Every time dental charges were raised over the past 10 years, the Opposition said the same thing, but there has been a steady increase in the courses of dental treatment. They have increased by 20 per cent. over the past 10 years. I suspect that each rise in charges brings a slight drop in the service partly because people defer treatment which they would otherwise have carried out immediately and partly because they have treatment before the charges are raised. However, after that the general trend picks up. Dentistry surveys have shown that the cost of the treatment—we must remember that only the test was free—is the fourth most important factor. The most important factor is that people say to themselves that there is no need for a dental check; the second factor is pain; and the third is the difficulty of finding a good dentist. The cost was the fourth factor. We must consider whether costs are the deterrent that Opposition Members make them out to be in an attempt to stir up a scare.

Mr. Turner

Does the hon. Gentleman know where the cheapest spectacles can be found now? They are to be found in markets all over the country. There are hundreds of thousands of spectacles on stalls. People try on the spectacles and try to read the book provided on the stall. That is how spectacles were sold in this country 50 years ago and that is what we are getting back to. That is where people who cannot afford eye tests are going to get something to suit their eyes.

Mr. Maples

That is happening to a limited extent.

Mr. Turner

It is a disgrace.

Mr. Maples

Yes, and it certainly should not happen. To the extent that it is happening, it is limited and it happened when there were free eye tests as well.

Mr. Turner

No.

Mr. Maples

It certainly did. The argument is that it has happened since changes were made in the way that spectacles were paid for. There is no evidence that what the hon. Gentleman described has happened only since April last year.

The logic of the argument about deterrence should extend beyond the test because only the test was free. One always had to pay a contribution towards dental work or for the spectacles that might or might not have been needed after a test. If the Opposition are to take their argument about deterrence to its logical extreme, the tests should be free as well, and the cost would become far more than £150 million.

Let us suppose that the Opposition are right and that there is a deterrent. I shall refer to glaucoma later, because it is serious. Apart from that, what are the consequences? They are that people will walk round wearing the wrong glasses for slightly longer than they used to, or they will have toothache. They are not exactly life-threatening conditions, whereas the £150 million can be spent on alleviating real suffering. As always in politics and public spending, there is a trade-off.

Mr. Turner

The hon. Gentleman is talking about hospital beds and putting people into hospital beds when they do not need to be there. They would not need to be in those beds for operations because they would have received preventive treatment. Why does the hon. Gentleman cast mean motives on professional people by suggesting that they are prducing false statistics on fewer eye tests? Why does he say that people had eye tests when they did not need them only because they were free? Why does not the hon. Gentleman take people on genuine trust and regard them as honest?

Mr. Maples

I rely on the results of the NOP survey, which proved exactly the opposite to what the hon. Gentleman is trying to deduce. As for his point about hospital beds being filled up with people who need hip operations because they cannot have eye tests, that is rubbish. The hon. Gentleman should analyse—

Mr. Turner

I said eye operations.

Mr. Maples

The hon. Gentleman did not. He said operations in general. The idea that free eye tests were somehow the early diagnosis of all sorts of acute hospital cases is the most awful rubbish.

Dame Jill Knight

A moment or two ago, my hon. Friend said it was not serious to be wandering round wearing the wrong glasses. I assure my hon. Friend that if one is driving a car it is very serious to be wearing the wrong glasses.

Mr. Maples

I do not think that anybody who owns a car will have any difficulty in coming up with £10 for an eye test.

Who are the people who are being asked to pay the £10 or £12 and of what consequence is it to them? We know that the exemptions cover children, pregnant mothers and people on income support and family credit—about 35 per cent. to 40 per cent. of the population. The other 60 per cent. who are being asked to pay have had amazing increases in their take-home pay over the past 10 years. The cut-off for family credit is about three quarters of average earnings. Somebody on three quarters of average earnings has had an increase in his take-home pay of £2,084 over the past 10 years. If he were on average earnings, he would have had an increase of over £3,000 in his take-home pay, and, even on half average earnings, which is now £7,500 a year, he would have had an increase of £1,500 in take-home pay.

All levels of earnings at which people might be asked to pay the £10 have had increases in take-home pay of over £1,500 in the past 10 years. In that context, it is palpable nonsense to suggest that £12 every other year is a significant item in a family budget. It cannot feature at all. We are talking about a cost of £6 a year to have an eye test every other year to somebody whose income has increased by at least £1,500 over that period. It is not unreasonable to ask people as they become better off to make some contribution at the margin to their health care. It basically affects only those whose household incomes have increased by more than £1,500 per year. As my hon. Friend the Member for Pembroke (Mr. Bennett) pointed out, the average family spends £10 a week on alcohol. We are suggesting that they should spend £10 every two years on an eye test.

Glaucoma is more serious. Undoubtedly, eye tests show it up early in some cases, but the eye test was never a screening process for glaucoma. If it is thought as a matter of public policy that we should screen for glaucoma, we should do it some other way than through a random eye test, whether it is free or paid for. The Government have acknowleged that by making a special exemption for people who are more likely to have glaucoma or who are related to people who have it—there is a large hereditary element in it. To a substantial extent, that matter is taken care of.

As I have already said, one third, or perhaps even 40 per cent., of the population do not have to pay for the eye test, and the other 60 per cent. have had such substantial increases in income that the charge cannot be a deterrent that could lead to serious consequences. We are going through a time when people are able, willing and prepared to take greater responsibility for themselves and not to expect the state to do everything for them. As their real incomes rise, it is the policy of the Government, which I wholly applaud—it is one reason why I got into politics—that they should be left with more of their income in their pockets through less taxation and more of the responsibility for paying for things for themselves where they can. At the very best, it is patronising for the Opposition to suggest that they are not capable or responsible for making that decision and that they are likely to be deterred from taking care of their health by a charge that averages out at £6 a year.

An interesting way of looking at that argument is that, in 1988, the year when the charges were debated and when the legislation was passed the Opposition objected to a 2p income tax cut in the Budget. They said that the money should have been spent on improving the Health Service. That cut in income tax is worth £180 a year to someone on average earnings. The charge for an eye test is £12 every other year. The Opposition suggested that those who would have preferred that additional £180 not to be given back to them but to be spent on the Health Service are so stupid, shortsighted or mean-minded that they will not spend £12 every two years, having had a £180 a year tax saving, on an eye test. It does not add up.

If people are willing, as the Opposition argued at the time, for the money to be spent on the Health Service, surely they are willing to spend a fraction of that amount on one item of health care, which is obviously a sensible way to protect the health of their eyes. It is patronising and silly to suggest that people are not responsible for themselves. Clearly they can come up with £10 or £12 a year.

The Government need no lectures from the Labour party on the funding and management of the Health Service. Over the past 10 years, the Government have spent £3 for every £1 that the Labour party spent on it—an increase in real terms of 40 per cent. That increase in real terms is £9 billion. We spend more than £40 a week for every family of four on the Health Service. There are thousands more doctors——

Mr. Turner

It is not enough.

Mr. Maples

It will never be enough if the service is free, in the sense that we will never be able to remove all the waiting lists. All that I can say is that it is an awful lot more than the previous Labour Government spent.

We have the largest-ever hospital building programme. We treat more patients as in-patients, out-patients and day cases, and we need no lectures from the Opposition on the funding of the Health Service.

It is interesting to look at the Opposition's policy review, which they euphemistically call "Looking to the Future". It seems to be a giant step back to the 1960s. There are no commitments to spend any additional money on health care. However, there is a commitment to bring back free eye tests and dental checks. There is also a commitment to abolish competitive tendering. Those three things together will cost £200 million and will not deliver one iota of additional health care. They will not improve health care one little bit. If that £200 million were available, it would build four new district general hospitals every year. The Opposition are saying that they would choose to spend it on removing those three things which are purely political dogma—they are not related to health care at all.

If one extends the logic of the Opposition's argument to prescription charges, which they were going to remove at one time, and to providing free glasses and free dental care which, if the charge for a test is a deterrent, must equally be a deterrent, one is talking of a sum well in excess of £1 billion. That sum would add absolutely nothing to the quantity of health care delivered to the public. It is extraordinary that, in the Opposition's document, the future of the Health Service rates one page, half of which is taken up with community care. There are no commitments to additional spending apart from the ones that I have mentioned. Even the ones that are mentioned must be taken with a pinch of salt.

In the public expenditure debate, the hon. Member for Derby, South (Mrs. Beckett), who has some responsibility for the Labour party's attitude to public spending, said: What we are promising is an increase for pensioners and an increase in child benefit. Everything else that is regarded as a desirable aim is also listed, quite clearly and specifically, as something that we hope to do as resources allow."—[Official Report, 13 February 1990; Vol. 167, c. 179.] It is difficult to know whether the hon. Member for Livingston (Mr. Cook) has co-ordinated his policy with that of his hon. Friend. One assumes that he has, but there is a conflict between the commitments made in "Looking to the Future" and what the hon. Member for Derby, South said. The hon. Lady made her statement categorically and reiterated it twice in response to interventions from my right hon. Friend the Chief Secretary to the Treasury. She said that that was all that the Labour party would commit itself to doing if it were to come into government.

If what the hon. Lady said is correct, what the hon. Member for Livingston said about £200 million for abolishing competitive tendering and the charges for eye and dental check-ups is on the wish list. In other words, the Labour party is saying, "These are the things that we should like to do if resources allow." Well, we do that—if resources allow, we increase the resources that are given to the National Health Service, which is why we have been able to spend an additional £9 billion on it. One suspects that those things are not Labour party commitments, and that they are part of the letter to Santa Claus which the hon. Member for Livingston is puffing up the chimney with the smoke and which the hon. Member for Derby, South, who is sitting at the top, is tearing up unless its commitments refer to child benefit or pensions. I hope that I have the attention of the hon. Member for Livingston.

When the hon. Member for Cardiff, South and Penarth (Mr. Michael) replies to the debate, it will be interesting to hear whether those three items—abolishing competitive tendering and reintroducing free eye and dental check-ups—are absolute commitments on the part of the Labour party when it forms its next Government, and whether they override the equally categorical statement by the hon. Member for Derby, South in the public expenditure debate on 13 February.

The Labour party seems to be trying to talk out of both sides of its mouth at the same time. On the one side, the Treasury spokesmen are trying to reassure the City, the markets, the press and the taxpayers that they are not trying to pick their pocket to a large extent to pay for a major public expenditure programme, while on the other side the Labour party is trying to say to the voters, "Of course, we shall spend billions of pounds on transport, education and health." Of course, the only reason for ever electing a Labour Government is that they would raise more money in taxes and spend it on public services.

However, the Labour party will be rumbled because taxpayers and consumers are exactly the same people and they will realise that the Labour party is delivering two totally different messages. One message says, "We shall spend a lot more money", and the other says, "We shall not spend any more money." It will be interesting to have that contradiction resolved. I repeat that taxpayers and consumers are the same people and they will rumble the con trick that the Labour party is trying to perpetrate on them.

In conclusion, our changes seem a sensible way of ensuring an additional £90 million for the Health Service. If one adds in the dental checks, a total of £140 million is available to be spent on better and more constructive things and on alleviating real suffering and life-threatening conditions. The structure exempts vulnerable people from the charges. Those who are liable to the charges have had enormous increases in their take-home pay in the past 10 years. Those on half average incomes have received a minimum of £1,500. It is not unreasonable to ask those people to pay £12 every two years. The Labour party's opposition to the charges—just like its opposition to competitive tendering—is pure political dogma. Changing the system would not deliver one iota more health care. It makes absolutely no sense to reverse the change. It is right as a matter of principle to reduce people's taxes and to leave them with more money in their own pockets and more responsibility for taking care of themselves. On the whole, people behave responsibly and it is patronising to suggest that they do not.

6.23 pm

Mr. Ieuan Wyn Jones (Ynys Môn)

I listened carefully to the hon. Member for Lewisham, West (Mr. Maples). With every speech by a Conservative Member we seem to hear higher figures for the money that the Government have saved as a result of not having free tests. We have heard £70 million, £90 million and even £150 million being quoted. It has even been said that we could have three new general hospitals as a result of the savings. What utter nonsense. Even Ministers have said that the money that is saved will be spent on primary health care—and whoever heard of the building of three new general hospitals being part of any Government's primary health care budget?

I also listened with great care to the Secretary of State. He said that the Government intend to give everyone the service that they require. However, he then spent half an hour telling us why the Government could not give everyone the service that they need. He also said that, even after the introduction of the changes, the Government were still paying for the tests of the third of the population who qualify for income support, and we know that the take-up of income support has been extremely low. Unfortunately, therefore, a number of people who would qualify for free tests if they applied for the income support, to which they are entitled, are not receiving free eye tests.

We all agree that the average charge is between £12 and £15. Although many right hon. and hon. Members can no doubt afford £12 or £15, many people cannot. Unfortunately, the people who will be hit hardest are the most vulnerable in our society.

The decision to abolish free eye tests disproportionately affects the elderly. The hon. Member for Brigg and Cleethorpes (Mr. Brown) said that many elderly people can afford to pay for their eye tests and referred to the average income of elderly people. However, the average income of elderly people is skewed by the fact that the income of the top one fifth accounts for a disproportionate amount of the income of all elderly people. The average pensioner's income is less than £100 per week—it is actually £98 per week, but four fifths of elderly people receive substantially less than that. They are therefore hit by charges for eye tests. We know that the cost of the elderly to the Health Service is substantially more than the cost of those who are not of pensionable age. We also know that 78 per cent. of elderly people between the ages of 78 and 85 suffer from severe eye conditions, yet it is precisely that category of vulnerable people that the Government are refusing to assist. That is deplorable.

There is no doubt in my mind—if they were honest, there would be no doubt in the minds of Conservative Members either—that substantially fewer people are now attending for eye tests than was the case before 1 April 1989. We all know that evidence from our constituencies. There is also the anecdotal evidence that we hear when speaking to our friends, colleagues and families. If the Government are seeking to rely on one set of statistics to justify their position, and if they refuse to accept any statistics that suggest an opposite point of view, they are a blinkered Government who are refusing to look at all the evidence.

The Secretary of State is a lawyer and, as such, he must look at both sides of the argument. However, he refuses to do so because the evidence does not fit the Government's position. The right hon. and learned Gentleman refuses to accept that anybody who can produce statistics to support a contrary point of view can have a valid argument. In those circumstances, I believe that the survey that the Government have produced is fundamentally flawed. The Government must look at the hard evidence that is produced by the practitioners, rather than relying on people's memories.

I shall conclude, as other hon. Members wish to speak. It is short sighted of the Government to dispense with free eye tests because, as we have heard in many valuable speeches, eye tests can detect other conditions. Ensuring that people have free eye tests actually saves money. Therefore, even if the Government are not prepared tonight to introduce free eye tests for everybody, I urge them to ensure that pensioners are entitled to free eye tests from this day forward.

6.29 pm

Mr. Keith Vaz (Leicester, East)

What an extraordinary speech we have heard from the hon. Member for Lewisham, West (Mr. Maples). Despite the fact that he sits on the Conservative side, I always considered him to be a reasonable person. How extraordinary that he should tell us that he received no representations whatever from his constituents protesting against the imposition of charges for eye tests. I advise him to keep his speech well hidden from his constituents in Lewisham, West.

Even before charges were introduced, some constituents of mine in Leicester felt that charges would have a detrimental effect on their health. On 31 October 1988 a group of pensioners went to Downing street and presented the Prime Minister with a gift. It was an unusual gift—a large pair of wooden spectacles and a large tooth. I do not know whether either of the items fitted the Prime Minister, but they were intended as a symbol of the effect that charges would have on people in my constituency. My constituents predicted over one and a half years ago that fewer people would have eye tests, and that is exactly what has happened.

Conservative Members are keen to give us facts and figures about the amount of money that has been spent on the Health Service. I agree entirely with what the hon. Member for Birmingham, Edgbaston (Dame J. Knight) said in her eloquent speech. I, too, believe that the facts are clear. She gave us facts on the national position and spoke of a 30 per cent. reduction in the number of eye tests. The figure for Leicestershire is lower but just as stark. According to the Leicestershire local optical committee, there has been a 25 per cent. reduction in the number of eye tests carried out on people in the county of Leicestershire. Hundreds of thousands of people—the hon. Lady said millions—nationally have serious eye disorders which will go undetected as a result of the introduction of charges for eye tests.

Contrary to what we were told by Conservative Members, people in my constituency were angry at the introduction of charges for eye tests. There was huge opposition to it. One person who worked hard campaigning against the charges in my constituency was Mr. Edwards who lives at 67 Marston road, Leicester. He was an optician. Shortly after the charges were introduced it was discovered that he had cancer and that it was terminal. Despite his illness, he campaigned vigorously in Leicester against the charges.

Mr. Edwards presented me with a petition signed by 105 people who opposed the scheme. That was all the names that he had time to collect in the limited time available before he died. I presented that petition to Parliament and shortly afterwards Mr. Edwards went into hospital and died there. I hope that that petition was a suitable memorial to the work that he did on behalf of local people to ensure that the voice of local people was raised against charges for eye tests.

Retinitis pigmentosa is an eye disease which affects a fair number of people in Britain. I have been told that one person in every 4,000 has the potential of developing the disease. A Leicester local councillor, Mary Draycott, members of whose family suffer from the disease, brought to my attention the fact that those who suffer from the disease are not exempt from charges for eye tests. Pressure on local doctors has increased greatly since the introduction of charges for eye tests simply because in the past relatives of those who suffer from retinitis pigmentosa were entitled to a free test. They can no longer have a free test. First, they must go to their general practitioner, who must refer them to a hospital doctor, who, in turn, must refer them to an optician for a free eye test. I wrote to a Minister—not the Minister who is at the Dispatch Box but a previous Minister—about that matter urging her to initiate a scheme to exempt such people from paying for eye tests. Unfortunately, her response was negative.

I received a letter from a Mr. Clinton Smith who is the honorary secretary of the Leicestershire local optical committee. He wrote to me on 11 April 1989. In opposing the charges introduced by the regulations, he contrasted the view expressed by the Government about the tests with the way in which people operate according to the family doctor service. He said: It is like suggesting that people can accurately decide for themselves what treatment they need from a family doctor and, although the doctor is trained and able to assist with the best possible advice in their interest, they are encouraged for commercial reasons to risk their health and happiness, and possibly their life, by demanding only an inferior part of the service should be given. That is what we are discussing today. An inferior service is being provided because of the introduction of charges for eye tests.

Opposition Members are right to draw attention to the whole range of cuts in the National Health Service. One must see charges for eye tests in the context of the cuts affecting our local health services. The hon. Member for Edgbaston wanted to know where it would all end. I can tell her. It will end in the same way as it has ended in America—in a privatised Health Service. I visited America recently and I know that other hon. Members from both sides of the House have done so, too. When I was there it cost £25 to see a doctor. That is exactly what is intended by introducing charges for eye tests. We shall have a more and more privatised Health Service which we regarded as free at the points of entry and of need.

In my constituency and across the county of Leicestershire cuts have bitten into the local Health Service. Hon. Members from both sides of the House recently had a meeting with the Secretary of State about charges for tests and cuts in the Health Service. It was like communicating with a brick wall. If any hon. Members were thinking of seeing the Health Secretary to lobby on behalf of their health authorities, they should not bother simply because the Secretary of State is not interested in providing any assistance either to Labour or Conservative Members.

I shall finish by quoting from a letter that I received on the day of the Third Reading of the Health and Medicines Bill on 1 November 1988. A student came all the way from Leicester and handed me a letter which was as relevant now as it was then. She urged me to vote against the imposition of charges for tests. She said: You may be able to eat with false teeth, walk with false legs but you cannot see with a false eye. That is what we are saying to the Government. We urge them to put away their false eyes and consider the position in a positive and constructive way. We hear a great deal these days about reviewing the poll tax because of enormous opposition to it. I advise Conservative Members that now is the time to review charges for eye tests and abolish them.

6.37 pm

Mr. Tim Devlin (Stockton, South)

I have an obvious interest to declare in that I have worn spectacles since I was 13. Since then, I have seen the eye test develop from a relatively unsophisticated process to the detailed test that is provided now. The last time that I went to the optician to have my eyes tested—last year—it took about 40 minutes to go through all the electronic and other tests, including blowing air into the eye to detect glaucoma. When one visits the optician, as I do every year, one is always faced with a charge.

I remember that when eye tests were free the cost of spectacles was amazing. At the age of 19 I paid about £70 for a pair of spectacles. When I went to buy spectacles last year the cost for certain pairs was as high as £200 or £300. However, since the introduction of greater competition in the supply of spectacles brought about by the Government, it has become possible for people to buy spectacles for as little as £25. Taken with the cost of the test, which is only £10 or £12—a reasonable charge for 40 minutes' work—the total charge is reasonable. It is certainly within the reach of many people in Britain to have their eyes tested once a year or once every two years.

When the reforms were first suggested last year I was one of the most sceptical Conservative Members. I went to see the Minister privately to discuss whether they were necessary. I assure the hon. Member for Leicester, East (Mr. Vaz) that I for one have no plans for the privatisation of the Health Service. I can tell the rest of the House that many Conservative Members would fight to the death rather than see that happen. Many, if not all, of us recognise the great value of the NHS. It will long remain so.

I looked up the history of the NHS charges to see what the precedents were for this form of charge and found that they were first introduced by the Labour Government who set up the NHS. I looked further and found that when the then right hon. Member for Ebbw Vale, Mr. Bevan, was Minister for Health, he said that charges in the National Health Service were "not a tax" on the Health Service, but "a readjustment within it". This is just another series of readjustments which were first brought about by the Labour Government.

Last week I returned from the Soviet Union. In that socialist Nirvana, which many Labour Members undoubtedly aspire to establish here, there are Health Service charges for a whole range of items, such as medicines, prescriptions and eye tests.

After careful consideration, I believe that there is much to be said for what the Government are doing. They are releasing a great deal of money for investment elsewhere in the service and I know that the Minister is monitoring the matter all the time.

6.41 pm

The Minister for Health (Mrs. Virginia Bottomley)

We have had a brief and, at times, heated debate on a subject which is of great concern and importance to many.

Frankly, Labour Members cannot have it both ways. Many whinged and groaned about the supposed demise of optical services, questioned our commitment to going ahead with the survey and pressed us for the results. We have undertaken an independent survey and made the results available in full. There is no conspiracy or concealment. The facts speak for themselves. Once again, the doom and gloom mongers have been seen in their true colours. The growth of the uptake of sight tests that took place through the 1980s is continuing.

At a time of rising prosperity—after all, the average family has seen an increase in living standards of 34 per cent. over the past 10 years—those who can do so should pay for their sight test. All will agree that the vulnerable, the frail and the needy should have free sight tests. That is why children, students, people on low incomes, the blind, the partially sighted, diabetics and those with glaucoma and their older relatives are eligible for free tests.

Reference has been made to several surveys produced recently, each showing a fall in sight test demand since the introduction of charges. The plain fact is that most surveys have been commissioned either directly or indirectly by the profession or those with a special interest. There is no doubt that extensive pre-publicity about charges encouraged many people to bring forward their appointments to avoid the new arrangements. Indeed, my right hon. and learned Friend the Secretary of State mentioned that some opticians even stayed open until midnight to beat the April 1989 deadline.

We estimate that in the 15 months between 1987 and April 1989 about 1.8 million more sight tests were carried out over and above what would normally have been expected. That is a revised figure of an earlier estimate and relates to all of Great Britain. It takes account of the large number of sight tests conducted before 1 April 1989, but which were paid for later.

Hon. Members will be aware that during the passage of the Health and Medicines Bill the Government undertook to monitor the effects of the new system. We have met that undertaking in full. We commissioned the independent market research company, National Opinion Poll, to survey the number of NHS and private sight tests carried out in the first quarter of 1990. As my right hon. and learned Friend made clear, we have acted swiftly to make that information available to the House today.

I want to make it clear, however, that we have in no way sought to conceal the fact that NOP, in undertaking the survey, made a minor error. It altered the wording in the later weeks of the survey. That does not affect the number of tests undertaken, but we are concerned that it affects the interpretation given about whether or not the test was private or on the NHS. This is spelt out fully in the documents without any attempt at concealment. Indeed, NOP takes full responsibility for that error.

The NOP report concludes that an estimated 4.5 million adults—a total of 5 million people if children are included—received a sight test in the first three months of 1990. That compares with 4.4 million in the same quarter of 1989.

As I have made clear, there is no disagreement that the proposed changes resulted in a dramatic increase in the number of those seeking tests. That is why to establish an underlying pattern we need to look at the 1987 figures. In assessing the report we projected forward the expected uptake on the basis of the upward trend established during the decade. If consumers are seeking eye tests at the same rate as that established trend, we would now expect 3.5 million to have come forward in the first quarter of 1990.

We recognise and, again, make it clear in the comments on the report that surveys of this kind encourage over-estimation by the interviewee. Our independent survey, even when generous allowance is made for possible over-reporting, suggests that there were an estimated 4.1 million sight tests in the first quarter of 1990–600,000 more than the trends would reasonably suggest. Even if we assumed a 50 per cent. rate of over-reporting, there would be more tests that in 1987. Therefore, the survey provides firm evidence, which is endorsed by many of the reports available in the optical press, that the market is again on the upturn.

The hon. Members for Livingston (Mr. Cook) and for Ross, Cromarty and Skye (Mr. Kennedy) referred to the Economists Advisory Group. We have never said that our survey is the only one to be believed. Indeed, paragraph 8 of our report suggests that the true figure may be somewhere between the NOP figure and that in the most recent EAG reports.

My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who is a champion of this subject and who is well known and respected in this House, made several important points. Her comment, and that of the hon. Member for Halifax (Mrs. Mahon), that patients are being referred to hospitals to obtain an eye test has not been borne out in evidence. I cannot believe that practitioners would follow such a course of action.

Mr. Dalyell

Will the Minister give way?

Mrs. Bottomley

I am afraid that I have little time.

Mr. Dalyell

rose

Mrs. Bottomley

Pensioners have never been automatically exempted from optical charges on the grounds of age rather than income.

We heard excellent contributions from my hon. Friends the Members for Brigg and Cleethorpes (Mr. Brown), for Lewisham, West (Mr. Maples) and for Stockton, South (Mr. Devlin). We are confident that eyesight tests are on a stable course. We take seriously the importance of providing a Health Service with a proper emphasis on primary health care and on eye tests. Only recently we made possible domiciliary visits so that pensioners who cannot leave their homes can now receive an NHS sight test at home. That started on 1 June. It is a further recognition of our desire to target resources on those who are vulnerable and to make sure that they can benefit from a test.

Similarly, in April this year when the Government increased the money spent on the value of optical vouchers, we targeted those in greatest need. We redefined voucher band A so that more patients would fall into the higher group and receive more help.

Many hon. Members have spoken about the importance of prevention, and the need for people to understand that their eyes must be cared for and protected. Hon. Members will be aware that, with the new GP contracts, prevention and health promotion are fundamental concepts. Those aged over 75 will receive regular visits and health checks, and sensory perceptions will be part of that assessment: vision will of course be checked. The Government intend to collaborate with GPs to ensure that they have all the relevant information to ensure that their patients receive the care that they need.

I hope that the Government have laid to rest the myths about the take-up of eye tests. We are at the beginning of a new campaign to draw to people's attention the importance of looking after their eyes, and we hope to put the disagreements of the past behind us and work with the profession on a further campaign in the autumn.

An eye test costs less than an MOT, about the same as a haircut—or perhaps two if one shops around—and about the same as reading The Sun or The Daily Mirror one day a week for a year. Free NHS sight tests are available to one in three of the population. We are confident that our policies of providing health care for those who need it, and ensuring that we have a preventive Health Service, are well and truly vindicated. I urge the House to reject the motion.

6.51 pm

Mr. Alun Michael (Cardiff, South and Penarth)

I am saddened by the cheap and dismissive way in which the Minister ended her remarks. Occasionally, when debating the Government's health policies, we succeed in detecting some twisted logic or some vestige of reasoning. However, today's debate has confirmed yet again that there is no logic or sense—or any redeeming feature—in the imposition of eye-test charges. As my hon. Friend the Member for Livingston (Mr. Cook) made clear at the beginning of the debate, there is overwhelming evidence that the Government's policy has proved every bit as devastating as we predicted in April 1989.

Today the Secretary of State attempted to bluff his way out of another disaster. His defence was based on a breathtaking dependence on a single opinion poll; and, by definition, an opinion poll reflects opinions rather than facts. His figures depend on retrospective analysis—which is not an accurate or a dependable method of dealing with this type of question—and on gratuitous insults aimed at an entire profession and at people who have genuinely tried to get at the truth. The hon. Member for Birmingham, Edgbaston (Dame J. Knight) eloquently blasted him out of the water on that point.

The Secretary of State's figures fly in the face of all other available evidence. They were produced in a press release today in a desperate attempt to minimise the effect of this debate. He mentioned them reluctantly at the tail end of his speech, only after I challenged him to do so; they are no substitute for the proper figures and objective research that he and his colleagues have refused to produce over the past 15 months.

The Minister for Health added nothing except fine sentiments, which are not reflected in the actions of the Government and depend on the same flawed source. However, she contradicted the Secretary of State by acknowledging the validity of other evidence. She tried to re-announce a development implemented on 1 June.

The case is simple. Many people have been deterred by the charges. People are suffering, and some will go blind through serious eye conditions remaining undetected. Businesses are having to close because of the downturn in tests. Even those who are entitled to free tests are being deterred by the system that the Government have introduced.

This is not, as some Conservative Members try to suggest, a peripheral service for which a charge is appropriate: others, such as the hon. Member for Edgbaston, understand that. However, those who took and did not critically examine the brief from Conservative central office clearly do not understand. In today's debate, and over recent months, the ministerial response has been convoluted and the Government have tried to spread doubt and confusion. They have tried to say that we do not know what is happening. We need only read the blocking answers of the Minister for Health during recent months to recognise her single-minded determination not to know what is going on.

The Minister's colleague in another place, Baroness Hooper, was equally unhelpful, but rather more confident. When she was asked on 2 May about people entitled to free eye tests, she stated categorically: There is no change in the uptake of eye tests in that proportion of the population."—[Official Report, House of Lords, 2 May 1990; Vol. 518, c. 1039.] Funnily enough, she did not have the benefit of the information that the Minister is re-using today. She is wrong.

The Minister has managed to cast a cloak of darkness and opinion over the English figures, but the figures in Wales were given to me in a parliamentary reply on 8 May. In the six months from 1 April 1989, the numbers almost halved, from 330,000 to 170,000—a truly devastating drop. The Welsh Health Minister tried to say that it might be due to more people's taking private tests, but that is not true: the House has had the facts. An independent survey by the Federation of Ophthalmic and Dispensing Opticians shows a drop of 36 per cent. The other figures referred to by my hon. Friend the Member for Livingston show the extent of the downturn across the country. Against that, the Government's own investigations offer no independent or substantial evidence for their case.

The Government say that there was bound to be a drop in the first couple of months after the charges were brought in. In April 1989, the Secretary of State for Scotland tried to suggest that a downturn after 1 April could be explained by people's success in rushing to beat the deadline. Apart from the curious logic of that, if charges will not deter, why should the lack of a charge and the imminence of an imposition cause an upturn? The history of events show that he was wrong. An increase of some 6.3 per cent. in the number of tests before 1 April hardly accounts for the drop of 36 per cent. recorded independently by the FODO, and certainly does nothing to balance the 49 per cent. drop in free tests reported by the Welsh Office.

The fact is that fewer people are having tests. Most serious of all is the evidence from Michael Bateman, the chairman of the FODO, who said: Since the introduction of the charges there has been an overall drop in the number of people going for eye checks, even amongst those who are still entitled to a free sight test under the NHS such as those on low incomes, diabetics, and relatives of glaucoma sufferers whose own sight could be at risk. The Government's third attempt to confuse us is the suggestion that the figures produced by optometrists arid independent sources may be inaccurate. There is overwhelming evidence that they are accurate. Opposition Members have asked questions—not dependent on those surveys—all round the country, and the evidence has mounted each time we have asked. Let us take referrals of new ophthalmology outpatients. The Welsh figures show a downturn late last year—just when one would expect reduced detection to follow the reduction in the number of eye tests—before the major increase in serious cases of which we are now hearing. In Pembrokeshire, for instance, there was a drop from 424 to 296.

The hon. Member for Pembroke (Mr. Bennett)—who intervened briefly at the beginning of the debate, although he is not here now—may like to know that Mr. Nick Ainger, who will join us on the Labour Benches after the next general election, rang me last night to tell me the views of opticians in his area. One optician told of an elderly lady who went to see him yesterday. She had not had an eye test since 1976; she was blind in one eye and losing sight in another. She said that she had been reluctant to come in because of the cost of spectacles, as she is not on income supplement. How many like her have still not reached the point of desperation when they cast aside their financial worries and take a test?

That optician reported a downturn of nearly 25 per cent. since last April. He believes that the Government should give free eye tests to all retired people now. Another optician in Pembroke dock says that pensioners who are not on income support are failing to turn up for appointments because of the charges. The same is true of unemployed people who are not on income support—perhaps because a member of the family is working—but whose family financial problems are nevertheless acute.

The Secretary of State claimed earlier that we still pay for one third of the population. He is wrong: one third may be eligible, but they may also be deterred. In Holyhead, near where I was born, an optician confirmed yesterday that he has experienced a downturn of 40 per cent. An independent sample undertaken by HTV Wales showed a drop of 47.5 per cent. in Carmarthen and a drop of 39.8 per cent. in one of the most deprived areas of the country, the Cynon Valley. However, the problems are not limited to poorer areas: similar figures were produced by an independent survey by the Kensington, Chelsea and Westminster family practitioner committee.

After I had illustrated the situation in Wales I received a letter that graphically illustrates what charging means—it is not just about figures. An optician passed to me a letter that he had received from the father of a 19-year-old student who was not exempt from the eyesight charges. The optician told me that she therefore had to pay, which fortunately she could, but that others would be deterred. The letter reads: Dear Sir, On Thursday 22nd February at 12.30 pm my daughter had an appointment to see the optician to have her eyes tested. He noticed that there was something wrong at the back of her eye and told her to go to the doctor. This she did, and was admitted to hospital on the same day and was operated on a few days later for the removal of a brain tumour. I should like to thank the optician for his prompt action—he probably saved my daughter's life. I am sure that we would all like to thank the professional opticians who detect such conditions. They deserve more respect than was shown to them by the Secretary of State today. I am told that such cases are far from unusual. Far better than thanks would be an announcement from the Minister that the dogmatic experiment of charging for eye tests has proved a disaster and that that dogmatic charging will be abandoned forthwith.

You, Mr. Speaker, will know the prayer: Grant me the serenity to accept things I cannot change, the courage to change things I can, and the wisdom to know the difference. The Government have the power to make the necessary change and the Prime Minister should have the wisdom to revert to the decision not to go ahead with the charges which she justified in a letter of 23 June 1980, saying that it was in reponse to strong representations that such a charge, in a service which has a preventative function, would be wrong in principle and could deter patients from seeking professional advice Those comments apply as strongly today as they did at any other time, but this time she and her Government have pressed ahead against all available advice and evidence. This time the charge has been brought in and that charge has now deterred—it will go on deterring. It remains wrong in principle and the Government should remove eye test charges now.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 209, Noes 275.

Division No. 224]	[7.01 pm
AYES
Abbott, Ms Diane	Fatchett, Derek
Adams, Allen (Paisley N)	Fearn, Ronald
Allen, Graham	Field, Frank (Birkenhead)
Alton, David	Fields, Terry (L'pool B G'n)
Anderson, Donald	Fisher, Mark
Archer, Rt Hon Peter	Flannery, Martin
Armstrong, Hilary	Flynn, Paul
Ashdown, Rt Hon Paddy	Foot, Rt Hon Michael
Ashton, Joe	Foster, Derek
Barnes, Harry (Derbyshire NE)	Foulkes, George
Barnes, Mrs Rosie (Greenwich)	Fraser, John
Barron, Kevin	Fyfe, Maria
Beckett, Margaret	Galbraith, Sam
Beggs, Roy	Galloway, George
Bell, Stuart	Garrett, John (Norwich South)
Benn, Rt Hon Tony	George, Bruce
Bennett, A. F. (D'nt'n & R'dish)	Gilbert, Rt Hon Dr John
Bermingham, Gerald	Godman, Dr Norman A.
Bidwell, Sydney	Gordon, Mildred
Blair, Tony	Gould, Bryan
Boateng, Paul	Graham, Thomas
Boyes, Roland	Griffiths, Nigel (Edinburgh S)
Bradley, Keith	Griffiths, Win (Bridgend)
Brown, Gordon (D'mline E)	Grocott, Bruce
Brown, Nicholas (Newcastle E)	Harman, Ms Harriet
Brown, Ron (Edinburgh Leith)	Heal, Mrs Sylvia
Bruce, Malcolm (Gordon)	Henderson, Doug
Buckley, George J.	Hinchliffe, David
Caborn, Richard	Hoey, Ms Kate (Vauxhall)
Campbell, Menzies (Fife NE)	Home Robertson, John
Campbell, Ron (Blyth Valley)	Hood, Jimmy
Campbell-Savours, D. N.	Howarth, George (Knowsley N)
Canavan, Dennis	Howells, Geraint
Carlisle, Kenneth (Lincoln)	Howells, Dr. Kim (Pontypridd)
Cartwright, John	Hoyle, Doug
Clark, Dr David (S Shields)	Hughes, John (Coventry NE)
Clarke, Tom (Monklands W)	Hughes, Robert (Aberdeen N)
Clay, Bob	Hughes, Simon (Southwark)
Clelland, David	Illsley, Eric
Clwyd, Mrs Ann	Ingram, Adam
Cohen, Harry	Janner, Greville
Cook, Robin (Livingston)	Jones, Barry (Alyn & Deeside)
Corbett, Robin	Jones, Ieuan (Ynys Môn)
Corbyn, Jeremy	Kennedy, Charles
Cousins, Jim	Kilfedder, James
Crowther, Stan	Kinnock, Rt Hon Neil
Cryer, Bob	Kirkwood, Archy
Cummings, John	Knight, Dame Jill (Edgbaston)
Cunliffe, Lawrence	Leadbitter, Ted
Cunningham, Dr John	Lestor, Joan (Eccles)
Dalyell, Tam	Lewis, Terry
Darling, Alistair	Litherland, Robert
Davies, Ron (Caerphilly)	Livingstone, Ken
Davis, Terry (B'ham Hodge H'l)	Livsey, Richard
Dewar, Donald	Lloyd, Tony (Stretford)
Dixon, Don	Lofthouse, Geoffrey
Dobson, Frank	Loyden, Eddie
Doran, Frank	McAllion, John
Douglas, Dick	McAvoy, Thomas
Dover, Den	McCartney, Ian
Duffy, A. E. P.	Macdonald, Calum A.
Dunwoody, Hon Mrs Gwyneth	McKay, Allen (Barnsley West)
Eadie, Alexander	McKelvey, William
Evans, John (St Helens N)	McLeish, Henry
Ewing, Mrs Margaret (Moray)	Maclennan, Robert

McNamara, Kevin	Rowlands, Ted
McWilliam, John	Ruddock, Joan
Madden, Max	Salmond, Alex
Mahon, Mrs Alice	Sedgemore, Brian
Marek, Dr John	Sheerman, Barry
Marshall, David (Shettleston)	Shore, Rt Hon Peter
Martin, Michael J. (Springburn)	Short, Clare
Martlew, Eric	Sillars, Jim
Maxton, John	Skinner, Dennis
Meacher, Michael	Smith, Andrew (Oxford E)
Meale, Alan	Smith, C. (Isl'ton & F'bury)
Michael, Alun	Smith, Rt Hon J. (Monk'ds E)
Michie, Bill (Sheffield Heeley)	Smith, J. P. (Vale of Glam)
Mitchell, Austin (G't Grimsby)	Smyth, Rev Martin (Belfast S)
Molyneaux, Rt Hon James	Snape, Peter
Moonie, Dr Lewis	Spearing, Nigel
Morley, Elliot	Steinberg, Gerry
Morris, Rt Hon A. (W'shawe)	Stott, Roger
Morris, Rt Hon J. (Aberavon)	Straw, Jack
Mowlam, Marjorie	Taylor, Mrs Ann (Dewsbury)
Mullin, Chris	Trimble, David
Murphy, Paul	Turner, Dennis
Nellist, Dave	Vaz, Keith
Oakes, Rt Hon Gordon	Walker, A. Cecil (Belfast N)
O'Brien, William	Wallace, James
Orme, Rt Hon Stanley	Wareing, Robert N.
Owen, Rt Hon Dr David	Watson, Mike (Glasgow, C)
Patchett, Terry	Welsh, Andrew (Angus E)
Pendry, Tom	Welsh, Michael (Doncaster N)
Pike, Peter L.	Wigley, Dafydd
Powell, Ray (Ogmore)	Williams, Rt Hon Alan
Primarolo, Dawn	Williams, Alan W. (Carm'then)
Quin, Ms Joyce	Wilson, Brian
Radice, Giles	Winnick, David
Redmond, Martin	Wise, Mrs Audrey
Rees, Rt Hon Merlyn	Worthington, Tony
Reid, Dr John	Wray, Jimmy
Richardson, Jo
Robertson, George	Tellers for the Ayes:
Robinson, Geoffrey	Mr. Martyn Jones and Mrs. Llin Golding.
Rogers, Allan
Ross, William (Londonderry E)

NOES
Adley, Robert	Bruce, Ian (Dorset South)
Aitken, Jonathan	Buchanan-Smith, Rt Hon Alick
Alexander, Richard	Buck, Sir Antony
Alison, Rt Hon Michael	Budgen, Nicholas
Amery, Rt Hon Julian	Burns, Simon
Amess, David	Burt, Alistair
Amos, Alan	Butterfill, John
Arbuthnot, James	Carlisle, John, (Luton N)
Arnold, Jacques (Gravesham)	Carlisle, Kenneth (Lincoln)
Arnold, Tom (Hazel Grove)	Carrington, Matthew
Ashby, David	Cash, William
Aspinwall, Jack	Channon, Rt Hon Paul
Atkins, Robert	Chapman, Sydney
Baker, Rt Hon K. (Mole Valley)	Chope, Christopher
Baker, Nicholas (Dorset N)	Clark, Hon Alan (Plym'th S'n)
Baldry, Tony	Clark, Dr Michael (Rochford)
Banks, Robert (Harrogate)	Clark, Sir W. (Croydon S)
Batiste, Spencer	Clarke, Rt Hon K. (Rushcliffe)
Bellingham, Henry	Colvin, Michael
Bendall, Vivian	Conway, Derek
Bennett, Nicholas (Pembroke)	Cope, Rt Hon John
Benyon, W.	Couchman, James
Blaker, Rt Hon Sir Peter	Cran, James
Body, Sir Richard	Critchley, Julian
Boscawen, Hon Robert	Currie, Mrs Edwina
Boswell, Tim	Davies, Q. (Stamf'd & Spald'g)
Bottomley, Peter	Davis, David (Boothferry)
Bottomley, Mrs Virginia	Devlin, Tim
Bowden, Gerald (Dulwich)	Dickens, Geoffrey
Bowis, John	Dicks, Terry
Boyson, Rt Hon Dr Sir Rhodes	Dorrell, Stephen
Braine, Rt Hon Sir Bernard	Douglas-Hamilton, Lord James
Brandon-Bravo, Martin	Dunn, Bob
Brazier, Julian	Dykes, Hugh
Bright, Graham	Evans, David (Welwyn Hatf'd)
Brown, Michael (Brigg & Cl't's)	Evennett, David

Fairbairn, Sir Nicholas	MacKay, Andrew (E Berkshire)
Fallon, Michael	Maclean, David
Field, Barry (Isle of Wight)	McNair-Wilson, Sir Michael
Fishburn, John Dudley	McNair-Wilson, Sir Patrick
Fookes, Dame Janet	Major, Rt Hon John
Forman, Nigel	Malins, Humfrey
Forsyth, Michael (Stirling)	Mans, Keith
Forth, Eric	Maples, John
Fowler, Rt Hon Sir Norman	Marlow, Tony
Fox, Sir Marcus	Marshall, John (Hendon S)
Franks, Cecil	Marshall, Michael (Arundel)
Freeman, Roger	Martin, David (Portsmouth S)
French, Douglas	Mawhinney, Dr Brian
Gale, Roger	Mellor, David
Garel-Jones, Tristan	Miller, Sir Hal
Gill, Christopher	Mills, Iain
Gilmour, Rt Hon Sir Ian	Miscampbell, Norman
Glyn, Dr Sir Alan	Mitchell, Andrew (Gedling)
Goodhart, Sir Philip	Mitchell, Sir David
Goodson-Wickes, Dr Charles	Monro, Sir Hector
Gorman, Mrs Teresa	Montgomery, Sir Fergus
Gorst, John	Moore, Rt Hon John
Gow, Ian	Morris, M (N'hampton S)
Grant, Sir Anthony (CambsSW)	Morrison, Sir Charles
Greenway, Harry (Ealing N)	Morrison, Rt Hon P (Chester)
Greenway, John (Ryedale)	Moss, Malcolm
Gregory, Conal	Moynihan, Hon Colin
Griffiths, Peter (Portsmouth N)	Neale, Gerrard
Ground, Patrick	Nelson, Anthony
Hague, William	Neubert, Michael
Hamilton, Hon Archie (Epsom)	Newton, Rt Hon Tony
Hamilton, Neil (Tatton)	Nicholls, Patrick
Hampson, Dr Keith	Nicholson, David (Taunton)
Hanley, Jeremy	Norris, Steve
Hargreaves, A. (B'ham H'll Gr')	Onslow, Rt Hon Cranley
Hargreaves, Ken (Hyndburn)	Oppenheim, Phillip
Harris, David	Page, Richard
Hawkins, Christopher	Paice, James
Hayward, Robert	Parkinson, Rt Hon Cecil
Heathcoat-Amory, David	Patnick, Irvine
Hicks, Mrs Maureen (Wolv' NE)	Pawsey, James
Higgins, Rt Hon Terence L.	Porter, Barry (Wirral S)
Hind, Kenneth	Porter, David (Waveney)
Hogg, Hon Douglas (Gr'th'm)	Portillo, Michael
Howard, Rt Hon Michael	Price, Sir David
Howarth, Alan (Strat'd-on-A)	Renton, Rt Hon Tim
Howarth, G. (Cannock & B'wd)	Riddick, Graham
Howe, Rt Hon Sir Geoffrey	Ridley, Rt Hon Nicholas
Howell, Rt Hon David (G'dford)	Ridsdale, Sir Julian
Hughes, Robert G. (Harrow W)	Roberts, Wyn (Conwy)
Hunt, David (Wirral W)	Rossi, Sir Hugh
Hunter, Andrew	Rost, Peter
Irvine, Michael	Rowe, Andrew
Irving, Sir Charles	Rumbold, Mrs Angela
Jack, Michael	Ryder, Richard
Janman, Tim	Sackville, Hon Tom
Johnson Smith, Sir Geoffrey	Sainsbury, Hon Tim
Jones, Gwilym (Cardiff N)	Sayeed, Jonathan
Jones, Robert B (Herts W)	Scott, Rt Hon Nicholas
Kellett-Bowman, Dame Elaine	Shaw, David (Dover)
Key, Robert	Shaw, Sir Giles (Pudsey)
King, Roger (B'ham N'thfield)	Shaw, Sir Michael (Scarb')
King, Rt Hon Tom (Bridgwater)	Shephard, Mrs G. (Norfolk SW)
Kirkhope, Timothy	Shepherd, Colin (Hereford)
Knapman, Roger	Shepherd, Richard (Aldridge)
Knowles, Michael	Skeet, Sir Trevor
Lamont, Rt Hon Norman	Smith, Tim (Beaconsfield)
Lang, Ian	Soames, Hon Nicholas
Lawrence, Ivan	Speller, Tony
Lawson, Rt Hon Nigel	Spicer, Sir Jim (Dorset W)
Lee, John (Pendle)	Spicer, Michael (S Worcs)
Leigh, Edward (Gainsbor'gh)	Squire, Robin
Lennox-Boyd, Hon Mark	Stanbrook, Ivor
Lester, Jim (Broxtowe)	Stanley, Rt Hon Sir John
Lightbown, David	Steen, Anthony
Lilley, Peter	Stern, Michael
Lloyd, Sir Ian (Havant)	Stevens, Lewis
Lloyd, Peter (Fareham)	Stewart, Allan (Eastwood)
Luce, Rt Hon Richard	Stewart, Andy (Sherwood)
Lyell, Rt Hon Sir Nicholas	Stewart, Rt Hon Ian (Herts N)

Stradling Thomas, Sir John	Waldegrave, Rt Hon William
Sumberg, David	Walden, George
Summerson, Hugo	Walker, Rt Hon P. (W'cester)
Tapsell, Sir Peter	Waller, Gary
Taylor, Ian (Esher)	Wardle, Charles (Bexhill)
Taylor, John M (Solihull)	Watts, John
Taylor, Teddy (S'end E)	Wells, Bowen
Tebbit, Rt Hon Norman	Wheeler, Sir John
Temple-Morris, Peter	Whitney, Ray
Thatcher, Rt Hon Margaret	Widdecombe, Ann
Thompson, D. (Calder Valley)	Wiggin, Jerry
Thompson, Patrick (Norwich N)	Wilshire, David
Thorne, Neil	Wolfson, Mark
Thornton, Malcolm	Wood, Timothy
Thurnham, Peter	Woodcock, Dr. Mike
Townend, John (Bridlington)	Yeo, Tim
Townsend, Cyril D. (B'heath)	Young, Sir George (Acton)
Tracey, Richard	Younger, Rt Hon George
Tredinnick, David
Twinn, Dr Ian	Tellers for the Noes:
Vaughan, Sir Gerard	Mr. Alastair Goodlad and Mr. Tony Durant.
Viggers, Peter
Waddington, Rt Hon David

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House supports the Government in its view that those who can afford to pay for sight tests should do so and that the money which was previously spent by the National Health Service on free sight tests for those who could afford to pay is better spent in other ways in improving health care; believes that this will not lead to the nation's health or sight being put at risk nor deter those from seeking sight tests who need them; and fully supports the Government's policy that sight tests paid for by the National Health Service should continue to be available to those on low income, children and those most at risk of blindness from diabetes and glaucoma.