HL Deb 08 March 2005 vol 670 cc719-24
Lord Warner

rose to move, That the draft order laid before the House on 24 February be approved [10th Report from the Joint Committee].

The noble Lord said: Adjusting my spectacles, I can say that this is an order about patients. Patients are at the heart of our changes to the regulation of opticians and other health professions. This order will improve the way that the General Optical Council protects patients: by setting standards for the profession; by taking action when an optician falls below those standards; by requiring continuing education and training; by limiting the exercise of important specialisms to those who have a recognised expertise, and by legalising the direct sale of contact lenses, and setting standards for it.

The Government have a programme to modernise the way that health professions are regulated. This order is part of that. It updates the legal framework for opticians in a way that follows the model we used for doctors, nurses and other health professions. Our work is making regulation more responsive to patients' needs and better at protecting them. Noble Lords will recall that Dame Janet Smith's report from the Shipman inquiry raises some important issues about the regulation of doctors, and as we address those we are thinking carefully about the regulation of all health professions, not doctors in isolation.

Regulatory bodies have risen to the challenge that we have set them. The General Optical Council is not an organisation which is on the front pages of daily newspapers. But it has played a full part in bringing changes about. The GOC has worked hard with us to develop the proposals in this order and I commend the work that is has done in this area.

It is in the nature of amending legislation that the order can be hard to follow. I hope that the version of the Opticians Act "as it would look", which we have made available, is helpful. I would like to summarise quickly the main changes that the order brings about. The first big group of changes we encounter on reading the order, after some material about committees, concerns registration. Article 9 brings in student registers. These will protect patients by ensuring that students get their practical experience under the control of the GOC. Students spend time with patients and it is right for patients to have the same protection with a student as they do when they see a registered optician.

Article 11 brings in the recognition of specialisms. The General Optical Council has immediate plans to recognise three kinds of specialist: those who can fit contact lenses, those who can administer drugs as part of their practice, and those who will in future be able to prescribe drugs. Extending prescribing to properly qualified optometrists will benefit patients by allowing them to receive a wider range of treatments, more quickly. The order allows the GOC to identify which optometrists have gained the specialist knowledge to prescribe safely.

Article 12 brings in a legal requirement to have insurance. I am clear that this is an important step forward in protecting patients. At present, regulators such as the GOC tell professionals they need to be adequately insured, in case they have to pay damages to a patient. But we may not find out that someone has failed to insure until after the event, when there is a patient who cannot be compensated.

After these registration changes, the next big area of improvement is in professional training and development. Here I want to draw attention to Article 14 of the order, which brings in powers to have compulsory continuing education and training. The days are now long gone when a health professional gained a lifetime's knowledge before qualifying and anyone's practice can become stale. The optical professions have, very responsibly, built up a voluntary system of continuing education and training. This new order ensures that all will now need to comply. Patients will be protected and have confidence that the person treating them is up to date with knowledge and skills.

We then move on to the largest section of the order, on fitness to practise. This is a major updating of how the GOC deals with an allegation that an optician's fitness to practise is impaired. The same legal approach ought to apply to a problem with a doctor, nurse, dentist or optician or many other health professionals. When our legislative changes are complete, it largely will. At present however, the GOC lacks powers which it needs to have. For example, at present the GOC can deal only with what the law calls "misconduct". Sometimes, however, the underlying problem is poor health, or poor professional performance, which can affect the ability to do a job. The order spells out that the GOC can take action on those matters too, avoiding the need for hair-splitting debates about the meaning of "misconduct".

Another example is that if the GOC finds that an optician's fitness to practise is impaired, it has limited options at present: to strike him or her off; to suspend their registration; or to do nothing. The order will give it a new option, to impose conditions on the person's registration for a period. Those might be to seek training, or anything else reasonable that would make the practice safe for patients.

The last part of the order I would pick out for mention now is about contact lenses. Articles 18 and 20 free up the market so that a patient who wants to can buy contact lenses direct from a supplier; for example, on the Internet. This is a freedom which some patients, very reasonably, want. Obviously they need confidence, though, that the lenses they receive will be the ones that the optician intended.

In future he will provide a patient with a specification and the seller must have the specification to carry out a sale. The law will also require the seller to employ an optician or doctor to direct the sale. "Direct" in this context means that an optician needs to be in the management chain, accountable for what goes on between customer and seller. That will safeguard patients by allowing the General Optical Council to intervene against either the company or the optician if they fail to maintain high standards.

A further point on contact lenses is to regulate the sale of cosmetic lenses in the same way as other contact lenses. Those lenses are not harmless simply because they do not have an optical effect. All lenses can prevent normal amounts of oxygen from reaching the eye, which can lead to bacterial infection. Cosmetic lenses are no different, so again an optician should be involved. When an optician supplies a lens he can help the user to minimise the risk by dealing with whether the eye is suitable for contact lens wear; which lens is appropriate; advice on care of the lenses and eyes; and advice on aftercare if there are problems.

These are long-awaited reforms that will make a difference to patients. The Council for Healthcare Regulatory Excellence gave its, full support for these proposals, which are absolutely necessary to make the GOC more effective in protecting the public … I hope that the consultation and legislative processes will proceed speedily so that the GOC can implement the proposed changes as soon as possible".

Organisations as varied as the British Contact Lens Association, NHS bodies, the College of Optometry and the Institute of Optometry have expressed support. In the words of one NHS respondent, These changes are welcome as they pave the way for more efficient and transparent processes within the GOC as well as bringing the processes into line with those of the other healthcare professionals". I beg to move.

Moved, That the draft order laid before the House on 24 February be approved [10th Report from the Joint Committee].—(Lord Warner.)

Earl Howe

My Lords, on behalf of these Benches I express my appreciation to the Minister for introducing the order, which I welcome without hesitation. As he rightly says it is the latest in a series of reforms to the regulation of the healthcare professions heralded originally by the NHS plan. I am in complete unanimity with him on the desirability of maintaining the principle of professional self-regulation while ensuring that the way in which the regulatory bodies are structured and composed give the general public confidence in the professional ability of the practitioner and, if need be, the confidence that they will be protected if things go wrong.

In the latter regard my understanding is that the hearings panel of the General Optical Council will be composed of optometrists, dispensing opticians and lay members. If the Minister can elaborate on that it would be helpful. The balance on that panel is important because it is from that panel that the members of the Registration Appeals Committee and Fitness to Practise committee will be drawn. Those committees, perhaps more than any others. will determine the sense of collective ownership which the GOC will, we trust, engender. Of course, having said that, it is worth emphasising that the number of complaints against optometrists is very small. That in itself should give the public reassurance.

I should like to thank the Minister for kindly arranging to send me an amended version of the Opticians Act 1989 which is, of course, the current governing statute. The amendments to the Act, which this order will create, highlight some quite serious shortcomings: the limited range of cases in which the GOC can act; its limited powers in relation to fitness to practise cases; and the absence of a power to order an interim suspension. In addition, the GOC cannot at present set standards of competence for new or existing registrants or acquire adequate insurance against professional liability. Nor can it require opticians to undertake continuing education and training.

All these important lacunae are appropriately addressed in the order before us. Additionally, I particularly welcome the provisions relating to prescribing powers for certain categories of specialist, which seem to me entirely justified.

I also welcome the fact that the sale of cosmetic contact lenses is now to be regulated and will have to be supervised by a suitably qualified person. I have been anxious about this for some time and tabled a Question for Written Answer on the issue as far back as 1998. The reply I received was that the Government were keeping the matter under review. We have known for some time that those who sell these lenses fail to provide information on how they should be cleaned and stored which seriously increases the risk of certain eye infections, one of which, acanthamoeba, can lead to ulceration of the cornea and ultimately to blindness. So this is not by any means a trivial matter. I am glad that at long last it is to be dealt with.

I want to ask the Minister a question on continuing education and training. Compulsory CET has been warmly welcomed by the profession with the exception of one particular group. Dispensing opticians have been particularly exercised by the CET proposals since they will be forced to pay for their CET to maintain their registration with the GOC but, since they are private practitioners who do not operate under the General Ophthalmic Service, they will not receive any contribution from the NHS to help them to meet their costs. Given that very many of those private practitioners relieve the NHS of a burden which otherwise it would have to carry, I wonder whether the Minister has any sympathy with the concern which they have expressed.

This is an important order. I am glad the Government have found parliamentary time to bring it forward. I wish the new General Optical Council well as it takes forward these very positive modernising changes.

9.15 p.m.

Baroness Barker

My Lords, I too welcome this order. I also thank the Minister very much for circulating a revised version of the measure which was extremely helpful. I welcome in outline the quite dramatic step forward that this represents for the General Optical Council. It is clear that the range of measures which will be open to it will turn what has been a rather blunt instrument into a much more finely tuned one. In particular the fitness to practise reforms should be welcomed by practitioners and users.

I have three questions about that for the Minister. First, on the consequential amendment, I wonder whether the protection of vulnerable adults legislation should be incorporated into this measure. My views may be coloured by a case I heard about that involved an optician. I ought not to go into details, but I would like to raise the issue.

My second question is whether the mis-selling of glasses will be covered by the regulations. I imagine that it will, but I would be grateful if the Minister will say how it will be covered.

Thirdly, can the Minister tell the House what provisions there will be to involve users in the consultative committee? The involvement of users is a valuable method of driving up good practice and would seem to be within the spirit of the order in updating the profession.

I welcome the order as it applies to contact lenses. I have long been concerned about the sale of contact lenses and glasses by people who are not able to tell customers at the point of purchase whether the glasses or lenses are suitable. By and large, I welcome the order as I think it will protect people from eye conditions that are potentially extremely damaging —and I say that with the heartfelt emotion of someone who once struggled to wear contact lenses and gave up the attempt.

As a parliamentarian given the responsibility of scrutinising the regulations, I feel that there is a matter that I must raise. The explanatory note says that in 2002–03 US regulators were notified of about 100 adverse incidents involving cosmetic contact lenses. That is 100 out of how many? What proportion of sales are we talking about? How widespread is the issue? The answer to that does not appear in any of the papers. The Minister may not be able to answer me tonight, but I would like to have a sense of how widespread the issue is and, therefore, whether the measures are proportionate.

Lord Warner

My Lords, I shall answer the last question first, mainly because I know that I do not know the answer. I also have the figure of 100, but what it is 100 out of, I am not altogether sure. I need to look into the details of the research and then I will write to the noble Baroness. Mis-selling is covered by the regulations and would be misconduct.

The noble Earl, Lord Howe, raised a question about the hearings panel. It is the main innovation in the order and is a way of putting some distance between the council and individual fitness to practise decisions, and of giving those decisions greater independence. Any allegations will be heard by the fitness to practise committee, which will be set up afresh for each hearing, using people from the panel. The panel will not contain council members. The hearings panel will be made of up three groups: optometrists, dispensing opticians and lay people. The composition of the panel will be set out in rules made by the General Optical Council that will be laid before Parliament. I cannot give more details than that, but that is the current position.

Regarding the dispensing opticians, we are in a difficult position. They are not included in primary care trust lists, and their position will be considered as part of the review of general ophthalmic services, which will begin shortly. However, I cannot give any assurance at present that NHS money will be available to reimburse dispensing opticians for time spent on training. As with all professionals, though, they need to keep their training up to date. That is the best I can do for the noble Earl at this time.

I have tried to respond to the points raised by noble Lords. I am grateful for the support for this order from both Benches opposite, and I commend it to the House.

On Question, Motion agreed to.

Baroness Andrews

My Lords, I beg to move that the House do now adjourn during pleasure until we are ready for the Third Reading of the Prevention of Terrorism Bill. The precise time will be shown in advance on the Annunciator.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 9.25 to 10 p.m.]