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The Minister for Community and Social Care (Alistair Burt)
It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) not only for securing this debate but for the usual thorough and highly competent way in which she has presented her case, which was full of facts, information and understanding, and informed in particular by her visits. It will be slightly easier to respond to one or two of her requests than to others, but I will come to that in my remarks.
Before anything else, I acknowledge what everyone recognises, which is that, although all our senses are precious, sight is probably the one that we value most. Sight is the key way in which children learn about the world. Ultimately, as the hon. Lady said, undetected sight problems can lead to a reduced quality of life and unnecessary damage to the eyes, which we all wish to prevent. The risk is that the vision of children with learning disabilities can be overlooked and assumed to be just part of their overall condition and behaviour. There is no doubt about the background to the campaign she mentioned.
We all share the desire that all children should be able to access sight tests, especially that group of children for whom we know that visual impairment is much more possible. There are more than 100,000 pupils in special schools in England. New arrangements have been introduced for children and young people with special educational needs or disabilities to develop more integrated approaches to meeting need. There is rather more variability than the hon. Lady suggests, and that variability is necessary to cope with the different conditions we are talking about.
A new framework was introduced in September 2014 that will see commissioners and local authorities working together to agree arrangements for meeting the needs of children with special educational needs. That includes publishing a local offer of services and ensuring that health and education professionals undertake a co-ordinated assessment of a child or young person’s needs that will inform an education, health and care plan. The plan has to consider the aims and aspirations of the young person and focus on the outcomes that will have the biggest impact. It has to include the needs of a child or young person with a visual impairment. That approach has tremendous potential for stimulating much more joined-up approaches in local care settings; meeting children’s needs; and helping health commissioners and local authorities to understand jointly how population needs can be supported by more flexible delivery methods.
The hon. Lady spoke about a postcode lottery, which is the term commonly used when anything that is provided in one area is not provided in another. I am slightly hesitant about using that term, because it suggests that nothing can be done and implies that it is an accident of fate, when in fact it is not. The difference in provision in different areas often depends on the ability of the leadership and management in an area to recognise a problem and the local determination to make a change. We get change around the country when somebody takes a lead and does things differently, often because they have been stimulated by changes at a national level and have taken the opportunity to do something differently. I recognise that, at its worst, the term “postcode lottery” implies that people get less of a service in one place than another. However, we lever up standards by pointing to what is done best. If we did not allow for some variation, we would not be able to learn. I take the hon. Lady’s point, but SeeAbility’s work in London demonstrates what can be done and shows others the way forward.
David Mowat (Warrington South) (Con)
The Minister is right that the term “postcode lottery” can be pejorative. We need centres of excellence that can be spread out more widely. Warrington hospital is well-funded in that regard, and it considers itself a centre of excellence, at least in Cheshire. For that spreading out to happen more quickly, we need a national programme or some kind of national impetus, which is where the Minister might come in.
Alistair Burt
I am delighted to recognise the centre of excellence about which my hon. Friend speaks so powerfully. I will talk about the national side when I get to the conclusion of my remarks. I will illustrate how we are moving forward and what we are doing, which will address some of the concerns raised by the hon. Member for Mitcham and Morden and my hon. Friend.
Let me turn to the issue of children with learning disabilities and problems with vision. It is widely recognised that children with learning disabilities have a greater risk of a wide range of eye problems, including refractive errors that require correction with glasses, squints, cataracts and glaucoma. All children under 16 and those between 16 and 18 in full-time education, including children with learning disabilities, are entitled to free NHS-funded sight tests. Sight tests are an extremely valuable heath check of the eye that can pick up a need for glasses and early signs of eye conditions, many of which can be treated if they are found early enough.
As the hon. Lady said, NHS England is responsible for commissioning the NHS sight testing service. I will come on to the work that NHS England is doing with SeeAbility in a moment. The hon. Lady said that she is concerned that an optical practice is not necessarily the best environment for undertaking a sight test on a child with learning disabilities. I agree, which is why we want greater use to be made of different ways of providing sight tests for children with learning disabilities. The NHS can contract with providers for mobile, funded sight tests for children, which can take place at special schools. We appreciate that that provides a familiar environment for the test, as the hon. Lady said, which best serves the child. Any provider can apply for a contract with NHS England to provide those services, provided they meet the conditions for holding a general ophthalmic services contract. I will come on to the point about payments in a moment.
However, I am aware that, even with current provision, the concern remains that children with learning disabilities may find it more difficult than other children to access services. SeeAbility has been doing valuable work in that area to develop evidence and promote awareness of the specific needs of children with learning disabilities. I am pleased to accept the invitation to meet SeeAbility and visit one of the schools in which such work has been going on. It will not be my first visit. I visited it when it was the Royal School for the Blind when I was Minister with responsibility for disabled people 20 years ago, and it will be nice to renew the acquaintance.
I am also aware of SeeAbility’s “Children in Focus” campaign, which seeks a nationally commissioned service to provide sight tests and glasses for that important group of people in special schools. In addition, I understand that SeeAbility has recently been awarded a contract by NHS England to provide eye care services at a number of special schools in London.
Reducing health inequalities is a key part of the five-year forward view and NHS England’s 2015-16 business plan. In that context, I know that NHS England recognises a growing body of evidence that suggests that access to sight tests and glasses is an issue for some children and that regular eye tests and the wearing of appropriate glasses make a vital contribution to those children’s health, educational progress and general quality of life.
As the hon. Lady said, NHS England has been in dialogue with SeeAbility about sight test provision for those pupils, and it has met Dr David Geddes, the head of primary care commissioning. I welcome the engagement between the NHS and patient groups. As I said, SeeAbility has recently been awarded a contract by NHS England to provide eye care services at a number of special schools in London. NHS England is keen to see how that work is going, so that it can consider what can be built on it and see whether the model of care that is right for that cohort of parents can be rolled out elsewhere. Some good early work has been done, but it is early days. It is appropriate that NHS England carries out some longer term work with SeeAbility to assess how that contract is working and see what can be done. Although we would all like to see rapid progress, it is early in the contractual relationship, and NHS England needs to develop the evidence base further.
The hon. Lady rightly spoke about fees. SeeAbility has pointed to a structure that is considerably higher than the current fee of £21.31 per test. We all recognise that the current financial stresses in the NHS mean that a robust case has to be built before further funding is committed. NHS England is happy to work with SeeAbility to understand better what financial model best contributes to those patients’ needs. Its view is that SeeAbility has done some very good early work, but it is only two months into the contractual relationship. We therefore need to take a little longer to find out what is actually happening and what more can be done. NHS England expects to have concluded that work by next spring, and it will be in a position to consider the need for changing the current arrangements and possible service developments.
I hope that gives the hon. Lady a sense of where this is going. First, we all recognise the scale of the problem. Secondly, because there is now more variability in the NHS’s ability to meet this need, some things are being tried out to see how they work—particularly through the contract with SeeAbility. I am keen to see how it works in practice, which is why I am happy to accept the invitation to see some of the work it is doing in schools. I will work with NHS England on how it is assessing the work and on the next steps.
In closing, I reiterate that I recognise the importance of properly considering the needs of children with learning disabilities in service planning. If children are to be given the best chance in life, it is important that any vision problems that could affect or impair their development are identified and addressed. I am pleased that NHS England is closely looking at this issue and is already in discussion with SeeAbility. I look forward to hearing about the outcomes of NHS England’s work in this area and its proposed way forward.
The early day motion that the hon. Lady mentioned states that, as a start, it
“encourages the Government and the NHS to work together to create a comprehensive national programme and a properly-funded system to make sight tests available in all special schools in England”.
In the spirit of encouraging the Government and NHS England to work together to see what can be done, the hon. Lady can be sure that that is indeed happening.
I look forward to meeting SeeAbility and NHS England to pursue this matter further. I am sure the House will have a further opportunity to discuss it in the future. Once again, I thank the hon. Lady for securing the debate and conducting it in her normal thorough and effective manner.
Question put and agreed to.