NHS: Backlogs

Lord Stoneham of Droxford Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I can assure the noble Lord that bureaucracy is not the aim of the game and that getting money to the front line is the priority. We have record levels of investment in this area. We are currently devoting about 12% of GDP to health spending, which sits alongside the highest in the world. That is not to say we do not have to make sure every penny of that is spent effectively and, where possible, on the front line rather than on back office and bureaucracy.

[Lord Stoneham of Droxford (LD)]

My Lords, the key test of any organisation with a backlog of maintenance is whether it sustains that expenditure when it is under financial pressure. So will the Government commit that the extra money they have budgeted for maintenance in the health service will be maintained in real terms when inflation is running at 10%?

[Lord Markham (Con)]

We understand the importance of the programme, as I mentioned, and, in terms of the finances of the country, we have people in high positions who know its importance in the health debate. So the noble Lord can rest assured that it is top of our agenda, and we will be fighting hard to make sure that the capital programme is given the priority it needs.

Opticians Act 1989

Lord Stoneham of Droxford Excerpts

Monday 8th February 2016 Lords Chamber

[Lord Stoneham of Droxford (LD)]

My Lords, I speak in this debate not as a health expert but in my capacity as business spokesman for these Benches and as somebody who is interested in encouraging innovation, improving the export potential of our country and encouraging science-based university innovation centres of excellence. I also spend quite a bit of time discouraging practices which suggest or encourage unfair competition.

To me, this is a restraint of trade issue. As the noble Lord, Lord Faulkner, said, exactly the same arguments were used against the sale of reading glasses in 1989 as are now being made against adjustable-focus glasses. The Minister would do well to read the report at that time as a way of convincing himself that the arguments in this debate should be answered.

Health and regular eye tests are things that I am not expert at discussing. As I said, I am more interested in the competition aspects, but I think that by freeing up the market a little, a bit more competition might increase the number of eye tests, as was shown in the case of the sale of reading glasses.

I am one of those who finds it convenient to go into an optician for regular eye tests, and I use one. I do not use it purely because it is the cheapest way of getting glasses but because there is the convenience of fitting and getting regular maintenance, for which it is good to have a relationship with a local optician. Glasses in this country are about variety, style and fashion, however we might think of them as items for improving our health and eyesight. Until recently I went to one optician for 20 years, mainly because the lady who used to serve me always used to tell me how good I looked in the pair of glasses she was trying to sell me.

It is a competitive market and cost is very important. I accept that opticians have to earn a profit. However, I recently changed my optician. The nice lady had gone. When I went to get my spectacles repaired, I was told that they could not be repaired because they had got bent and there was a danger that they would break. I was assured that I needed a new pair. I went to another optician and got the old pair repaired in five minutes. I subsequently bought a new pair when the lenses needed to be upgraded. We should not hide behind health issues in protecting opticians unless they are really warranted. We should encourage competition and choice.

This is a patented British product and I do not believe that it will be what I call a real blockbuster that puts all our opticians out of business. As I said, fashion, style and brands will still rule as the country becomes more affluent. Despite all the arguments, as we have already heard, the threat of selling reading glasses did not undermine the opticians’ business. However, there will be a market from these glasses among people who want to buy a second or spare pair and among diabetics who need to adjust their lenses regularly. There will also be a demand for sunglasses and so on in the leisure market. I think that there will be a huge market in the third world, where there is no network of opticians and price can be critical. We have heard that 1 million pairs are being sold in the US and Japan. If this company wants to sell these glasses in other markets, how convincing will it be when it has to admit that it cannot sell them in its home market? It must go with its hands tied behind its back when it goes into those sales opportunities. Frankly, the Department for Business, Innovation and Skills and the Department for International Development should be jumping up and down encouraging this product and pioneering further development.

I have several questions for the Minister. First, will he reread the documentation of the 1989 review, when reading glasses was the issue under discussion, and will he perhaps reflect on how similar the arguments are in relation to these glasses? Secondly, does he intend to have discussions with the Department for Business, Innovation and Skills on how we can encourage competition in this area? That would, I believe, lead to even more eye tests being carried out by opticians. Thirdly, will he also engage the Department for International Development to look at the great potential for this product in developing countries?

--- Later in debate ---

[Lord Stoneham of Droxford]

I reiterate to the Minister why it is so important to read the report about reading glasses. Exactly the same arguments were used then—that they would undermine eye tests—yet exactly the opposite happened.

[Lord Prior of Brampton]

I have made a promise, and that will be among my other reading material. I do not know how long the review is; we shall see.

However, reading glasses are for a very specific, limited purpose, so might not lead people to think that a sight test is no longer necessary. Self-adjustable glasses, on the other hand, are for wider use, and could potentially lead people to think that their vision needs have been met. They may make do with those glasses for longer, and not consider the need for a sight test. In that way, the case might be slightly different from that of reading glasses.

I accept that there is reasonable concern about the potential impact on the take-up of sight tests if these glasses were to be made available over the counter. It is important to be clear that a sight test is not only about checking whether or not you need glasses. As I said earlier, it goes much further than that. A sight test can identify at an early stage diseases such as macular degeneration, glaucoma, diabetic retinopathy and cataracts. Good vision is also particularly important for safety on our roads, both for drivers and pedestrians. So I appreciate the concern raised by the GOC in respect of the safety of drivers using these self-adjustable glasses.

I draw a distinction between the current proposal—which, as I understand it, is for a range of magnification beyond that of ready readers—and magnification restricted to that of ready readers. I am not sure whether or not that makes sense. It makes sense if you read it slowly.

Even if the concerns I have outlined were overcome, it would be very difficult to justify a greater range for the adjustable, and arguably more risky, product than is allowed for ready readers. There is no appetite that I am aware of to extend the exemption applied to ready readers to stronger prescriptions, and similar objections would apply in that they would cease to be simply aids for the limited activity of reading.

However, I note that while the GOC standards committee did not endorse the idea of sale of adjustable glasses restricted to the ready readers range, it commented, as the noble Lord mentioned, that this might be acceptable. I do not know whether those proposing change have had further discussions with the GOC on this point but, if not, it would be sensible to do so before further consideration by the Government. I am not sure whether the noble Lord has had further discussions with the GOC. He might like to say so at the end. This does not mean that the GOC is convinced that this would be a sensible change or that the Government are minded to consult in the near future. I merely highlight that the GOC’s response was nuanced.

Changes to primary legislation are for government, although noble Lords will obviously appreciate that changes will only be made in the light of professional advice, and one of the sources of that advice will be the GOC. The GOC’s report was nuanced and is probably worth following up. I have an instinctive gut feeling of sympathy for the arguments made by the noble Lord but there are genuine objections from the GOC.

NHS: Research and Development

Lord Stoneham of Droxford Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

No, my Lords. The very point that I made to the noble Lord, Lord Winston, was that by the creation of the National Institute for Health Research, we were avoiding the very thing which used to happen in the past. Now, we can be quite certain that research money from the NIHR will be used to support research and not be diverted into other places.

[Lord Stoneham of Droxford]

My Lords, we welcome the greater emphasis that the Government are giving to NHS research and the commitment to the National Institute for Health Research. However, there is an acute shortage of clinical academics who are both medics and front-line researchers. What steps are the Government taking to rectify this situation so that we can get better links between research and patient outcomes?

[Earl Howe]

I share the concern of my noble friend, although he will be pleased, I am sure, to know that through its integrated academic training programme, the NIHR has taken a lead in reversing the decline that we have seen in recent years in clinical academic careers. Around 250 NIHR academic clinical fellowships and 100 NIHR clinical lectureships are now available annually for medics, which is good news. I also think that intercalated degrees play a very important part in developing the next generation of clinical academics, as does the INSPIRE programme from the Academy of Medical Sciences.