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Eye Examinations (Children)

Volume 447: debated on Tuesday 20 June 2006

8. What steps her Department is taking to ensure that children receive regular full eye examinations. (78467)

Free sight tests are available under the NHS for children under 16, and for those in full-time education aged 16 to 18. Sight tests allow the opportunity to review all aspects of eye health, including investigations for signs of disease. Information about the extensive arrangements for providing help with NHS optical services and other health costs is set out in leaflet HC11, “Are you entitled to help with health costs?”.

Last year, 2.8 million children received an NHS eye test, which is less than a quarter of the almost 12 million children who are entitled to a free eye test. How does the Minister think those figures reflect on her Department’s ability to implement its promises and ensure the good health of our children?

That does not necessarily mean that all children need an eye test. It would be a waste of money if we expected people to have eye tests when they do not need them. We provide every parent with a personal child health record, which gives them information about what to look for in terms of their child’s eyesight. The booklet “Birth to five” is provided for all first-time parents and gives advice and information. As part of the national service framework, we want to develop an orthoptist-led programme for pre-school vision screening, which ensures that eyes are working and developing normally. In those ways, we are making sure that when children have a problem, or are perceived to have a problem, they receive an eye test as required.

I accept the fact that all children may not need eye tests, but may I ask whether the Government have ever conducted any surveys to make sure that no children have fallen though the net, as they obviously will not know whether they need an eye test? In my childhood, such testing used to take place in schools.

My right hon. Friend is right about the measures that we should put in place to see whether children require a more extensive eye examination, which is why, as part of the national service framework for children, young people and maternity services, we have developed, as I said, an orthoptist-led programme of pre-school vision screening to check whether children’s eyes are developing normally and whether there are any developmental problems that require a more extensive eye test. That is a better screening procedure, but if parents have any worries, they can use the information that we give every parent after the birth of their child to make sure that they follow up any problems. If they are in doubt, they should seek an eye test, which, of course, is free.

There is a lot of talk about preventive medicine, but I do not remember a generic campaign on the need for regular eye tests ever taking place. If we wish to make an early intervention in eye disease or an early diagnosis of systemic disease, and if we are concerned about road safety or industrial safety later in life, eye tests are essential. Is it not time that the Department of Health encouraged everyone—and not just children—to have regular eye tests?

Of course we encourage them to do so. The research results of the last national campaign, I believe, did not receive a good evaluation, so we offer targeted support. As I said, every parent receives a personal health record for their child that includes information and advice so that they can find out whether there are any problems with their vision. All new parents receive a booklet, “Birth to five”, which explains problems to which they should be alert, including problems in their child’s vision. The national service framework, too, deals with pre-school screening and vision development. Our approach is targeted, and it includes a review of local optical services that gives primary care trusts a greater role in identifying people who do not take up the opportunity to have their children’s eyes tested so that they can target communities where such tests are needed. I hope that that review will give PCTs greater opportunities and flexibility to work with opticians and others to provide the service that the hon. Gentleman would like.

After an eye examination, some children may need an eye operation, but hospitals in different parts of the country are paid different rates by their PCTs for performing the same operation. Why do we need those differential rates, as costs are uniform and there are national contracts on pay and conditions for consultants, nurses and all other staff in “Agenda for Change”?

Those different rates are the primary reason why we have looked at the tariff, as we wish to make sure that there is a level playing field for health services. Clearly, we can look at the issues that my hon. Friend has raised, but may I add that we introduced free eye tests for everyone over 60? I am pleased to say that, for people of advancing years, the wait for cataract surgery is three months or less.

I have to say that that was an extraordinarily complacent answer. If we do not test children’s eyesight, how can we know the extent of the problem? There is poor take-up of eye tests among school-age children, and, after their eight-month check, only 50 per cent. of children have their eyes checked before starting school, so it is more likely that sight defects will emerge as the visual system develops up to the age of seven, which can lead to permanent visual loss and subsequent problems keeping up at school. Why, therefore, did the hon. Lady’s Government fail to support Conservative amendments to the Health Bill in another place, which would have ensured that all children receive a proper eye examination before they start school?

I am not sorry that the hon. Gentleman does not like my answer, because I would not expect him to do so. I thought that I gave a comprehensive answer, as I explained the information that we give to parents, the pre-school screening programme that we have developed, and the local services developed by PCTs based on need. We are thus meeting the needs of both children and adults in the community. I am incredibly short-sighted and use both contact lenses and glasses, and my children, too, wear glasses. As a parent, I acted when the problem emerged, and we must make sure that parents have the right information so that they can act. Pre-school screening will help, but I do not see the sense of paying for unnecessary, full eye tests if they are not required.

When I was at school, it became obvious to me, and to the teachers, when I needed to be sent for an eye test. I was sent for a test after being moved from the back of the class further and further forward, until I got right up to the chalk board; no one sent me for one before then. However, I am still disappointed in some respects. How much research has been done into the effects on young developing eyes of old-style cathode ray tubes and new LCD and plasma screens? If tests have been done showing that long exposure to such screens has a detrimental effect on young eyes, can we let parents know as quickly as possible, because many of them would like to limit exposure to that risk?

I will write to my hon. Friend with any information that I can supply on what research has been done. However, it is common sense to say that too much time spent in front of a screen is not good for anyone—not only for their eyesight but for their general well-being, given the lack of physical activity. Less is more, I would say.