§ 'All retirement pensioners shall be entitled to purchase lenses and frames under the provisions of the General Optical Service.'.—[Mr. Dobson.]
§ Brought up, and read the First time.
§ Mr. Deputy Speaker
With this it will be convenient to take the following: New clause 4—Concessions for registered partially sighted people and for old age pensioners—'The following paragraph shall be inserted after paragraph 2 subparagraph (1) of Schedule 12 to the National Health Service Act 1977:2A.—It shall be the duty of the Secretary of State to provide by regulations for payments to be made by him or376 by any authority established under this Act to meet, or to contribute towards, the cost incurred (whether by way of charge under this Act or otherwise) for the supply of optical appliances for which a prescription has been given in consequence of a testing of sight under this Act—
Amendment No. 10, in clause 1, page 3, line 27, at end insert—
- (a) for any person who is on the blind or partially sighted register; or
- (b) who is an old age pensioner.".'.
§ (5A) Subsections (3), (4) and (5) of this section shall not have effect until two years after subsections (1) and (2) of this section have come into effect, and then only if the price of identical lenses and glasses supplied outside the general optical service has fallen below those charges set out in the National Health Service (Dental and Optical Charges) Amendment Regulations 1984 (S.I. 1984, No. 229) and the National Health Service (Dental and Optical Charges) (Scotland) Amendment Regulations 1984 (5.1. No. 292). ' .
§ Mr. Dobson
I should like to think that we could continue our non-controversial consideration of new clauses, but I doubt whether I shall carry all Members on the Government Benches with me on new clause 1 and amendment No. 10.
The Bill provides for the abolition of the right to buy National Health Service spectacles. We believe that that is wrong in principle, that it will be bad in practice and that it will prove unpopular.
We suspect that the Government also thought that the idea would prove unpopular because when the Secretary of State announced changes in the law relating to opticians it covered 68 lines in Hansard and only one line referred to the abolition of people's right to buy NHS spectacles. The provision affects 3.2 million people a year.
The Secretary of State followed up that furtive approach by playing down the provision at a press conference the same day. When he publicised the Bill, he issued a press statement outlining its provisions, the main body of which did not even refer to the abolition of the NHS supply. Mention of it appeared in an appendix to the press statement. I do not think that the Secretary of State is particularly proud of the provision.
Many people at present freely opt to buy NHS lenses or frames, or a combination of the two. They buy them because they are the cheapest, top-quality goods on the market. There is no logical justification for the abolition of the right to buy cheap top-quality goods.
The Government say that the remaining provisions relating to opticians are based on the Office of Fair Trading report. I and many others question the arguments in that report. We are not in a position to question the Office of Fair Trading's assertions about what would happen if the NHS supply were abolished because it never considered that aspect. It is hard to justify basing changes on a report which did not consider what would happen if people buying at the cheapest end of the market could not do so any longer.
Originally the Government claimed that they had the support of the Consumers Association and the National Consumer Council for their propositions. They cannot claim that now because both bodies have expressed severe doubts about what is likely to happen to the glasses market if the NHS supply is no longer available.
On Second Reading I asked the Minister for Health if he could give one example in economic history of the cheapest, top-quality goods—NHS lenses have 80 per cent. of the market—being taken off the market and the average price being reduced as a result. Needless to say, 377 the right hon. and learned Gentleman has not come up with an example. If he did, he would destroy the whole basis of market economics for ever.
I also asked the Office of Fair Trading, on which the Minister chooses to rely so often, whether in its databank of economic activities and historic facts it could find an example of the cheapest top-quality goods being taken off the market and the general price being reduced. Needless to say, it has not been able to do that. It gave me a rather trivial and unsatisfactory reply. As most in the profession would agree, that is on a par with the appendix to the Office of Fair Trading report on opticians generally which was rather shoddy.
The Government argue that, faced with the genuine problem of private sector glasses and their high price, they should get rid of cheap, public sector glasses. It is difficult to understand the logic of that. It is useful to remind the House of the differences between NHS prices and the average private sector prices.
NHS frames cost between £2.5 and £13.5. Prices were not increased in the last round of dental and optical increases in March. There is no complaint that NHS prices are too high. NHS single vision lenses, since the recent increases, cost between £4.20 and £9.45. NHS bifocals cost between £12.25 and £16.50. I have not heard any complaints about those prices. The average price of a pair of old-fashioned styled single vision glasses supplied by the private sector is £43. It costs £57 for a pair of old-fashioned private sector bifocals. The price of private sector glasses is not likely to come down if the low-priced NHS glasses are removed from the market.
I have received a letter, from which I have been given permission to quote, about the likely effects of the disappearance of the NHS supply. The letter is not from someone whom the Minister can say has a vested interest. The Minister usually dismisses opticians because they have a vested interest. The letter is from the ophthalmic optician at the low vision clinic at St. Thomas's hospital. She has no vested interest. She sells nothing. She exercises her skill in an effort to benefit people with extremely low vision at that great teaching hospital.
The letter reads:
In the low vision clinic we prescribe many types of aids for those with reduced visual acuity, including complicated spectacle prescriptions, telescopic and magnifying lenses. These aids are at present provided either free of charge or carry a large subsidy under the hospital eye service.Should the Minister make changes in this system the patient will be faced with the prospect of charges for these aids which may cost anything from £80 to £100. The patients include a vast majority of elderly people, many of whom, although by no means all, are registered as blind or partially sighted.Is it right that such people are to be denied the ability to read their correspondence, to live relatively independent lives and the possibility of employment because they are unable to afford the aids which would enable them to do so?Those are extremely cogent points and are better than any that I attempted to make in Committee.
The Opposition believe that the measure will prove as harmful in practice as that ophthalmic optician suggested. However, we also object to the measure in principle because it is the first erosion of the right for anyone to obtain NHS services, whatever his income. If the House does not accept the new clauses and the amendment, only those aged under 16, those aged between 16 and 19 and in full-time education, and those whom the Government 378 would define as the statutory poor will be entitled to obtain NHS glasses. Everyone else will be expected to buy them in the private market. The next logical step would be to say that only the poor should be entitled to obtain NHS prescriptions and that others should pay the full price for whatever pharmaceutical product they need after they have received a prescription from the doctor. One saw signs of that thinking in last week's debate on Health Service charges, although not from the Government Front Bench. However, the minds of some Conservative Back-Bench Members were clearly moving in that direction.
We oppose this measure because it is a retrograde step. We do not believe, on the strength of what happened on Second Reading and in Committee, that we can stop the Government carrying out this damaging attack on the principles of the National Health Service, so new clause 1 and amendment No. 10—and I suspect new clause 4, which is proposed by the alliance—are only damage-limitation clauses.
Amendment No. 10 seeks to delay the abolition of the right to buy NHS glasses until two years have elapsed from the commencement of the abolition of opticians' monopoly to supply glasses. The amendment also provides that the abolition of the NHS supply will occur only if, as a result of the other changes in the Bill, the price of comparable glasses in the private sector falls below the price of NHS glasses as fixed by the House last week. I cannot see how the Government can reject that proposition. If they are confident that the extended competition will reduce the price of spectacles, they should allow this test to be carried out. They should be happy to see how the market moves after two years and, if it has moved so that private glasses are cheaper than NHS glasses, they can go ahead with the abolition of the NHS supply.
The revenue accruing to the Government from this proposal—about £17 million—is trivial compared with the total budget of the NHS of £15,000 million. If the Government urge their Back-Bench Members to reject amendment No. 10 they will be asking them to pass a vote of no confidence in the principles and practice of the remainder of the Bill. They will be saying that they are not confident that the price of private glasses will fall below the price of NHS glasses. If they are not so confident, in effect they are saying that they will abolish the NHS supply not because they are confident that glasses will become cheaper but because they want to save £17 million and they do not care whether prices fall.
To be fair, I should say that the Government propose that some groups—youngsters aged under 16, students in full-time education aged between 16 and 19 and people receiving supplementary benefit—should continue to have the right to buy NHS glasses. However, those groups amount to only 35 per cent. of those who buy spectacles. The most important group who will be excluded from the continued right to obtain NHS glasses will be retirement pensioners.
§ Mr. Kenneth Clarke
The hon. Gentleman is implying that National Health Service frames and lenses are being withdrawn from the market. There is no question of their being withdrawn from the market, because so long as public demand for them exists I assume that they will be manufactured and will be available for sale to the public. We are withdrawing the, for most people, small 379 subsidy that is available to all patients who choose that range of glasses. If the hon. Gentleman was about to suggest that pensioners should be entitled to free glasses or to reduced-price glasses, as is the Liberal party in its new clause, I must remind the House that that has never been the case. We have never had special arrangements for pensioners, so I do not understand the hon. Gentleman's point.
§ Mr. Dobson
At times the Minister loses touch with reality, and I say that as one of his admirers. As he knows, one problem with the high price of private spectacles is that some rogue opticians who are trying to make more money than they should have managed to persuade people, who have a statutory right to buy NHS glasses, that none were available. Does he believe that profiteering opticians, especially the new ones whom he is bringing into the optical market, will say to patients, "You can have these cheap supplies if you want them"? Of course not. The new entrants into this market will wish only to make money, not to provide a service.
The Minister is a member of a party that claims to be in contact with industry. He should invite representatives of the optical manufacturing industries to speak to him. For years they have geared their production to producing, in large quantities and at low prices, glasses for the NHS. They know that the market for NHS glasses will disappear. That is why so many of them are perturbed and expect massive layoffs in manufacturing firms that can no longer compete in a confused and difficult market.
The Minister says that there will be cheaper glasses. The Opposition have always accepted that some of the plainest and simplest glasses may reduce the price. They will have to reduce a great deal to become cheaper than NHS glasses. We have all also said, and will continue to say, that complicated glasses or even glasses of average complication are likely to increase rather than reduce in price. We firmly believe that we should maintain the NHS supply to everyone.
Pensioners receive free prescriptions. They do not receive free glasses, although when the Leader of the House answered a question on the subject he was plainly under the misapprehension, as are many of the public—excluding pensioners — and many Conservative Members, that pensioners receive free glasses. They do not. They need to be protected from the likely price rises.
Pensioners will be more affected than most people because of the effects of age. Older people generally have worse eyesight than when they were younger. Generally they need stronger and more complicated lenses than they did in their younger days. Old people's eyesight deteriorates quicker and therefore they need new and more complicated glasses more often. They need special glasses more often than younger people for the post-operative period. They should be entitled to continue to buy NHS glasses, which the Minister wishes to deny them, or, better still, they should be entitled to receive free glasses.
I give one or two examples of what is likely to happen to the price of glasses that pensioners may wish to buy. Thames Television, not so far as I know an outpost of the Labour party even if it is located in my constituency, did a survey of how much a patient would have to pay for a pair of post-glaucoma operation spectacles. It found that in the NHS a woman would have to pay £11.35, but if she went to the private sector the same day for that product she would have to pay £46.40. I suggest that that is a 380 substantial difference. In another case it found that NHS glasses would have cost £22 while the private alternative would have cost £80. In the face of such increases, pensioners need to be protected from the Bill's provisions.
It is rumoured—no one has said anything formally as far as I know—by the aficionados of health in the Press Gallery and the bars and tea rooms behind it that the Government are thinking of making a concession for people or pensioners who need complicated lenses. It is suggested that the Government are contemplating free glasses or possibly glasses at a reduced price. Hardship springs not just from cost but from the means of the people involved. It is a combination of two factors. A sliding scale which will cope with the complication and possible expense of lenses and with the scale of income is likely to prove a bureaucratic nightmare and pensioners will be the least able to understand the sliding scale.
In our new clause and amendment we are asking for clear entitlements. We believe that optical services should be free to all pensioners and to all blind and partially-sighted people. We regard our proposal as a containment operation. That is second best compared to maintaining the principle that the Government are seeking to erode. We want to see continued, and are determined to reintroduce it if the Government remove it from the system, the principle that everyone should be entitled to obtain NHS glasses which year in and year out, good years and bad, have proved to be the cheapest and best on the market and about which the only criticism has been the design of some of the frames.
We should stick with what we have. We have the best system in western Europe. It has produced the cheapest glasses in western Europe. The Government's proposals are wholly retrograde. I hope that some Conservative Members will come into the Lobby with us to protect people, particularly pensioners, from what the Government are doing.
§ Mrs. Jill Knight
There has been some confusion about NHS glasses that I should like to clear up. With the greatest respect, I advise my right hon. and learned Friend that he should not tell people that NHS glasses will continue to be provided, because they will not. While they may be available to be bought, they will not be available to the patient as they presently are. There must be no confusion about that. The only people who will be entitled to NHS glasses at the present rates will be children or people on supplementary benefit. Everyone else will have to buy on the open market.
§ Mr. Meadowcroft
Will the hon. Lady spell that out a little further? As I understand it, there is, rightly, a subsidy towards the provision of some of the NHS lenses. Is the hon. Lady saying that the difference between what she is suggesting and what the Minister said is that that subsidy will no longer be available?
§ Mrs. Knight
It is wider than that. Although it is an extremely complicated matter, I was trying, partly because of time, but mainly for clarity, to make the position plain to all hon. Members. There are subsidies at the moment and they will be withdrawn. As the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, NHS glasses at present are the best buy. They are the cheapest for the quality in the world. No one can touch us. They will no longer be available at the same rate. Let there be no doubt about that.
381 The reason why NHS glasses are such a good buy is that ophthalmic opticians provide them at cost. They make no profit on NHS glasses. For years, ophthalmic opticians in business have had to subsidise the provision of NHS glasses by charging more for private frames. Anyone who believes that after the Bill goes through opticians will be able, without the subsidy, to provide the same glasses at the same price I am afraid is misleading himself.
I cannot possibly support the hon. Member. I shall support the Government if we vote on new clause 1 because, although he spoke ingeniously, he mixed two different major points. One of them is that elderly people need glasses and often require glasses of greater strength. That is true in relation to glaucoma, when special glasses will perhaps need to be used for a short time after operations. It is untrue, however, that all ladies over 60 and all gentlemen over 65 are so poor that they cannot afford to pay the right price for their glasses. That fact must be clearly established.
I find it unacceptable that some hon. Members, who should be able to pay the true cost of their spectacles, can wear NHS spectacles that we all pay for. It is nonsense to suppose that we should spend scarce taxpayers' money on people who can well afford to pay for what they need, especially from the Health Service. It is extraordinary that people are unable or unwilling to pay for their health adjuncts. That should be said clearly.
It is true also that many elderly people have an income that is just about at the level of supplementary benefit. They will no longer be able to get NHS glasses at the present cost. My right hon. and learned Friend is well aware of that. He takes on board what is being said and, indeed, wrote to me recently on the matter. I agree with him. He said:The group which concerns me is those who need expensive lenses but whose relatively modest income excludes them from getting free or reduced cost glasses under the present arrangements. That is the problem I agreed to address in Committee.He went on to say that his objective was to find a way to help them without subsidising those who are well able to pay for their glasses. That is sensible and shows that my right hon. and learned Friend is well aware of the problem. He will not give public money to make articles artificially cheap for those who can afford to pay the right price, but he seeks to help those who need special glasses but who cannot afford them.
I pay tribute to my right hon. and learned Friend for his efforts. We shall deal with them later. At present—I know exactly what the hon. Member for Holborn and St. Pancras (Mr. Dobson) was referring to when he spoke of his worry — we do not really know whether the Government help will be 2p or £20. It is uncertain because of the wide drafting of the new clause. We need to make that clear. However, although I warmly support his views on the matter, I cannot support the new clause or the others that we are debating with it.
§ Mr. Meadowcroft
If the Bill is passed unamended, elderly people will be entitled to NHS glasses only if they receive supplementary benefit, which is an inadequate provision. About 2 million elderly people out of 9.5 million pensioners receive supplementary benefit, but there are many more whose incomes are just above 382 supplementary benefit level. It is common knowledge that many older people who are entitled to benefits do not claim them, and they in particular will suffer.
The record shows that many old people are concerned about the matter, as 75 per cent. of registered blind and partially sighted people are over 65 years old, and 27 per cent. of all elderly people have some visual impairment. It is also the case that about 14 per cent. of older people have substandard vision, which can often be corrected by glasses. If the Bill goes through in its present form, old people with visual impairment might be deterred from seeking help to correct their sight.
The Minister was faced with this problem recently when he answered questions put to him in a Radio 4 programme on 4 April. He and an optician spoke in the "You and Yours" programme. He said:The vast majority of consumers, and that includes the vast majority of pensioners, will benefit from the changes we are making.By accepting that the provision would affect the majority of pensioners, he clearly accepts that the minority will not benefit from the proposals. In the new clause we are dealing with the most vulnerable section of that minority. If we are to believe the Minister, that minority includes those who need very complex lenses, such as old people who are recovering fom cataract operations, who need to change their prescriptions frequently. The new clause is concerned mainly with those people.
The Minister said in an earlier debate that he intended to assist those who needed very complex lenses, when the differential between the NHS price and the actual cost was especially marked. However, so far as I know there is nothing in the Bill that would carry out his promise.
A little later in the same Radio 4 broadcast, the Minister was phoned by an elderly person who said that she could not afford to buy a new pair of trifocal lenses. The Minister's reply deserves close scrutiny. He said:She is amongst a small group who might need some help and for whom we are trying to devise a method to cover. There were a very small number of patients, and it really is a tiny proportion, who require glasses that are intrinsically very expensive. Trifocals sound expensive to me; our optician guest would know better than I do. If she is not much above the supplementary pension level she might have difficulty in affording it and we have said that we are going to try to find a way in which we can give additional help for those people.The logic of the position was set out by the Minister in his reply to the questioner. If he is sincere in accepting that a small group of people need help, he and his hon. Friends should support the new clause.
The Minister's final sentence makes the case for us. Those on the partially sighted register and the elderly are likely to be within the "very small number" referred to by the Minister. The new clause provides a straightforward and effective way to help them. The clear upshot is that, even by the Minister's own admission, people will suffer if the new clause is not passed. They will suffer medically if, because of their concern at the cost, they do not seek glasses. They will suffer financially because they cannot afford the higher price.
Going beyond the Minister's admission, I suspect that the "very small" category to which he referred will be fairly large. The Minister's argument, which is acceptable on its own terms, is that competition and choice will bring down prices. That may be true in the case of simple lenses. That is why my colleagues and I support allowing opticians to advertise. However, if competition and choice are such panaceas, what damage could it do the 383 Government for them to leave in place the NHS safety net? If people could buy gold-rimmed, diamond-encrusted trifocal glasses privately at the same price as NHS glasses, no doubt they would do so. As they cannot, the safety net would cost nothing.
The abolition of the NHS provision will cause serious hardship. The hon. Member for Holborn and St. Pancras (Mr. Dobson) read a quotation from yesterday's television programme in which the marked difference between the two prices was shown to be from £11 to £46 in one case and between £22 and £80 in another. I can see no way in which the competition and freedom of choice promoted by the Bill will bring the prices of complex lenses down to anything like the NHS level. By the nature of the specific requirements of those lenses there can be few, if any, economies of scale.
I should like to commend our new clause to the House in preference to that in the name of the hon. Member for Holborn and St. Pancras as our new clause extends not only to the elderly but to people on the partially sighted register. There is an overlap between the two categories, but there will remain a significant number of people below pension age who are on the register and could suffer the same hardship. One example is the people whom I mentioned before — those recovering from cataract operations.
Commenting in advance on the new clause, the Minister referred to its sweeping provisions that appeared to offer free provision for all. It is worded to enable that to happen, by regulation, if that is wished. It enables subsidies to be paid if the Minister wishes to do so by regulation.
I say to the hon. Member for Birmingham, Edgbaston (Mrs. Knight) that people pay differentially for their spectacles through tax. There is no way that one can get round the fact that the whole point of the National Health Service is not to penalise people at the point of need, but to endeavour to make people pay when, in theory, they are better able so to do. To suggest that we can charge more to those who can afford it simply because they have a physical need for more expensive spectacles flies in the face of the principle of the NHS.
It is the opinion of myself and my hon. Friends that incorporating the new clause will plug a gap in an exceptionally leaky Bill. It should ease some of the Minister's anxieties.
§ Mr. Roy Galley (Halifax)
My hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) identified the central concern in the Bill, and I support her.
The Bill gives considerable protection to those on low incomes. The new clauses are too widely drawn. As my hon. Friend said, they would not lead to the optimum use of resources in the Health Service. I am sure that my right hon. and learned Friend the Minister will take on board this point about those just above supplementary benefit and low income levels who are visually handicapped. I use the words "visually handicapped" advisedly and do not, as did the hon. Member for Leeds, West (Mr. Meadowcroft), refer to those on the blind or partially sighted register. I believe that the definition goes wider than that. That is a great weakness in the new clause proposed by the hon. Gentleman.
I sincerely hope that before the debate is completed my right hon. and learned Friend can give us some fairly clear assurances about the steps that he proposes to take to assist 384 those who are visually handicapped, who need frequent changes of complex spectacles and whose incomes are not substantial. Many opticians accept that the general price of spectacles will go down as a result of the Bill. The hon. Member for Holborn and St. Pancras (Mr. Dobson) may not be confident of that, but when an optician writes to hon. Members and predicts a 30 per cent. fall in the price of spectacles I believe that we can have considerable confidence.
Nevertheless, there is an element of doubt about bifocal and multifocal lenses. There is genuine concern on Conservative as well as Opposition Benches. I hope very much that my right hon. and learned Friend will take ghat point on board and give us some clear assurances tonight, if possible, on what he proposes to do.
§ Mr. Jim Craigen (Glasgow, Maryhill)
I support the new clause moved by my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson).
Before the parliamentary boundary changes were made last year, the Possilpark blindcraft workshop was in my constituency. I have taken considerable interest in the affairs of the National League of the Blind. Recently the Scottish secretary of the league, Tom Watson, said chat more people will enter into the world of darkness if the legislation is passed. It will have a damaging effect on general optical provision in the country. Generally, we have been improving the level of optics, which is to our credit. It would be most unfortunate if the message tapped out by my hon. Friend in relation to the new clause were not accepted.
It is a fact that two thirds of old-age pensioners do not receive supplementary benefit. I am particularly concerned not with those to whom the hon. Member for Birmingham, Edgbaston (Mrs. Knight) referred, who have a penny or two in the bank, but with the great number who do not qualify for supplementary benefit and still have a real financial problem. The pressure to buy cheaply will be paid for dearly in terms of poorer eyesight in the long term.
I hope that the point behind the new clause will be accepted. The hon. Member for Leeds, West (Mr. Meadowcroft) referred to the partially sighted. I believe that our new clause 20 to some extent covers the concern that he expressed about the partially sighted. We should strengthen the availability of services such as eye testing for old-age pensioners, because there is no doubt that more such people are dependent on their eyesight for many activities. Opticians rightly realise that they have to spend a little more time when the average old-age pensioner comes in for a test. If fly-by-night people move into this area, the advances that have been made under both Governments, in raising the level of services, will be seriously knocked back, and we shall pay a heavy price in the long term.
§ Mr. Michael Morris (Northampton, South)
I have not previously spoken on the Bill, but I have watched with great care what has been going on and, like most hon. Members, have received a volume of correspondence from opticians in my constituency. I have to tread particularly carefully as my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) is a constituent of mine.
I should like to pick up a couple of points about the market that seem not to have been fairly adjudged. One 385 should recognise that the very existence of NHS spectacles and the pricing of them has prevented any manufacturer from going into that end of the market. No one would ever consider producing an inexpensive range of glasses at the moment because they know that one is provided by the state. However, if one removes that provision by the state, there is an opportunity. I hope that the logic of that argument is irrefutable. If one removes the NHS provision, there is a gap.
The hon. Member for Holborn and St. Pancras (Mr. Dobson) would argue that, because all manufacturers are capitalist rogues, no one would produce an inexpensive range of spectacle frames. However, I suggest that all the experience of over-the-counter medicine shows that major multiple chains of chemists—it is reported that they may come into this market—are the envy of the western world. Some 50 per cent. of the chemists' market is controlled by Boots. Not one hon. Member would criticise the service that Boots provides, not just in dispensing but in the whole range of medicines available to the general public. It is inconceivable that if Boots decided to produce glasses it would offer to the public merchandise that was not of a very high standard. Perhaps there would be a difference in that the materials used in the manufacture of inexpensive spectacles would be cheaper than those for the middle price range.
Therefore, there seems to be a lack of logic in the hon. Gentleman's argument. There is every likelihood that an inexpensive range of spectacles will be put on the market by some manufacturers.
§ Mr. Dobson
If the hon. Gentleman is confident that private prices will fall below the present NHS charges, will he support my proposition that the change should not be made until that has happened?
§ Mr. Morris
The hon. Gentleman is a good debater, but I did not say that private prices would fall below NHS charges. I said that there would be an inexpensive range of spectacles which might be broadly competitive in price. They will not necessarily be cheaper.
There is another aspect to be considered. If NHS glasses were such a success, one would expect that nearly 100 per cent. of our pensioners would use them, but the proportion does not approach that. Like other people, the elderly are fashion conscious. The evidence suggests that many elderly people—particularly if they are female—are just as fashion conscious about their glasses as anyone else—if not more so.
§ Mr. Morris
The hon. Gentleman confirms what I am suggesting. Those elderly people tend not to buy the cheapest glasses available. They buy frames that suit their image and their requirements, and on the whole they find those glasses in the private sector.
The hon. Member for Leeds, West (Mr. Meadowcroft) said that he accepted that, given freedom to advertise, the price of the glasses that comprise the bulk of the market would fall by about 30 per cent.
§ Mr. Morris
The hon. Gentleman quoted that figure, and I suspect that I know where it came from. Yesterday I attended a seminar for Council of Europe members—it 386 was nothing to do with this subject—at which I learned that, according to a federal trade commission report, deregulation of the advertising of spectacles in the United States was followed by a fall in price of 30 to 40 per cent. and there was no evidence of a fall in standards.
My hon. and learned Friend is right to suggest that if we remove the subsidy—whether the average subsidy is £5 or £2—and make state provision for children, for those on supplementary benefit and for the difficult area of specialised and technical glasses—which my hon. Friend the Member for Edgbaston has told us that the Government are considering—the rest of society will get cheaper glasses.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
The speech of the hon. Member for Northampton, South (Mr. Morris) was an example of dogma flying in the face of common sense, not to speak of compassion. He argued that there are certain aspects of the competitive theory that are attractive and that could perhaps, under certain circumstances, mean cheaper glasses for certain sections of the public, but he recognised that there will be large disadvantaged groups. He expressed a hope that the Minister will be able to do something for them. That is not a constructive attitude to the legislation, or a compassionate one.
For the benefit of the hon. Gentleman, I shall amplify some of the points made by my hon. Friend the Member for Leeds, West (Mr. Meadowcroft). I have here the DHSS statistics for spectacles provided in 1982 under the NHS general ophthalmic service. Approximately 5 million patients were supplied with complete spectacles or with lenses for existing or new frames. Of those people, some 450,000 or 9 per cent. were children, and about 1.3 million or 27 per cent. were exempt on grounds of low income. However, as the hon. Member for Birmingham, Edgbaston (Mrs. Knight) has made clear, the remainder of those who are currently given support for the purchase of ophthalmic services—3.2 million people or 64 per cent.—will lose that support. When the hon. Gentleman voices his concern about that group, he should remember that it amounts to nearly two thirds of all who are given support at the moment. I am sure that as two thirds of those who now receive State support are to be deprived of it, the hon. Gentleman will join me in expecting from the hon. and learned Gentleman some substantial arguments in favour of what he wants to do, and some information about what he will do to cushion the effects of the measure.
§ Mr. Morris
The hon. Gentleman wears glasses, as I do. We are included in that figure of two thirds. I have NHS lenses in a private sector frame and I therefore receive a subsidy. The figure of two thirds includes the vast majority of the market.
§ Mr. Kennedy
The hon. Gentleman moves swiftly from premise to conclusion without much justification in between.
My hon. Friend the Member for Leeds, West answered the point made by the hon. Member for Edgbaston. The fact that certain sections of the population can afford to turn to the private sector in whole or in part when purchasing these services does not legitimise what the Minister seeks to do. The ethic of the NHS is freedom to use at the point of need. It is freedom of access, without any particular reference to ability to pay. That should apply as much to spectacles as to coronary treatment.
§ The Under-Secretary of State for Scotland (Mr. John MacKay)
§ Mr. Kennedy
Clearly the Minister does not agree. It is sad that the Minister responsible for health in Scotland does not uphold the ideal of the NHS, in that he does not believe that treatment should be free at the point of use, irrespective of ability to pay.
§ Mr. MacKay
The hon. Member is making enormous jumps of the imagination. Coronary treatment is given to all patients, who all require the same treatment. In the case of spectacles, there is not one simple basic frame. Fashion plays a part—sometimes quite an expensive part. The spectacle frame does more than fulfil a strictly medical need, and that "more" is what people should pay for.
§ Mr. Kennedy
I accept the Minister's point, and shall have to clarify my own argument. It does not matter whether we are talking about spectacles or coronary treatment. If one accepts that the NHS is there at the point of use, and that the important thing is the patient's need, not his ability to pay, one cannot in all conscience accept the fact that two-thirds of those who currently receive State support for their ophthalmic treatment will lose it. I accept that among those who are to be deprived of support there will be some who are fashion conscious about the frames that they are using, as opposed to the lenses. At the same time, a large number of the groups specified in our amendment—the blind, those on the partially sighted register and old-age pensioners — will undoubtedly suffer.
Having spoken for rather longer than I intended, I conclude by urging the House to support our new clause 4.
§ 6 pm
§ Mrs. Elaine Kellett-Bowman (Lancaster)
I very much hope that my hon. Friend the Member for Northampton, South (Mr. Morris) is right in supposing that Boots or some similar supplier will come on the market and supply a wide range of cheaper spectacles for the general consumer, but I share the anxiety of my hon. Friends the Members for Birmingham, Edgbaston (Mrs. Knight) and for Halifax (Mr. Galley) about the position of people, perhaps on small occupational pensions, whose income is just above supplementary benefit level. I share even more the worries about those who are severely handicapped optically, such as those who need prism lenses. The Minister referred to fashion, but I am sure that nobody could be accused of choosing prism lenses as a matter of fashion. They are extremely expensive and have to be frequently changed. I have written to the Minister about a number of cases and have received sympathetic replies, with promises to consider the matter carefully. I hope that he will give details of that consideration today as many of us attach great importance to it.
§ Mr. Kenneth Clarke
The purpose of this part of the Bill is to extend to people who need glasses the benefits that we are convinced that choice and competition will bring.
The Office of Fair Trading report has been mentioned. That report analysed the present position which hon. Members and the professions have sought in varying measure to defend. At present, a monopoly on the supply of any optical appliance is reserved by law to a particular profession in a way in which services such as the treatment of illness are not reserved by law to the medical 388 profession. That monopoly has involved a complete ban on advertising, with only modest relaxations allowing the use of small labels on spectacles in windows.
The result is that competition has not been allowed to flourish and consumers have not been able to exercise a wide choice. For example, it is illegal for anyone other than a qualified optician to sell to anyone else frames without lenses in them. Even empty frames can be handed over only by a qualified optician. The person wishing to purchase such frames does not have the advantage of being able to compare prices or to discover the location of premises through advertising in the media. The consequences of that are experienced by the general public as well as noted by the Office of Fair Trading. Prices are often excessive and the price of the same glasses may vary widely according to the choice of the optician. It is high time that the usual benefits of choice and competition applied to this sector as to others. We believe that consumers will benefit, especially pensioners, as so many of them need spectacles.
§ Mrs. Jill Knight
Is my right hon. and learned Friend not aware that the selling of frames is limited to professionally trained opticians because a frame is no use if the required prescription cannot be put into it and no one knows like a professional man whether a frame bought elsewhere is suitable? That is why the monopoly, as my right hon. and learned Friend describes it, came into being. We should appreciate that it was established for very good reasons. Incidentally, I am sure that he is aware that doctors are certainly not allowed to advertise.
§ Mr. Clarke
It is possible that if a person chooses a particularly large or exotic frame and requires a particularly complicated lens there will be a problem, but it will affect only a tiny minority and it is not the reason for the rule. As I understand it, the rule applies because of a narrow legal ruling on the meaning of a phrase in the present legislation which, accidentally but in our view contrary to the public good, produced a situation in which even empty frames must be purchased from a dispensing optician.
As for advertising, we do not propose the usual forum of non-professional advertising for this profession, so there is no suggestion that an optician will be allowed to claim, for example, that he tests eyes better than the man down the road. We propose, however, that opticians should be allowed to advertise their whereabouts, their hours of opening, the range and price of frames available and all the other basic information that allows a market to flourish and consumers to exercise some choice as to where they go for what they require. This will ensure that prices are kept down and will avoid the disparities and unfairness described by the Office of Fair Trading in the present imperfect market. If the result is a downward pressure on prices and pressure to achieve a high level of consumer satisfaction in dealing with patients' needs, everyone will benefit, not least the many pensioners who need spectacles from time to time.
Some hon. Members have suggested that the proposal is an attack on the free National Health Service. The hon. Members for Leeds, West (Mr. Meadowcroft) and for Holborn and St. Pancras (Mr. Dobson) both made that claim. It is essential that the NHS provides properly for the health needs of the population. Hon. Members overlook the fact that the NHS will continue to provide a free sight test for everyone regardless of age or means.
§ Mr. Clarke
For the time being — that is the proposal as it stands. The free sight test will be given to everyone. Indeed, so as to ensure in a somewhat paternalistic way that everyone receives that benefit who needs it, it will continue to be illegal to provide spectacles to a patient except against a prescription based on a recent sight test.
§ Mr. Clarke
Yes, we all agree on that—with the exception, I suspect, of Lord Rugby when the Bill reaches another place. Regardless of age or means, everyone will receive free health care at the point of delivery. The comments of the hon. Member for Glasgow, Maryhill (Mr. Craigen) about many more people descending into darkness and claims about failure to detect glaucoma and the like are based on a total misunderstanding of our proposals. The health care will be preserved free at the point of delivery for everyone who requires it. There will also be other safeguards where we believe that there may be a health risk.
We are talking about the lens and frame business—the supply and purchase of the appliances that people put in front of their faces when a sight test shows that their eyesight needs correcting and they decide that something must be done about it. We are concerned about the price of spectacles. I am confident that the present prices of private spectacles will be markedly reduced. The amendment relates to the effect on the prices and availability of current NHS lenses and frames.
In making a change of this kind, we are all anxious to ensure that we do not increase costs for those who cannot afford it. The result is that the Government have throughout made it clear that the general ophthalmic service will remain available on its present basis to all children and to those on low incomes who at the moment obtain their spectacles free or with some remission of the charges. That is the starting point. However, we are concerned about the remainder—adult patients who do not at present qualify for any remission, or for free spectacles under the GOS.
At present, any adult, regardless of age, income, or the condition of his eyes, can, if he chooses, buy frames and lenses from the particular range that the state provides. By and large, it is a matter of consumer choice whether a person wants to buy those spectacles and lenses. A small amount of subsidy is given under the present arrangements to those who happen to prefer them. My hon. Friend the Member for Northampton, South (Mr. Morris) is quite right. He is one of those who wears National Health Service frames with NHS lenses. My hon. Friend the Minister for Social Security quite often comes in wearing a pair of NHS frames with NHS lenses. I am not very good at recognising NHS frames, but I do not think that the hon. Member for Leeds, West is wearing them. We support my hon. Friend the Member for Northampton, South and my hon. Friend the Minister for Social Security, but not the hon. Member for Leeds, West, because he has chosen a different type of spectacles.
At times, the state specifies certain types of spectacles. The John Lennon metal frames came into fashion. The little half-moon frames are rather popular now. Last year, I had the ridiculous task of having to choose a new ladies' frame. It was not a free choice—all the professional 390 interests wanted me to choose very unattractive frames so that I would not damage their private market—but nevertheless many ladies rather liked the ones that we came up with and they get support as well.
NHS funds are being used in a curious way. Most of those who have a particular taste in frames and lenses obtain a modest amount of subsidy from the rest of the population who either do not wear glasses or have a different taste in them. It is high time that we got out of that business. We believe that with the benefits that competition, choice and heightened consumer consciousness will bring, it is high time that that money was spent on more valuable things in the NHS.
§ Mr. Meadowcroft
The point that we are making is that everyone should have the right to a particular level of service from the NHS. If, for reasons of vanity or whatever, people wish to wear a different style of frame or lens, they can do that and pay for it. We are asking why the Minister will not allow the present access to the NHS to remain for pensioners and those on the partially sighted register.
§ Mr. Clarke
We are retaining the GOS. Indeed, we have always proposed to retain it with the subsidy involved for children and those on low incomes. They at present obtain help under the GOS. We are talking about the extent to which we should provide support for those outside those groups who have a particular taste in spectacles. As things stand, it is the subsidy that will be withdrawn. That is the difference between what the patient pays for his NHS glasses and what they cost the NHS. It is quite a small amount of money. We are not withdrawing the glasses.
Popular NHS glasses, frames and lenses will still be made for the benefit of those who require them. We are not taking them off the market, as the hon. Member for Holborn and St. Pancras implied frequently in his speech. Those who like the John Lennon metal frames will be able to buy them. However, they will have to do so without the benefit of the small subsidy that they at present obtain under the GOS. On average, the subsidy amounts to £5. That is the difference between what the patient pays and the cost of the lens. But that is only the average. For four out of five NHS patients, the subsidy amounts to £2. Only 1 per cent. of all NHS patients obtain a £15 subsidy. Only 50,000 GOS patients obtain more than a £15 subsidy. Thus, we are talking about small amounts of money.
Those subsidy figures must be borne in mind before one decides in which direction the market will move. The hon. Member for Holborn and St. Pancras produced some extraordinary figures from Thames Television. I have heard some astonishing figures being bandied about and they tend to alarm the public. Of course, if an old-age pensioner is told that, as a result of the Government's measure, her glasses will cost £90, she will be rather against it. But at present her reading glasses cost £2 more to us than she paid for them. They will still be manufactured and available. Indeed, competition and advertising may lead to greater downward pressure on their price than is the case at present with the NHS as the monopoly purchaser.
My hon. Friend the Member for Northampton, South is again right. We have rather driven people out of the lower end of the market by providing state frames for so many years. As a result, as British manufacturers have 391 tended to make NHS spectacles, most of the low-cost frames available are manufactured abroad. That is another unfortunate side effect of the policy. Those glasses will still be available. It is possible that nothing will happen to reduce the price of NHS glasses, so our old-age pensioner might have to pay £2 more once every two years. But maintaining that subsidy is not the best use of NHS funds.
I believe that the generality of prices will be kept down and that other people will be drawn into the low-cost provision of spectacles and lenses. I also believe that the choice will widen at the lower end of the market, which will enable us eventually to go over to the system of grants for low-income groups and children, which we think should be introduced to replace the present provision of NHS frames and lenses.
As the House will have gathered, I am quite unrepentant about the broad range of policy. We are preserving essential health care free at the point of delivery. We are stopping spending money on minute subsidies to my hon. Friend the Member for Northampton, South and others. However, the money can be spent elsewhere. Nevertheless, we have a problem with that small section of the population who have particularly difficult prescriptions. My hon. Friends the Members for Halifax (Mr. Galley) and for Lancaster (Mrs. Kellett-Bowman), among others, have raised that point. Some people happen to need particularly complicated prescriptions. As I said, 50,000 GOS patients obtain a subsidy of more than £15 when they buy a pair of spectacles.
Throughout, we have accepted that there is a problem and we have been considering what can be done about those who need more expensive glasses. Hon. Members have cited what I said on a radio programme or in Committee, and recent press speculation. However, on Second Reading, my right hon. Friend the Secretary of State said:On the other hand, it has been argued that there are those with the very poorest sight who need complicated and more expensive lenses, and I am certainly prepared to consider the evidence on that to see whether they can have continued access to NHS glasses." —[Official Report, 20 December 1983; Vol. 51, c. 297.]There has been concern, and we are contemplating doing something following what my right hon. Friend said that will enable those who require more expensive dispensing to continue to have access to the GOS. For example, we could go through the NHS provision and specify certain of the more powerful or complex NHS lenses. We could then say that all those who need those lenses can, if they so wish, obtain GOS glasses at cost price to the GOS. We are identifying here the patients who need the more expensive lenses, and they will include some of the more prosperous patients.
§ Mrs. Kellett-Bowman
My right hon. and learned Friend talks about the cost price. The cost price of an expensive prescription might be very high.
§ Mr. Clarke
It will not be anything like the figures that have been bandied about. The subsidy to any patient under the GOS does not, except in a handful of cases, exceed £30. All the other figures, such as those from Thames Television, seem to be totally invalid when comparing NHS glasses with some different provision in the private sector. The subsidy does not exceed £30 for patients under the GOS, except for a handful of exceptional cases. Nobody receives a subsidy of more than £40.
§ Mr. Clarke
They are the people with whom we are concerned, because by definition we are talking about the cost. We are talking about the more powerful and more complex lenses. It is in those cases that people fear that the price will go up. People fear that if we do not have the restraining influence of the GOS, the price will go beyond their capacity to pay. They are people who do not qualify for help, or low-income groups. We are considering the regulations, but it seems to us that it might be a wise precaution, for the time being, to preserve access to the GOS for those patients who wish to have it. Of course, many of those people will not choose to use GOS glasses; they may decide to get non-GOS glasses. But where people want GOS glasses it may well be right to allow them to have them.
§ Mr. Meadowcroft
The Minister sweeps aside the evidence of the television programme. In the case mentioned, the identical prescription was taken to a private firm to be made up. It was not a question of comparing like with unlike. If there are such tiny numbers of people requiring a high level of subsidy, why will the Minister not accept the need to subsidise them at a proper level?
§ Mr. Clarke
Because that would be entirely regardless of means, and the GOS has never operated on that basis in the past. Mr. Magoo was a fairly wealthy man, as I recall him from the cartoons. Everyone has been concerned about the financial effects of the provisions that we are making, and we must concentrate the financial help on those having the financial difficulty. It is true that the change from the present arrangements will be most marked for those who do not qualify on low income grounds and who happen to need the more powerful and complex lenses. As people fear—I am not sure on what grounds —that the market in those lenses will take off, I am proposing to continue to allow them access to the GOS.
I have the sad disadvantage that I did not see the television programme. From the description of it, I am not sure what point it sought to make. If the House will regard me as the optician and the hon. Member for Leeds, West as the pensioner, at present I provide a pair of NHS glasses, which I obtain from the frame manufacturer and the prescription house. I give them to him at a GOS charge and I charge the NHS, say, £5 more. After the changes, I shall still be able to provide the same frames and lenses from the same source. Presumably they will cost the present amount, which is £5 more than he pays, so his price will go up by £5. I do not see how he can argue that somehow it will now be necessary to get some more expensive provision from elsewhere.
§ Mr. Clarke
I suspect that, guided by somebody with an interest in the subject, Thames Television has indulged in an extraordinary analysis of the consequences of what we are doing. I have heard some extraordinary analyses of what is likely to happen to the market in the next year or so.
§ Mr. Clarke
I will give way to my hon. Friend in a moment. I do not believe that the effect will be very shattering. There is no evidence whatever that all the high-powered lenses will go up in price. They tend to be made by specialists. The assertion is constantly made that the price of all the more difficult and unusual lenses will go 393 up. I have not seen any evidence to support the assertion. In addition, I do not accept the proposition of my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) that no profit is made on NHS glasses, and that they are all supported by the charges for private lenses. We have difficult but perfectly fair negotiations with representatives of the profession, in the course of which we agree their costs and their profit margin. It may not be as much as the opticians would like — very few negotiations produce the perfect solution for those who are bargaining about their income—but there is a profit on the NHS service. I refute the argument that it is a loss-making public service that has to be subsidised by a sometimes grossly excessive price charged for some of the private glasses.
§ Mrs. Knight
I am very sorry, but I must tell my right hon. and learned Friend that he is not correct. Profit is not made on NHS glasses. I was careful to say that the glasses were provided at cost, but even ophthalmic opticians and dispensing opticians have to cover their overheads. I assure my right hon. and learned Friend that it is not only Thames Television that produces figures such as those before us.
Cataract is a condition which needs strong lenses to compensate for the removal of the eye's own lens by an operation. I have information about a 78-year-old woman who is now paying £22.35—
§ Mr. Deputy Speaker
Order. The hon. Lady is making a very long intervention. She must not make another speech.
§ Mrs. Knight
I accept your ruling, of course, Mr. Deputy Speaker. Briefly, that lady will have to pay £80 for something that she now gets for £22.35. We are impaled on the horns of a dilemma. If the cost is as little as my right hon. and learned Friend says, surely there is no point in making any change. On the other hand, if it makes a great deal of difference—as many of us think it will—the people who have to pay will suffer.
§ Mr. Clarke
If the lady in question is now paying £22, my guess is that we are paying about £40 to the people who provide her with her glasses. But let us assume that it is one of the tiny minority of cases in which there is a £30 subsidy. It is possible that the NHS is paying £52 for the £22 glasses. After the change, why on earth should the supplier charge the old lady £80 for something for which it is at present charging the Government £50? Only the strangest operation of the market could possibly cause the cost of those glasses to go up in that way. But in case, for some reasons which have escaped me, it is possible that that will happen, that lady, if she receives a subsidy of more than £15, can have continued access, under the GOS, to glasses at cost. In that way, we shall be able to safeguard her position.
Many cataract patients and many hospital service patients will already be qualified, on low income grounds, for either free or reduced charge spectacles, and will continue to be so qualified. My announcement about the possibility of allowing those receiving more than £15 subsidy to have continued access will also benefit many of the patients from the hospital service, including many of those who have had cataract operations.
394 I understand the fears that lie behind the questions that have been raised, but I think that they are based on a false expectation of what will happen after we make the changes. I believe that my proposal will enable us, when the regulations are made, to look after those who have the sharpest price increase. Most of the others, including most pensioners, will find that they have benefits.
It is possible already to find on the market some private spectacles which are cheaper than the equivalent NHS spectacles. As no one can advertise that fact—because of the way in which the profession is organised—it is rather hard to find them. Nevertheless, they are there, and more of them will emerge. As I think my hon. Friends have agreed throughout, anything that we do otherwise to ease the transition for those with more difficult eyesight should not be extended to old-age pensioners.
I believe that the hon. Member for Leeds, West is correct in saying that the new clause would merely enable us to provide for old-age pensioners. As I read it, it requires us to make grants to old-age pensioners, regardless of need. That is the effect of the amendment moved by the hon. Member for Holborn and St. Pancras. I echo what my hon. Friends have said. There are old-age pensioners who on income grounds are not necessarily those most adversely affected. An old-age pensioner who requires reading glasses may well be not so financially disadvantaged as somebody much younger with a large family who needs more powerful glasses. I think that the proposals that extend the provision to all old-age pensioners are misguided.
As to the suggestion that a free service should be provided to all old-age pensioners, as far as I am aware that has not been the case since 1951. Successive Labour Governments as well as successive Conservative Governments have never seen the need for extending exemption or establishing a free service to everyone above a certain age.
I observe that my hon. Friend the Minister with responsibility for health in Scotland has now resumed his place. We are discussing a curious subject. It is a combination of health and fashion, or something in between. It is health, in that it involves an essential appliance that certain people have to wear if necessary to correct their eyesight, coupled with fashion, in that it involves the style of the appliance when they choose what they require to wear to correct their vision.
We are protecting all the health elements of the service. We are providing sight tests free at source, with legal restrictions to limit sales of contact lenses, and sales to children. I believe that we have thoroughly safeguarded the health aspect of the problem by everything that we have done. The appliances will remain available. By the extension of competition and choice, many patients and pensioners will now discover much more easily where to obtain a wide choice of reasonably priced spectacles than is possible under the existing arrangements.
However, when one considers sheer fashion, the practice of Ministers choosing a particular type of spectacles and giving a small subsidy, if everybody agrees with the choice, is one that we should end. Even if one can conjure up some kind of case for it, it is easy to look elsewhere in the Health Service and identify where that money could be better expended for more patient good. We are allocating expenditure on the Health Service in all 395 kinds of vital areas as rapidly as the economy can stand. It must be right to consider such anomalies, and to withdraw them, because the time has come to enable a freer market to look after consumer interests, and to stop Health Service money being diverted into what has become an out-of-date anomaly.
§ Mr. Dobson
All the problems in the Bill spring from the Government's blind faith in market forces. The Government use the Office of Fair Trading report to justify their blind faith. The Office of Fair Trading report assumed that no prescription would be required, and that Joe Soap and Josephina Soap would walk into a shop and buy a pair of glasses. Once the obligation is introduced to get a prescription, that does not apply.
The report also assumed that the NHS supply would continue. The Government are proposing to abolish the NHS supply, which invalidates everything that the Office of Fair Trading said about bringing down the price of glasses. I should not have said perhaps that the Government have a blind faith in market forces, because, if they had, they would accept amendment No. 10. We are saying that, if market forces reduce prices below the present NHS prices over the next two years, they can go ahead and abolish the NHS supply. The fact is that they do not have any faith in market forces, and they know that market forces will not reduce the price of private glasses below the present price level of NHS glasses.
The Minister gave as an example the famous 924 ladies' frame which he introduced. That was obviously stupendously successful. It sold like the optical equivalent of hot cakes. In fact, it damaged the private market. If the private market were working properly, some entrepreneur would have introduced the 924 glasses himself, and undermined the NHS. However, that did not happen, because the NHS did it, and the Government are not interested in doing anything to benefit ordinary people.
The Minister fails to recognise that the cheapness of NHS glasses springs not only from the subsidy provided, but from the fact that manufacturers have a guaranteed market, and can therefore have long production runs. That saves them a great deal of money, and enables them to compete. The hon. Member for Birmingham, Edgbaston (Mrs. Knight) claims that there is no mark-up and the Minister claims that there is a small mark-up on NHS glasses. What undoubtedly exists is a big mark-up on private glasses. Those factors combined keep the price of the NHS supply to a level at which, for most glasses, the private sector is not able to compete.
The Minister then makes the ludicrous claim that NHS suppliers have somehow driven out manufacturers who might have competed for the lowest part of the market. He said that this may mean that supplies have to be imported from abroad. I am willing to challenge the Minister. I will resign from the Labour Front Bench, if I am still on it, if, in two years' time, after these provisions have been brought into operation, British suppliers are still supplying as much or more of the market for glasses. I will do that if he will agree to resign if the foreign manufacturers, at the end of the two years, are supplying as big a proportion of, or a greater proportion than, the British market. I do not know whether he will accept that bargain—we will have to make it behind the Chair.
396 I am disappointed that the hon. Member for Edgbaston will not support the new clause. We have apparently come to the parting of the ways—our views cannot go on meeting like this.
I am astonished by what the hon. Member for Halifax (Mr. Galley) said. His electors ought to know that he thinks, as asserted by one optician—and he must be the only person in the country who says this—that the price of glasses, as a result of these measures, will be reduced by 30 per cent. I am not the mathematician of the year, but he is clearly worse than me. If there were even a 30 per cent. reduction in the price of the private glasses that I quoted from the Thames Television examples, the position would still arise where the NHS ones were £11.35 and the private ones were £30, or the NHS ones were £22 and the private ones were £50. He still has not benefited the electors of Halifax very much, even by a 30 per cent. reduction, and we are dubious about whether that would happen.
Conservative Members clearly do not recognise that, at present, presumably as a result of the free play of market forces, and the exercise of private choice by every individual, 80 per cent. of people with glasses in the country choose to buy NHS lenses, and 40 per cent. of them choose to buy NHS frames. Conservative Members wish to deprive them of the right to exercise that choice. That is what they will do, if they do not support the new clauses and amendments that we are proposing.
I deal next with the pensioners. Two thirds of pensioners are not entitled to supplementary benefit. As a result, not only will they not get free glasses, but they will not have access to the NHS supply, which has the cheapest top-quality products on the market.
I wish to comment on what the Minister would regard as his concession. He says that the Government are still considering the possibility of doing something to help people who have complicated prescriptions for expensive glasses. I think that that is a give-away. He roamed back in the history of the Bill to recall that the Secretary of State, as long ago as the Bill's introduction, had said that he was willing to consider the evidence on this matter. This is the heart of the matter. The Minister accepts that this is the group of people whose interests will be most damaged by the proposals in the Bill. It is revealing that the Secretary of State, when he came to the Dispatch Box to introduce the Bill on Second Reading, said—as if it was something new—that he was willing to consider the evidence on this matter, which is the heart of health care for the eyes of the worst-sighted people in the country. It demonstrates the extent to which the Bill is a product of a lunatic baying after market forces, with no concern for the eye care of most people in the country. It typifies everything about the Bill and about the Secretary of State. I hope that Opposition Members will support the new clause. I doubt whether any Conservative Members will do so, but if they do not it will be to their shame.
§ Question put, That the clause be read a Second time:—
§ The House divided: Ayes 82, Noes 179.397
|Division No. 270]||[6.39 pm|
|Archer, Rt Hon Peter||Bidwell, Sydney|
|Barnett, Guy||Blair, Anthony|
|Beckett, Mrs Margaret||Boothroyd, Miss Betty|
|Beith, A. J.||Callaghan, Jim (Heyw'd & M)|
|Bennett, A. (Dent'n & Red'sh)||Campbell-Savours, Dale|
|Bermingham, Gerald||Carlile, Alexander (Montg'y)|
|Cartwright, John||McCartney, Hugh|
|Cocks, Rt Hon M. (Bristol S.)||Maclennan, Robert|
|Cohen, Harry||Marek, Dr John|
|Corbett, Robin||Meacher, Michael|
|Cox, Thomas (Tooting)||Meadowcroft, Michael|
|Craigen, J. M.||Mikardo, Ian|
|Davis, Terry (B'ham, H'ge H'I)||Milian, Rt Hon Bruce|
|Dobson, Frank||Mitchell, Austin (G't Grimsby)|
|Dormand, Jack||Molyneaux, Rt Hon James|
|Dubs, Alfred||Morris, Rt Hon A. (W'shawe)|
|Dunwoody, Hon Mrs G.||Nellist, David|
|Eastham, Ken||O'Neill, Martin|
|Ewing, Harry||Orme, Rt Hon Stanley|
|Field, Frank (Birkenhead)||Pike, Peter|
|Fisher, Mark||Powell, Rt Hon J. E. (S Down)|
|Foot, Rt Hon Michael||Radice, Giles|
|Forsythe, Clifford (S Antrim)||Richardson, Ms Jo|
|Foster, Derek||Ross, Stephen (Isle of Wight)|
|Freeson, Rt Hon Reginald||Short, Mrs R.(W'hampt'n NE)|
|Freud, Clement||Silkin, Rt Hon J.|
|Garrett, W. E.||Skinner, Dennis|
|Godman, Dr Norman||Smyth, Rev W. M. (Belfast S)|
|Gould, Bryan||Soley, Clive|
|Hamilton, W. W. (Central Fife)||Steel, Rt Hon David|
|Harman, Ms Harriet||Stewart, Rt Hon D. (W Isles)|
|Hattersley, Rt Hon Roy||Stott, Roger|
|Healey, Rt Hon Denis||Tinn, James|
|Hogg, N. (C'nauld & Kilsyth)||Wallace, James|
|Howells, Geraint||Wigley, Dafydd|
|John, Brynmor||Wilson, Gordon|
|Kaufman, Rt Hon Gerald||Winnick, David|
|Kennedy, Charles||wrigglesworth, Ian|
|Kirkwood, Archibald||Young, David (Bolton SE)|
|Lewis, Ron (Carlisle)||Tellers for the way|
|Lloyd, Tony (Stretford)||Mr. Frank Haynes and|
|Loyden, Edward||Mr.donald Dewar|
|Adley, Robert||Conway, Derek|
|Alexander, Richard||Coombs, Simon|
|Alison, Rt Hon Michael||Cope, John|
|Amess, David||Couchman, James|
|Ancram, Michael||Cranborne, Viscount|
|Arnold, Tom||Crouch, David|
|Ashby, David||Currie, Mrs Edwina|
|Aspinwall, Jack||Dorrell, Stephen|
|Baker, Nicholas (N Dorset)||Dover, Den|
|Batiste, Spencer||du Cann, Rt Hon Edward|
|Beaumont-Dark, Anthony||Dunn, Robert|
|Bendall, Vivian||Fallon, Michael|
|Bennett, Sir Frederic (T'bay)||Fookes, Miss Janet|
|Benyon, William||Forth, Eric|
|Berry, Sir Anthony||Fowler, Rt Hon Norman|
|Bevan, David Gilroy||Fox, Marcus|
|Biffen, Rt Hon John||Gale, Roger|
|Biggs-Davison, Sir John||Galley, Roy|
|Body, Richard||Garel-Jones, Tristan|
|Boscawen, Hon Robert||Goodhart, Sir Philip|
|Bowden, A. (Brighton K'to'n)||Goodlad, Alastair|
|Boyson, Dr Rhodes||Gorst, John|
|Braine, Sir Bernard||Gower, Sir Raymond|
|Brandon-Bravo, Martin||Grant, Sir Anthony|
|Bright, Graham||Greenway, Harry|
|Brinton, Tim||Griffiths, E. (B'y St Edm'ds)|
|Brown, M. (Brigg & CI'thpes)||Hannam, John|
|Browne, John||Hawkins, C. (High Peak)|
|Bryan, Sir Paul||Hayhoe, Barney|
|Buck, Sir Antony||Hickmet, Richard|
|Burt, Alistair||Hirst, Michael|
|Butterfill, John||Hogg, Hon Douglas (Gr'th'm)|
|Carlisle, Kenneth (Lincoln)||Holt, Richard|
|Chapman, Sydney||Howarth, Alan (Stratf'd-on-A)|
|Chope, Christopher||Howarth, Gerald (Cannock)|
|Clark, Hon A. (Plym'th S'n)||Irving, Charles|
|Clark, Dr Michael (Rochford)||Jackson, Robert|
|Clarke, Rt Hon K. (Rushcliffe)||Kellett-Bowman, Mrs Elaine|
|Cockeram, Eric||Knight, Mrs Jill (Edgbaston)|
|Colvin, Michael||Lang, Ian|
|Lewis, Sir Kenneth (Stamf'd)||Sackville, Hon Thomas|
|Lilley, Peter||Sainsbury, Hon Timothy|
|Lloyd, Ian (Havant)||St. John-Stevas, Rt Hon N.|
|Lloyd, Peter, (Fareham)||Shaw, Sir Michael (Scarb')|
|Lord, Michael||Shelton, William (Streatham)|
|Luce, Richard||Shepherd, Richard (Aldridge)|
|Lyell, Nicholas||Sims, Roger|
|Macfarlane, Neil||Smith, Tim (Beaconsfield)|
|MacGregor, John||Speed, Keith|
|MacKay, Andrew (Berkshire)||Speller, Tony|
|Maclean, David John||Spencer, Derek|
|Major, John||Squire, Robin|
|Malins, Humfrey||Stanbrook, Ivor|
|Marland, Paul||Stern, Michael|
|Mather, Carol||Stevens, Lewis (Nuneaton)|
|Maude, Hon Francis||Stewart, Allan (Eastwood)|
|Mawhinney, Dr Brian||Stradling Thomas, J.|
|Maxwell-Hyslop, Robin||Tapsell, Peter|
|Mayhew, Sir Patrick||Taylor, Teddy (S'end E)|
|Mellor, David||Thompson, Donald (Calder V)|
|Meyer, Sir Anthony||Thompson, Patrick (N'ich N)|
|Miller, Hal (B'grove)||Thorne, Neil (llford S)|
|Mills, lain (Meriden)||Thurnham, Peter|
|Mitchell, David (NW Hants)||Townsend, Cyril D. (B'heath)|
|Moate, Roger||Tracey, Richard|
|Morris, M. (N'hampton, S)||Trotter, Neville|
|Moynihan, Hon C.||Twinn, Dr Ian|
|Murphy, Christopher||van Straubenzee, Sir W.|
|Needham, Richard||Viggers, Peter|
|Newton, Tony||Waddington, David|
|Nicholls, Patrick||Wakeham, Rt Hon John|
|Norris, Steven||Waldegrave, Hon William|
|Onslow, Cranley||Walden, George|
|Osborn, Sir John||Waller, Gary|
|Ottaway, Richard||Wardle, C. (Bexhill)|
|Page, John (Harrow W)||Wells, John (Maidstone)|
|Page, Richard (Herts SW)||Wheeler, John|
|Parris, Matthew||Whitfield, John|
|Peacock, Mrs Elizabeth||Wiggin, Jerry|
|Pollock, Alexander||Wilkinson, John|
|Powell, William (Corby)||Winterton, Mrs Ann|
|Powley, John||Winterton, Nicholas|
|Prentice, Rt Hon Reg||Wolfson, Mark|
|Price, Sir David||Wood, Timothy|
|Proctor, K. Harvey||Woodcock, Michael|
|Rhodes James, Robert||Young, Sir George (Acton)|
|Rhys Williams, Sir Brandon|
|Robinson, Mark (N'port W)||Tellers for the Noes:|
|Roe, Mrs Marion||Mr. Archie Hamilton and|
|Rowe, Andrew||Mr. Michael Neubert|
§ Question accordingly negatived.