§ 8.9 p.m.
§ Lord RUGBY rose to ask Her Majesty's Government whether they will initiate a policy to abolish restrictive practices in the distribution and sale of reading lenses and spectacle frames. The noble Lord said: My Lords, the object of my Unstarred Question in so far as I am concerned, and I believe others who are also taking part, is in no way aimed at reducing the status or the remuneration of professional people engaged in the enormously valuable sciences concerned with the nation's eyesight.
The person to whom, with whom and about whom my address is concerned, is loosely termed "middle-aged" and specifically the middle-aged emmetrope—that is, a person with normal eyesight and with both eyes in balance. At about the age of 50 the great majority of such middle-aged emmetropes undergo a subtle physiological change in their eyesight. That change affects, above all, their ability to
read the printed word. Because he has normal eyesight, the aging process of the eyes has demanded that the intellectual side of his life would be limited in the extreme without a reading aid. That can take the form of a magnifying lens, or two lenses in binocular form. The history of this relationship—the aging eye, the printed word, the lens—goes back 800 years as recorded by an Italian who wrote:
I can no longer read without these things called spectacles".
§ Because of this dependence on this aid to the middle-aged eyesight and the extension it provides into old age, a fruitful and creative boost was given to civilisation. In fact, the early manuscripts of the Bible were copied by elderly scholars because they had magnifying lenses and the spread of the printed word across the face of Europe was accompanied by Jewish pedlars selling reading spectacles, enabling the elderly to read those Bibles—no doubt with the exhortation, "Magnify the word of the Lord".
My Lords, my recent Question as to whether it was ethical to deprive those with normal sight (the emmetrope) of their ancient right to select and purchase magnifying lenses in whatever form and for whatever purpose without compelling them to undergo eye tests by statute—and that is by retail opticians—puts into perspective this long history of that freedom of choice. Imagine Shakespeare's Judge in the Seven Ages of Man whose spectacles played a vital part until just before his days are ended:
The lean and slippered pantaloon with spectacles on nose".
Anyone telling him that it was wrong to use those glasses without an eye test would certainly have been treated to some choice modern idioms.
§ Under present legislation no person may sell any optical appliance unless the sale is effected under the supervision of a registered practitioner (medical or optical), and anyone selling an appliance for correcting, remedying, or relieving a defect of sight may be prosecuted, and such is the anatomy of these monopoly powers. It is my submission that the section of the community which is hardest hit is precisely the middle-aged and those beyond middle-age who, as I have said, have normal eyesight and, due to reduction 954 in physical and active pursuits, have become more than ever dependent on intellectual and handicraft pursuits.
§ Having once discovered that they need a reading aid, this optical control can make them commercially vulnerable by denying them these aids unless they admit to being a patient of the National Health Service or private patients, but both categories in essence are incorrect. They are normal. They are certainly not in need of remedial treatment, and they have no defect of the eyes. Such remedial treatment is young by comparison, and heavily indebted to the work and research done by researchers no doubt using reading lenses and microscopes.
This is borne out by Dr. Elsom in the address given to the Worthington Society in 1934 on the subject which was headed The Origin and Development of Spectacles. In his opening statement he says:
When we remember that at 50 the emmetrope (the person with normal sight) can no longer read small print, nor do fine work, nor indeed near work for very long together, we realise what a marvellous boon these optical aids are to us, both for pleasure and even for our livelihoods.
In other words, if I may interpolate, if the print were larger the aging emmetrope could throw away his glasses. I quote again:
If it were not for these glasses a large part of the population would be entirely incapacitated from earning their daily bread, not to mention the sufferings of many others with faulty sight of various kinds.
So here is an acknowledged leading medical expert highlighting the two separate sides, and even illustrating his lecture with a slide showing the people buying their glasses at Woolworth's, with the comment,
No doubt the prospective purchasers had a good deal to do with their choice of lens.
Here, indeed, was private enterprise supplying instant replacement of broken or lost spectacles, and who can foretell what accidents or emergencies can occur? The loss of spectacles can be entirely incapacitating, as the doctor stated in his lecture. At our meeting recently with the Committee of Ophthalmic Opticians this was brought up, and I quote their reply:
… neither the optical industry nor the professions can so completely change the supply structure in this country as to be able to provide instant replacement of broken or lost spectacles. Depending upon the location, replacement to a known prescription will take between one to
four days. The remedy, which seems reasonable to me as a regular spectacle wearer, is to have a spare pair of spectacles; ideally, an identical prescription but, if not, the spectacles discarded when the last new prescription was obtained.
In other words, if you are so incapacitated it is due to your own negligence in not carrying a spare pair, and the ophthalmic services see no reason to cater for such emergencies.
§ The consequence of this attitude is to make people who travel abroad buy their spare pairs of glasses cheaply and quickly while they can. These spectacles I am wearing were bought in New York for about £5. Indeed, under our present restrictive implementation of the Opticians Act it is quicker, and possibly cheaper, to get a return ticket on Skytrain and buy two pairs of reading glasses off the shelf in New York.
The enabling vehicle which paved the way for the Opticians Act 1958 was the Interdepartmental Committee of Statutory Registration of Opticians. They deal under the heading "Consideration of Certain Special Problems" with the subject of bodies corporate supplying glasses to the public, a section of which I should like to quote.
We think, too, that the supply of glasses by bodies corporate may suggest to the public that considerations appropriate to commercial, rather than to professional, life may sometimes influence the service provided. On the other hand, it is only fair to say that we have received no evidence that these arrangements have led to substantial evils.
There seemed little point in saying this. Nevertheless, their problem clearly was concerned with shutting out Woolworth's, and it was confirmed in Lord Crook's letter which he sent to our Committee that this was in fact their intention.
§ The moment was indeed opportune after the shortages of the war and then 5½ million spectacles being dispensed free of charge under the National Health Service in 1951. Under such subsidised onslaught no private enterprise could survive. And what about the public conscience being offended by considerations appropriate to commercial, rather than professional, life sometimes influencing the service provided? What deductions do the public draw today? Spectacles displayed in the shop window but no price tags; a compulsory eye test before the sordid com- 956 mercial details can be discussed and the price disclosed. Does pressure take place at this time to buy an expensive frame? From all accounts it does, and indeed it would be surprising if it did not. Opticians, if they display in shop windows, are traders like everyone else; but at the same time enjoying the immunity from competition given to them by the General Optical Council. Comparisons may be odious to that body, but nevertheless in that period of pre-war to today, prices have risen by 2,000 to 3,000 per cent. for reading glasses. In those days it took 400 reading glasses to equal the price of a pair of field glasses. Today it takes two or three pairs of field glasses to equal a pair of reading glasses.
§ There are roughly 60 million people in this country. It does not take much mental arithmetic to guess that about I million people come into the age group of needing a reading aid every 12 months, to swell that vast majority already using these aids. It is indeed a captive market of staggering numbers. These people should be treated as having the power of decision in relation to their optical help by the time they are middle-aged. The 50 year old emmetrope should be a consenting emmetrope and not a victim of a powerful monopoly.
§ Encourage by all means the regular testing of eyesight without the enforceable MOT, or mandatory optical test. Patients must be seen to be voluntary patients and not coerced in any way into having eye tests; that is only normal medical ethics. Let people who trade in optical appliances be subject to competition and offer free choice and plenty of availability. My Lords, there is much disquiet among the middle-aged and more elderly in what appears to them to be an exploitation of their vital needs, which were better served under free enterprise. For the reasons I have set out, the abolishing of monopoly control on reading glasses is, in my opinion, now urgently sought.
§ 8.20 p.m.
My Lords, I must begin what will be a very brief contribution to this little debate by proudly donning my National Health Service spectacles. While I shall be brief, I must thank and congratulate the noble Lord, Lord Rugby, for drawing the attention of the House to some very 957 troublesome, costly and wholly unnecessary bureaucratic muddle which really should be swept away as soon as possible.
As a doctor, I do not think noble Lords will expect me to ask that all the kinds of protection from which the medical and Para-medical professions benefit should be swept away, but there are many matters in which they should. The noble Lord, Lord Ferrier, who was in his place until a few moments ago, has battled hard to get doctors to accept that it is not wholly improper for a chiropractor occasionally to lay his hands upon a patient. There are those who have talked about the monopoly in conveyancing enjoyed by solicitors, but this matter to which our attention has been drawn is important in that it really illustrates the way in which we should look at protection, whether it be for a profession, industry, trade union or whatever. Surely restrictive practices can be justified and allowed to continue only if they exist in the interests of the consumer, customer, client, patient or whoever it happens to be.
The noble Lord, Lord Rugby, talked, and rightly, about the special problem of the middle-aged who suffer from presbyopia, in other words they become increasingly long-sighted. When we first suffer from it, we tend to say there is really nothing wrong with our eyes, just that our arms are a bit short when we cannot get the paper far enough away. They are a group of people who have this problem and meet with this bureaucratic muddle. Like the noble Lord, I have no wish to return to the good old days, if they were good, when one could easily get a pair of glasses by wandering into Woolworth's, rummaging about in a tray and finally picking up a pair of glasses and marching out at very little cost with one's sight instantly restored; that sort of freedom is perhaps dangerous. But there are things which should be done, and soon.
My reason for rising is merely to draw attention to another matter in this field. For many years after the National Health Service was introduced on 5th July, 1948 it was necessary, before a patient could have his eyes tested, for some reason which always remained inexplicable to me as a general practitioner, for that patient to wander along to see his general 958 practitioner and get from him a little green form, known as an OSC1, which had emblazoned on it, "I have today examined you and certify that you require your eyes tested". I can certify that the nature of the examination usually consisted of asking, "Do you want your eyes tested?" The answer would be, "Yes", and then one would say, "There you are then, your green form". That wasted a great deal of the patient's and the doctor's time when doctors were having difficulty in coping with unnecessary work.
My point in referring to that is that it took 25 years to get rid of that wholly unnecessary burden on doctors and patients alike. All I can say at this late hour is that if it takes 25 years to get rid of some of the muddles about which the noble Lord, Lord Rugby, talked, I fear there are noble Lords in this House now who will not benefit greatly from this interesting little debate.
§ Lord NORTHFIELD
My Lords, while my name appears next on the list of speakers, I know that the noble Lord, Lord Orr-Ewing, has to leave. Would he care to speak before me?
§ 8.25 p.m.
§ Lord ORR-EWING
My Lords, I am most grateful to the noble Lord, Lord Northfield, and I apologise to the House because I shall have to leave before the end of the debate: I cannot leave my wife waiting for me. I promised to collect her at a certain hour and I had no idea that this debate would come on quite so late.
§ Lord ORR-EWING
Yes, my Lords, I am wearing my National Health spectacles and can see quite well. I congratulate the noble Lord, Lord Rugby, who has taken a great deal of trouble and has produced some amusing comparisons relating to the price of spectacles compared with the price of, for example, field glasses. Like other noble Lords, I got on to this matter because I read in the papers that a person who was selling glasses had been disciplined—that was the word used—by the General Optical Council because he had the impertinence to display in his window the price of a pair of spectacle frames. When we 959 saw the General Optical Council their defence was that it would be misleading to put the price on because, in addition to the cost of the frames, there was the cost of the test, the cost of the lenses and the cost of putting the lenses in the frames.
If one assumes that all the public are quarter-wits who cannot protect themselves in anything they buy, and that there is no law—which there is—about incorrect advertising, that is one thing. But a tremendous amount of consumer protection law has been built up since this set-up was arranged by Nye Bevan. If that were not so, you would need to have somebody controlling absolutely everything, and I feel we have gone far too far in looking after the interests of those who test eyes, those who manufacture spectacle frames, those who manufacture lenses and those who put them together, without well and sufficiently enough looking after the resultant price and the consumer who has to pay for them—and as the noble Lord rightly said, there might be one million people a year buying, probably more than one pair of spectacles each.
The General Optical Council seems to think we have the best of all possible worlds. The very fact that noble Lords in all parts of the House are taking part in this debate shows that that is not so. Since I raised the matter I have received a large number of letters saying, in effect, "Thank goodness somebody somewhere is raising this matter. It must be put right". I am sure they are honest people. The last letter I received came only a few days ago and said, "I have just had a pair of replacement spectacles. I admit they are bifocal and I admit they are private, but the bill has come to £106". This has got completely out of hand.
I realise that it takes a long time to put the law of this land right and that Acts of Parliament are unpopular whatever the Government in power, but I wonder whether, in the interests of protecting the consumer from this escalating price, the matter should perhaps now be submitted to the Restrictive Practices Court or the Director General of Fair Trading, who might refer it on to the Monopolies and Mergers Committee, which he is entitled to do under the Fair Trading Act.
960 I appreciate that all that takes time, but I hope that, when the Minister replies to the debate—and I apologise that I shall have to absent myself, but I shall read in the Official Report what he and other noble Lords have said—he will give some assurance (not just flannel; we do not want him to say, "We will look at it") and some recognition that the time has come, after the stark examples which have been quoted, when something must be done to make this area of consumer protection far more effective than it is now.
§ 8.28 p.m.
§ Lord NORTHFIELD
My Lords, I must, like others, declare that I am over 50 and now wear spectacles. Luckily, these spectacles were bought in America for 10 dollars. They are all plastic with plastic lenses, which I gather are expensive here, and I can only say that they would probably cost £30 to £40 in England. This is the kind of racket—frankly, that is a worthy word to use—that we are asking tonight should be remedied. I buy these in America and I now go there with orders from friends to bring back pairs of spectacles for them; people are realising that one can do this abroad, in particular States in America. It is not like rummaging amid a pile of spectacles as one could in Woolworth's years ago. There is a proper stand of spectacles showing the degree of magnification and if one is bright enough to check first in Britain on the degree of magnification one needs as one reaches old age, one can satisfy oneself by getting glasses like these quite cheaply in America. Considering that I have been meeting noble Lords in the corridors in recent weeks who have told me that their spectacles have cost them £60 or £70, no doubt I shall be taking another batch of orders with me when I next go to America in March.
This is a serious matter. The noble Lord, Lord Winstanley, said that it took 25 years to get the green form changed. Well, if he will allow me to say so, it is just 21 years since I fought this battle in the House of Commons. In 1958 there was a Private Member's Bill, the Opticians Bill. I fought that Bill as much as I could in the House of Commons because it included the two aspects we have been considering tonight. At one 961 point I moved that a count be held to ensure that there was a quorum present. I did that in an effort to kill the Bill, but it was steamrollered through by a few opticians and a docile Government. A Private Member's Bill which, in my view, has done much good, but also much harm in this particular respect, was allowed through without proper amendment. At that time I moved an amendment on the issue regarding spectacle frames, and I seconded an amendment regarding reading glasses. So I have a pedigree in this matter. That was 21 years ago, and I hope that we do not have to wait 25 years before we get this situation remedied.
It is worth looking back at those debates in 1958 in the House of Commons. I moved an amendment to allow advertisements by opticians in an effort to have price competition on spectacle frames. I said that opticians were two kinds of people. They were professional people whose job it was to provide sight correction lenses; but in our society they had a second function, which was a purely trading aspect of a normal, commercially-produced article—the spectacle frame, many of which were bought for cosmetic reasons. Speaking of the professional status which the Bill gave to opticians, I said that I wanted to prevent the use of that status as a cloak for overcharging for spectacle frames on the purely trading side of an optician's work. I fought this battle for a very long time. Anyone reading Hansard must have thought that it took days. I was doing my best to drag it out and so kill the Bill; I failed.
I made my case on the basis of figures. It is very interesting to see what the figures were in those days. I said that at that time private frames that the optician was buying—I happened to know people in the profession who gave me these figures—were costing about a pound or so above the price of National Health Service frames, and opticians were charging £3, £4, or £5 extra for them; in other words, they were having a 300, 400 or 500 per cent. mark-up on the price of the frames. Without at that time saying that it was a racket, at least I said that it surely left room for price competition to move in and so see whether the 300, 400 or 500 per cent. mark-up was a legitimate margin.
962 What was the answer of the promoters of the Bill? There were two answers. One was given by Sir Hugh Linstead, who was then a leading pharmacist in this country. He said that we should entrust all this to the Opticians' Council; they would see that ethical standards would prevent the public from being fleeced. Well, I shall come to that in a moment. The second answer came from the promoter of the Bill, Mr. Russell. His only answer to me, 21 years ago, was that he did not mind an advertisement with prices inside the shop, but please, not in the shop window. If someone did not like the price shown inside the shop, he could go elsewhere.
Of course the answer to that—and we have seen it now over the years—has been governed by the Price Commission in their report on the Dollond and Aitchison Group, and I shall read to your Lordships what they say in paragraph 6.7 when they investigated this group of spectacle makers. They said:Anyone who wishes to purchase a pair of spectacles thus has no way of comparing prices charged by different opticians short of obtaining a prescription and then entering their premises and asking a series of detailed questions. In practice very few customers do this, as they tend to buy their spectacles at the optician's where their prescription was obtained".They are a captive market once they are inside the door, and really they have no way of knowing the position regarding prices. They cannot really say that they will not buy their spectacles there but instead will go to see Mr. So-and-so next door. That would involve all the business of going into the optician's and demanding a lot of the information about prices. We know very well that that kind of competition is in fact nil competition. The customer is a captive once he is inside the optician's shop. The only possible legitimate form of competition is to allow displays in windows, so that we can all see the various frames offered by different opticians.
Let us look at what has happened in the 20 years that all this business has been going on since I lost my campaign against the Bill. We have had the Optical Council, and they have published and had sanctified by the Privy Council a statutory order which was passed through both Houses of Parliament—we are all to blame in this, I might say. It is Statutory Order No. 167 of 1964—at least I think it is 963 No. 167. It prohibits the advertising and the display of prices in shop windows. Under the powers in the Opticians Act, as it now is, they have issued rules which have been approved by Parliament.
Since then the Price Commission have investigated the results. There have been two reports—I am not going to quote them at length—one in 1976 and another in 1979 on the Dollond and Aitchison Group, which has 10 or 12 per cent. of the whole market and is the market leader in supplying these goods (as I call them) to the community. It is interesting to see what the Price Commission said about this issue. They said:We would draw a distinction between the professional service involved in sight testing and prescribing, and the commercial service involved in supplying goods to the prescription given. Concerning the latter, we consider it important that competition should be permitted to play its part in encouraging efficiency and cost saving. If this distinction is accepted, then the restrictions on price display and advertising appear in a less favourable light. Far from protecting the consumer, they may bolster high cost production methods and high retail margins in the supply of spectacles and their component parts".That echoes exactly what I had said in 1958.
Even further, let us look at the figures which the Price Commission discovered in investigating, in greater detail than I have been able to do, one major group. It is very interesting; they come out with exactly the complaint that I was making in 1958—a 300 per cent. mark-up on frames. The figures are astronomical. On page 20 the report deals with one frame with a factory gate price of £3.78. By the time it is sold to the consumer in the same group's shops the price is £21 for the frame alone—never mind the lenses. There is another example: a factory gate price of £14.90 becomes £44 when the consumer buys the frame in the shops of the vertically integrated company, Dolland and Aitchison. I do not think that this firm is any worse than any others. They just happened to be picked on for the investigations.
So the Price Commission concluded:In our view, judged by the levels of their profit margins, return on capital employed, or cash flow, the four companies [in the D and A group] are earning more than adequate profit. In these circumstances we felt that some restraint on the companies' prices and margins was justified".964 They advocated open price competition with displays in the opticians' windows.
I believe that after all these years, and now sanctified by a couple of Price Commission reports—no matter how much noble Lords opposite doubt the work of the Price Commission—we are entitled to ask what is the Government's view. When the 1976 report came out Mr. Hattersley, who was then a Minister, in the Commons regretted the unwillingness of the Optical Council to modify their rules. Do the present Government regret the council's unwillingness the second time around, after another report, and are they prepared to do something about it?
If they are prepared to do something about it, I shall suggest two ways that I think are real starters. I suppose that one way is to introduce another statutory order repealing the earlier order. Let us repeal the rules laid down by the Optical Council. Let us send them back to them and say, "Parliament is not prepared to underwrite your restrictive practice in this way, and you must put forward more liberal rules allowing some price competition". That seems to be one way of doing it.
The second way is to amend the section of the 1958 Act, which I think is Section 25, which gives the powers to the Optical Council. In the middle of subsection (2) of Section 25, which slightly limits their prohibition powers, we could introduce words which will take away the power of the Optical Council to restrict price display in the shop window instead of allowing it just inside the premises. I would say quite frankly that, if the noble Lord, Lord Cullen of Ashbourne, would give us a nod this evening, there are plenty of noble Lords who would introduce a one-clause Bill tomorrow to amend the 1958 Act in this respect, by altering the powers of Section 25 to take away their prohibition powers in this major respect. I am pretty sure that, given the outcry in the House of Commons as well, we would get that Bill through. I hope we shall not have to come to that, but I think that in the end there will be plenty of volunteers around if all else fails.
I do not want to take much longer, but I want to say two other things. What the Dollond and Aitchison Report by the Price Commission also points out, which is very relevant, is that in America— 965 and this is very interesting—which has a market very similar to that in the United Kingdom in respect of spectacle frames, the Federal Trade Commission has overruled State laws which prohibited display and price display. So there is now the situation in America where, because of the abuse, the Federal Trade Commission has in fact forced the allowing of price display in all the States of America—and its report says that it found that prices were lower in the States which were allowing advertising. That is a very good lesson for us. In Germany, of course, prices have to be shown, anyway, by law. So we would not be alone in enforcing the right of opticians to compete, if they so wished, by open price display in their windows.
I conclude with one word, which is to try to say something about what I think are the opticians' objections. When you say to them, "Why are you against all this?", they say, "It is not in the public interest". That, if I may say so, is a lot of codswallop. In other words, I think they are covering up a restrictive practice. But they then have one point in their favour. They say, "How could you do it?"—because of course, the price of the frame is not a clear indication of the price of the complete spectacles. But the answer is not difficult. In a window you could put a note on some spectacle frames saying,Frame £5 plus cost of lenses and dispensing fee".In another part of the window you could have private frames and a note saying:Price £5—suitable for National Health Service lenses";which means that you get them at a very low price. But, no matter how you look at it, so long as you face up to the issue it is possible to arrange a form of price display that gets over the difficulty that spectacles are more than frames; they include lenses and the cost of prescribing and fitting.
I am not going to go into the other issue of the marvellous spectacles which the noble Lord, Lord Rugby, and I buy regularly in America. I think he made the case absolutely on that one, and I will not interfere any more, except to say that in 1958 Mr. Norman Pannell made a speech in the House of Commons and tried then to get some liberalisation. Again, 966 it works so well in America that I think we ought now to say this. Thirty years of the National Health Service has taught people, I am sure, to go to an optician when they need to for proper testing if there is a difference in the correction which each eye requires. That is one thing behind us. We have national standards and ways of behaving in these matters now. Anybody who really needs testing will go to an optician; he knows the price will be modest. With that behind us, and with those standards now accepted, we ought to bring back the freedom of the person who loses his spectacles, as I so often do, to go out and buy a spare pair "off the peg", with a simple correction in both lenses, which he can use all the time and need not worry about losing, given that they are so very cheap.
§ 8.45 p.m.
§ Lord SMITH
My Lords, I can be very brief, for I can express my views on this matter in a very few minutes. If we are concerned with lenses for therapeutic and correctional purposes, as of course we are, then, as the noble Lord, Lord Rugby, has said, under the Opticians Act 1958 these must be prescribed by an optician or by an ophthalmic medical practitioner. Quite clearly, certain restrictive practices apply here. I believe that if we were to go so far as to abolish them this would in fact be much against the public interest. Section 1 of this Act established a General Optical Council and charged it with certain responsibilities—responsibilities for promoting high standards of professional education and conduct among opticians. It was empowered to make certain statutory rules, to which reference has already been made.
In particular, the General Optical Council laid down two rules, the first being that opticians may only test sight and prescribe corrective lenses, and any disease identified must be referred to a medical practitioner. The second one, of course, is that in regard to publicity, where it is suggested that spectacle frames may be displayed but that, in that a skilled examination and the provision of lenses will form the major part of the cost—a greater part than the frames themselves—the prices of completed spectacles should not be indicated. In other words, it should not become a public competition 967 in regard to professional skills. I think we may feel that this argument is in fact a somewhat slender argument, and that this second regulation, even if not the Act itself, is deserving of being looked at and, perhaps, altered in some way.
As a doctor, I must confess that the most important effect of the Act itself is that a citizen who observes that his eyesight is becoming less satisfactory cannot merely buy across the counter spectacles which he believes, through trial and error, will improve the situation. He will at least have his eyes examined, and this really is a good thing, because the very first indication—not just one of many signs, but the very first indication—of serious organic illness may sometimes be a failure of vision of some variety, including merely difficulty in reading the printed word. This is no trivial matter, my Lords. I refer in particular, in the eye itself, to glaucoma or detachment of the retina; in the head, of the early effects of a brain tumour; and generally, of the early onset of diabetes or arterial degeneration—and there are many other, less common things one could cite. In all of these early detection may decide the efficacy or otherwise of treatment.
So, as regards lenses for therapeutic and correctional purposes, then, if indeed some have sought to manipulate the regulations improperly for their own profit—in other words, have operated a racket; and maybe this is so—by all means let us try to seek ways of checking this, perhaps by looking at the second of these two regulations and altering that. But not, I believe, by trying to do away with the 1958 Act itself, because I believe this would have serious implications, both for the optical and for the general health of the public, and also for the continuation of high standards of education and professional conduct among optical practitioners. If your Lordships will excuse a well-worn cliché, this would be throwing out the baby with the bathwater.
§ 8.50 p.m.
§ Lord SEGAL
My Lords, I must apologise for not having put my name down on the list of speakers, but I shall be brief. My sole purpose in rising now is to raise a matter to which I had hoped other speakers might refer. I want to plead for 968 something which I have raised on more than one occasion previously in your Lordships' House. It is the provision of reading lenses which would obviate entirely the provision of spectacle frames. Under the present regulations, patients have access under the National Health Service to contact lenses for a very small fee. Admittedly, these would suit only a minority of patients requiring reading lenses; but the cost in suitable cases would be far less than the cost today of complete spectacles with frames and prepared reading lenses. Without pressing the noble Lord at this stage to give a categorical assurance that wider provision will be made under the National Health Service for contact lenses in cases where they are suitable, may I, in the course of this debate, raise this matter in the hope that the Government will encourage the manufacturers of contact lenses to have a rather wider scope than they enjoy at present in the provision of these very necessary lenses for suitable patients?
Another matter which worries me is this. Can the noble Lord give an assurance that the very restricted provision of contact lenses is not due to the opposition of those manufacturers of spectacle frames who, under the present regulations, can reap rather too rich a harvest from the provision of the old-fashioned form of spectacles?
§ 8.52 p.m.
§ Lord WELLS-PESTELL
My Lords, I will not keep your Lordships for any length of time, other than to say that we on this side feel that the public interest requires that persons should be able to get an efficient and competent service without being fleeced. Most of us are aware that there is widespread concern among people at the cost of spectacles these days. I understand that it is difficult to get spectacles, if they are outside the National Health Service range, for under about £70. I can remember that when I myself went to be re-examined and had to get fresh lenses two years ago, I was asked to pay a premium if I wanted them within a certain period. I asked why and was told, "This is what the manufacturers require". I said that I refused to pay a premium because they had no right to charge it. I got my glasses without difficulty. I feel that there are a number of things which need looking into.
969 I am a little concerned—but I am sure there is good reason for it, as the noble Lord, Lord Winstanley, has said—that people should be able to go directly to an optician (and I knew that, because I went direct myself) and that spectacles can be prescribed when perhaps they are not required. We all know that the doctors will tell us that a substantial percentage (I do not know how many) of people who complain of headaches and who go to the optician are probably prescribed spectacles when they do not need them. I am not suggesting that we return to the days when we had to go to the doctor, but I do not think it is a very good move.
The only other thing I want to say is that I think the public could be assisted if the Government could see their way to having a much better range of National Health spectacles. Those I saw were not very attractive. They have not been improved—quite apart from the fact that if one asks some opticians to show one the range, they do not know where they are. Very few opticians, I believe, have them on show in a place where one can readily see them. I do not know whether the noble Lord is in a position to say whether anything is being contemplated about improving the range. If the range could be improved, they could be made more attractive to many young people in particular. The cost is laid down, it is very clear and one would know beforehand if one chose to ask what the cost would be. I should be glad to know whether the Government are contemplating any form of inquiry by the department itself into the provision of spectacles.
§ 8.56 p.m.
§ Lord CULLEN of ASHBOURNE
My Lords, I am sure the House is grateful to the noble Lord, Lord Rugby, for introducing the debate so entertainingly, and to those who have spoken today from their knowledge and experience of the subject. The debate has ranged widely, covering not only the question of the standard of care which should govern the health and wellbeing of the nation's eyesight but also the matter of price competition and the interests of consumers in the field of optical appliances. I have no doubt that the comments of noble Lords who have spoken in this debate 970 will be of immense interest to many outside this House, not just to those with professional interests but also to many of the some 25 million people who themselves wear spectacles.
The "restrictive practices" to which the noble Lord refers are those which stem from the provisions of the Opticians Act 1958. That measure was enacted to ensure that the eye care of the nation could not be entrusted to any person whose knowledge and skills were not of a suitably high standard. Sight is one of the most precious of our senses and it is surely beyond doubt that the safeguards for patients which this Act contains are a proper indication of the value we place upon it. In particular, the testing of sight is not just an exercise to determine whether a patient needs spectacles: it provides an invaluable opportunity for any abnormality to be detected through the examination of the eyes. Such abnormalities may be an early indication of disease not just of the eyes themselves but also, as the noble Lord, Lord Smith, has explained to us, of other parts of the body. It is vital (indeed, in some cases a matter of life or death) that those in the position of being able to detect such abnormalities should be sufficiently skilled to do so and, as is proper, refer the patient for medical opinion and any necessary treatment. Surely, there is no disagreement in this House that the testing of sight is properly reserved to those whose training and standards of practice are suitably regulated in the way the Act provides.
As to the supply of spectacles, the Act is similarly designed primarily for the protection of patients by preventing the sale of spectacles to members of the public by unqualified persons. It would be a retrograde step to return to the days when spectacles could be bought over the counter without a sight-test. Although the wearing of spectacles which have been "self-selected" might not be harmful in itself, their availability could well prevent patients with incipient eye or other diseases being seen by a qualified practitioner. It has been suggested that simple magnifying glasses should be made available for adults to select themselves and purchase. However, many patients need corrections other than simple magnification but, again, their individual needs cannot be properly 971 identified until they have had their sight tested by a qualified practitioner. In addition, it is essential that the individual patient's prescription is correctly dispensed by a suitably qualified practitioner whose standards of practice are properly regulated.
It is in the matter of the prices charged for spectacles where most public concern has been expressed. I am sure that most of my noble friends can quote instances from their own experiences or from those of relatives or friends when they have been asked to pay £70, £80 or even £90 for a pair of privately supplied spectacles. This evening we have heard from my noble friend Lord Orr-Ewing of a price of £106.
Not only are these considerable sums of money in absolute terms but they appear to be particularly expensive by comparison with the cost of a pair of spectacles supplied under the National Health Service. In drawing this comparison, I must stress that it would not be valid merely to look at what the patient pays in NHS charges, since NHS optical supply is subsidised from public funds. The amount of the subsidy varies according to the type of lenses supplied. It differs widely as between straightforward, single-vision lenses, where the subsidy is about £1.50, and the strongest bifocal lenses, where the subsidy can be as high as £29 for spectacles costing about £50. The true comparison must be between the prices of privately supplied spectacles and the total costs of NHS spectacles; that is, both the lenses and the frame and the professional fee paid to the optician for dispensing them. For a pair of NHS lenses in a NHS frame, the cost can vary from about £9 to about £50. However, few patients need the most complex and expensive spectacles, so that the average cost of a pair of NHS spectacles is at the lower end of that scale and is about £14.
§ Lord NORTHFIELD
My Lords, may I interrupt? The figures given to me in a Parliamentary Answer from the noble Lord were even less. It gave the average cost of lenses at about £7.60, and the cost of frames about £2.40. That is only about £10.
§ Lord CULLEN of ASHBOURNE
My Lords, I can only say that I am giving 972 to the House the figures which have been carefully prepared. The noble Lord may have a different source.
§ Lord CULLEN of ASHBOURNE
In that case, I must have been wrong the first time. My Lords, the differential between prices for private and NHS spectacles is thus considerably wide. In recent years, we have had two Price Commission reports on this subject about which the noble Lord, Lord Northfield, gave us much information this evening. The two Price Commission reports have drawn attention to the unduly high level of prices charged for private spectacles and to the related matter of the lack of price competition in the sale of optical appliances. This lack of price competition is mainly attributed to the restriction which the General Optical Council lays down in its rules of conduct that, on pain of being struck off the professional register, opticians must not display the prices of optical appliances in the windows of their premises. Although the council do not forbid the display of prices inside opticians' premises, in practice few opticians do so. Thus members of the public are not able to "shop around" and compare the prices charged by individual opticians and are unable to judge the expense they will incur before entering the optician's premises. The General Optical Council maintain that removal of this restriction would not be in the public interest. They contend that the advertising of prices could well result in patients choosing an optician for the cheapness of his spectacles rather than for the quality of his professional service, which is of paramount importance in a primary health care profession.
This key question of competition in the optical market is a matter which the Director General of Fair Trading, under his statutory duties to keep under review monopolies and uncompetitive practices, is examining to establish whether any action under the Fair Trading Act is appropriate. He has not yet completed 973 his consideration of the question. However, there are two related aspects of this question which involve optical practice under the National Health Service. First, it has been suggested that there should be better information available to patients about what the National Health Service provides. In particular, patients should be able to see the type of frames they can have. My right honourable friend the Secretary of State for Social Services is currently considering the question of amending the NHS Terms of Service so as to require opticians to display or show the range of NHS frames to patients and fully inform them of NHS provisions. His department has already issued a new information leaflet for patients which sets out how to use the ophthalmic services and contains illustrations of NHS frames and information about what patients can expect to pay.
Secondly, it has been claimed that in pricing private spectacles, opticians are influenced by a belief that they are insufficiently rewarded for the dispensing which they undertake under the National Health Service. The principle governing the amounts paid to opticians for their National Health Service dispensing is that they should be repaid the costs which they have incurred in providing the service; they receive the cost of the lenses and frames which they purchase and supply and, in addition, are paid fees for the various types of dispensing they undertake. Dispensing fees are negotiated between the Health Departments and representatives of opticians on the basis of periodic studies of the actual costs incurred by a representative sample of optical practices.
Between these studies, fees are reviewed using agreed methods in the light of the movement in general indices of relevant costs and charges in the pattern of dispensings actually carried out by opticians. Fees are paid at a standard rate to all opticians and reflect an average level of costs, so that the belief that they are insufficient may stem from those opticians who have the highest level of costs. In addition, because the last few years have seen a substantial drop in the number of dispensings involving NHS lenses being fitted into private frames, there has been no change in the level of dispensing fees for the last three years. However, the results of studies into the costs of opticians 974 are expected to become available shortly and, in the course of negotiations, it is hoped to achieve changes in the structure of dispensing fees which will prevent this situation recurring.
I do not think I have really been asked many questions, and of the ones I have been asked I am afraid I cannot reply to the question which was asked by the noble Lord, Lord Segal, about contact lenses. I was absolutely unprepared for it, although I see a note suddenly appearing on my desk here which says that contact lenses are not generally available and are supplied only under the Hospital Eye Service of the NHS. No doubt my right honourable friend the Secretary of State will be reading this debate and will take note of what the noble Lord has said.
§ Lord SEGAL
My Lords, I hope I may be forgiven for interrupting, but if they were prescribed by hospitals on a much wider scale they would probably turn out to be much cheaper than the provision of ordinary spectacles.
§ Lord CULLEN of ASHBOURNE
My Lords, it is well known that Conservatives dislike restrictive practices and have a good record in this respect, abolishing retail price maintenance in the early 1960s and setting up the Office of Fair Trading in 1973, which was sensibly extended by Labour in 1976 to include service industries such as the optical service.
Noble Lords from all parts of the House have expressed strongly held views about the forbidding of price displays in opticians' windows so as to protect the public. They suggest that the restriction operates against, rather than for, the public interest; and I am bound to say that I share this view. In fact I came across a piece of revealing information while preparing myself for this debate. I have learned from the Registrar of the General Optical Council that the principal reason for the council's refusal to change their rules on price display is that they do not know of any method of displaying prices which will not mislead the public or leave them vulnerable to "rogue" opticians. He explained that such an optician could attract custom by displaying frames which were, say, £5 below those displayed by his rivals, and then 975 charge an extra £5 or even more for his lenses or for his professional services.
The council would be delighted if a suitable method could be devised. It seems very surprising that this problem is as yet unsolved, particularly as in all EEC countries except the United Kingdom there is no such restriction, and in the Federal Republic of Germany, as the noble Lord, Lord Northfield, mentioned, opticians are already required to display prices; and in Eire legislation requiring price display has been enacted but is not in force.
In conclusion, I should like to assure the noble Lord, Lord Rugby, that while Her Majesty's Government consider it would be against the best interests of patients to abolish the statutory restrictions on the testing of sight and the supply of optical appliances under the Opticians Act, nevertheless they are fully aware that the level of prices for private spectacles and the lack of competition in the optical market give cause for concern. They are satisfied that the current examination of competition in the optical field by the Director General of Fair Trading is the appropriate means of dealing with this matter. I am not able to forecast when this examination will be concluded, but the Director General has told me that he expects to come to a decision within the next three months as to whether the General Optical Council's restrictions are within the scope of the Restrictive Trade Practices Act, or whether to make a reference to the Monopolies and Mergers Commission.