§ 6 p.m.
§ Lord Rugby
My Lords, I beg leave to move that this Bill be now read a second time. In rising to my feet to introduce this Bill, it is difficult to know where to start. There has been so much water under this bridge since I introduced an Unstarred Question about two years ago in your Lordships' House and it seemed that from that moment the subject was anything but dormant.
I can start with the Bill itself, and Section 21 of the Opticians Act 1958 in particular, which claims absolute rights over the sale of optical appliances, without defining an optical appliance, when optical appliances have been used by mankind for centuries. The beginning is literally enshrined in the Book of Genesis when water and light combined and light was split up into the colours of the rainbow and it could be refracted so that all creatures should have that miraculous optical appliance, the eye itself, with all the visual images needed to survive and sustain life.
To enact a law which would seek to put an attachment order on these properties of light and its manifold uses—because that is the nature of this monopoly—I would submit is of such legal complexity as to be 687 impossible to draft. It would be like King Canute making an attachment order on sea-water.
Moving quickly therefore from Genesis to the 12th century, when the Bible was being laboriously copied in longhand by monks who had reached middle age or (in optical terms) what is known as presbyopic age, and this being done with the aid of an optical appliance (a magnifying lens, no less), an enterprising Italian inventor suspended two such similar lenses from the ears, and thereby speeded the process up by releasing both hands to turn the page, to read and to write and to do other work. The beauty of it all was that the wearer needed only to turn the head to accommodate the visual images required. This man, had he but known it, could have said with complete justification, one small step for man, one gigantic leap forward for literature and for the whole civilisation.
So, my Lords, since those days 800 years ago when man came to harness these properties of light by means of calibrated and polished glass lenses, he has immeasurably advanced his fulfilment of life and the boundaries of his knowledge, and the great part of this has been accomplished by convex reading lenses. Such lenses are invaluable to the middle aged or presbyopes, who today seeking the same visual accommodation and freedom of choice enjoyed by their forefathers are officiously prevented from so doing under Section 21 of the Act.
The choice of reading spectacles is 100 per cent. safe and there are absolutely no risks whatsoever. Those are the words of a leading professor of optometry to his students in a third world country.
Perhaps it is of interest that one of our greatest export markets is supplying these very reading glasses to the third world. Why should we not give a lead in this country and give the same freedom to our own citizens?
In this connection, may I remind your Lordships of that great optical revolution which took place between the two great wars. It was when a multiple store by the name of Woolworth's recognised the needs of the presbyope—that of simple spectacle magnifiers which are geared to the printed word—and, with the technology of mass production, set about providing it. And, not only that, a whole variety of literature as part of the package. The effect upon the working classes was dramatic.
As a boy I was spellbound at the simplicity of the transaction. One merely had to place oneself at a convenient distance from the test card and if one did not already know from a previous purchase the precise glasses needed, then one placed a pair of glasses on the bridge of the nose and then, using those as a bench mark, by selection increased or decreased the strength according to comfort, selecting from a tray the glasses on display. That assessment of comfort could not be better decided than by the customer—no need for a third party. The transaction was quick, always available—6d for the glasses; 6d for the book—and from then onwards replacements could be put on the shopping list.
Here we had the artisan class—and, indeed, classes right across the board—providing for this functional optical requirement in the most elegant way ever devised. Quick, cheap, plentiful—for work or for 688 leisure. That, my Lords, was Socialism, in my humble opinion, at its best and I salute those two great contributors to the welfare of all mankind, the inventor of magnifying reading spectacles eight centuries ago and Woolworth's, which put them into mass production.
I come now to the period immediately after the war. That painful transition from a wartime economy to peacetime. That hard world of commercial reality in tandem with the ideals of welfare for all. It seemed to those like myself, endeavouring to struggle back to a new start in life, that much of the legislation of that time was based on dreams and aspirations. If it looked good, seemed good, then by golly it had to be good! The groundnut scheme—who could forget that?—was so full of hope but so hopeless in reality. In a flash that decade, the hungry 'forties, had made way for the profligate 'fifties, and pre-war memories of freedom from regimentation were buried in the rubble of war. This period was indeed the cradle of the Opticians Act.
It is with singular clarity I recall the passing of the Act. It came over as an announcement on the BBC radio news:Woolworth's are no longer to be allowed to sell reading glasses".Many people I believe registered a sense of outrage and horror at this freedom so easily removed—now so hard to regain. A freedom of centuries had gone by the board and that moment is frozen in time in my mind as a barbaric act.
There is no gainsaying that this was just part of an attachment order on all the historical inventions which harnessed the properties of light for the benefit of mankind and all their retail outlets. It was an attachment order which would rig the prices for all new inventions such as contact lenses—£170 in this country; £15 in America. Witness the appalling recent case of Mr. Le Scrooge convicted by his fellows for undercutting them. What chances are there for new inventions while this cartel is in operation?
A commercial franchise of this totality indentures the eyesight of the entire populace to this exclusive province of opticians. It excludes all competition. It claims exclusive promotional rights on all optical inventions, within their definition, but without legal definition in common law, for the past, the present and the future and at no time offering so much as a brass farthing for this commercial acquisition worth £700 to £1 billion a year. That is Section 21 in a nutshell. These glasses—our ancient lights—these windows by which we have obtained our enlightenment and our knowledge over the centuries, come to us now by courtesy of another god: a general optical dictatorship. It is all spelled out in these 30-odd words of Section 21 of the Opticians Act.
The interpretation of Section 21 does not, of course, reside within the common law of this land as we know it. It resides outside in the hands of a Quango which is sub-contracted by the Department of Health and Social Security to administer the Act and perhaps might therefore be called Quangeroo law. Demonstration of their powers have already been amply used to quell any threat to their inflexible control over the optical market; and where definitions are called for, their word is accepted as infallible. How are we, the ordinary people, to know the parameters, the definition of an optical appliance? Surely in a free society 689 we have a right to know these legal definitions. It is possible that without defining the areas of optical appliances, the commercial possibilities likewise have no restraints within this Act. If there is any possibility that these considerable powers are being commercially exploited by the use of subtle suggestion, by calculated deprivation, by tactics of delay or price cartels, then the public, who because of their National Health contributions, are paid up owners of this branch of the Health Service, are entitled to overriding safeguards against abuse and exploitation. Under the aegis of the General Optical Council. I regret to say that this has not been seen to be done.
The most common argument put forward by opticians to justify their control of the spectacle market is based on their ability to detect the onset of glaucoma, which affects rather less than one in a thousand. Their claims are not supported by medical opinion. The British Medical Journal in its leader of 13th December 1980 states:screening for glaucoma should be done in its own right by those who are qualified and not tied vicariously to the selling of spectacles".And the regional eye centre at Oldchurch Hospital, Romford, makes the following declaration as a result of a recent survey. I would like to read from their letter—and I quote:An eye-test leading to the supply of glasses may fail to detect disease and yet the person have the impression that his eyes have been passed. Now although opticians have some training in spotting disease, and many troubles are indeed spotted by them, this is not their primary role, whereas it is the primary role of ophthalmic medical practitioners"—in other words, those who have done a complete medical training. It continues:What is just as bad as missing some possibly treatable condition is the worry caused by falsely diagnosing trouble. There is so much widespread testing for glaucoma being carried out at present that I decided to count those referred to my hospital clinics from results of one particular test. Out of 27 in three months from this test, there were 5 who actually had glaucoma, 20 who had no disease and 2 who need further observation. Besides this there were 5 cases of glaucoma missed by opticians who had referred them because of some other trouble. The test not uncommonly upsets the patient—no wonder that the pressure may shoot up. Also, the patient is subjected to fear and worry over the false positive results. There are other more reliable tests but no test is without some risk and any test with such poor results isn't worth doing. An ophthalmologist can recognise glaucoma without these tests, but of course fancy apparatus keeps up the cost of spectacles and impresses some people. These pressure tests are not required as part of an N.H.S. sight-test and should really be done only with good reason or preferably left to the clinic where they would, in any case, be referred".My Lords, in the face of such evidence, can these restrictive practices on our rights be continued in perpetuity and when a full medical training involving so much other overall knowledge of the body is needed to make up a case history of glaucoma? Great concern is expressed in a letter, passed on to me, by the Socialist Health Association that if this Bill goes through, total eye care would be neglected. An ophthalmologist, asked to explain what that may mean, states that it is as meaningless as "total toe care".
Speaking as I do from the Cross Benches, it is without any particular bias. Like most people, I have paid my National Health Service subscription and therefore 690 ask: Are we getting what we have paid for My correspondence comes from every kind of background, including consumer groups, community centres, associations of the visually handicapped and a large number of doctors, all of whom are greatly dissatisfied. The answer is clearly, No.
The General Optical Council, by allowing such entrepreneurs as Slater Walker to get a hold on the market, and then for the tobacco multinationals to be involved with mergers and takeovers worth millions of pounds in a series of business deals to bring the high street opticians under their control, is really only the logical outcome of absolute marketing protection in absolutely the wrong hands. The business world of optical dispensers has been laughing all the way to the bank for too long and it does not give a tinker's cuss, except of course for the cash flow.
Many of your Lordships will have been lobbied by opticians asking that Section 21 should be retained by them. Who can blame them? But no other country in the world has seen fit to emulate this restriction on our own collective decision over our own eyesight and indeed over our health service. More and more people find they are better off abroad while on holiday or on business. In other countries there is no "sus" law which empowers opticians to brand people as patients simply because they require some simple reading glasses of their own choosing or to have a tailor-made, on-the-spot prescription for short sight or astigmatism. They are treated as customers and, in turn, customers can shop around for the best bargains. Advertising is permitted and fully qualified eye doctors are available for such things as contact lenses which as I said, are priced as low as £15 in America at the lower end of the market. These reading glasses are about £4.50 on the old Woolworth's principle of "choose your own because you know best but go and have your eyes tested if you can't get suited". Any eye test becomes an ignominious proceeding when thrust upon an unwilling client who has to ensure the twilight of semi-literacy before so-called prescriptions wait upon the pleasure of the dispensing optician.
I believe Section 21 has run its course and has been invalidated on a number of abuses. At the outset Parliament was given guarantees that there would be a progressive separation between the two functions of eye-testing and dispensing. Not only has it not happened but the reverse is now the universal practice. When these functions are combined under one roof, enjoying a seal of approval under the National Health Service and receiving our tax deductions in the form of subsidies, then indeed we all are gravely disadvantaged.
If those who test eyesight do not have the medical training so necessary to interpret symptoms which are interrelated with other deeper causes, then should they not just stick within the confines of eyesight testing for prescription lenses, within their own training and without the medical overtones which they do not possess? We demand that the NHS subsidy for which we have paid should not be seen to be going to companies acting within a cartel, index-linking their prices of spectacles and using the safety clause of Section 21 of the Optician's Act to protect that cartel. If, as I believe, this section should be removed from its present 691 context of the Opticians Act, then the way is open to a re-examination and a new deal so badly needed after nearly a quarter of a century. My Lords, I beg to move.
§ Moved, That the Bill be now read a second time.—(Lord Rugby.)
§ 6.17 p.m.
My Lords, although I do not agree with the purposes of the Bill introduced by the noble Lord, Lord Rugby, I think we can all agree that he has given us a lively and imaginative speech in introducing it. I must say, however, that I felt he let his imagination run a little wild when he suggested that Messrs. Woolworth were one of the harbingers of the socialist cause. I think that was a little exaggerated. Nevertheless, I am sure the noble Lord has done a service to the House in giving us this Second Reading opportunity to discuss many of the questions he has raised, and which I am sure others will raise, concerning the supply of spectacles. The subject has been several times raised in your Lordships' House at Question-time, but I think we all felt that those occasions were inadequate for dealing with the subject, and it is for that reason that this much fuller opportunity is to be welcomed by all of us.
I am bound to say to the noble Lord, however, that if he expects to amend the present law in just the way that his Bill proposes, in my view he is both optimistic and ill-advised. First, in a spirit of friendliness, may I explain why I very much welcome the debate, because it is clear both from the noble Lord's speech and from other exchanges that have taken place in this House, that there are many questions that can appropriately be asked about eyesight testing and the sale of spectacles.
Your Lordships will recall that several of the important questions were raised three years ago in the report by the Price Commission in 1979 which looked at the affairs of Messrs. Dollond and Aitchison and their group. I should like to mention just two or three of the issues which were raised in that report.
First, there was the whole question of prices and profitability; and that question will, I am sure, be raised again this evening as it is still a very live issue. For my part, I have little doubt that many customers in opticians' shops pay unnecessarily high prices when they are faced with expert salesmanship and—and this is most important—when they are not fully appraised of what alternatives are available, compared with what is being offered to them. I am sure that that is one important question that we need to consider.
Secondly, there is the question whether the rules of the General Optical Council are too restrictive, particularly their prohibition of advertising, and whether their rules work out in such a way that competition is unnecessarily and undesirably restricted. That, too, was a question raised in the Price Commission's report.
Thirdly—and this point was referred to by the noble Lord, Lord Rugby—is there sufficient distinction between, on the one hand, eye-testing and prescription, for which it seems to me, at any rate, as a layman, professional expertise is very necessary, and, on the other hand, the retailing of frames and lenses for which 692 less professional knowledge is needed, and for which, as I have suggested, in the interests of consumers more competition is desirable?
Then there is a fourth question, which was not, I think, raised in the report to which I have referred, but which is raised by the opticians; that is, whether the fees paid by the National Health Service to opticians are adequate. If they are not adequate, does this not tempt opticians to charge higher prices for frames and lenses, in order to get some compensation for their overheads in relation to the work which they do for the Health Service? I am not knowledgeable enough to know the justice one way or the other, but I believe it is an important question and, if there is something wrong in that respect, then it should be put right. All these questions are highly important and, as I said at the outset, although I oppose the Bill of the noble Lord, Lord Rugby, I can sincerely say that he has given us a very good opportunity, by bringing in his Bill, to air these various questions and others.
Why do I say that the noble Lord, if he thinks that he is going to alter the statute book in this way, is optimistic? I have been in your Lordships' House for a brief period and I was in the other House for a long period. I have witnessed many attempts by private Members in both Houses to alter the statute book and there are many hazards, as I am sure the noble Lord, Lord Rugby, is well aware. But there is one thing of which I am quite sure; that is, that any private Member, seeking to see his Private Member's Bill right through to the very end, needs to have, at least, that benevolent neutrality of the Government in office. It may be that he will get that this evening and we shall listen with considerable interest to the Minister who is to speak.
But I noticed in December last that Mrs. Sally Oppenheim, who has recently resigned but was then Minister for Consumer Affairs, announced that she was asking the Director General of the Office of Fair Trading to examine the Opticians Act 1958, particularly Section 21, to which the noble Lord's Bill refers, and Section 25, and to examine those two sections with particular reference to the question of competitiveness within the service. And, of course, many of the issues to which I have referred directly impinge on this question of competition. The Minister has not yet spoken, but it seems to me that he cannot very well have an attitude of even benevolent neutrality to a Bill of this kind when the Government have asked an organisation to inquire into the very issues raised by this Bill. That is why I think that the noble Lord is optimistic.
Why do I say that he is ill-advised? This is because I do not take so lightheartedly as he does the operation of going into a shop, taking spectacles off the peg, putting them on your eyes and walking out happily. I accept the statement that has been made in this House and elsewhere, that wearing the wrong lenses does not do harm to the eyes. That I am perfectly prepared to accept from those who are expert enough to know one way or the other.
But surely what is needed is not that negative approach of saying that no harm will arise. Surely, the objective should be to ensure that people get the spectacles that they need and that are most appropriate, 693 and I suggest that that can be done only if there has been a proper sight testing. Moreover, it is not just necessary that the customer should get the right lenses. It is necessary that he or she should get the right lens for each of two eyes. In my case, one eye is distinctly weaker than the other, so it is necessary to have two different lenses, and I am not at all confident that the simple process of taking spectacles off the peg can take care of that situation.
Then there is the point, so strongly made by the professional associations, that the qualified optician when conducting sight-testing can, and does, in the process spot incipient disease in the eye. It is claimed by the Worshipful Company of Spectacle Makers that since the passing of the 1958 Act, including this questioned Section 21, many thousands of people who consulted their opticians have been referred for early medical attention following routine eye examinations. That is a statement from a highly respected institution and I suggest that it is a statement which we cannot lightly pass over. That is why I say that it is ill-advised, as the Bill of the noble Lord, Lord Rugby, would do, to enable people to by-pass qualified opticians when seeking to purchase spectacles.
The question of the retail sale of spectacle frames and lenses is a different matter, and I accept—I am not in a position this evening to suggest the method—that there may be much that is open to question in the present method of retail operations. It may be that there is a lot to be done in relation to the present situation, in order that consumers can have much more information about how they may get value for money in these matters and to ensure that there is not a cartel operating against the consumers' interest. That I fully accept. I hope that by one means or another we shall reach a more satisfactory situation. However, I believe that the proposal contained in the noble Lord's Bill is not the path that we should follow in seeking that objective.
The whole question of competition in the retail trade for spectacles is the very subject of the review to which I have referred, which the Minister asked the Director General of Fair Trading to undertake. Surely we must await the results of that review before we take the step of giving a Second Reading to the Bill. If your Lordships will allow me, perhaps I may read out the terms of reference which Mrs. Oppenheim gave in asking for the review to take place:To assess the effects upon competition of the statutory monopoly to sell optical appliances conferred by Section 21 of the Opticians Act 1958 on registered medical practitioners and registered opticians and, secondly, the rules of the General Optical Council made under Section 25 thereof in so far as they relate to or affect the sale of such appliances".Surely the sensible way to proceed is to ask the appropriate people to make the appropriate inquiry. What is wrong, before that report has been received, before the examination has been made public, is to initiate legislation in this Chamber on the very subject which is to be under inquiry. For this reason alone, I think your Lordships would be well advised not to give a Second Reading to the Bill.
§ 6.32 p.m.
My Lords, we all owe a debt of gratitude to the noble Lord, Lord Rugby, for starting a debate and introducing an amendment to the 1958 694 Act which I, among many others, think has been on the statute book for too long and has resulted in a total distortion of the spectacle trade in this country—and in this country only, because no other country has followed our example in this field. I apologise to the House for the fact that at about 8 o'clock I have a commitment and must slip away. If, however, the noble Lord, Lord Rugby, does not get the assurances from the Government Front Bench for which he is pressing and he decides to divide the House I shall come chasing back here to support him in the Lobbies. May I also congratulate the noble Lord, Lord Oram, upon his carefully thought out speech which contained a lot of very good sense. It is very worth while having speeches like that on the record so that people in other places realise that this House draws attention to matters which ought to be put right and that it is fair and balanced in its comments.
I started to take an interest in this subject in the 1970s, although Donald Chapman, as he then was (now Lord Northfield) who sadly cannot be with us today and who has sent his apologies, was active in this field before I took it up. The more I looked at it the more disturbed I became at what the Daily Mail today calls "The Great Glasses Rip-off". For 7 million pairs of spectacles are sold to the public in this country every year. The average price now—I will support this assertion later—is between £40 and £50. You can go and buy bifocal spectacles in the private sector for well over £100. At the other end of the scale you can buy them for as cheaply as just under £10. However, the average must be of the order of £40 and £50. So 7 million times £50—to help those who are not numerate—comes to £350 million which is spent in one year by the public on spectacles. Admittedly, that is not 7 million people because most people have to have a spare pair, but 4 million to 5 million people certainly are customers each year.
Since this campaign started in both Houses and in all parties—because everybody believes that someting has to be done, even the noble Lord, Lord Oram, who has just sat down—one has had to look at the tremendous volume of representations received from the trade and from other interested parties. The noble Lord, Lord Oram, quoted a spectacle-makers' organisation; one must point out that they have a very considerable vested interest in retaining the present regime and the present way of marketing as it is, and untouched. It is my reckoning that £250 million of unnecessary profit is now going into various people's pockets—I hope taxed—as a result of the present set-up. When people say that everybody is very expert and that they are not very well paid, I should like to say that in the Ophthalmic Optician I came across some advertisements for sight testing. They are interesting. One of them says:Merseyside. Locum wanted. Sight testing only. Easy hours—£60 per day, cash".It cannot be an organisation which is very stretched for cash which can advertise in that way. Another advertisement says:Merseyside locum. Sight testing only; £70 per day".That advertisement does not mention cash. So a lot of people are making a lot of money and we ought to do better for the sake of the public who have to buy spectacles.
695 We had a debate in this House on 30th January 1980 which the noble Lord, Lord Rugby, initiated and in which I joined. At the end of the debate the noble Lord, Lord Cullen of Ashbourne, said, at col. 975, that the Government: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 the matter".That was two years ago. I was under the impression—and I think every Peer in this House was under the impression—that this matter was being properly investigated, but later it turned out that that investigation, by Mr. Gordon Borrie, was confined to the display of prices in the windows. Since then he has carried out an examination and found that roughly 50 per cent. of the people display prices. I did a little operational survey this morning. I went into Dollond and Aitchison, opticians who have something like 25 per cent. of the market—they themselves are very close to a monopoly—took off these spectacles which I am wearing and said that I was going away (which indeed I am) and wanted to take a spare pair with me. These spectacles cost me £5 in Hong Kong—to my prescription, which is a simple, balanced one. Both eyes need +2.75. My previous pair, which I had sat on while ski-ing, cost me, in dollars, £4 in the United States.
So I do find other ways of getting the spectacles which I need. I went into this small shop near Victoria to discover how much an equivalent pair would cost. I was shown in very small print on the frame a price of £34. I asked about the lenses and I was told that they would cost me £13.25, making a total of £47.25 against the £04 or £5 which I had paid abroad. I said, "Perhaps I could have National Health spectacles instead". They said, "Yes, you can, but you must undergo a sight test". I said, "I don't want to undergo a sight test; I know what my eyes are". "No", they said, "We cannot give you National Health Service spectacles unless you undergo a sight test". So I said, "Why should I saddle the poor taxpayers of this country with the cost of testing my eyes, which they will be paying for, when I do not need it?" They answered, "Sorry, those are the rules". We have a madhouse in this country if you have to undergo a sight test before you can get National Health Service spectacles, even though you are carrying a prescription with you, know what you want and can help to spread the costs and perhaps have less of a subsidy towards the National Health Service. We have not got things right.
Since the passing of the 1958 Bill, the General Optical Council has been helping—I cannot say that they have done it by mistake—a racket, and a very considerably lucrative one. In introducing this debate the noble Lord, Lord Rugby, mentioned glaucoma. This comes up every time. I could quote very similar figures to the ones which the noble Lord, Lord Rugby, quoted but I do not want to bore the House, as there are many speakers in the debate. The fact is that people like Professor Trevor Roper, senior consultant at Moor-fields, a Hospital of outstanding ability and prestige, reckons that about one person in 1,000 of the population 696 may have glaucoma. Other expert articles I have read say that in the 55–70 age group, the number of people who have glaucoma was two or three in a thousand. But many of these are not diagnosed and sometimes there are bad diagnoses. Sometimes, glaucoma is missed by ordinary sight testing. What makes us believe that it is essential to have an arrangement whereby the testing of sight is wrapped up in the selling of the spectacles? This is what leads to the high prices and the up-market selling, so that modest people who are a little frightened of losing their eyesight are persuaded to purchase more and more expensive frames; they are told that they look so much better and all their friends will be pleased to see them beautifully turned out in a pair of spectacles that cost £50 or £60, when they could buy something exactly the same for the wellbeing of their eyes for much less than that.
The noble Lord who is to wind up may tell us that an investigation is under way; I hope that he will not use exactly the same words which he used on 30th January 1980. Two Royal Commissions have already looked into this matter and both of them found that prices were unnecessarily high We have had one report from the Office of Fair Trading, which, for some reason which I do not quite understand, specialised in just the display of prices which had been previously banned by the General Optical Council. Now we have had it resubmitted by Sally Oppenheim, and this must have been one of the last tasks she undertook before sadly resigning for private reasons; in mid-December, we were told that it was resubmitted to Mr. Gordon Borrie of the Office of Fair Trading.
I hope that we can get one message across to the Government. It may be unnecessary to go ahead with this Bill, but I will leave it to my noble friend Lord Rugby to judge that. But we should certainly give the Bill a Second Reading unless the Government come forward and say we are going to tackle this matter with some enthusiasm and zest. People are being ripped off, prices are unnecessarily high, and the Office of Fair Trading—although I know that it has a lot on its plate—should within six months come up with a report and a recommendation. If that happens, I hope that the Government will enact their own legislation in the form they think best and make clear that we wish to preserve the rights of people to buy National Health Service spectacles. That is one quite separate issue and I hope to goodness we can have a better choice of frames and spectacles in that area as well. Also, we believe that, in other areas, there is a part to be played by the private system. When improved competition is restored to this country, as it has to every other civilised country, we shall get very much better value for money, and the 5 million people who buy spectacles every year will owe a debt of gratitude not only to my noble friend Lord Rugby but also to this Government as well.
§ 6.44 p.m.
My Lords, I always choose my words with care when I speak to your Lordships' House. But on a matter in which I must inevitably speak in part as a doctor with nearly 40 years of active medical practice behind me (and, I venture to hope, a few more years of active medical practice before me) perhaps I ought to choose my words with even greater 697 care. As the noble Lord, Lord Oram, has already suggested, we are here discussing two separate but related issues. First, we are discussing the very important issue of the need for regular and proper ophthalmic examinations for all people in general, and for those people and age groups who are known to be at special risk in particular. That is one matter we are talking about and it is a need which I would at the outset underline. Secondly, we are discussing the very important matter of the operation of undesirable restrictive practices by a professional group holding a monopoly—practices which are being operated to the detriment and cost of the consumer. Those matters are to an extent separate, but to an extent they are also related.
On previous occasions when this matter has been discussed, it may have been noticed by noble Lords that I have ventured, even as a doctor, to give some kind of qualified support to the noble Lord, Lord Rugby, in the efforts which he has been making. I will acknowledge at the outset that as a doctor I thought very carefully afterwards and wondered whether I was entirely right to take that stand. I am bound to say that since those times the hysterical nature of the screams of anguish and rage I have been receiving in every post from opticians have swept away any doubts I may have had. They were equalled only by the similar screams of anguish and rage I received when, in another place some years ago, I endeavoured to do something about the restrictive practices operated by solicitors in relation to conveyancing. Those reactions convinced me that I was right then as well. I am bound to say that any doubts I had have been swept away, and I believe that this matter is one which has to be looked at with very great care.
Let me make utterly clear that I acknowledge at the outset that many opticians perform a most excellent service in the screening process whereby, when they are carrying out optical tests, refraction and optometry, they discover various other matters which need further attention. I have no doubt about that service; there are opticians with whom I have maintained a very close personal and professional relationship over many years, and I have had cause to value their professional relationship over many years, and I have had cause to value their professional advice on many matters and to heed that advice. But it is a fact that this alleged safety net of screening by opticians is not necessarily as sound as it is sometimes alleged to be.
Since this matter was first raised I have sought the advice of many senior consultants in ophthalmology. I have even received some advice which I have not actually sought, but I have received only one approach from a senior consultant suggesting that the situation as it now is should remain; that was from a consultant up in the North-East, in Newcastle. Otherwise, without exception, each and every one to whom I have spoken said that they believe there is room for change. One professor of ophthalmology told me his opinion is that in the case of some opticians—I say "some" advisedly—they miss more cases of glaucoma than they actually discover. It is also his considered opinion that they find cases of glaucoma which do not actually exist and they therefore create a certain amount of panic, apprehension and anxiety as a result of that. That should not take away from the effective screening undertaken 698 by certain others, but the fact remains that if we believe that the very act of an eye examination by an optician is necessarily a foolproof method of screening for glaucoma and certain other matters, we are making a mistake.
Still wearing my medical hat, I come to the question of people wearing the wrong glasses. I have said over and over again, and say again now (even though I know that other doctors who may be speaking in this debate take a different view, I have never had my view contradicted): that it does nobody any harm to be wearing the wrong glasses. It is perfectly possible that they may not be able to see and may get run over and suffer all kinds of secondary and consequential harm, but I am bound to say professionally, as a doctor, that the popularly alleged condition of eye strain is a delusion. There is no such thing as eye strain. I do not believe that it does anyone any harm to wear the wrong glasses. I do not think it is a very useful thing to do, nor is it to be widely encouraged; but we must recognise and take note of the fact that many people do wear the wrong glasses—not because they go and rumage about in the old bin at Woolworths and choose a pair, but because glasses are handed around the family with extraordinary freedom.
As a general practitioner, I have been into home after home in which the glasses are handed down from the grandpa to the father, to the mother and so on. So in the end there is an assortment of glasses from which various members of the family make a choice. I am not suggesting it is a desirable practice, but I am saying it does not do any very great harm. I think it is important that people should have the right glasses; I think it is important that people should have the proper regular ophthalmic examinations which are necessary to detect certain forms of ophthalmic disease, and occasionally certain other kinds of disease, high blood pressure and other matters which can reveal themselves in an examination of the retina and so on. So I think that is important.
But with regard to these other matters, I do not need to go over the operation of restrictive practices which have been so well illustrated by other noble Lords. But I do say that I think it would be helpful if we could perhaps return to the old days, when one could go and have one's eyes properly tested and get a prescription, and then go away with the prescription and shop around and find from which optician or which practitioner we get the best deal in terms of price and everything else, and get our own spectacles that way.
§ Baroness Jeger
My Lords, if the noble Lord will allow me, is he not aware that one can do exactly that now?
My Lords, I am aware that one cannot do exactly that. The noble Baroness can go over and over again to opticians who will not issue a prescription for her to take to others.
The noble Baroness may have done it; I have done it. The noble Baroness has been around for a fairly long time, and it was easy to do it at one time, but it is not so easy to do it now. I wish, 699 too, perhaps that we could move to a situation in which more of those people and those special groups who are at special risk were referred not just to the optician—though there are opticians whose work is of a very high standard—but to ophthalmic medical practitioners, of whom we now have rather fewer than we did working under contracts with the family practitioner committees; that more and more of those people at special risk could be referred direct to the ophthalmic departments in hospitals in which they are examined for refraction, not necessarily by the consultant hut by a registrar or by somebody trained, and then I think we would sometimes find that the actual screening process about which noble Lords are rightly concerned is carried out a little better.
I merely say this. I do not know what Lord Rugby's intention is at the end of the day, but I do hope that before the end of the day, whenever that will be, we will hear something from the Government to make it clear that some steps are being taken. I am bound to say that I would not regard it as wholly satisfactory if Section 21 was just swept away and a total vacuum left and nothing else at all done. But unless the Government can give a clear indication of the fact that they intend to take certain steps to deal with the matters about which noble Lords are so concerned, I think it might be wise for noble Lords to express their views, perhaps by supporting the noble Lord, Lord Rugby. But it would not be necessary for us to do that if we received an assurance that something will happen as a result of this debate.
I repeat, my Lords, that we are looking at two separate but related matters. The fact that the screening process is important and should be carried out more effectively does not mean that we should necessarily acquiesce in the continuation of the operation of restrictive trade practices which are acting to the detriment of the consumer. I hope we shall hear news of some kind of action not very far off on the horizon.
§ 6.56 p.m.
§ Lord Richardson
My Lords, I crave your Lordships' indulgence to allow me to leave the House before the end of the debate, and I offer my apologies to the noble Lord the Minister and to my noble friend Lord Rugby. I have an engagement of many months standing that I feel I cannot possibly break.
When Lord Oram sat down I felt that I would do myself the relieving process of striking my name off the list of speakers and relieve your Lordships' House of a speaker. But then I thought of the delightful way in which Lord Rugby had introduced this Bill with his historical references and his imagery. Delightful thought it was, there was in it a certain amount that I felt was unfair to the profession of ophthalmic opticians and dispensing opticians, and in particular to the General Optical Council. Like all those statutory councils controlling professional matters—the General Medical Council (I declare an interest as I was its president for seven years) the General Dental Council—the General Optical Council were set up with one purpose only and that was protection of the public.
The General Optical Council has nothing whatsoever to do with the commercial aspect of the preservation 700 of the sight of this country. It has everything to do with the standards that can lead to the preservation and the proper preservation of that sight. It is composed of half and half doctors and opticians or those that represent their interests; doctors and members appointed by the Privy Council, one half, opticians, opthalmic opticians and examining bodies for opticians and ophthalmic opticians the other half. The Privy Council appointees are drawn, as are those for the other two statutory councils I have mentioned, from Members of the other House, from lawyers, from laymen of all kinds and all sorts of expertise. I cannot believe for one moment that this body is influenced by commercial interests. It will be solely concerned with the efficient and proper regulation of the profession; and I repeat the profession, because we are talking about professions, although they have got a strong commercial attachment. The ophthalmic opticians undergo a long university training. They are put through basic science at a high level, and to write them off as pseudo and ill-educated in their own particular sphere is less than fair, and I am sure is not what the noble Lord, Lord Rugby, would really wish to imply.
We have heard of the opinions of various people, screams of hysteria from various directions, as mentioned by the noble Lord, Lord Winstanley. I wish to refer to the opinion of the president of the Faculty of Ophthalmology of the Royal College of Surgeons, an ophthalmologist, a surgeon, a doctor, the head of that most august body. His opinion cannot possibly be regarded as biased. It cannot matter to him about the profits or the lack of profits that are enjoyed by opticians. What he is concerned about is the effect of withdrawing Section 21 of the Opticians Act 1958, I stumble over that date, not in a Freudian sense, but because I have so often said 1858, the date when the General Medical Council was created exactly 100 years before.
I wish to make the point that the ophthalmic opticians who examine the patients are largely dependent for their living on their other function—namely, that of fitting and of supplying spectacles. Your Lordships may find that that needs inquiry and, indeed, I am sure that all would welcome Mrs. Sally Oppenheim's last act as a Minister in this respect. But it does mean that if the patient has the benefit of a proper examination and properly fitted spectacles he can at least see. The noble Lord, Lord Winstanley, pointed out most amusingly the family habit of handing round spectacles and I can endorse that. He also said that sometimes people could not see. If you cannot see, you are rather dangerous when you are driving. If you cannot see you are at a social disadvantage because you may cut your best friend or your best enemy, and cause considerable disturbance by so doing. The importance of seeing really well and of being comfortable and of obtaining the best help with your vision that you can, affects your life very considerably indeed. In fact, it affects your intellectual appreciation and your enjoyment of visual matters.
I cannot help feeling that to go back to a state of affairs where there was an open market, and a free market where no one really knew who was most capable of doing a professional job and who was virtually untrained or self-trained, is most undesirable. 701 That is the viewpoint that I mentioned a moment or so ago of the President of the Faculty of Ophthalmology of the Royal College of Surgeons. He feels, and he has stated so in the medical press, in a letter to the Minister in another place and in The Times recently, that the passage of this Bill, as it now stands, would be very greatly to the detriment of the public good. He does not claim that all is perfect in this profession, any more than he would claim that it is perfect in his and mine. But he is perfectly clear and he does represent this most august body of ophthalmologists. The General Optical Council is of the same view. I have tried to persuade your Lordships that their opinion cannot have any colouration from commercial bias. So we have two bodies—one of which is there solely to protect the public, and the other is solely concerned with the standards of optical care in this country— who feel that the passage of this Bill would be a very serious blow to the public interests.
§ 7.4 p.m.
§ Lord Allen of Fallowfield
My Lords, in taking part in this debate, I should first like to express my interest in it on two fronts. The first is that up to mid-1979, and for many years before that, I was privileged to have an organisational representational view of those people who are working in the prescription and service industry of this particular profession. And in the knowledge that I know something about the tremendous skill, workmanship and, above all, reliability that is discharged in that function, I feel that that is my interest in making what representations I can in opposition to the Bill.
Secondly, I have no wish at any time to defend an unnecessary monopoly, particularly a monopoly that can be claimed to be dangerous to the public generally. I do not see Section 21 in that setting. If I felt that that monopoly was highly dangerous and inadvisible for the public good, I would not hesitate to say so.
I know, like many other noble Lords here, that the eye is one of the most fragile and precious organs of the body and any useful measure to protect it is worthwhile. I see Section 21 as that useful measure, and I am sorry that I cannot agree, as a layman, with some of the medical advice that one has heard in this House. I know that those in the profession with which we are concerned are not pure and right on all accounts and I suppose that the same can be said of those engaged in some parts of the medical profession. But I believe that the repeal of Section 21 will be seen, if not in this House, outside, as an attack on the ophthalmic optical and dispensing optical profession. It can be nothing more than that. I think that it is sad that one should use Bills of this kind to attack a profession which is a long-standing, time-honoured profession and a profession which discharges tremendous skill in the benefit books. If the price of spectacles is too dear, then I say, like other noble Lords who have spoken before me, let the Director General of Fair Trading in his review determine so; it should not be dealt with by the process of this Bill based on individual experience, because individual experience differs from one person to another.
I am also unhappy about another effect of this Bill if it were passed. I believe that it would open the door to the importation of cheap and shoddy spectacles— 702 cheap and shoddy spectacles from Taiwan, Hong Kong and places like that. Those engaged in this profession know full well that they cannot match those standards. Are we to have a repeat—
§ Lord Rugby
My Lords, may I interrupt for a moment? Is the noble Lord saying that because something is made in the Far East it is shoddy?— because I believe that some of the finest lenses in the world are today made in the Far East.
§ Lord Allen of Fallowfield
Yes, my Lords, I am saying that on the evidence of those who have purchased them. I quote:We bought a pair. Frame: cheapest quality, moulded plastic with plastic joints. Sharp edges from moulding. Lenses: Inaccurate power, vertical prism, surfaces pitted, scratched and with concentric waves, flat form, chipped edges with no bevel".That is an indication of the glasses that one is told one can pick up in Woolworth's and probably in the hardware shop on the corner, or maybe the butcher's or somewhere stupid like that; and I think that this is running a great risk.
§ Lord Allen of Fallow field
No, my Lords, I have given way once. This is running a great risk with the health of the public of this country.
The second point I want to make—a point which interests me considerably—is that if we have an importation into this country, of what I can only describe, quite unrepentantly, as cheap and shoddy products, it will advance the 3 million unemployed in the United Kingdom. There are a few thousand people involved in the industry making lenses and frames, and, obviously, if the British market is to be flooded with that kind of cheap commodity, that will have its effect in the same way as cheap commodities have had an effect on the textile industries of Britain and many other countries.
Therefore, I ask the House, but particularly the Government, not to be too influenced by the clamour to support the repeal of Section 21, but to pledge themselves to examine most carefully the upshot of the review report of the Director General of Fair Trading. If he, in all his wisdom and all his in-depth examination, advises that the cost of spectacles in this country is too dear, so be it. But I prefer that process of determining how one is to proceed in this matter than the individual experiences of people, whether they buy a pair of spectacles in Hong Kong or Taiwan, or whether they buy them here in Britain.
The criticisms of the supporters of the Bill seem to fall as follows: first, the price of spectacles in the United Kingdom compared with other countries; secondly, the availability of cheap reading glasses; and, thirdly, the alleged lack of competition in the profession. I say this as a non-member of any repeal lobby or anti-repeal lobby. I accept—although from what I have heard in this House already from those who support the Bill, I doubt whether some others do—that the subject and the arguments are extremely complicated, with close interrelationships between clinical and professional service, the supply of prescription spectacles, eye care and health screening, the price fix of 703 health service, part health screening, fashion spectacles, and so on. At the end of the day I think that the criticisms crystallise down to: Do the present arrangements that exist in the United Kingdom mean that the public are paying relatively too much for optical services and spectacles? If that is the case, as I said previously, let the review determine it and let it not be determined through the process of a Bill of this kind.
It seems to me to be assumed by some that because it is possible in a few countries—and I hasten to add very few of the developed countries in the western world—to buy unprescribed, ready-made, cheap frames, with lenses already fitted, to assist in close vision for as little as £2 to £3, the price paid for individually prescribed spectacles manufactured to British Standards and supplied under the control of registered qualified opticians is expensive. I ask, is it not this basic assumption, which is both misleading and very largely incorrect, that is at the heart of the divergence of views in this House on this Bill?
To all those who find it possible to support this Bill, I must ask very sincerely and seriously that they reconsider their position in the light of the following considerations. First, relative to all other countries, optical services in the United Kingdom rate among the best, and they are freely and conveniently available daily to the public, very much more so than in many other countries. Secondly, the eye examination and sight test is free to all in the United Kingdom who cannot afford to pay; the service and the spectacles are completely free and are provided to a very high standard under the National Health Service.
Thirdly, for those who can afford to pay, the price of spectacles range from £8.85 to as much as £100, in steps of roughly £3, for the exclusive high fashion frames, with sophisticated lenses. They are available to be taken advantage of if it is wished. Complete freedom of choice is given—the standards and the service are the same, irrespective of the price paid. I defy anyone who goes into an optician's shop to say that there is a differentiation in standard or service.
Fourthly, I understand that approximately 68 per cent. of people who wear glasses are over the age of 40. I am informed that this is due mainly to natural changes that take place in the lens of the eye in the mid-forties, resulting in the need for assistance in close and intermediate ranges of vision. I am advised by those whom I have consulted in the profession that the demands on the human eye, due to technological and environmental changes and increased literacy and longevity, have resulted in continual pressures during the last 30 years for developments and improving standards of eye care. Also, many people over the age of 40 develop signs and symptoms of abnormalities relating both to their eyes and to their general health, which certainly manifest in their eyes.
I think that it is frivolous to lead the public to believe, or to lead Members of this House to believe, that you can go into any old place and pick up a pair of glasses or that you can carry on with a pair that you have had, which your in-laws have had, or which your father or mother has had, in the belief that this is a satisfactory alternative to the protection that is already written into Section 21. I do not believe that.
Again from information that I have sought, I 704 understand that there are no countries in the western world or any developed countries where spectacles and optical appliances made to prescription can be obtained from anyone other than a qualified or trained person. The Bill before this House repealing Section 21 of the Opticians Act 1958 would clearly mean, if passed, that any spectacles made to prescription or ready-made, contact lenses or any other optical appliances could be obtained from any source and without qualified supervision and advice. That is a disastrous step backwards, not forwards.
When one looks at the arguments objectively and rationally, I think it can be seen that there would be substantial reductions in the quality and the standard of service and product that the British public enjoy at present if the noble Lord's Bill goes through. The Bill seems to want to destroy quality and reliability, and to replace it by a cheap and shoddy product range. That is the essence of the repeal of Section 21. It saddens me to believe that people who, in this Bill, want to replace quality and good standard of service will, in other places, defend the importance (as I do) of high standard and good quality products. More than that, if the Bill is successful, it would mean opening the doors to the importation of cheap, shoddy imports. In my view, that would be a disaster for the profession. I sincerely hope that the Bill is not given the protection it seeks, particularly by the Government.
§ 7.20 p.m.
§ Lord Gisborough
My Lords, I also must apologise for having to leave before the end of the debate. This Bill is in principle an attractive Bill. The idea behind it is well worth while. Where there is a monopoly, or where there is a restrictive practice, then obviously every effort must be made to get over it. There is no doubt that we have some very expensive spectacles on the market. Most of the very expensive ones are expensive through fashion as much as anything else. If one wants a fairly ordinary pair of spectacles—like these—which are perfectly respectable, they do not cost a huge amount.
Having said that I support the principle of reducing the price—and who does not?—there are a number of dangers that have to be taken into account. Many of them have already been covered, so I shall not do more than mention them. Under the Bill it will be possible to obtain very much more simple spectacles without examination. It has been mentioned already that there are many pathological conditions of the eye which are now discovered during examination which will undoubtedly go undetected. In some cases this will lead to impeded sight, blindness, and in fact even death.
In one small practice in the country near my home there are some five patients a week who come in for eye testing, and who are referred for medical treatment. The sight of several patients a year is saved by this particular practice through early detection of various diseases such as glaucoma, and no doubt there are others. Last week one lady came in for a routine examination and it was discovered that she had an active tumour in her eye, and action was taken which has undoubtedly saved her life.
It is also rare (and this has been mentioned) even for reading that simple magnification is the best answer. Both eyes are never the same—or very seldom the same. 705 There will also be patients who will be tempted to buy cheap spectacles; those people with low incomes. We know that they are now entitled to have them prescribed and fitted free—that is to say, school-children, the unemployed, the low paid, people on supplementary benefit, and so on. It is quite likely that these people would see the cheap Taiwan spectacles and buy them over the counter when they could be getting them free. If either this Bill or some similar measure was passed, it would be desirable to have an advertisement to show people, who might not otherwise realise it, that they need not even buy the cheap spectacles but they could get spectacles for nothing.
Now almost anybody can get national health spectacles for about £8. They are probably cheaper and better than some of the imported ones. We have had mention of £2, but I have been advised that they are more likely to be about £9. Again, where they were being sold it would be necessary for public warnings to be given that, in spite of the cheap ones, spectacles are free for certain people who cannot afford to buy them.
So far as the opticians are concerned, their trade in private spectacles and private work subsidises the loss they make on national health work. Undoubtedly if the profit from the private work were creamed off, then the opticians would need increased payments for their National Health Service work. At the moment National Health Service lenses and frames account for some 43 per cent. of the national work. The national health lenses in private frames account for about 44 per cent., and private lenses in private frames about 13 per cent. That 13 per cent. virtually subsidises the work on the national health.
Then we come to the question of the comparison of costs for spectacles in Britain as opposed to abroad. I am advised that United Kingdom spectacles are actually cheaper than the average in the Common Market. Obviously they vary, but that is on the average. Then one compares with the United States where we know that spectacles are much cheaper. Of course, in the United States the cost of an examination is about £8 to £12 whereas here you can have a National Health examination for about £4, so the British make up for the profit in selling the spectacles.
Also, in the United States there is no National Health Service, and therefore all the examinations and all spectacles sold are private, and therefore are all profitable. Obviously, if everything is profitable then the profit on each pair of spectacles and each examination can be less than where there is very much less of the profitable work. The result of this is that the average income of opticians in the United States is probably about twice that of the British opticians.
We then also had the point made that under the Bill if one is not careful one will find that contact lenses will be able to be fitted by unqualified people. This could have horrific results. I am advised that it could lead to corneal damage, blindness, and so on, and there would be no public protection. Contact lenses require not only a great deal of training for fitting but also equipment which I am advised is valued up to about £5,000. It could be a very serious situation if they started to be fitted by people who are not qualified. The optical service in Britain is certainly one of the finest in the world. I do not think there is any cause 706 for criticism of it. There is no reason why a way should not be looked for to make it more efficient at less cost. I do not think that this Bill is in any way an attack upon the profession, as has been mentioned. It would be quite wrong for that thought to be allowed to stand unchallenged. But there is always room for change in any system, and I hope that the Government will take this as the start of an initiative and either accept the Bill or, more likely, start their own initiative to bring down the price of spectacles and look at the whole matter. We must beware of the too easy path, because that could lead to great damage to the service and damage to individuals.
§ 7.28 p.m.
§ Lord Hunter of Newington
My Lords, we owe a great debt to the noble Lord, Lord Rugby, for having persisted in his concern about these matters. I am told that some 40 per cent. of opticians' premises now display the prices of lenses and frames. This is substantially due to his efforts in the past. The fact that the Government have thought fit to refer certain aspects of this matter to the Office of Fair Trading is also a result of public concern. The case for what appears to he an unnecessary restriction on purchasing has been made, and the amending Bill before the House proposes quite simply that Clause 21 be struck from the Act. Nothing else. The question is, what is the effect of this Bill and what consequences will ensue?
The Bill will mean that persons will be able to obtain spectacle frames and corrective lenses, including contact lenses, with or without a sight test and prescription from any qualified or unqualified person. The effect of the Bill, then, would be to deregister the dispensing element of the optical services, and allow dispensing of prescriptions by unqualified persons. It seems unlikely that a qualified prescriber would be happy about this. More seriously, a point which has been mentioned several times is the proposal that fitting contact lenses could also be done by unqualified persons.
The Act would continue to set rigorous standards for dispensing opticians. But anyone who wished could set up in business in competition with them. Dispensing opticians qualified to supply lenses and frames but not test sight would still be required to register with the General Optical Council under Sections 2, 3, and 4 of the Act.
Making alterations to legislation is important if the case for doing so is made out, and therefore one must examine the medical side of this issue. I was surprised to see the figures—they have been circulated to many people—which show that between 10 and 15 per cent. of patients in a recent survey were referred to their general practitioner for study. I knew that many were—of course, one does not know which ones were referred—but I found that a surprising figure.
I am also concerned about children with eye complaints. There was only one part of the speech of the noble Lord, Lord Rugby, which upset me, and that was with regard to children trying on glasses and being told, "You will be all right if you can see with those". I am sorry to have to tell the noble Lord that that will not do. If a child has a lazy eye, he may be blind by the time he grows up if he gets the wrong prescription for his glasses and is not able to explain what is wrong with him. Inevitably, similar considerations apply to the 707 elderly with eye complaints. There are, therefore, quite serious medical difficulties; and let us not forget that for the person who gets glaucoma it is 100 per cent. so far as he is concerned.
The consitution and role of the General Optical Council would have to be revised with the abolition of the monopoly in the supply of glasses. There would have to be changes, for example, in the acitivities of its disciplinary committee; likewise the duties of the companies committee, which deals with matters relating to bodies corporate, other than matters which go to the disciplinary committee; and the rules concerning companies' requirements, which are at the moment approved by the Privy Council, would have to be changed also. Undoubtedly, therefore, the constitution and role of the General Optical Council would have to be altered, and of course, in that respect, Section 20 would start to look rather foolish.
I can summarise the position, as I see it, in a few points. I believe it is proper to use the correct machinery to determine whether a monopoly situation has arisen. Next, it is proper to ask whether there is serious interference with individual freedom, and in that context I must cite one example of interference, and it is something which appears to be a nonsense. You can go into a shop and buy spectacle frames containing sunglasses, but if you buy the same frames with lenses, then restrictions apply, whereas in respect of sunglasses there are no restrictions. Thus, there seems to be something of a nonsense concerning frames.
What are the medical consequences and has the Act worked well? We are told—the noble Lord, Lord Richardson, has taken a lot of trouble to research this—that those who work closest to the matter believe it has worked well. I believe the whole question of charges has confused matters, which is a pity because, for reasons which are nobody's fault, I understand that the whole question of charges and the upping of rates has been under consideration since 1978. Your Lordships should put that matter aside because I should have thought that it will almost certainly be resolved soon as a result of negotiations.
As I said, the constitution and role of the General Optical Council would need to be revised in the light of the abolition of this monopoly. I suggest that the noble Lord, Lord Rugby, considers carefully the consequences of the repeal of Section 21 and that the Government consider the slightly ridiculous position about spectacle frames and sunglasses frames, along with the matters referred to the Office of Fair Trading. But the examination of the person, the prescription and the dispensing of that prescription is part of a service of which we in this country can be proud. Each is essential to safeguarding the standards of the eye care of the people of this country. Tidy things up by all means, but do not recklessly abandon a system which has worked well in the past.
§ 7.35 p.m.
§ Baroness Phillips
My Lords, I would not have intervened following so many distinguished medical speakers had it not been for the fact that no one has mentioned my noble friend Lord Crook, who was in on the first Act but who, sadly, cannot be here this evening. He is a man of great integrity and compassion who has 708 been responsible for many interesting pieces of legislation on health and safety matters. He has particularly asked some of us to speak tonight.
I thought the noble Lord, Lord Rugby, introduced the Second Reading of the Bill delightfully. He attempted to turn our flesh by hinting—I admit, in ways I did not quite appreciate—that Slater Walker had had something to do with the supply of spectacles. That, as the noble Lord probably realised, was enough to make most noble Lords on this side of the House decide to support his Bill. It was a rather clever move on his part.
The noble Lord, Lord Winstanley, mentioned a family with a collection of spectacles which were passed round for selection. I might inform him, if he does not already know, that a number of families also have, and pass round, a selection of drugs, no doubt dispensed through him. I have even known families with a selection of false teeth which are passed round. I suggest that that sort of thing is not a particularly good argument for saying it is a desirable practice.
I am sure the noble Baroness would not wish to misrepresent me, my Lords, and I did not suggest for a moment that it was a desirable practice. I merely pointed out that it went on, and it goes on largely, I believe, because of the present cost of spectacles.
§ Baroness Phillips
My Lords, the noble Lord, Lord Rugby, by introducing the Bill, is seeking to put certain things right and a lot of sympathy goes in his direction for that. One aspect of his appeal is the cost of spectacles. I personally do not wear spectacles, but every supper party of mine since the Bill was published has been ruined by friends shouting at me that they are paying too much for their spectacles. That may or may not be the case, but I suggest that competition will not necessarily bring people cheaper spectacles. Where can one find a higher degree of competition than in the car repairing industry? Nevertheless, the charge is £40 just to look under the bonnet. Can that be put right by an Act of Parliament? Call in a plumber and he will charge you twice as much as you pay for a new pair of spectacles, merely to join two pipes together. In other words, competition does not necessarily being reduced prices. On the other hand, it can bring many undesirable elements in its train, so there are misconceptions flowing from many of the arguments.
I accept that possibly opticians have been guilty in not always giving information about National Health Service spectacles; that seems to be a frequent complaint. However, I have many medical people in my family and I have great respect for the profession. It is easy to say that people have not been "knocking" the profession, but I think from some of the comments that have been made, that they have been, perhaps selecting the one who is not so good and using that example as an argument to represent the whole.
The National Health Service are very slow payers; I would say the Government generally are slow at paying. Six months ago I gave a lecture and I am still waiting for my fee from the Department of Education. All doctors and dentists will tell you how slow the NHS are at paying, and those who receive money 709 for the dispensing of spectacles will say exactly the same. Surely that could be put right—and it would not need an act of Parliament to do so. Equally, I think we would agree that there is a lack of information about prices. As I understand it, action is being taken to put right the fact that prices have not been clearly displayed, and this, too, does not need a sweeping Act of Parliament.
Two or three days ago we were dealing with the Local Government (Miscellaneous Provisions) Bill, and your Lordships will have noticed in it several clauses referring to registering people who are dispensing certain services, presumably in competition. In other words, the emphasis of the age is more towards accountability, not towards moving out into an open market. If it is important to register a person who undertakes ear-piercing, tattooing, electrolysis and acupuncture, I am sure we would all agree that it is equally important, if not more important, to have some form of accountability and a system which protects the standards of a profession, the members of whom look after one's eyes.
Everyone has quoted figures this evening. A statistic which I thought was interesting arose from a week during which ophthalmic opticians recorded figures which showed that 25 per cent. of the patients were not issued with a prescription. To me that seems, above all to show the opticians' integrity, since obviously it would be to their advantage to recommend spectacles, but that they have not done. To me that is the mark of the professional. The professional will tell you what you need or what you do not need. Incidentally, I recall my son-in-law, in general practice as a doctor, saying that the worst thing one could tell a patient was that there was nothing wrong with him, because he simply would shop around until he found a doctor who was more obliging and who would diagnose a particular disease or ailment. So perhaps the people who were told that they did not need spectacles shopped around until they found an optician who told them that they did need them.
I was also rather intrigued to learn that the noble Lord who introduced the Bill placed great emphasis on the fact that there was no description of an optical appliance. Well, he might not like it, but there was a description in the original Act, which states:Optical appliance' means an appliance designed to correct, remedy or relieve a defect of sight".If we are going to talk about the old days and about going to Woolworths, I can recall my father—he was a countryman—describing how people used to take out teeth at a fair. One particular individual had no skill beyond having a strong arm, and I gather that a large brass band played outside the tent to drown the screams of the people inside receiving the attention of the unskilled operator. So if we go back far enough, we see that it was possible to purchase anything. I am not very happy about the fact that we have too much self-medication. It is too easy to purchase all kinds of things over counters, and we certainly do not want to add to this situation yet another great professional service.
I believe that this Bill, if passed, would be a very sweeping Act. It would put us right back, it would be a retrograde step. I rejoice in the National Health Service. I think that we have the most wonderful 710 health service in the world. A member of my family, who is a doctor, went to America recently. He was enthusiastic about the National Health Service before he went, but he came back doubly enthusiastic. He said he had seen someone lying on a stretcher, bleeding to death, being questioned, and the first question was, "How much can you pay?" Do we really want to return to a world in which we buy spectacles over the counter? Presumably one could then go and buy false teeth in that way—it is a very close analogy—if one has the space to put them in and can determine which is which. If one thinks about it, there is no limit to this kind of thing.
We are talking about what is a very honest profession. The fact that they are not too well paid by the National Health Service will not be put right by a Bill of this kind; it will probably make it even worse. I am very intrigued by the fact that many noble Lords have emphasised how rich opticians are. I am astonished that noble Lords on the other side of the House worry about someone being rich; I thought that that is the system they believe in. It seems to me that the labourer is worthy of his hire. If opticians are dispensing spectacles, one is receiving the benefit of their years of training. If it is right for an engineer to argue like that, it is certainly right for anyone trained in the opticians' profession to do so, too. I hope that this Bill does not go any further because I feel that it would become a sweeping Act of Parliament and would have very retrograde effects.
§ 7.44 p.m.
§ Lord Ferrier
My Lords, I should like to congratulate the noble Baroness who has just sat down not only upon the robust nature of her speech, which saves me several pages of what I was going to say, but also upon her reference to the noble Lord, Lord Crook, whom we remember so well. My memory of his taking part in debates in this House goes back 20 years or more and I hope that the noble Baroness will convey to him the extent to which we miss him. While on the subject of people who are not here, I would mention that in his opening remarks the noble Lord, Lord Rugby, referred to optical glass used for spectacles. I vividly recall talking with my old friend Lord Ritchie-Calder. In none of the obituary notices that I have seen was there any reference to the fact that as a young man he had a lot to do with H. G. Wells, and I remember his confirming something that I said to him. H. G. Wells, in one of his books—I think it was The Outline of History—measures the advance of civilisation by the development of optical glass, going back to the study of the stars in Egypt.
I must also mention the touch of surprise and delight that there seems to be a consensus of opinion that we might ask the noble Lord, Lord Rugby, to withdraw his Bill when the time comes, after we have heard what the Minister has said. I have two strong reasons for saying that. The first is simple and is that in my view the Opticians Act 1958 is an integral part of the National Health Service and Section 21 as I see it is the kingpin of its fabric. To remove it would be of vital significance, as many noble Lords have said. I am a staunch supporter of the National Health Service—I agree with everything that the noble Baroness, Lady Phillips, has said—and the fact that I am strongly critical of its 711 apparently stubborn response to recognising the place which manipulative therapy now holds in the relief of back pain—the therapy generally—does not mean that I am not a robust supporter of the main fabric which is or should be the envy of the world. I want to add to its efficacy, not to detract from it as the Bill appears to be suggesting. The manifold benefits of the National Health Service must not be imperilled.
The second of my reasons is a rather personal one and many of the points I have noted down have been dealt with by other speakers, so I shall be brief. I had not intended to say too much about it until I read the hysterical and inaccurate ballyhoo which appeared in an article in the Daily Express this morning. The article got wrong even the number of the section of the Act which the noble Lord wants to repeal.
The fact is that one must respect the dedication of the noble Lord and his supporters, and the sincerity of their commitment really makes a nonsense of the position today. What I mean is this. The noble Lord's campaign has highlighted a position which should never have been allowed to arise had the nettle been grasped some years ago. My information is that the situation sprang from the wholly inadequate 20-year-old provision for the remuneration of the professional skills which these practical opticians apply to the service of the public. This point was touched on by I think the noble Lord, Lord Winstanley. If opticians have been compelled by circumstances to charge high prices for special supplies, as may well be the case, I say, as the noble Lord, Lord Winstanley, said in other words, the old Latin tag, caveat emptor.
I have a foxhunting daughter who is approaching middle-age. She has had a pair of spectacles built for her for hunting, with special frames and wide vision. They cost her £75, which she was willing to pay; she sees no reason why she should have any subvention from the state for spectcales of that nature. There must be many special spectacles made which cost money, and there is no reason why people should not pay for them.
I do not pay much for mine. I am wearing now spectacles which to the amusement of my optician I describe as my battle specs. I have reading specs here, and I have those which I use when I look at television and now when I am driving my car, or, indeed, when I go to the Peers' Gallery if I want to observe closely what is going on in another place. I do not think any of them cost me £20. They are all standard frames under the National Health Service, and they were supplied by three different practitioners in three different towns. So I have reason to feel that there is a good deal of error in some of the unkind judgments of what Lady Phillips properly described as a most important profession.
I look back over rather a long life. I was granted, I believe, above average sight which was possibly impaired a bit by many years in the tropics, and yet I wore spectacles at my prep school because I got astigmatism, whatever that might be. Then I served in the Army and I went to the East, and I became quite a decent shot with a rifle, and so on; and I seldom wore dark glasses. Then I was struck down by malignant malaria and was treated, as we were in those days, with massive doses of quinine, and so I 712 found when I had been sent home ill that I had to wear spectacles for my desk work, and I have worn them ever since. This was all I needed until the years caught up with me, and every now and then I have taken the advice of my medical adviser and had an examination.
Four or five years ago I went to my oculist, who said, "I do not want to fuss you but you should get your doctor to send you to a specialist lest you might be getting glaucoma", whatever that may be. I say this because glaucoma has been mentioned by several noble Lords, and it was also mentioned in this article I spoke of as being something which professional opticians have tried to treat. I have never heard of any such thing. My experience is that I was sent to a specialist, and the specialist examined me for quite a long time. I must say I wondered what he was up to, but apparently my long years in the tropics made me rather an interesting subject.
This specialist said, "The first thing I can tell you is that you can tell your optician how wise he was to send you to me". I said, "It was a she, as a matter of fact", and he said, "Well, tell her, because I can see what she was up to. I have given you a careful examination, and you are not liable to get glaucoma". I give this as an instance of what can go on between the ordinary person like myself, ageing like anything, and a professional optician.
As for what the noble Lord, Lord Winstanley, said, I told this story about my experience to a friend who said, "It is interesting you saying that, because my aged mother had attention drawn to the presence of a brain tumour by the condition of her eyes". As the noble Lord, Lord Winstanley, said, the eye can show warning signs of danger in various parts of the body.
Finally, is the noble Lord aware that under this Government negotiations are proceeding now to improve the fees payable to opticians for their services to the state, and that these fees are to apply from the end of next month; and, further, that when agreed they are to he back-dated for four years to indicate the accepted fact that they have been too low for too long?
The noble Lord, Lord Oram, was right in mentioning this position. Further, the noble Lord will know now, if he did not before, that the Department of Fair Trading is carrying out this examination to which the noble Lord, Lord Allen, referred, and the relative questionnaire to interested parties is going out at this moment. I am informed that the various optical organisations are co-operating wholeheartedly with this inquiry, and find it a most welcome proposal with which they propose to co-operate.
I hope the Minister who is going to reply will set out what Dr. Vaughan said on this subject the other day in reply to a Question in the other place. Might it not have been wiser if the noble Lord has held his horses before involving your Lordships in this, as was suggested by the noble Lord, Lord Oram? At the same time, as I have said before, one respects the sincerity of the noble Lord's belief; and the fact is that his campaign over the years has served to highlight and to help to clear up a situation which has become, in some parts of the media, at least, almost a witch-hunt.
§ 7.57 p.m.
§ Lord Harris of High Cross
My Lords, I am delighted 713 to follow for the first time a charming contribution from the noble Lord, Lord Ferrier. But I must say that I am disappointed in what I regard as his misguided conservatism in this matter tonight, remembering that a year or two ago he led me in a magnificent charge against the medical profession over their bigoted exclusion of chiropractics—an interest we have in common. Yet, tonight, he seems to have fallen for the view of the noble Lord, Lord Richardson, or he has fallen for the view expressed by the noble Baroness, Lady Phillips, that what we are proposing in this Bill would in some way damage the National Health Service, which I do not believe for one moment.
§ Lord Ferrier
My Lords, will the noble Lord permit me to interrupt him? I certainly did not mean to say what he thinks I did. I am highly critical, as I said in my speech, of the National Health Service where it does not take on more, as it should over chiropractics, and think that it should not cast some away, as proposed in this Bill.
§ Lord Harris of High Cross
My Lords, I will pursue that with the noble Lord another time and hope to win him to my more consistent view in the matter. I want to thank the noble Lord, Lord Rugby, and congratulate him on his persistence and perseverance over a number of years. I hope he will not mind my revealing that he is a founder member of the non-party Repeal Group which I mentioned briefly in connection with the Shops Bill the other week. It is the Repeal Group which has encouraged him to bring this Bill before your Lordships' and I personally hope that he is ready to carry the issue to a Division if that looks like being necessary to jolt the Government into taking some action in place of their repeated words of concern.
Others have exposed the questionable, if not often false, medical arguments that buttress the present scheme, which requires, we are now told, 7 million people buying glasses each year, to shop at a registered optician for what are grandly called their "optical appliances". I want to develop a more general argument. The essence of my complaint against Section 21 of the 1958 Act is that it confuses the roles of the professional and the tradesman in a single person and gives that person power to raise his income by keeping up the price of what he sells.
The consequent abuse of collusion among opticians was predicted over 200 years ago by Adam Smith in The Wealth of Nations—and I will now offer one of my favourite quotations:People of the same trade seldom meet together even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices".In this, a profession is not wholly different from a trades union which naturally endeavours to raise the income of its members by restricting competition from alternative suppliers who could do the job equally well. The noble Lord, Lord Richardson, took the view that anyone concerned with the profession of medicine or its ancillary activities is somehow above any concern for his income. I beg leave to doubt that—and I could bring many friends from the medical profession, at any rate in private, to my side against the noble Lord.
714 No one denies that opticians perform valuable services and that may include diagnosing eye diseases that call for treatment. For this purpose opticians receive due training, as do electricians. But we are not required to hire an electrician when we want to change a light bulb or to mend a fuse. Yet most people who, as the noble Lord, Lord Rugby, said, wear glasses for simple magnification, are now legally compelled to go through a full medical examination each time they want stronger spectacles and are then compelled to buy those spectacles from a registered optician.
It was likened by the noble Lord, Lord Winstanley, in an earlier contribution (on 14th October at col. 373) to requiring a medical examination before allowing anyone to buy a walking stick—although he did not add that it would also be like giving doctors a monopoly of selling walking sticks, which, we may be sure, would then come in more ornate varieties at suitably fancy prices.
Turning to another useful profession, it is true that regular dental examination can spot tooth decay, but we would not think of making everyone buying a tooth brush go to the dentist and buy their tooth brush only after submitting to a full inspection of teeth. Periodic check-ups with dentists or with opticians are a matter of prudence. May I suggest to the noble Lord, Lord Hunter, that the proper role of compulsion in optics is in school examination of eyes, especially for squints which, I gather, are best corrected at an early age.
Despite what we have heard tonight, it remains true that among the fears that are played upon by the apologists for the opticians' cartel is the old wives' tale that wearing the wrong glasses can damage your eyes. We are now told that it can no more damage your eyes than listening to pop music might damage your ears. I think the House ought to recognise that the optician's union is running one of the most blatant, Government-protected closed shops. Of course, it dresses up its special pleading in a professional white coat. The game was rather given away in an earlier code of practice by the now defunct British Optical Association, which regretted that for over 300 years opticians had practised in shop premises, and went on to urge them to get away from the shop atmosphere and, above all:No prices should be exhibited, otherwise the optician can hardly escape from the accusation that he is a salesman rather than a professional man".Difficult though it may be for some of the earlier speakers to accept, I believe that there is no hard and fast dividing line between a profession and skilled trade—except perhaps the accent of the practitioners. There is certainly no justification for questioning the restrictive practices of ASLEF and SOGAT whilst viewing the professional restrictive practices that we are here concerned with through the rose-tinted spectacles conveniently provided free by the Association of Optical Practitioners. I would venture to say that anyone who cannot see through this optical illusion needs more than his eyes examined.
Accordingly, I commend this Bill and would leave with your Lordships the magisterial words of a leading article in the British Medical Journal of 13th December 1980:Deletion of the monopoly clause from the Act … will be hotly 715 contested by opticians. Yet what harm would result? As in other countries where there are no statutory restrictions, the mass of the public would continue to have their eyes tested by opticians or eye doctors, and the simple puchase of glasses over the counter would be confined to the normal-sighted over-50s who simply need reading help".
§ 8.6 p.m.
Lord Paget of Northampton
My Lords, I feel that we can all be grateful to the noble Lord, Lord Rugby, for having brought to our attention some matters which I think can only be described as rackets. On the other hand, I felt that in his opening speech he took a far too extreme view. He rather tended to represent opticians as ignorant artisans laughing all the way to the bank. I do not think that anything like that is a fair description. I think that the great majority of them are highly conscientious, professional men, often working, as the noble Lord, Lord Winstanley, has said, in close and fruitful partnership or co-operation with the doctors. I believe that the service that they provide is a good service and again I believe that the national health optical services are probably the best in the world.
The trouble is that for the services which the opticians are providing they are quite grossly underpaid in cash. The idea of these being rich, overpaid people is really nonsense. I think it was the noble Lord, Lord Orr-Ewing, who referred with horror to a payment of £60 a day. I do not think that he has caught up with inflation. There are not many garage hands who are not getting that; and here we are dealing with professional men. That is the gross amount; and after tax and insurance there is very much less when they get it home. I believe that the National Health pay is about £4.05 for a test and a conscientious test should take half an hour; and £4.05 when one relates it to premises that have to be kept, to the employment probably of a receptionist and probably a secretary, and all the expenses that go with premises, is a hopeless under-remuneration.
I believe that it works out like this: 90 per cent. of the optician's time is spent on NHS for which he gets rather less than 30 per cent. of his income. Instead of cash, he is remunerated by a monopoly. This is a method of payment which was more familiar in the days of the first Queen Elizabeth than in the days of our Queen Elizabeth. Public servants whom the Government could not afford to pay were granted monopolies. Those monopolies turned out to be very unpopular. They were among the great grievances that ended in the parliamentary war. When Thomas Wentworth (late Lord Strafford) forced his great Bill through Parliament, one of the leading subjects was the abuse of monopolies because monopolies outlived the service for which they had been granted and passed into other hands.
That I think to a considerable degree is what we are seeing here. The private partnerships of opticians, professional men working together like dentists or doctors, providing an excellent service. But this is an ineptly drafted Act. It is contrary to the report of the noble Lord, Lord Crook, which expressly advised that companies should not be allowed to start in the optician business. That aspect was cut out. Companies came in and there is a situation in which one 716 finds opticians ceasing to be primarily professional men, although many of them serving the companies try hard to retain their professional independence and do a good job.
Nonetheless, when one finds some of the companies offering television sets as a reward to the optician who sells the most spectacles, it becomes a little difficult not to regard the examination as auxiliary to the sale instead of the sale a consequence of the examination. It is a conflicting motive, a conflicting interest. So we see the monopoly passing from the man who required rewarding and is being justly rewarded by the public—since the Government cannot afford it through a monopoly—into the hands of a shareholder who has done nothing at all. This is the main problem which we have run into. That is seen regarding national health frames.
There are optical shops whose primary job is selling spectacles with an examination subsidiary to the spectacle selling. Naturally, the effort is made to sell the more expensive frames rather than the utility frames. This is where I became interested in a purely personal way. Like the noble Lord, Lord Orr-Ewing, I broke a pair of spectacles when I was about to go abroad. I went to two West End opticians, both of whom told me that they could provide me within 24 hours with a set of spectacles so long as I bought private ones. If, at third or half the price, I wanted national health ones, that would take at least three weeks. When I went down to the country, where I live, Market Harborough, and went to a non-company private optician, he had a drawer in which he kept frames for temporary use if somebody was short of a pair of spectacles. He provided me with what I wanted without charge. This is the difference in attitude that one finds.
The noble Lord, Lord Allen, said that the question that we have to consider is whether the public are paying too much for optical service and spectacles. My answer to that is that they are paying far too little for optical services and far too much for spectacles. We want to try and get these more apart. On any reasonable basis if you compare them with the dentist or anybody else in a very similar position, payments to opticians under the National Health Act should be at least doubled—probably more than doubled. If we were simply to pass Lord Rugby's Bill and deprive them of their monopoly payment, they would be left without a living wage, without any possibility of maintaining their standards of service, and the whole national health optical service could be wrecked. We could not allow that to happen just because one form of payment is objectionable. If one wants the service one must provide for it. Where is the money to come from? That is a problem for the Government, who at heart have always been opposed to a free health service and certainly think that the patients should pay something, or something more than they do.
I personally suggest that they put a tax on glasses, remove the monopoly, and vote that tax to paying the optician a proper fee. There is a tremendous lot of scope here. We go back to the old Woolworth's tray. That contained perfectly good, reading glasses from a physical point of view with serviceable frames. The cost of them was not six pence a pair 717 but sixpence a lens. The total cost was a shilling. If one uses the multiplier of 15, which I think we do these days, there are sunglasses with frames which are not as durable as the national health glasses, or even others, but which do reasonably well at round about the 15 shillings mark. One can see them in many chemists today.
One could open up competition and, if necessary, import. If anybody bought the kind of imported glasses described by the noble Lord, Lord Allen, that kind of "mug" would have only himself to blame, for this is a case of caveat emptor. They could carry a very substantial tax without their price going up if competition is allowed. From the point of view of the optician being properly paid by the National Health Service, the prescription could go to anybody in a position to perform it. I would have thought that that proposition was at least worth looking at.
I conclude with these words. The speech which impressed me most was that of the noble Lord, Lord Richardson. He spoke from great experience and knowledge. He pointed out in a moving way what folly it would be simply to remove this section and do nothing else about it. Although I am in great sympathy with what the noble Lord, Lord Rugby, said, I hope that he will withdraw this Bill if he gets an assurance that the Government will look into this matter, and get on with it.
§ 8.20 p.m.
§ Lord Energlyn
My Lords, permit me to follow the suggestion made by the noble Lord, Lord Paget of Northampton, that we should attach a tax to the provision of spectacles and use that tax to give adequate and proper fees to the practising optician. That brings me to a point that has not been brought out, namely: Who are the opticians who could qualify for that tax? When you look at the Bill it is perfectly obvious that too little care was given to the qualifications of the people who can be regarded as opticians servicing the National Health Service. I would draw your Lordships' attention to the register, in which you will see that there are two groups. There is the group which the noble Lord, Lord Paget, supports and which is also supported by the noble Lord, Lord Winstanley, and others—the optician who is an ophthalmologist or pharmacist, who is well trained, well versed and holds responsibility for diagnosing complaints in the eye. Why is it that it requires nine different diplomas to cover that subject?—because in nine different ways these gentlemen or ladies can become qualified to receive payment from the National Health Service. When you look at their qualifications you find that at least three of them come under the Worshipful Company of Spectacle Makers. That clearly has nothing to do with a malformation of the eye or other clinical problems.
I speak with some confidence, because for many, many years I have taught optical mineralogy. This is a form of optics which is really quite erudite, but inside it are simple and thoroughly understood parameters, touched on by the noble Lord, Lord Ferrier, who has been the only speaker to talk about optical glass. The situation, as revealed by the noble Lord, Lord Harris, is that you are dealing with a group of 718 people who are practising within a narrow subject, controlled by simple optical parameters, thoroughly understood, but all of them dependent upon the quality of optical glass. Therefore I suggest that there is merit in my noble friend's Bill, if only to cause the Government to appreciate that there is here great room for registration improvement.
If we take a comparable profession, say, the pharmacy profession, here is another profession that services the National Health Service. Here you have a service which is strictly controlled—it has been controlled for three-quarters of a century by the Pharmaceutical Society of Great Britain, which is renowned throughout the world for its standards—and every pharmacist is legally held in his shop and is not allowed to discharge a prescription if he is not in the dispensary.
There is nothing like that in the qualifications of these so-called "dispensing opticians". These are the gentlemen to which I should like to draw your Lordships' attention. In order to qualify for NHS prescriptions as a dispensing optician, they have to win a diploma, of which there are no fewer than seven; and the qualifications for embarking upon obtaining such a diploma are three O-levels and two A-levels. That is the primary qualification.
Here are people making a great issue about the professional skill, et cetera, of these dispensing opticians, and these are the people I am talking about. Therefore I say that as regards this Bill, if we were to revise the whole thing, let us next time state, as in pharmacy and in other areas of medicine, precisely what we mean by "a registered optician". That person should have the highest possible qualifications. It is really the gentlemen and ladies called "dispensing opticians" who have created the situation to which my noble friend is referring: they are the people who are commercialising spectacles.
I turn now to the actual manufacture of spectacles. What have you got? You have got a magnifying glass held in a frame; and the only reason you put it in a frame is for convenience, because otherwise a hand lens would do the job just as well. We have had a great deal of talk about measurement of the focal length of the eyes, and so on and so forth. It is clearly a lot of eyewash, because it is the eye which does the job. All the lens does is to help the eye to bring into focus the object one is trying to look at. It is just as simple as that. The parameters are known.
Therefore, in manufacturing the lenses we have a method of mass production and we in Britain are as good as anybody else. I do not fear competition from anybody in the production of the lens. Where the trouble has arisen, in my opinion—and this is why I support my noble friend's Bill—is that the gentlemen who have these very curious qualifications and have formed High Street "optical salons", are drawing over the whole situation a mystique. They say to you: "I am very sorry but we cannot let you have these spectacles for at least two days." If you put the screw on, you might get them perhaps in a day; but always there is a delay, when in point of fact I would guess that if you went into the back store you would find all the lenses ready to be put into the frames. If that was not the case you could not produce these lenses at 719 the price at which they are being produced today. It is a mass production process.
We come now to the question of contact lenses. Why is it that, as my noble friend has pointed out, there is a differential so that contact lenses in this country cost about three times the price they cost in America? There are good commercial reasons for that, but what I should like to point out is that contact lenses could be made more efficiently than they are at present if the Government allowed free enterprise to examine the method of making the polymer which is the basis for the lens.
I can claim to have had some experience of this, and have been fortunate enough to obtain some of the materials that have been looked at in different parts of the world for the making of contact lenses. It seems to me that if private enterprise or free competition were allowed to enter this world of contact lenses they would produce a contact lens which could be inserted into the eye as easily as a set of artificial teeth is put into the mouth. By that I am not exaggerating, because the contact lenses that are made at the moment are bedevilled by the irritation caused by the fringe of the lens, and it is the nature of the polymer that controls the fringe.
In summary, what I am really saying is this. I shall naturally support this Bill, if only to raise the level of this profession by concentrating rules and regulations regarding qualifications. There should be only one qualification, such as pharmacy, aad the rest of it I would regard as so much eyewash. Lastly, I support the Bill, too, because it is a very sad thing that in microscopy we are about to lose the only firm in this country that is now making microscopes. This is very sad, when you think of the raw material from which optical glass can be made. We are looking at areas of unemployment. In Lochaline, there are deposits of sand of incredible purity, but because of the lack of a commercial outlet they are not being used. They are the sands that you would use for super optical lenses. Therefore, I would support my noble friend by making such remarks as I have made. Some of them may be oblique, but I hope that some of them may impress your Lordships to support the Bill.
§ 8.32 p.m.
§ Lord Mottistone
My Lords, the noble Lord, Lord Rugby, is to be congratulated on bringing this Bill before us. There is a great deal behind what he has said, in that reading glasses are what most people require. I can tell a story about a Canadian admiral friend of mine, when I was the naval adviser to the United Kingdom High Commissioner in Ottawa some 15 years ago. He was in his mid-40s, and he went into his office one morning without his specs. So he had to borrow his secretary's specs and unfortunately, it was at a time when ladies had very ornate specs with great curls up the sides. About an hour or so later, he was told that the Minister wanted to see him. He was desperate, because he felt that he could not go to see the Minister in his secretary's specs. On the other hand, he could not read without his own. So he hastily rang up the medical director-general and said "I must have a pair of specs, and quickly", to which 720 the medical director-general replied. "Certainly. All right, Bob." He sent them alone in time and they were very respectable specs, probably like mine.
After the meeting was over, he thought "That's very peculiar. How did he know what to give me?" So he rang up the medical director-general and asked him how he knew what to give him, and the reply was "It's perfectly all right Bob. I know that you are in your mid-40s, I know that you are in the navy, I know that you started off with very good eyesight and everybody requires exactly the same specs." That is the point which the noble Lord, Lord Rugby, made to us. It is probably true that something like 75 per cent., if not more, of the glasses that people get are reading glasses, and 95 per cent. of the people who have them are quite unharmed if they get the wrong ones. If they do, it is their own fault, because they have not complained. All of that makes a great point about this Bill.
But I am sorry to have to say to the noble Lord, having started off so encouragingly, that because of the nature of the Bill I cannot support it in its present form. As so many times when we deal with legislation in your Lordships' House, it would be so splendid if we did not have to start from where we are now. We have an Act of Parliament of 1958, which is jolly nearly 25 years-old. That is getting pretty old for legislation of this kind these days, and it probably needs revision anyhow. It would not be right to sweep away Section 21 just like that, without any other modification of the Bill, and it would not be very easy. I have examined this Bill fairly carefully to see how, if we give this Bill a Second Reading, we could later provide what might be called a rational set of amendments to make it work. I have come to the conclusion that we would have to put Section 21 back in again by amendment, and that would make a bit of a nonsense of the whole Bill.
Your Lordships may wonder why I say that. I think it is because the Act, as it stands, has created the General Optical Council and all that goes with it. I go alone with those noble Lords who take the view that most of the ophthalmic opticians—and it is those that I am concerned about—are good honest chaps who try to do a good job. But here I go alone with those noble Lords who have pointed out that they really do not get paid for their expertise. The noble Lord, Lord Energlyn, rather said to us that they have no expertise, anyhow. Those whom I know are bachelors of science and I think that you would count that as some kind of expertise. Why they are is another matter, but they seem to be. The fact is that they use a fair amount of expertise. Maybe we need to look into whether they need to have this expertise, and whether in practical terms it is necessary for them to—
§ Lord Mottistone
I would rather not, because it is a bit late. One could go on popping up and down all the time. The point is that you have to think how these people are rewarded. From what I have heard, it seems that the Government are extremely mean in what they pay them for such expertise as they demonstrate when they are doing their testing, and it is in this area where, if we want to have cheaper specs under the 721 present system, we should invite the Government to make their correction and concentrate on rewarding people in the right way for the job that they do.
Furthermore, they are providing a service against the general background of the National Health Service. I think we all applaud the National Health Service, in principle, though we probably all have points of detail to find fault with. It creates its own aura and part of the by-product of it is Acts of Parliament, like the 1958 Act which we are being asked to amend. I suggest to your Lordships that it is not reasonable to muck about with the 1958 Act too much, without having a look to see how this fits into the National Health Service.
It may well be that we could have people who were less highly qualified than the ophthalmic opticians, but we should have to make sure that the service which the opticians provide is provided from somewhere else. For example, I have a daughter who is very short-sighted, and we were at least two or three years later than we should have been in finding that out. That may or may not have done her harm. It never occurred to us to take her to the optician, because she did not know that she was short-sighted, as she could read perfectly well and did not trip up. So her condition was not very obvious. If the doctor had provided the sort of service which doctors used to provide in the 1930s, it could have been that he would have been more aware of the fact that this child was short-sighted, and something would have happened. But he did not, because, on the whole, he has decentralised that side of his activity to the opticians. Whether or not this is a good thing and whether or not this shares out the load in the right way I do not know, but before we start playing about with the opticians we have got to look at what is provided for those people who need a service. I think everybody is agreed that some people, however few in number, do need this kind of service.
The noble Lord, Lord Energlyn, mentioned the pharmacists. They are a similar problem. They also are an offshoot of the National Health Service. When I was the director of the Distributive Industry Training Board who had dealings with the pharmacists, because we trained them in their shopkeeping activities, I discovered that now they all need to have university degrees. Many of these young men with university degrees who are temperamentally inclined to become pharmacists do not want to be shopkeepers. Some of them are stupid enough to think that they are too grand to be shopkeepers, while many of them just do not have the "feel" for ringing up the till, exchanging money over the counter and all the other things which go with the excitement of shopkeeping. This is very understandable, because they are people with university degrees who do not do that sort of thing. The problem is that it is becoming more and more difficult to get people to become pharmacists and then to run small chemist shops. There is room for them in the big chain stores. They can have the professional who, as the noble Lord, Lord Energlyn, quite rightly said, has to be there if they are doing business in drugs. He does not have to be bothered with running a shop. You have another fellow in, say, a branch of Boots to do this for you. This is tragic. If this attitude is carried too far we shall lose many of our little chemist 722 shops which, like our corner shops, we should dearly like to be given a reasonable chance to continue in the foreseeable future.
I suggest to your Lordships that this rather blunt Bill is not suitable to be given a Second Reading. I am sorry to have to say so because there is a lot of good behind it. When my noble friend on the Front Bench comes to reply to the debate, I hope, as many other noble Lords have said, that he will be able to say to us: Yes, we are going to take this reference to the Office of Fair Trading very seriously indeed; Yes, we are going to study the problem; Yes, we realise that the Act of Parliament which is under consideration is 25 years old and needs a good look at; and yes, we will look at it against the general background of the National Health Service with a view to coming up with legislation of our own within at least a year, and possibly less, in order to try to provide a balanced picture which is better for the public and better for the opticians.
§ 8.44 p.m.
§ Lord Bowden
My Lords, the hour is indeed very late. The best thing I can do for your Lordships is to recount, only briefly, the way in which the ophthalmic opticians have developed and become professional men in the last 25 years. A great deal of the history was made in Manchester, and not a little of it in my office. For many years my institute trained people to go into ophthalmic optics by giving them a two-year course which led to a diploma. About 25 or more years ago we decided that the time had come to improve the education of these people.
We had lengthy discussions about the best way to achieve this. As a result, we decided that they needed much more contact with the medical profession so that, when looking into people's eyes, they could become aware of malfunctions of various kinds which needed reference to the medical profession. So I organised some very lengthy discussions between the two protagonists: the ophthalmic opticians on the one hand, and, on the other, the representative of the General Medical Council. It so happened that he was in charge of the eye hospital in Manchester and my own director of our little department was the representative of the ophthalmic opticians. By getting these two people together in my office, I could dragoon them into making agreements which, when they went to London, they had fair copied and signed on behalf of the two professional bodies which they severally represented.
This put me in a very privileged position. We decided that there must be much more intensive training of these ophthalmic students in the whole problem of medicine. We were able to negotiate a very satisfactory agreement, by which all students of ophthalmic optics had a period under training in the eye hospital watching the consultant, or the registrar or whoever it might be treating patients and learning the kind of thing which needs the attention of the highly trained, highly-skilled and sometimes highly-paid medical man.
I remember that I caused a certain amount of frenzy by reminding the medical representative, when he became a little uneasy about these things, that it was not until the barbers severed their connection with the surgeons that the surgeons became respectable about 200 years ago. I reminded him, too, of the days when a man needed nothing more than a pair of pliers to set 723 himself up as a dentist, and that these days had not gone past until about 1922. Now I said that the time had come to do a similar job for the ophthalmic opticians, because their profession was becoming more and more demanding and needed more and more sophisticated techniques and apparatus and a much greater understanding of the anatomy of the eye. This was agreed.
After the system had been working for a year or two we were able to institute the very first degree course in ophthalmic optics ever to be given in this country. That is why, the noble Lord will be glad to know, so many of the ophthalmic opticians these days are now B.Scs. The first were Manchester graduates. Now there are many from all the other schools of ophthalmic optics in this country, all of whom have followed our example and co-ordinated their activities with those of some local teaching hospital. It is a splendid arrangement. It is still working very well indeed. Only last week I attended a meeting at which a library was dedicated to the memory of Mr. Marton who was the representative of the ophthalmic opticians and who led the discussions with the medical profession.
I remember that when the time came to discuss our entry into the Common Market we had a series of committee meetings to discuss the equivalents of the professional qualifications which people had in Europe and in England. There were many profound differences. The medical profession here has a totally different series of consultancies and specialisations from those in Europe. The architectural profession in Italy at that time was open only to Italian citizens who had taken an engineering degree in one of the ancient universities of Italy. We decided that, of all the professions, the one in which the qualifications were most different was that of the ophthalmic optician. Our people were very much better educated than their equivalents in Europe. There was no doubt about this. It was decided that there could be no equivalents easily given between what the French call an opticien and what we call an ophthalmic optician. They had never had the opportunity of contact with a medical school which our people had been having for several years.
I introduced a debate in this House at the time of our discussion of the conditions for entry into the Common Market in which we discussed this and many other equivalents of professional qualifications. At that time the Commission in Brussels was trying to enforce rigid uniformity on all professions of similar types throughout Europe. I remember that I announced, to the astonishment of this House, that it might well be that our entry into the Common Market would be possible only if there were a shotgun marriage between the Bar Council and the Law Society. I was not in the least surprised when the Lord Chancellor leaped to his feet and, without taking those two steps to the left which I believe are obligatory before he makes a speech, said: "Under no circumstances will this happen". I thought to myself, "The opticians are safe", and I rubbed my hands as I did so.
There can be no doubt at all that the opticians have transformed and turned themselves into a profession over the past 25 years. They are studying all sorts of new techniques and ideas for diagnosing not only the rudimentary refractory troubles, including astigmatism, which the noble Lord, Lord Energlyn, will remember 724 was first discovered by an Astronomer Royal who had it himself and spent a great deal of time and effort calculating how to cure it. Our optical men are well trained. They are an extremely dedicated profession. I discovered when talking to them last week, as I have done many times in the past, that they still have enormous self-respect and enormous regard for their ability to treat the problems of the public, and they also have enormous regard for the trust and goodwill which the public obviously feel for them.
I want your Lordships to believe that the ophthalmology profession is worthy of this country. It is probably the best of its kind that there is. It became the best of its kind by its own efforts over some 25 years, starting just after the war. It would be a most dreadful thing to try to downgrade it because, like so many other professions, it has its own black sheep.
The problem of remuneration has been adequately discussed already. There is no doubt that these people are underpaid, grotesquely, for the work they do in prescribing in the first place, and it is scandalous that many of them feel forced to persuade people to buy more expensive spectacles than they need in order to make up the balance. It must be said that most of these spectacles use continental frames. One of the problems which the Office of Fair Trading should study is why it costs, wholesale, about 50 per cent. more to buy a Zeiss frame in England than it does to buy a Zeiss frame in Germany. This is a problem analagous to that of the purchase of motorcars, which come much cheaper in Brussels than in England (and which is equally worthy of the study of the Office of Fair Trading).
There are many things which we could properly discuss tonight, but I am quite sure that the idea of solving any problem at all by eliminating the responsibility of these dedicated people and making it unnecessary for the ordinary person who needs spectacles to consult someone qualified would be a disastrous mistake. There is no doubt that some lucky people need only reading glasses; my goodness! I wish I could say the same.
There is no doubt, too, that some ophthalmic opticians are good and some surgeries are not. I myself had occasion to feel this. I have strong views about what I call the iatrogenic diseases. I went in for an operation on a cataract and emerged with the cataract still intact and all my front teeth missing because somebody's hand must have slipped while I was on the operating table. This was a few years ago, and I am afraid that I have since lost the sight of an eye. Be all this as it may, I do not feel the medical profession as a whole is to be blamed for this. There are some things which one has to accept as being inevitable, but I believe that the ordinary community get a very much better deal as a result of the dedicated service of ophthalmic opticians than they would in any other way. For this reason, I do not think we should give this Bill a Second Reading.
§ 8.54 p.m.
§ Baroness Jeger
My Lords, I would like to thank the noble Lord, Lord Rugby, for giving us the opportunity to have this debate, but, without being discourteous, I do not thank him for this Bill. I should make it clear that, although I am speaking from the 725 Front Bench, so far as this side of your Lordships' House is concerned there is a free vote, but I believe I am expressing the views of many of my noble friends.
I should like to repeat the tributes which have been paid to the noble Lord, Lord Crook, who chaired the original committee dealing with these very difficult matters. Had he been well enough to be here, I believe we would have had an even better debate. I hope he will read with interest, although I am sure with criticism also, some of the speeches which have been made tonight. We must surely all look forward to having him back among us.
The ophthalmic services are an integral part of the National Health Service; that has to be the starting point and many speakers have made this clear. Eyesight is one of the most precious of the human faculties and it has to be cherished. I believe that we have the best service in the world and it should not be reduced in any way at all. The problem has emerged during this debate that essential diagnostic and prescription services have been caught up in the market place of spectacle sellers, especially frame sellers. It is claimed by some that there is a racket, and some noble Lords have given examples. In my view, these accusations must be met by dealing with the system and not damaging the service. I understand that this question is at present before the Director General of the Office of Fair Trading, and I would like to ask the noble Lord the Minister when the report is expected. I am sure that he will have understood from all the speeches made tonight that there is some impatience and anxiety that this work, which has long been delayed, should go ahead as quickly a spossible. I would say to the noble Lord, Lord Rugby, that I do not suggest that it is in anybody's interest for important decisions to be taken before this report is received. I understand there have been discussions and some progress has been made in consultations with the profession.
There have been references to the display of National Health Service frames and prices, and I understand that there has been much progress. That is one of the important factors in this argument. I have also heard that National Health Service payments for diagnosis and the supply of NHS spectacles are so low that running expenses (and we all know about increased rates, heating, lighting and wages bills) are getting way ahead of the income that can be derived from providing these services. If this is so, perhaps the Minister can tell us whether any consideration is being given to upgrading the National Health Service payments.
I should like to remind the House what the payments now are. I understand that the current gross NHS examination fee is £4.50, and that the gross dispensing fee is £4.20. Talks have been going on with the Optical Whitley Council for a long time and it would help our discussions if the Minister could give us tonight some news of the outcome of those discussions.
While the talks are continuing I should like to make one or two suggestions which might meet some of the genuine grievances made by the public. For instance, I believe NHS opticians should always be required to give their patients a copy of the prescription. This could be very useful to the patient if he lost his glasses on holiday or just wanted a spare pair. It would also give the patient the freedom to shop around with his 726 prescription—but always getting that prescription made up by a qualified dispenser, and not (as some noble Lords seem to be suggesting) giving it to a shop girl in an American chain store who would have no idea of how to begin interpreting or reading the prescription. It would be rather like taking a doctor's prescription to a grocer instead of a pharmacist, if that was allowed to happen.
I have referred to the movement towards the display of prices. I also believe that any optician receiving NHS payments ought to be required to show clearly in his window, so that the patient does not even have to go inside his shop to see them, a display of National Health Service frames and their prices. I would also, without vanity, like to ask that there might be some wider range of choice in National Health Service frames, which I am sure could be arranged without necessarily increasing the expense. It is the variety I would like to see increased.
Part of the problem could be solved by the patients. In my view, some noble Lords have made rather wingeing speeches about exploiting patients. Patients do need more information, though they are not a captive audience. It is easy, I know, to be overwhelmed by a dazzling display of fashionable and even exciting spectacles. The glamour trade in spectacles has exacerbated this problem, and many people fall for the temptation of some quite outrageously exciting spectacles for which it would be quite unfair to ask the NHS to pay. I find that too many patients do not realise their rights. I think there should be much more of a campaign on this, and particularly that they should not have to buy their spectacles from the firm where their eyes are tested. I think this would do something to break this link, of which many noble Lords have complained, between the clinical work and what I call the marketing work.
I find that not many patients know, as I have found out, that they can insist on new lenses being put into old frames, if suitable. Of course, the temptation not to tell patients of these economies is all the greater when the people concerned are being so desperately and unfairly underpaid. I think that is at the heart of much of the problem. What we need to do tonight, I think, is to hope that the Government will agree to some ways of tackling the abuse without dismantling the essential part of the National Health Service.
I know that references have been made to the fact that in some states in the United States of America the whole situation is more relaxed; but, my Lords, I ask: when do we have to take lessons in health care from the United States of America? I know doctors in America, where I spent several months last year, who envy the protection that ophthalmic patients have here, and only wish that they had the same arrangement that we have. The United States is a long way behind pre-war Britain in the provision of health services. Of course we were selling spectacles as they are now being sold in the United States, but we brought in the 1958 Act because we recognised that that situation was intolerable and was damaging to the public. For noble Lords to suggest that we should now strike out this most important part of the Act, which was brought in to rectify an intolerable situation, means regression in every sense of the word.
I must emphasise, though I speak with hesitation 727 after the very powerful speeches of Lord Richardson and Lord Hunter, the very great danger in the free supply of contact lenses particularly. The thought of contact lenses and fluid being sold over the counter by totally unqualified people is frightening and dangerous, and would particularly affect many young people who seem to prefer contact lenses for all sorts of reasons of their own, and I feel would face abuse and damage.
The difficulty is that self-diagnosis really does not work with eyesight. Of course an old person feels that all he wants is some magnification, and if this Bill were to pass he could shop around for glasses which would help him to read. As he got older I suppose he would go and buy an even stronger pair. But as has been made clear, the difficulty in reading may indicate all sorts of other problems, often without symptoms presenting themselves. So that this professional approach is something that we must not lose. I feel if it were just a question of buying glasses, then there might be some merit in giving consideration to the noble Lord's Bill if glasses were just a decorative feature; but glasses are part of the health and wellbeing of our people. I am sure we would never have passed the 1958 Act had that not been so.
The arguments have of course been elegantly advanced by the profession. I think much of the information that has come from the profession has been very helpful and useful. I certainly do not regard it as hysterical or over-stated in any way. I have learned a lot when trying to understand this Bill. But I would say that if we accept—and I am sure the Government will—their clinical arguments, they must help us to clean up the monopoly of the marketplace. The two must go together. As long as people feel "ripped off", as we know some of them do, the propaganda against the profession will continue and we shall hear more of Bills similar to this Bill. To this extent I think the noble Lord, Lord Rugby, has done a service, and I hope he has alerted the profession to public disquiet and to urgency in this matter.
My Lords, if Section 21 is repealed the clinical protection of the public afforded through the General Optical Council will be removed. But the public also needs protection against profiteering and restrictive practices. In opposing this Bill, none of us want to sustain a situation where professional expertise could possibly be used as a cover-up for restrictive practices. What we arc hoping the Government will be able to say tonight is that steps they have in mind will bring about changes in the whole situation, so that we can sustain the invaluable clinical work that is part of the NHS, and at the same time we can see that remuneration is fair, conditions of work are fair, and that the market in spectacles is not totally inseparable from the clinical work, which is invaluable.
§ 9.7 p.m.
§ Lord Cullen of Ashbourne
My Lords, we have had an extraordinarily interesting debate. Quite a number of the issues are familiar ones, but we have had many other quite new aspects spoken about today, and many of these aspects, 1 think, will be of great interest to the Director General of Fair Trading, who, as your Lordships know, is now examining the whole position.
728 On many occasions over the past two years or so we have heard the noble Lord, Lord Rugby, together with my noble friend Lord Orr-Ewing, and the noble Lord, Lord Northfield, express their concern about the level of prices being charged for private spectacles. I am sorry that the noble Lord, Lord Northfield, is not here because I regard him as one of the "Three Musketeers" who have been operating on this matter for so long. I am also very sorry that the noble Lord, Lord Crook, was not able to be here today because he really is the father of the Opticians Act. It is unfortunate that he is not here and I am sure that he is sad not to be here.
Outside this House there have been many expressions of concern on the score that the noble Lord has raised, not only through the media but also through a large volume of letters from individual members of the public. Ministerial boxes have had more than their fair share of letters on the subject of spectacle prices. As the House well knows, Her Majesty's Government have consistently expressed their own concern at the widespread allegations of overcharging by opticians. They have well understood the pressure for action from within this House, and indeed, are sympathetic to the aims which underlie the Bill. Despite this, however, the Government's view has been, and still is, that it would be highly irresponsible to initiate hasty changes in an area where public health is involved. They have never lost sight of the fact that, as the noble Baroness, Lady Jeger, has just pointed out to us, the Opticians Act was put on the statute book to safeguard one of the most precious of our senses.
As your Lordships well know, I have on many occasions over the past two years stressed the point that to make spectacles freely available "over the counter" could result in patients missing the opportunity for the early detection of eye and other disease which a sight-test by a qualified practitioner affords. Several noble Lords have even gone to the lengths of playing down the importance of these medical considerations, whereas other noble Lords may feel that I have laboured the point and overstated the case.
I think that those of your Lordships who have such thoughts would do well to ponder on the results of a recent survey sponsored by the Association of Optical Practitioners. This has been referred to by several speakers—in particular, I think the noble Lord, Lord Hunter of Newington, and the noble Lord, Lord Winstanley. The survey shows that over a five-day period, 417 ophthalmic opticians tested the sight of 16,152 patients. Of these, 2,047 patients were referred to their general medical practitioner. These referrals represent approximately 13 per cent. of all patients having sight-tests which, for the ophthalmic optician profession as a whole implies that something of the order of 1,000 patients per week are found to have a condition warranting medical advice. And 18,000 patients per week means nearly 1 million patients a year. Therefore it is no trifling matter.
The types of condition detected and referred for treatment range widely; they include cataract, suspicion of systemic disorder (such as diabetes), vascular abnormality, possible side effects of medication and glaucoma. This last condition is a particularly insidious one which, in its early stages, while the sufferer is unaware of his condition, can cause irreversible 729 damage to the eyes. I am sure that, on the basis of this information, many of your Lordships will feel that, if anything, in my past statements I may have understated rather than overstated the case.
It is for reasons like this that the Government have refrained from taking precipitate action; they have foregone the opportunity for quick and easy popularity through the hasty amendment of the Opticians Act which, like the Bill we are debating here, might appear to be a ready answer but which, on closer examination, would have serious and anomalous effects.
The noble Lord, Lord Hunter, pointed out the effects of the present Bill in considerable detail so I shall not say very much about that. The effects would be to allow the freedom to purchase spectacle frames and simple lenses "over the counter" which the noble Lord, Lord Rugby, and other noble Lords seek. However, it would also allow the parents of children who need spectacles and patients with very poor sight or with the need for more complex prescription lenses, to purchase spectacles freely from unqualified pesrons without prescription. I am sure that I need not elaborate on the possible consequences of this; nor, indeed, on one of the most extreme consequences which the Bill would allow—and again this is a matter to which the noble Baroness, Lady Jeger, referred—that any unskilled person would be able to supply and fit contact lenses. The dangers of this must be apparent to all of your Lordships.
It is for these reasons that the Government's own actions in this matter have been taken only after the most careful consideration. Many of your Lordships will recall that at the end of 1979 the Director General of Fair Trading gave consideration to making a reference of the optical market to the Monopolies Commission. He decided instead to try to obtain a voluntary agreement with the General Optical Council to revoke its long-established statutory role prohibiting the display of prices in opticians' windows. Sadly, this was not greeted with wholehearted enthusiasm, though the General Optical Council decided to lift its ban on the price displays. This relaxation came into effect in May last year, but, to the Government's regret, brought only a limited response from opticians.
Some opticians began to display prices but the response was not a ready and wholehearted one. In view of this, Her Majesty's Government decided that it was necessary to obtain a thorough assessment of those parts of the Opticians Act concerned with the monopoly in the supply of spectacles and the powers of the General Optical Council to place restrictions on optical trading. This review, which was announced by my right honourable friend the then Minister of State for Consumer Affairs in another place on 16th December 1981, is now being carried out by the Director General of Fair Trading. He expects to have completed the substantial task of obtaining evidence from the widest possible range of interests, and to report later this year.
The Director General has not been asked to make recommendations about the Opticians Act itself as this would clearly involve health care questions which require wider consideration. But what this review is designed to do is to give a clearer picture of the state of competition in the optical market and to identify the factors underlying the pricing of spectacles. Once 730 its results are known, Her Majesty's Government will consider possible hanges in the present arrangements on a sound basis and with a full understanding of all the issues involved.
In addition to initiating this review, the Government been taking action to improve the ophthalmic services offered by the National Health Service. My honourable friend the Minister for Health has been discussing with the optical professions and with manufacturers, proposals to improve the range of NHS frames and lenses. He has secured the agreement of the professions to amend the NHS terms of service so as to require opticians to display or show the range of NHS frames to patients. Several noble Lords have mentioned the importance of NHS frames being actually displayed or shown patients, and this has now been agreed with the professions. Discussions on the addition of new frames to the NHS range are well advanced and the Minister for Health hopes to make an announcement on this shortly. I have no doubt that all sides of the House will welcomd these changes and the improved facilities they will offer to patients.
In addition, negotiations have been taking place between the health departments and representatives of opticians on the level of fees payable for the sight-testing and dispensing which opticians carry out for the National Health Service. The noble Lord, Lord Oram, will be pleased to hear this, as I am sure will my noble friend Lord Mottistone. From 1st April 1982, these fees will be increased so as to reflect the increased costs of providing NHS services. Because virtually all optical practices in this country undertake both NHS and private services, practice income from NHS fees may well have a bearing on the pricing of private spectacles. I have no doubt that the Director General of Fair Trading will be examining this factor in the course of his review.
My noble friend Lord Ferrier also mentioned that there was to be a payment for arrears, and when the final negotiations re completed in two or three months' time, there will be an arrears payment. I trust from what I have said that the noble Lord, Lod Rugby, will accept that the concern of the Government over allegations of over-charging matches his own. The difference lies in the method of tackling the problem. I think that the warnings expressed by a number of your Lordships during this debate confirm that the Government's carefully considered approach is the right way to tackle this particular problem, and that hasy measures, however well-intentioned, can be dangerous. The prospect of unqualified people suplpying contact lenses is infinitely more serious than that of wearers of private spectacles being overcharged.
In conclusion, I can assure your Lordships that the Director General's review has not been initiated as a convenient device for shelving the matter, but as an important first step in the Government's programme for action to ensure that the public gets value for money and that patients get the spectacles they need, whether through the National Health Service or privately. I am sure that the House is grateful to the noble Lord, Lord Rugby, as I think every speaker has said, for his efforts over the past few years, which have played no small part in highlighting the problem and prompting the action which Her Majesty's Government have initiated. I hope that he may feel that we have had a valuable 731 debate with many views aired, and that he will accordingly be prepared to withdraw his Motion.
§ 9.21 p.m.
§ Lord Rugby
My Lords, I should like to thank the noble Lord, Lord Cullen, for giving us his summary. I do not myself altogether feel that the public at large are going to have many of their fears allayed as a result of this debate. All too often I have heard the-word "patient" used, whereas we have also heard that 80 per cent. of the people who require spectacles are people who merely need reading glasses; they are in truth perfectly healthy people merely suffering from increased age, requiring standard spectacles which, as a noble Lord has said, are immediately available somewhere in the optician's shop and are withheld officiously on the basis of an eye test, and a lot of mumbo-jumbo, in order to pretend that that person in fact has something wrong with his eyes.
All too often the optician concerned will know perfectly well exactly what he is going to apply to that person's eyes by way of a pair of spectacles, which he will make him wait for for possibly up to a fortnight. I believe that this is really where the great fear of the public is today. This is why one's files are full of people complaining. Two years ago I put down an Unstarred Question. I believe that that was a knock on the door. Today I think we have had more of a battering ram on the door. Next time, my Lords, I am afraid that the key that you have will not be sufficient to hold the door shut. But, at the same time, in view of the late hour and the few Members who are here, I would beg leave of the House to withdraw the Motion.
§ Motion for Second Reading, by leave, withdrawn.
§ Bill, by leave, withdrawn.