§ Order for Second Reading read.
§ Mr. WEST RUSSELL
I beg to move, "That the Bill be now read a Second time."
In view of the lengthy sitting of the House yesterday, and the controversial character of the subject which was then under discussion, it is not suprising that the House at this moment presents a somewhat attenuated appearance. The interest taken in this Measure by hon. Members and by other people throughout the country is well known, and it is a Measure in regard to which there is no difference of opinion. I am aware, however, that there are hon. Members in this House who feel that they will not be able to support the Second Reading of this Measure. While there may be a considerable difference of opinion in regard to some of the details of this Bill, I venture to state that there are few, if any, hon. Members who are not in complete accord with the broad principle upon which the Bill is based. This form of legislation is not unknown, and it is not a new form. I believe I am right in saying that ours is the only country where there is no legislation affecting the registration of opticians. In Australia, and certainly in every State of the United States of America, legislation obtains at the present moment which governs, controls, and directs the operations of opticians.
It may be that, as a result of that legislation, the people of the United States of America are, probably, the most bespectacled people in the world. This is not because the eyesight of the people of the United States is more deficient than the eyesight of the people of this country, but it is because the people of the United States of America have long since realised the fact that good eyesight is of enormous national importance. No doubt defective eyesight prevails in the United States just as it prevails here, and constitutes a national problem in regard to which the United States is, perhaps, ahead of us. I think 806 I am right in saying that, at the present moment, in this country, among adults, as well as among children, there are more spectacles worn than some few years ago, not for the reason that the eyesight of the people of this country is worse than it was 10 years ago, but it is largely due to the voluntary efforts made by the opticians of this country to improve matters, and they have made a definite attempt to cope with the problem.
While there may be differences of opinion with regard to this Bill as it is drafted, there is little difference of opinion among hon, Members as to the principle upon which the Bill is founded. There may be some matters with regard to the application of this principle to opticians about which hon. Members have some doubt. The same principle is embodied in many Acts of Parliament. We have many State registers affecting dentists, and we have also State registers applied to nurses and midwives. There are, probably, many more State registers than hon. Members are aware of, and it is a principle that has been accepted, and has been in operation with regard to some other professions for a considerable time, and has met with considerable success. It would appear from the Amendments on the Order Paper, that some hon. Members are in doubt as to whether that principle which has been applied in the case of dentists, midwives, nurses and architects, is a kind of principle that ought to be applied with regard to the profession of the opticians.
I desire, as briefly as I can, to present to the House the grounds, as I see them and understand them, upon which the opticians claim to be registered in this country. What is it exactly that constitutes a fit and proper subject for registration? What is it exactly that makes a profession or a craft a proper subject for the application of this principle of registration? There have been many discussions in this House in regard to this principle, with the result that hon. Members have been left with some considerable guidance as to how the question should be approached. I will suggest one or two considerations. For example, if it can be shown that the work of the profession affects the welfare of the country to such an extent that it is a matter of public importance, that is a relevant consideration. If it can be shown that a certain standard of qualification, 807 skill and knowledge is a matter of public interest, that, I think, is a relevant consideration. If it can be shown that such a standard of qualification and skill can only be maintained provided those practitioners are prepared to give a considerable time to specialisation, and if it can be shown that such status and powers for the optician as may be given to a body governed by such registration as is asked for in this Bill, will work to no disadvantage to any considerable section of the community, that, also is one of the considerations which hon. Members might well have in mind when considering this question.
There is, perhaps, one other consideration. Some three weeks ago this House discussed a Bill for the registration of architects, and that Bill received its Second Reading without a Division. There were some hon. Members in all quarters of the House who opposed that Measure, among them the right hon. and gallant Gentleman the Member for Newcastle-under-Lyme (Colonel Wedgwood). The right hon. and gallant Gentleman is, as we all know, pledged to oppose all private legislation in this House, especially when it emanates from this side, and, as an individualist, he is opposed to what he described as "these close corporations" He was opposed to the Architects Bill. he is opposed to the Accountants Bill. and he is opposed to the Engineers Bill But he drew this distinction, which I think is of special interest as coming from him. He said that where the public health was concerned, as in the case of dentists and midwives, and he went on also to speak of this Bill, he believed that a case concerning those professions could quite well be made out— that is to say, where the main consideration was the public health. I contend from that that this Bill, on the ground that it touches the public health of this country very materially, should have the support of so great an individualist as the right hon. and gallant Gentleman the Member for Newcastle-under-Lyme. I am sorry that he is not here to-day.
§ Notice taken that 40 Members were not present; House counted; and 40 Members being present— —808
§ Mr. RUSSELL
Before this interruption, I was trying to suggest to hon. Members such considerations as they might well have in mind when considering whether the principle of registration should be applied to opticians. I want now to point out, in the light of those considerations, exactly the field in which the opticians are at present operating. I think it will be agreed that the work of opticians, and the effect of it on the welfare of the country, is indeed a matter of national importance. I sometimes wonder if it is fully appreciated exactly what is the state of things in this country at present with regard to the eyesight of the people. Only the other day I took a cutting from a paper in which reference was made to the work being carried on by a council in this country for the preservation of the eyesight of the people, and it gave some statistics which, to me at any rate, were extraordinarily striking. It is said on very good authority that at the present moment something like 15,000,000 people in this country, or about one-third of the population, are labouring under a measure of defective eyesight; and, on statistics which, I believe, are vouched for, there are in the industries at the present moment some 4,000,000 people at least suffering from short sight, disease of the eye, or some defect of eye construction; while in a report last year by the Board of Education, it was stated that in that year alone something like 16,000 school children were treated for squint. According to this cutting, also, there is a high percentage— something like 24.8 per cent.— of school children suffering from defective sight. In these figures we have it suggested how grave a problem defective vision presents to us at the present moment.
Who, exactly, are coping with that problem? Until recently, extraordinarily little was done, and what has been done has been by the voluntary enterprise and effort of the present Opticians' Council. I will ask hon. Members to consider, not only what has been achieved by these councils, but exactly the way in which they are going about their work. They recognise that it is a matter of great national importance that we should have a body of skilled men with a standard of qualification, with the result that we have in the Council of the British Opticians 809 and in the Council of the Worshipful Company of Spectaclemakers a registration of something like 3,500 opticians of whose qualifications some guarantee is given. Their course for training and preparing entrants to this Council is a very severe course indeed, a training which enables opticians not only to test the eye and to provide the spectacles that are necessary, but also to equip them with a knowledge of the construction of the eye and of the matters pertaining to it. The education that is training this useful body of men to deal with the problem of defective eyesight is being carried on by these voluntary associations— there are others, I daresay, but these for the most part.
There is another aspect of this question which is of very great importance. Under National Health Insurance there is what is known as ophthalmic benefit. In 1923, when it was first provided, the position of the approved societies was very perplexing. There was no body to administer it, and it was at that time that the Joint Council of Qualified Opticians was brought into being. It was through them that we were able to provide the approved societies with a body of qualified men who were able to carry out the work made possible by this benefit, and in 1922, by way of indicating the progress that has been made in the years since then, there are these very striking features. In 1923, something like £ 3,000 was spent on ophthalmic benefit; in 1924, — 17,000; in 1925, £ 24,000; and in October, 1926, there has been spent something like £ 63,000. That benefit was administered by the Joint Council of Opticians. This is a discretionary and not a Statutory benefit, and one over which the Minister of Health has no control whatever. In the first five years of the National Health Insurance, the surplus for distribution as ophthalmic benefit was something like £ 32,000 a year. There has been a second valuation and, according to that, there is a distribution of something like £ 420,000, and when you take that distribution for some five years you have no less a sum than £ 2,000,000 distributed for ophthalmic benefit. The position at the moment is that there is no real authority established by law for the control and direction of that £ 2,000,000, but, sooner or later, it must come about that somebody, such as it is hoped will be created by this Bill, 810 will be brought in to co-operate with the Minister of Health for the distribution of that ophthalmic benefit. This Bill is to register qualified opticians. There is a very complete register of something over 3,000 members, and even this body already exercises very considerable disciplinary powers over its members. Here is a body which is purely voluntary, but whose work would be infinitely more effective, with resulting benefit to the State as a whole, if something of the status was given to opticians that has been given to dentists and other bodies of that kind.
There is, of course, some opposition to the Bill, and there are two main quarters from which it is coming. There are the unqualified opticians. Who are these unqualified opticians? They are, first of all, those who make no attempt at sight-testing, but simply provide spectacles without any prescription. There are a large number of quacks and vendors of spectacles who have neither the apparatus nor the ability to test sight, and naturally there is something of a vested interest there which would be affected by the Bill. Then there are a large number of opticians who are not qualified, but have had a long experience in this kind of work and who might have difficulty in satisfying the tests by examinations that are suggested in the Bill. But there is nothing prohibitive in the Bill. There is nothing to hinder anyone who is carrying on the work of an optician from doing so. All it will do is to enable the public to distinguish between men with regard to whose qualifications some guarantee is given by this responsible body, and opticians whose qualifications cannot be vouched for by a responsible organisation. There is in the Bill power suggested to be given to this body to consider each case on its merits, and though certain unregistered opticians may not be able to pass the necessary examinations, still, it is not, by examination alone that their claim for registration will be decided. While the Bill will tend to eliminate all quacks and mere sellers of spectacles, who constitute a very considerable danger, it will, at the same time, he able to create and register a body of men with a standard of qualifications and able to give a guarantee to the general public that these men have the qualifications for such work as sight-testing and spectacle-making.
811 The most serious opposition to the Bill comes, as one would expect, from the medical authorities. As I understand their opposition, it is that a Bill of this kind would give to opticians a status that would rather suggest to the general public that the registered optician was capable and qualified to deal with all matters concerning the eyes. One is well aware that defective eyesight comes under three heads. There is the defective sight that is due to some construction of the eyes, and that can be readily remedied by the provision of glasses. There is the defective sight that is due to some disease or trouble within the eye itself, and there is also the defective sight and the error in refraction that is due to some trouble that is not centred in the eye at all, but is somewhere in the constitution. But the curious thing is, that of this defective eyesight 95 per cent., it is said, is due entirely to error of refraction arising from some construction of the eye and only 5 per cent. is due to some disease, or arises from some other cause.
As I understand the opposition of the medical authorities, it is that the danger within that 5 per cent. is so great that while you might have a highly-qualified optician able to test the eyes and prepare a prescription for glasses and to provide the glasses, he has not had the training necessary to enable him to diagnose any trouble that may arise either from disease of the eye or some other weakness in the constitution. I want to suggest in regard to the very small percentage of cases in which this danger is rife that hon. Members who have given study to the training and education of opticians will realise that, while it is true that an optician may not be able to diagnose the disease of the eye or diagnose what is the source of the eye trouble, his training is such as to enable him to detect it. It enables him to realise and to see cases that are not cases to be dealt with merely by spectacles, but cases that are to be passed on to some medical authority. And hon. Members must bear in mind, that at the present moment a great deal of this— most of it— is being done by opticians, and not by medical practitioners.
812 12.0 n.
What is the practice in regard to Health Insurance? It is quite true that it is necessary for the panel doctor or for the medical doctor to give the letter which will authorise the provision of this ophthalmic benefit, and I venture to think that in the vast majority of cases it is only a letter, not prescribing what is necessary to be done, but simply authorising a person to go to an optician to have his eyes tested and to have glasses provided accordingly. So that it is the practice at this present moment. I dare say there are many who are of this opinion that, although the general knowledge of medical practitioners is very great, it is doubtful whether, as compared with the specialised knowledge of the optician who is dealing with these cases from day to day, he is better fitted to deal with those cases than the optician. The point which I wish to lay before the House is that this Bill will do little more than regularise the practice that is going on at the present moment. It is a Bill which gives authority and status to the Opticians' Council that exists at the present time.
I quite realise that in moving the Second Reading of this Bill, we are in some difficulty. I do not know that there is any precedent for the position in which the Bill finds itself at the present moment. There is, as hon. Members are aware, a Departmental Committee sitting to inquire into the merits of this Bill. I do not know what my hon. Friend the Parliamentary Secretary to the Ministry of Health will say in connection with this matter, but I would say this: It will be a mistake, and unfortunate, if the time that is devoted to the Second Reading of this Bill is altogether lost. I hope when my hon. Friend rises to bless the Bill, as I hope he will and advise the House to give it a Second Reading, the position will be that the control of the Bill before it gets to the Committee will be in the hands of the Government. I hope that by that time the Departmental Committee will have reported. If, after the Bill has obtained a Second Reading, we can have the Report of the Departmental Committee available, it will be a considerable advantage during the Committee stage. I have tried to present, as best I could, the claims on 813 which the Bill is based, and I hope the House will see its way to give it a Second Reading.
§ Mr. ROY BIRD
I beg to second the Motion.
I should like to congratulate my hon. Friend on having covered pretty well the whole of the subject, and on having made such a strong appeal to the House to give the Bill a Second Reading. My hon. Friend referred to the Council as being formed of the organisations interested in the promotion of this Bill. Perhaps the House would like to know something of the credentials of these organisations who have made it their business for some years to look after their own interests as opticians and the interests of the public. There are two organisations, the British Optical Association and the Worshipful Company of Spectacle Makers. The last mentioned company is one of the Ancient City Guilds, who have done so much in charity and so much in connection with the education of our people. The Spectacle-makers' Company have specialised in teaching their members, and those who are not necessarily liverymen of that company, the practice of optics.
These two organisations have joined together in forming the Joint Council of Optical Practitioners. That Council was formed in the circumstances to which my hon. Friend referred, but I would like to go back a little more into the history of these opticians, so that the House may realise that they are worthy of some reward. I will go back to the time of the war, when the British Optical Association were requested by the War Office to take over the spectacle department of the Army. Not only did they take over the spectacle department of the Army, but they formed centres at home and on all the fronts, which were placed in charge of qualified opticians, who had been examined by the British Optical Association and passed by them as, qualified to take charge of a centre. It may be of interest to the House to know that these men who were in charge of the centres not only dealt with spectacles and with sight, but in many cases they administered drugs, without medical supervision. We shall hear from hon. Members who have medical qualifications something with regard to the use of drugs; but it is a fact that during the war the opticians who were in charge of 814 these centres at home and on the fronts did administer drugs.
It has been explained how these two bodies formed the Joint Council of Optical Practitioners. My hon. Friend referred to the number of registered members of that body as being well over 3,000, but he did not refer to the number of medical men who appear on the Register of the British Medical Association as ophthalmic surgeons, or those who have some special qualification to deal with the eyes. The number who do appear on that register is comparatively small; only 700. That 700 has to be sub-divided, because only about 25 per cent. are what one would really describe as ophthalmic surgeons. Fifty per cent. of those on that list are members of the medical profession who do not specialise in the eyes, and diseases of the eye, but who at some time have held an appointment or, possibly, have written a paper dealing with the eyes. The remaining 25 per cent. have no special qualification to deal with the eyes or, perhaps, I should say that they have no special qualification which is shown in the Medical Register.
Let us take that number of 700, and try to realise what is the claim of the medical profession and what it means. They say that 700 men can deal with the whole eyesight of this country. Some very interesting figures were given during the inquiry of the Royal Commission on National Health Insurance as to the distribution of these medical men over England. It is interesting to take one of the appendixes which was put into the evidence and see how these ophthalmic surgeons are distributed in a certain number of specified towns. In 358 towns there were only 397 qualified ophthalmic surgeons practising. If we take ten towns in the list which are health resorts and ten towns which are industrial centres we find that there is a very small number of ophthalmic surgeons in the industrial centres, and that they are congregated either in the West End of London or in the big provincial towns or in famous health resorts. Therefore, the medical profession are claiming, if they do claim, to do what is a physical impossibility, that is, that their members who are qualified as ophthalmic surgeons should look after the whole community. In a great many towns there is no ophthalmic surgeon at all, but there are 815 qualified opticians. In the towns to which I have referred where there are only 397 medical men who are ophthalmic surgeons, there are, approximately, 2,500 qualified opticians, and I suggest to the House that that is a very material consideration for them to have in mind when they are considering what should be done in this matter.
We are in the same position that the country was in when my hon. Friend the Parliamentary Secretary to the Ministry of Health was busy in connection with the Dentists' Bill. I have turned up an article which he wrote in the "Daily Mail" at that time, and he put it in this way:The question to-day is neither the quite proper sensitiveness of the qualified dentist, nor the livelihood of the unqualified. It is the broader issue of the welfare of the community as a whole.He went on:Now, in spite of a situation which it is no exaggeration to call critical, the number of dentists per million of the population has, over a period of 40 years, actually decreased from 155 to 177. The aim of the Dentists Act is to reverse that process, to increase the number of competent dentists, and gradually weed out the others.Then the hon. Member goes on to speak of some of the quacks who are acting as dentists, and he says— —
§ The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Sir Kingsley Wood) indicated dissent.
§ Mr. BIRD
I understand he does not disclaim it. He says in this article:True, it does, with these exceptions, temporarily accept unqualified men; and for this plain reason, that to-day the country's teeth demand greater attention than the combined battalion of qualified and unqualified practitioners can give them. The Dentists Act is essential if the British nation is to be stopped from digging its grave with its teeth.816 I hope when my hon. Friend gets up to bless this Bill, that he will say that eyes are really more important than teeth. You can, I am informed, replace teeth, but if you are unfortunate enough to lose your eyes, you cannot replace them. It is essential in the interests of the community that opticians who hold qualifications should be labelled by being placed on a state register. Only yesterday I walked into a well-known store in this country, and I observed glasses for sale at 6d. a pair. I invested 1s. 6d. in buying three pairs, and after testing my eyes with a board on which were various sizes of writing— —
§ Mr. RHYS DAVIES
Can the hon. Member tell us where these glasses were manufactured. Were they manufactured in this country?
§ Mr. BIRD
I am afraid I cannot tell the hon. Member where they were manufactured; they are certainly cheap and nasty. But a great many people wear them. A charming young girl was behind the counter, and she was wearing glasses. I asked her whether she got hers from the shop, and she said "Oh, no. I should be blind by the time I am 30 if I wore those." That is not much of a recommendation for the spectacles sold in the store; and I am told by an optician friend that if anyone wore these glasses they would cause blindness at quite an early age. This Bill, unfortunately, does not go far enough to prevent this. It is not a prohibitive Bill, it is a permissive Bill, and I should have been happier in supporting a measure which would have prohibited the sale of glasses or the testing of eyesight by quacks. I would have liked the Bill to have set up a register of opticians fully qualified, who would not endanger the community.
The Bill itself does not want much explaining, because, although it appears to be rather long, there are not many operative Clauses. Clause 3 provides for the establishment of a register, and enables those who are qualified to be placed upon it. I should like, however, to draw the attention of hon. Members to paragraph (b) of this Clause, because it meets the case put forward by the Opposition to some extent, and deals with certain opticians who are not qualified, according to the standards in the Bill, but who, at the same time, have some 817 sort of qualifications. It says that those opticians who satisfy the Board that they have been engaged in the practice of optometry in Great Britain during a period of five years next before the commencement of the Act, and who pass to the satisfaction of the Board's examiners a practical examination in optometry, which is deemed by the Board to be sufficiently comprehensive to safeguard the public, shall be placed on the Register.
It may be difficult for a man when he gets to a certain age to pass a written examination, but it is not so difficult for a man who has been practising for many years to pass a practical examination, and if one of these unqualified opticians is not capable of passing a practical examination in optics to be set by the Board, he should not be entitled to be labelled and placed on the register as a qualified optician. There is a right of appeal which I commend to my hon. Friends who are members of the medical profession. Under Clause 13, anyone who is aggrieved, who does not like a decision of the Board refusing him permission to go on the register, or removing his name from the register, has a right of appeal to the High Court. The constitution of the Board is provided for in the Schedule, and hon. Members will see that it is not to be selected by opticians themselves, but is to be nominated by the Ministry of Health. That will secure that the first Board is properly qualified, and will represent not only the opticians but also the Ministry of Health, the General Medical Council, the Scottish Board of Health and the Board of Education. I know there are other Members who desire to speak, and as the Mover of the Second Reading dealt with the matter very fully I only want to say in conclusion that I hope the House will give this Measure a Second Reading. It will be a Measure of protection to the public, it will be of great assistance to the Ministry of Health, approved societies, and all local authorities, and it will be some measure of award to those opticians who have done so much by theoretical and practical study to improve themselves, so that they can preserve the eyesight of the public which, after all, is its most priceless possession.
§ Dr. VERNON DAVIES
I beg to move, to leave out from the word "That" to 818 the end of the Question, and to add instead thereof the wordsthis House declines to give a Second Reading to a Bill— the subject-matter of which is at the present time being investigated by a departmental committee.In moving this Amendment, may I say that hon. Members associated with me do not for a moment deny the right of this House to consider any Bill which may be brought before it, irrespective of whether it has been considered in another place or not, but we feel that it is right we should place before the House certain facts in connection with this Bill and point out the disadvantage of coming to any very definite opinion upon a subject which is at the present moment, so to speak, sub judice. We are emboldened in this attitude when we remember that there are two hon. Members of this House who are sitting on that Committee. The proposal that we have to make is not really to examine the Bill Clause by Clause, but to show how in our opinion it is a bad Bill and impossible to work, and to be allowed to put before the House certain facts which may enable hon. Members to form some sort of opinion on the Bill. The House has to bear in mind that within recent years there has been rather an epidemic of applications for registration by organisations or societies of practitioners. We have had the osteopaths. We had earlier in the year the architects, whose Bill has been referred to a Select Committee. Now we have the optical practitioners. As soon as any Bill like this is brought forward, we are surprised to find the number of organisations and people who in one way or another are affected by any Bill providing for registration. It has brought very forcibly to my mind the well-known couplet:Big fleas have little fleasUpon their backs to bite 'em,Little fleas have lesser fleas,and ad infinitum."We find that there are numbers of these organisations, bodies of men of superior or less attainments, some larger in numbers than others, and yet one's great difficulty is to find out who or which part of the organisation is the "big flea." That is the difficulty that we have to face in relation to this Bill. We have been informed by the Mover of the Second Reading that the promoters of the Bill were the Joint Council of Qualified 819 Opticians, which really consisted of the British Optical Association and the Spectaclemakers' Company. One of the first things that the promoters have to prove is that they are qualified and competent to speak for the whole of the profession; secondly, that their status is recognised in the profession and that they are voicing the wishes of the great bulk of the profession. I find from information that has been given to me and from information which has been given to the House to-day, that this Joint Council of Qualified Opticians consists of a little over 3,000 members. Yet there are 30,000 persons in the United Kingdom who obtain the whole or part of their living from practice as oculists. Therefore the 3,000 to 3,500 are a very small proportion of the total number. I find that the organizations which hold examinations and grant certificates are the College of Opticians, the National Association of Opticians, the Institute of Chemist Opticians and the Joint Council of Qualified Opticians. The Institute of Chemist Opticians, very unfortunately or presumptuously, say that the Joint Council of Qualified Opticians has no right to speak for the rest of the profession. They even go so far as to say that they themselves are the only qualified people by Statute among the lot and the only people who have passed a Statutory examination. It seems to me that the Council have assumed that they are the leaders of the profession, that what they require should be granted, and that they are competent and authorised to speak for the whole of the profession.
§ Mr. ROY BIRD
I think the hon. Member mentioned the National Association of Opticians. They are supporting the Bill.
§ Dr. DAVIES
I have so far referred to one organisation disapproving of the Bill, namely, the Institute of Chemist Opticians. They are 5,000 in number. These points do not, or should not, interest the House very much. We have to look at the matter more or less from the point of view of public utility. Is there a need for a Bill for the registration of opticians? If there is a need are these the proper people to bring the proposals forward, and is it in the public interest? I think 820 I have indicated that the promoters of the Bill have not the unanimous approval of the profession. We have heard a great deal this morning about the qualifications of these gentlemen. Yet we have not been able to get very much information as to what the qualifications really are, or who decides as to the standard for the examinations. Is it simply that the Joint Council make their own standard and grant their own diplomas? The subject is necessarily of very great importance, because we are dealing with the eyesight of the nation, which of course is of the greatest importance. When the Mover of the Second Reading referred to the United States as the most spectacled nation in the world, I could not help thinking of a remark made to me by an ophthalmic surgeon of very long experience who is now retired. He said that he never in his professional life knew any patient to go into a spectacle shop and come out without spectacles. It is quite possible that in America there are large numbers of people wearing spectacles who really do not need them. But as the hon. Member who seconded the Motion for the Second Reading mentioned, the principal opposition of the Bill probably comes from the medical profession. The medical profession has adopted a very definite attitude on the subject. It says that the eye is an important organ, that training for the treatment of eye diseases calls for special and prolonged study, and that even when a man is qualified, if he wishes to practise as an eye surgeon, he should after qualification undertake special work in connection with the eye.
§ Dr. DAVIES
I am speaking largely from memory. He undertakes a course of lectures, and in my time I had to make 30 practical attendances at the hospital. But I did not practise as an ophthalmic surgeon. To do that I should have been compelled after graduation to take a special course in the eye, and should have had to hold a position as House Surgeon in an eye hospital. It will be found that practically all the ophthalmic surgeons in this country have had extended post-graduate training as house surgeons in eye hospitals. One argument used to-day was that this Bill 821 would do little more than regularise what is the present practice. I differ from that. A body of unqualified men with a certain amount of training, which may be limited or otherwise, are asking for State approval of their profession by the grant of registration. If they are successful, it means that the public will say, "These gentlemen are registered opticians; they have received the approval of Parliament, and, there fore, they must be competent to eximine and treat eyes." That is a position which cannot be maintained. I find that one college gives its degree or diploma for 50 hospital attendances, of which 25 at least must be devoted to the anatomy, physiology, and pathology of the eye. These three important scientific subjects connected with the eye have to be learned in 25 lectures. We as medical men say that is an absolute impossibility, no matter how clever the student or how expert the lecturer. It is impossible to give any man adequate training in these subjects in such a short time.
§ Dr. DAVIES
Possibly, and if a Bill were produced which merely set out definitely what the qualifications and training were to be, it would have an additional claim upon the attention of the House, but this Bill is vague and impracticable. The suggested board is to consist of 12 members, one of whom is to be nominated by the General Medical Council. I do not think for a moment that the General Medical Council would nominate a member. I think it would be without their jurisdiction. Eight members are to be members of various optical societies probably chosen by this joint board, but not giving any of the other organisations the right to be included. In two or three years, probably, the whole registration would get into the hands of this small joint council, to the detriment of the rest of the profession.
§ Dr. DAVIES
I do not want to criticise it from the medical point of view. I am taking up the attitude that there is a case for a Bill, but I maintain that those promoting the Bill are going much too far 822 when they claim that these opticians by their training are not only able to deal with errors of refraction, but also to detect any disease in the eye. There I join issue with them. I do not think the training which they get is sufficient to enable them to detect all kinds of diseases, and, from that point of view, as a medical man, I differ. But there is, undoubtedly, a place for the optician. We know it has been the practice for a long time for most patients to go to these gentlemen to have their eyes tested, and I believe that 90 per cent. of the eyes examined have no disease at all. It might, however, happen in some ease among the remaining small percentage that spectacles would be given to a man or a drug would be put into his eye which would do irreparable damage, and that is the point which this House ought to consider. The importance of the subject is increased by the fact that optical benefits are given by the approved societies, and the Minister of Health has to be certain that the insured people are getting efficient optical benefit with the minimum of danger. Money is being spent by the State and by the people themselves, and the approved societies naturally want to see that they are getting the best results for their money. I think the great difficulty has been the shortage of ophthalmic surgeons and the very high fees that are charged— fees which no approved society and few insured individuals can afford to pay regularly.
The point to which this House might devote attention is whether there is no scheme whereby the claims of the doctors and of these opticians can be met. I say at once, that if the optician were to be satisfied with the purely refractive work there would not be a word to say against it; but the difficulty is that they claim to be able to detect disease and to send on any case of disease for medical treatment. But will they send on such eases? A young man who thinks he knows his work very well may come across a case of inflammation of the eye and may recommend the patient, in the first instance, to go to a medical man but if the patient says to him, "You know all about this. Cannot you do something yourself?" he may very well agree and treat the ease. They do treat such cases— chemist-opticians particularly— and there will be the temptation for an ambitious young man, anxious to get on, 823 to undertake a little more work than he ought to undertake and some day there will be an accident. If this council could be assured that their Members would only do the refractive work and nothing else, then I think it might be all right, but as long as they claim to be capable of detecting any form of disease in the eye which may be due to local conditions or general conditions, they are taking a stand which they cannot justify, which the Minister of Health ought not to approve of and to which I would not advise the approved societies to assent. The hon. Member for the Scottish Universities (Sir George Berry) who is an expert ophthalmic surgeon will probably tell the House from the medical point of view of the many dangers which are inherent in the present Bill. From the point of view of the benefit of the public and the necessity of safeguarding their interests and of seeing that thet best return is obtained for the money spent in optical benefit, I ask the House to refuse a Second Reading to the Bill until the Select Committee has reported.
§ Sir GEORGE BERRY
I beg to second the Amendment.
I do so, not because I have any personal interest in the matter, or any axe to grind, but because I am convinced that legislation on the lines proposed in the Bill would not be in the interests of the public. I admit at once that there is no reason why the public should not be assured of the services of properly qualified opticians. In some way or other the public should be able to discriminate between the skilled optician and the less qualified or unqualified vendor of spectacles. As matters stand at present, there are these different societies which have been mentioned who examine their members, and from whom the members get the right to put certain letters after their names which indicate that they have undergone a proper test according to the requirements of the society. I think that ought to be sufficient in the public interest.
The need for optical benefit is now very much better realised than it was a generation or two ago. At that time spectacles were considered to do harm to the eyes, and on that account, even if they were required, were not used. Now the pendulum 824 seems to have swung rather in the opposite direction, and spectacles, however unsightly and for which there may be only the flimsiest pretence of necessity, are worn by a great number of people. We have just heard, for instance, of the very much bespectacled people of America. As I say, it was supposed at one time that spectacles did harm to the eyes, but there never was any real justification for that belief. Now the contention of a number of opticians is that, unless there is suitable correction of optical defects, more or less serious damage may be done to the eye. Let me tell the House that in my experience, which is fairly considerable, I have never known a case where spectacles, however unsuitable, did any serious harm to the eye at all. I mention that because the Seconder of the Motion for the Second Reading referred to the possibility of people becoming blind by wearing spectacles which cost 6d. instead of 6s. or a good deal more. That is an impossibility. It is an exaggeration. There is such a thing as a considerable amount of discomfort being caused by unsuitable spectacles, just as there is discomfort produced by wearing non-fitting boots or a non-fitting dental plate, but to say that there is any actual danger of serious injury to the eye is an exaggeration.
§ Lieut.-Commander BURNEY
The hon. Member has so much knowledge of this subject that I would ask him whether it would be true to say that, if unsuitable spectacles were given to a person to correct, say, astigmatism, and he wore them for a year, they would not increase the defect from which he was suffering?
§ Sir G. BERRY
Without answering that specific question, I do not agree that it would do any harm, but I would like to put the view before the House that, although spectacles, even if unsuitable, do not do harm, if they are suitable, they are capable of doing a great deal of good. In that way you can cure squint and double vision, you can prevent headaches, and you can, to a certain extent, arrest actual diseases of the eye, so that while the negative effects of wearing spectacles are negligible, the positive effects are, on the other hand, good, and that, to my mind, is the justification for the public having the services of skilled opticians. That, however, does not 825 justify, in my view, the legislation which it is proposed to introduce by this Bill— it does not justify going any further— for the simple reason that it is calculated to mislead the public to arouse in them a mistaken and, therefore, undesirable degree of the sense of security. The public cannot generally discriminate between ophthalmic benefit and optical benefit. Ophthalmic benefit is very much more comprehensive, even if we accept the definition of the term optometry which is given in the Bill. Real ophthalmic benefit can be got now, as has been pointed out, because under the National insurance Act some of the friendly societies are referring their members to ophthalmic surgeons whose names have been given in a list from the Ministry of Health. Consequently, the real ophthalmic benefit is available.
I can corroborate what has already been said about the natural inference that the public makes when it is known to be the fact that such a large percentage as 95 per cent. of cases of eye trouble are cases of only optical defect, but the inference from that is that the trained optician is likely to be able, by the selection of proper glasses, to do all that is necessary for the individual. In point of fact, the skilled optician is perfectly competent to undertake the correction of optical defects. That is a very simple matter, and it is simple for this reason, that it is a matter which has been investigated by physicists, physiologists, and ophthalmic surgeons, and it is a matter of skill, which can be acquired in a few weeks or months, but the point of real importance, which has already been referred to, is that the eye is not only an optical instrument, one which, curiously enough, is less perfect in some respects than the instruments which are produced by human ingenuity, though in other respects, of course, it is more perfect than anything which exists, but the eye is also a percipient sense organ of most complex structure and functions, and it is also associated with other organs of the body. It is for that reason that the eye is subject to so many defects and diseases.
Where failure of the sight is complained of, it means not only that there may be an optical defect, but that there may be disease, either local or intimately associated with some deranged functional activity or disease in other organs. The 826 optician, as has been said by the Mover of the Amendment, may be able to know of the existence of these diseases, and he may be able, perhaps, to discriminate in some cases between defects due to diseases of the eye and optical defects, but he cannot do so without being liable to make a great many mistakes, unless he has had the full training of a medical man. In fact, it is owing to this complexity of the eye that the medical curriculum of the universities and the different licensing bodies requires the student to take up the study of diseases of the eye only in the last six months of the time devoted to his studies. Before doing so, he has to study physics, physiology, pathology and medicine, and it is only on completion of these studies that he is able to understand their bearing upon functional or organic diseases of the brain, the spinal cord, and the sympathetic nervous system. Even then, the doctor who wishes to specialise in ophthalmic surgery has to undergo a very considerable supplementary training both theoretical and practical. The well-qualified optician's work is excellent and beneficial. But with full appreciation of that work, I nevertheless feel confident that it would be wrong to proceed with the Bill for the institution of a registered body which would not only create a monopoly but, by doing so, would give a false impression of security to the public. For these reasons, in addition to those which have been given by the hon. Member for Royton (Dr. Davies), I beg to support the Amendment.
§ Mr. BARNES
I would like to support the Amendment, but I must confess that I do so for entirely different reasons from those which have been given by the hon. Members who have just spoken. I do not profess to be able to give any view with regard to the different sections of the great professions which are interested in this Measure. I wish to approach it from a rather wider ground than that of professional interest. I think every hon. Member will agree with the declaration of the hon. Member who moved this Bill, that the purpose of this Bill, and of similar Bills which aim to give a standard of service to the community, or to raise the qualifications of any trade or profession, should have the support of hon. Members on all sides of the House. Certainly the organisation for 827 which I can speak, the co-operative movement, places that in the forefront. We believe that the interests of the consumer, or the recipient, of services should be the primary governing consideration; that, whether the person is a butcher, a carpenter, a doctor or a solicitor, all those services should exist for the purposes of consumption, which represents life and living. From that point of view, I certainly support strongly and enthusiastically the principle that we should strive, by setting up standards of qualification in all phases of life, to improve service. I think that is essential in regard to eyesight, because I believe there is no physical defect that is so tragic as the loss of eyesight. The general statement would apply, from my point of view, even from a sentimental consideration, even more strongly to this particular Bill. But, having stated that, I cannot overlook the fact that very often there is an attempt to promote this object which eventually does not serve the object at all. It merely leads a profession into the status of a close corporation, and that is the point I want to emphasise in relation to this Bill. It appears to me that Parliament and the public are not giving sufficient consideration to the rapid tendency which has developed in the post-War period, on the part of a number of professions, to seek privileges that really place them in the category of close corporations.
While I am not opposed to this Bill, or to any similar Bill, such as the Dentists Bill or the Architects Bill or others of a similar character, I feel that the time has arrived when Parliament should review this development which is taking place, not in isolated cases such as we have considered, but as part of a broad, general policy in modern life, for the purpose of establishing certain governing conditions. That is the reason I support a proposal that the Bill should be considered by a Select Committee. I would like to go further and see the Government establish a Commission to consider how far these privileges can be given to the profession for the purpose of establishing standards of, conduct and service, but, at the same time, incorporating measures of public control which will prevent abuse. I have no hesitation in saying that, in my view, in regard to the powers of the medical 828 profession, the powers of the legal profession, and the powers given in the Dentists Act and Measures of that description, there is considerable abuse of the privileges which Parliament has conferred.
As far as the co-operative movement is concerned, I would like to put one or two specific points to the promoters of the Bill. In the first place, we go all the way in an attempt to safeguard the community against the practices of quacks. One could apply that in far-reaching directions in other ways, but, keeping specifically to this Bill, we are with the promoters in safeguarding the community against quacks. Again, we believe in the standard of qualification that the promoters intend to promote. In the co-operative movement, we safeguard one or two very important factors We have a drapery department, a grocery department, and other departments, with fully-qualified men. After meeting their requirements in the way of salary or adequate wages— which is another governing condition of the co-operative movement— the mutual benefit that comes from these services we gather up and distribute to the members, as consumers, in the form of dividends. We admit that, whatever standard is necessary in any profession, we must conform to it. We demand than a working-class organisation should have the right to employ a member of one of these professions— if he conforms with the standards laid down for members of that profesion— giving him an adequate salary, in order that the members of that organisation may secure his services on terms of mutual benefit to themselves. We find that we cannot employ a solicitor at a fixed salary as we can employ a butcher, or a draper or grocer.
§ Mr. BARNES
We can employ a solicitor in that sense, but my point is that if a corporate body of working-class people, with tens of thousands or hundreds of thousands of members, desires to give a legal service to its members through a solicitors' department, just as it gives them a grocery service or a drapery service, the payment in each individual case has to be based on the fees laid down by the profession. In other 829 words, all that that organisation is doing is to provide a business for an individual colicitor.
§ Mr. BARNES
My point is that we cannot get the ordinary benefits provided by a mutual aid organisation, because of the rules and regulations laid down by the profession. Why should a bricklayer, a grocer's assistant, a butcher's manager, or the manager of a drapery department, be on a different status from a solicitor and professional men of that class? We are opposed to the development of the principle of individual practice in those professions; it places those in the community who desire the services of those professional men at the mercy of the corporate body controlling that profession. Hon. Members spoke about the tyranny of trade unions and the privileges of trade unions. The few privileges and opportunities that working-class organisations like trade unions have under the law are now being taken away from them by the Party opposite; and many professional men on the opposite side of the House who support the Government in taking away those few privileges are here this afternoon supporting privileges which they deny to trade unions. In these Debates we wish to bring out contradictions of that sort. If it be right for the legal profession to have a standard of fees and a standard of qualifications, I say it is right for a carpenter or for workmen in other industries to be able to establish their standards by law.
Another point I wish to emphasise is that no restrictions ought to be imposed which will close the avenue of entry to these professions to the children of working-class parents. That is a vital point to be considered in connection with Bills of this sort. Whilst a profession does not lay it down in so many words that the avenue of entry shall be closed to working-class children, yet in practice the standard of examination and the courses that have to be taken make these professions the privilege of the middle class.
§ Mr. MELLER
Can the hon. Member name any profession which, by its rules or regulations, prevent or deter any boy 830 or girl from an elementary school, from having full opportunities to enter the profession?
§ Mr. BARNES
I stated specifically that it is not in the rules and regulations that this barrier exists.
§ Mr. MACQUISTEN
Surely the hon. Member must know of distinguished men in all professions who have sprung from every line of life.
§ Mr. BARNES
If I did not state it clearly at first, I desire to make it clear now, that I do not say that the rules and regulations embodied in Bills of this description are the hindrance, but that in practice, on account of the standard fees and other factors established by such legislation, it becomes increasingly difficult for children of the working classes to enter these professions, and it becomes increasingly easy for the professions to become more or less the preserve of what may be described as the middle class. In many of their departments co-operative societies employ qualified persons from certain professions, and children of working class parents can in that way find an entry into the profession without any fees and without any charges, and at the same, time get wages. Many working class families could not possibly send their children into a profession of this sort unless the child were able to earn a small wage towards meeting the expenses of the home; and in these departments, limited in number though they are, an opportunity is provided for the flow of working class children into professions of this sort.
While I do not say it is the intention of the opticians to develop their profession on those lines, I think it is desirable that these points should be made in this Debate, in order that this point of view should be brought to the attention of the Government and the Members of the House. While the purpose of the Bill is right, and while, from the public point of view, we have a responsibility for seeing that the consumer gets what he pays for, and is not left at the mercy of quacks and frauds, there is a corresponding obligation upon Parliament to see that out of the privileges we give abuses are not allowed to develop.
§ Mr. MELLER
I want to support the Bill. I do not think it is necessary to go over the details which have been put before us so fully and fairly by the hon. Member for Tynemouth (Mr. Russell), nor do I think it is necessary to discuss it very much from the medical point of view. Two hon. Members of the House who are members of the medical profession have spoken with very great fairness. If I understood their criticism aright, it is not that they object to the setting up of a body of persons who shall have some standard which is easily recognised and is a protection for the public, but that they fear that if we once set up a body such as this, if we give recognition to opticians, there is a danger that the opticians, having thus acquired a certain official status and recognition, will exceed the powers which they are seeking in this Bill, and will do something which is likely to prove dangerous to the people as a whole. That is a fair and reasonable criticism. If I thought this Bill was the outcome of a desire on the part of opticians to perform work which to-day is properly performed by the surgeon oculist I should oppose it at once; but I do not believe that is the intention behind the Bill.
The promoters of the Bill have had to survive pretty close and fierce criticism before they could bring this Bill forward at all. It has had to be subject to inquiry, and at the present moment a close inquiry is being made into those claims. I am sure the Minister of Health is not willing to give his blessing to a Bill of this kind unless he is satisfied that the ultimate result is going to be to the advantage of the public as a whole. I am sorry we have to discuss this Bill without the advantages which would accrue from the recommendations of such a body as has been referred to. I think, however, that we ought to place before the House the views which we believe to be right in regard to this particular Measure. I think this Bill can only be considered in relation to the actual facts and circumstances under which optical advice is given at the present time. What has been the real practice for many years past? We are told to-day that there are very few skilled ophthalmic surgeons in the country, and that there is a totally insufficient number of them to meet the requirements of the mass of the people who require optical treatment. 832 Generally speaking, owing to the development of National Health Insurance and other provisions, it can hardly be said that poor people cannot obtain medical advice because they cannot afford to pay for it. The practice is that a person goes to the doctor and says, "I am troubled with my eyes," or "I have a headache," or something of that sort. Of course the medical practitioner is not as well qualified to determine whether the trouble in the eyes is due to some disease of the body, some error of refraction, or some trouble in regard to the organ about which he has been consulted.
We have been told that the amount of instruction which the ordinary medical practitioner gets with regard to the 'treatment of the eye is comparatively small. It is true this subject comes within his period of training, but the instruction given is something considerably less than that which is given by one or two institutes who are now dealing with the question of examinations on this subject in order to determine whether a man should obtain the certificate issued by the two bodies which have been mentioned in this Debate. The medical practitioner, generally speaking, is less qualified in this respect than one of these opticians, unless he is a member of the Joint Council of Qualified Opticians, and he has obtained their certificate. In the majority of cases, the doctor gives a certificate to the effect that, in his opinion, the patient requires ophthalmic treatment, and when you inquire on what grounds the doctor has based that advice, you probably get no answer, or it will be to the effect that in the opinion of the doctor the person claiming is suffering from some trouble it the eyes, and should be seen by an ophthalmic surgeon who is the only man capable of dealing with that complaint. Certainly before the introduction of National Health Insurance, the practice in this country was very largely that if a man approached a doctor he would recommend them to see a certain optician, and unless the patient had the means to go to an ophthalmic surgeon, and unless he thought there was something seriously wrong with his eyes which required an ophthalmic surgeon, he would go to an optician for treatment.
The opticians have done very well, certainly of late years since those organisations have been set up providing 833 examinations and tests as qualifications for opticians, and since then probably less errors have been committed than before. What does this Bill propose to do? What is the main object behind it? I think it has been said that one of its objects is to safeguard the public. The hon. Member for Tynemouth (Mr. Russell) said the object of the Bill was little more than to regulavrise what is going on at the present moment. What is going on now is that there is an increase in the number of persons who are coming forward and asking to have their qualifications tested, and who desire to obtain the certificate which this Bill gives. That is a further safeguard to the public. What this Bill does is what was done under the Dentists Act, under which you had a number of persons who were qualified to act as dentists, together with a number of persons who were brought in who were acting as dentists but who were not qualified by examination. Those persons who came in under the Dentists Act, 1921, and were not qualified dentists, had to satisfy the Board that by their experience and by the recommendations of qualified dentists practising in their neighbourhood they were persons who might safely be entrusted to carry on dental work.
This Bill does more than that. It does not bring in all the persons who in the past have been practising as opticians. It says, "You may go on practising as you are doing, but the public will not accept a man as an optician whose skill and qualifications have not been certified." Such men must submit themselves to some test in order to show that they are qualified, and those who do not do this are the men we have to fear. I think that is a real safeguard for the people of this country. What will happen as a result of this Bill? First of all we shall have a status given to the man who is registered. The public do not always know the meaning of the initials behind men's names, but they will see on the optician's window, "Registered and qualified optician under the National Health Insurance Act," or under the Opticians Bill, and this will convey to those persons who come along for treatment that the optician he is consulting has stood some test in regard to his qualifications. It has been stated in this Debate that the people who are promoting this Bill represent but a small 834 portion of the total number of opticians in this country, and that they are allocating to themselves a claim which they ought never to have made. The Institute of Chemist Opticians— —
§ Dr. DAVIES
What I said was that this was a small body numerically, but I was very careful not to judge their competency in any way, and I was merely speaking numerically.
§ Mr. MELLER
I think the hon. Member said they were the only body holding certificates after examination. Let us examine that point for a moment. What is the certificate of examination? It is a certificate that they are qualified pharmacists, not opticians. One might as well put in a certificate in relation to any other profession, and say that, because a man has passed an examination, not for optical work but for some other object altogether, therefore he is a person who ought to be taken as being of first rank. I do not think my hon. Friend would suggest that for one moment. I think that probably the farthest that he would go would be to say that the chemist is a man who has had some technical training, and is probably better than the man who has merely been trained as a worker.
§ Dr. DAVIES
I think the point is that the chemist optician is the only one who has a statutory examination; but opticians as a whole may pass an examination approved or carried out by themselves. In the case of the chemist, however, it is a statutory examination.
§ Mr. MELLER
Again I am obliged to, my hon. Friend. But the statutory examination for which they sit is not an examination for testing their skill with regard to the supply of optical glasses.
§ Sir BASIL PETO
May I point out that the examination of a chemist in-includes are following matters: Propagation of light; laws of reflection and refraction; photometry; simple properties of mirrors, lenses and prisms; the eye as an optical instrument; correction of errors of vision by means of lenses All that is subject-matter which has to be included in the examination for a qualified chemist.
§ Mr. MELLER
I am surprised to learn that the examination for a qualified chemist is so extensive as my hon. Friend says. I take his word for it. I should have thought, however, that probably that syllabus would include some subjects which a chemist might take, but which are optional. I take it that the main purpose of the chemist is to deal with dispensing, but what does this Bill propose? What is the Board of Examiners which is in operation at the present moment in connection with the institutes that are promoting this Bill, and which is to be continued in similar form if the Bill passes, and if this body is set up as laid down in the schedule to the Bill? It is to include examiners who are themselves ophthalmic surgeons— not outside persons at all, but men who are jealous of their profession and of the standing which they hold in the medical profession, and who are not likely to admit men to compete with them who are going to be a danger to the public and a danger to the practice of their own profession. The Measure, as it has been out lined already, shows very clearly that it is desirable that opticians who are dealing with this delicate organ of the body shall be so qualified and tested that people may with safety look to them for treatment.
Some reference has been made to the position of approved societies, and the development which has taken place in the granting of ophthalmic benefit to insured persons as a result of the second valuation, and I think it is well that the House should know the position of the societies and the attitude the Minister has taken up on this matter. When the second valuation came along, and it was anticipated that there would be a large demand for additional benefits, including ophthalmic benefit, the Minister thought it desirable that there should be published a list of ophthalmic surgeons to whom cases of difficulty should be sent. But he did not withdraw from the societies under his scheme their right to send to opticians cases merely of errors of refraction; and I think that medical men in this House— and we have an eminent ophthalmic surgeon here— would not deny that a really qualified optician is quite as capable of dealing with an error of refraction as an ophthalmic surgeon. Therefore, it was a matter for the 836 societies to discriminate, because it was utterly impossible, having regard to the amount of money at their disposal, that every case requiring ophthalmic treatment should be sent to an ophthalmic surgeon. They have had to rely partly on the certificate of the medical practitioner, and, secondly, upon the skill of the optician.
I speak from a very large experience in this matter, having myself had to deal with some thousands of applications in regard to ophthalmic benefit, and T have tested very closely indeed the advice which has been given by the medical practitioner and the result of the examination by the ophthalmic surgeon; and I am bound to say— and I say it as the result of a wide experience, my claim to which I think no hon. Member will deny— that I am confident in supporting a Measure of this kind. I believe the body which has promoted this Bill has endeavoured in all honesty, and with a desire to improve their profession and to safeguard the interests of the people of this country, to increase and enlarge by means of this Measure a body of persons who are eminently capable of dealing with simple errors of refraction. Further, I believe that these men have been so trained, and are honourable enough, and the advantages held out to them are so great, that they are not likely to err on the side of treating a case of disease in order to get payment for the spectacles.
Hon. Members who know something of the relationship between ophthalmic surgeons and opticians will know that there is very close co-operation between them, and that ophthalmic surgeons to-day rely very largely upon the opticians, as medical specialists rely upon their students in the hospital, to send cases to them. What happens when a man sets up in Harley Street? A plate is not sufficient there; he relics upon the practice which has prevailed in the profession for many years, of students saying, "if you want to see a man as a specialist in so-and-so, my old master is the man to go to." That is the way in which their practice is built up. If the ophthalmic surgeon is satisfied with the way in which his prescriptions are carried out by the optician, he sends eases to the optician, and the optician, in return for the kindness thus rendered to him, sends cases to 837 the ophthalmic surgeon; and the result is very good for the people of the country as a whole. The optician is not going to risk his reputation by prescribing glasses in a case where he knows it would be a danger to prescribe, and he knows also that, in watching the interests of his patient and looking after the interests of the ophthalmic surgeon, both in the end will do well. Therefore, I say there is very little risk, if you have men with proper qualification's for testing eyes, that they will go beyond their province and do something that is likely to endanger the life or the health of the individual. I think I have said enough to express my view that the House will be well advised to support this Bill, if the Parliamentary Secretary is prepared to say that he can go forward with it. If he is not, I hope the House will reserve their judgment till some future time, and will come down ultimately on the side of a Bill of this kind.
§ Mr. RHYS DAVIES
I rise to support the Amendment which has been moved by the hon. Member for Royton (Dr. V. Davies). I think it would be well if the House understood exactly what the Amendment means. It calls upon the House to decline to give a Second Reading to a Bill the subject-matter of which is, at the present time, being investigated by a Departmental Committee. I trust that every hon. Member will support that view, so that the Departmental Committee may first of all be able to inquire and report to the House any recommendations that it desires to make on the subject. This Bill, an the face of it, would seem to be very simple, but those who are compelled to listen to arguments from all the parties involved in this Measure will know how very difficult the problem becomes. I hesitate therefore to intervene in this discussion for that very reason. I would, however, like to say just one or two words. The Mover of the Second Reading hardly did justice to the Measure, and I do not think he helped the case one bit by asking us to bear in mind that the law in the United States provides for the registration of opticians. I know something about America. The distinction between the administration of American and British law is the difference between a Ford motor car and a Rolls-Royce. It does not weigh at all with me that, 838 because a thing has been done in America we should follow suit. We should rather do a thing on principle; as to whether it is right or wrong to do so; and we shall have to make up our minds later, when we receive a Report from the Departmental Committee, as to what should be done in this connection. As I have said, the hon. Gentleman who moved the Second Reading of the Bill hardly did justice to its Clauses. What I regard as the most important Clause of all is Clause 3. When the Bill has dealt with the register itself, it goes on to say:Any person of or over the age of twenty-one years shall be entitled to be registered and to receive a certificate as a registered optical practitioner under this Act who satisfifies the Board"— —and so on; and then it says that one of the qualifications must be:That he has been engaged in the practice of optometry in Great Britain during the period of five years next before the commencement of this Act.That, of course, follows the principle that has been laid down in connection with previous registers. With regard to the several organisations that are interested in this problem, the British Medical Association, naturally, takes the usual attitude towards this question— the attitude of malignant opposition to any progress of any kind anywhere. Consequently, I think we may dismiss the British Medical Association on that score. It is not that I want to be harsh towards the British Medical Association; it comprises a very large body of men who do great service to the community. But when any other organisation proposes to touch its preserves, it at once becomes the mightiest and most influential trade union organisation in this country; and I do not envy the task of any smaller body which attempts to compete in medicine or surgery with the British Medical Association. The optical practitioners, and all those who deal in spectacles and eye testing, have several organisations; but the body in which I am most interested is the one mentioned by the hon. and learned Member for Mitcham (Mr. Meller). In listening to arguments on this Measure, I find that the British Medical Association, as usual, stands its corner; the optical practitioners then come along, and the optical chemists and the spectacle makers too; but hardly anybody bothers about the consumer.
§ Mr. DAVIES
I am glad to have a Scotsman on my side on that point anyhow. I do not think I shall be far wrong if I say that this issue has been raised— and I am not going to commit myself to-day either in support of or opposition to the Measure, we shall have to do that later— I am satisfied that this issue has been raised simply because there are funds in hand which apparently must be dipped into by someone. The doctors were the first to teach the lesson. They declared a strike in 1912 even in breach of contract. When the National Health Insurance Act carne into operation they got their terms; and no Act of Parliament has been passed through this House to declare that that strike was illegal.
§ Mr. R. DAVIES
If the hon. Member, who is a medical man, will induce the British Medical Association to join the Trade Union Congress, we will then all join together. I am not so sure he will be able to do that. To me, the kernel of the problem is the several demands made on the funds of the Approved Societies, and the hon. Member opposite is as conversant as I am with that point.
§ Mr. H. WILLIAMS
On a point of Order. As the hon. Gentleman is a member of the Departmental Committee, is it, strictly speaking, in order for him to express definite views on the Clauses of the Bill while he is sitting in a judicial capacity elsewhere?
Mr. DEPUTY-SPEAKER: (Captain FitzRoy)
I am not aware that there is anything out of order in the hon. Gentleman expressing his view, no matter what the situation is.
§ Commander WILLIAMS
Is it not really almost in the position of a judicial body which is to give a very well-defined opinion, and is it not rather unusual, to say the least of it, for a member of it to take part in the discussion on the Bill?
Whether it is unusual is quite another matter. I do not think it raises a point of Order.
§ Mr. R. DAVIES
My object in rising was not to support or to oppose the Bill. All I desired to do was to appeal to the House, in view of the fact that there is a Departmental Committee sitting, to allow it to stand, or if at all possible to secure the adjournment of the Debate in order that we should deal with the recommendations of the Committee when they are made. I have no intention of entering into the merits or otherwise of the Bill, but, being of the same nationality as the hon. Member who has interrupted me, it is very difficult not to stray into these side issues. I trust the House will bear in mind what the Amendment is that we are discussing, and that we shall neither vote for or against the Bill until we receive the recommendations of the Departmental Committee.
§ Sir K. WOOD
We have now had a considerable discussion and many points of view have been expressed and I hope I may make a few observations and then give the House a little advice. I should first like to, congratulate my hon. Friend on the very able and full speech he made in introducing the Bill. We are all unanimous that its subject-matter touches very closely indeed the question of the public health and on that account only it deserves consideration, because the preservation and improvement of sight is one of the things we must constantly seek to do. I suppose eyesight is certainly one of the most precious of our possessions. I should like to make one observation in case there is any misunderstanding outside the House with reference to my hon. Friend's statement as to the amount of defective vision and whether or not it is increasing. He quoted from a newspaper, which he has handed to me, which made the statement that there were some 15,000,000 people suffering from defective eyesight. It is a matter about which obviously it is impossible to give any exact estimation, but you get a very fair indication of the extent of defective vision from figures which the Board of Education have from time to time provided. In 1913 it was estimated that not less than 10 per cent. of the children of school age suffer from defective eyesight, while in many areas the percentage was as high as 25 per cent. In 1920 the average proportion requiring treatment and observation among schoolchildren was estimated at 10 to 15 per 841 cent. In 1923 myopia was found in about 10 per cent. of children at the school-leaving age. In 1923 some 135,000 children were ordered spectacles. The proportion of children with defective vision to the total number of children inspected in 1924 was 11. 1 per cent., and in 1925 the figure dropped back to 10. 2. Therefore I think the conclusion we can very fairly arrive at is that the prevalence of defective sight amongst school-children is fairly constant and is about 10 per cent. Last year there was some slight improvement but I do not know whether we can attach any importance to the figures. I think we may take it roughly as I have indicated. If you apply those figures to the population generally as a very fair estimate, and making certain allowances for age and occupation and matters of that kind, you can roughly estimate the number of persons with defective sight in England and Wales as about one in five.
§ Mr. PETHICK-LAWRENCE
Is defective sight a technical term or would the hon. Gentleman explain a little more exactly. Is everyone who has to have glasses considered to have defective sight?
§ Sir K. WOOD
I hesitate to give a definition, but I should say when a person requires treatment, and I suppose treatment of a, nature which would require some aid by means of glasses. If that is so there are probably not less than 8,000,000 people in the country who are affected. The general conclusion I should come to from the discussion we have had is that undoubtedly there is a case for something to be done, but there is considerable divergence of opinion as to the manner in which the problem should be approached, particularly from the point of view that has been advanced by the medical profession here to-day and on many occasions. It is true the doctors have urged, with a certain amount of weight, that there is an appreciable percentage of cases in which great harm may be done by an optician who, probably qualified so far as that particular aspect of the profession is concerned, might very well, through lack of other kinds of medical knowledge, overlook a treatment which might be necessary and which if not pursued might do a great deal of harm, either by wrong diagnosis or by using wrong spectacles. How far 842 that argument is valid, in my opinion and in that of the Minister of Health, can only really be ascertained by a full investigation of the facts. It is all the more important that there should be an impartial inquiry owing to the very large amount of money now being spent by approved societies on optical benefit. Ophthalmic treatment and optical appliances are included in the list of additional benefits which may be given by approved societies under the National Insurance Act, and it is regarded by the insured people as a most important benefit, which from the point of view of popularity only comes second to dental benefit. There is a very widespread demand for this benefit by insured persons. It is true that after the first valuation of approved societies there was only a sum of about £ 32,000 for this additional benefit, but since July, 1926, following upon the second valuation, ophthalmic schemes which have been sanctioned by my Department for approved societies have jumped from 500 to 5,800, and the money that is now allocated is no less than £ 420,000 a year. I mention that figure and the importance of the benefit in order that we may see the necessity of approaching the matter very carefully and to see that everything that is done will be done in the interest of the country as a whole. There are 12,000,000 persons who are now members of approved societies and branches which are able to give assistance by way of treatment or glasses. The practice at present is that an insured person has to get a written recommendation from a duly qualified medical practitioner before treatment is available, but there are many difficulties in connection with administration which hon. Members can find set out in the report of the Royal Commission.
I think the question we have to face to-day is whether in so difficult and complex a matter as this undoubtedly is, from the various speeches we have heard, it is safe to give a Second Reading to the Bill or whether we should not leave the matter to the judgment and recommendation of the Departmental Committee. I do not say this House, if it likes, has not a perfect right to give a Second Reading to a Bill while the Committee is sitting, but as a Departmental Committee has been set up under the able chairmanship of the hon. and learned Gentleman the Member for Rusholme 843 (Mr. Merriman), it would be a rash thing for us to give a Second Reading to the Bill. The terms of reference are to examine the Bill and to make recommendations, to say exactly what should be done and the manner in which, if the principle is accepted, it should be put into operation. I appeal to the promoters of the Bill whether under these circumstances they cannot well be content, as they have presented their case to the House and the country and advanced their arguments in favour of the Bill, to leave it to the Departmental Committee. It is a very excellent Committee. I do not thick there has been any criticism of it at all. If the Second Reading is carried, obviously a very embarrassing situation might be created and the Bill might very well reach a Standing Committee before the Departmental Committee has had time to consider the matter or frame its recommendations. I have had an opportunity of speaking to the Chairman of the Committee and he tells me they are already sitting and are making progress and are ready to come to an impartial judgment on the whole situation. In these circumstances, I venture to suggest to the House, and particularly to the promoters of the Bill, that it would be the right course for them, having presented their case to the House so effectively, not to proceed further with the Second Reading. I do not think that any of us, whatever our views upon the Bill, would desire to vote against the Bill proceeding further. I think Members of the House will agree that the promoters have very well justified their case in bringing this matter before the House. I think everyone will agree with that. Therefore, I hope that my hon. Friend who moved the Second Reading of this Bill so ably will be prepared to say, "We have had our opportunity. We have presented our case and in view of the fact that the Departmental Committee, in whom we have every confidence, have not given their decision, we will not ask the House to proceed further with the consideration of the Bill." I beg, respectfully, to make that suggestion to the promoters of the Bill.
§ Mr. RUSSELL
In view of the statement which has just been made by my hon. Friend the Parliamentary Secretary 844 to the Ministry of Health, a statement which, I am sure, will be appreciated by the promoters of this Bill both for the encouragement it has given and the sympathy which it has expressed, I beg, on their behalf, to ask leave to withdraw the Bill.
§ Major Sir RICHARD BARNETT
On a point of Order. Is it not competent on the Question, "That the Motion be by leave withdrawn," for me to address the House?
§ Amendment, by leave, withdrawn.
§ Question again proposed, "That the Bill be now read a Second time."
§ Sir R. BARNETT
I venture to think that it would be better to give a Second Reading to this Bill and thus confirm the principle of the Bill and then to defer the Committee stage of the Bill until the Departmental Committee has reported. It is perfectly obvious that there is something here which needs a remedy, and the principle of the Bill might very well be confirmed by Second Reading this afternoon. My right hon. Friend opposite has said, "Oh let us adjourn this Bill until we have had the Report of the Departmental Committee." After exploring the hidden mysteries of the sympathetic strike until four o clock this morning it is no small ordeal to come down to this House to deal with any other Measure, but I considered it to be my duty to do so because I have been urged by many of my optician constituents to say a word about this Bill. I agree with what has been said about the 6d. shops that sell spectacles. That evil is not touched by this Bill. Not very long ago I happened to meet a friend who had fallen on evil days and noticed that he was wearing spectacles. I said, "Are those new?" He said, "I got them this morning for 6d. from So-and-so's stores." I threw them in the waste paper basket and sent the man to an optician who found that he was suffering from very bad astigmatism.
I think that the hon. Member for Mitcham in an admirable speech put his 845 finger on the spot when he said that the dentists were a real analogy here. We do not allow anyone to call himself a dentist unless he is a qualified man, and we do not want the optician to call himself an optician unless he is also a qualified man. We want to get really qualified opticians who have passed an examination and who are able to detect disease where it exists and send the sufferers to the oculist. I think the House has been amazed this afternoon to hear from the Member for the Scottish Universities (Sir George Berry) that it does not matter what kind of spectacles a man has, they do not permanently injure his sight. That is an amazing proposition. He was challenged at once from these benches. He was asked whether it was not the case when men get wrong glasses that the astigmatism becomes very much worse. I do not want to see our people wholly blind or partially blind. Most people in this country at one stage in their life suffer from astigmatism. But disease of the eyes is a serious thing. Let us endeavour to provide a standard such as is set up by this Bill. I know it is very difficult for my hon. Friends who have moved the Second Beading of this Bill to resist the appeal of my hon. Friend the Parliamentary Secretary to the Ministry of Health. I suppose they cannot really persevere in resisting this appeal, but I do hope that it does not mean the shelving of this important question, because it is one that calls urgently for reform.
§ Mr. DEPUTY-SPEAKER (Mr. James Hope)
I think there is some doubt as to the procedure in this matter. The Amendment has been withdrawn but the Question now before the House is, "That the Bill be now read a Second time." It will be necessary to negative that Motion. That has not the same effect as carrying an adverse Resolution in the sense that the Bill be read a Second time upon this day six months. The only thing the House will decide is that the Bill be not read a Second time on this particular day.
§ Commander WILLIAMS
I do not wish to enter into the Bill which has been very fully discussed, but I should like to say one word about a Minister coming here and proposing to defer a Bill because a Departmental Committee 846 is sitting on it. It is quite obvious, that as far as this particular Bill is concerned, the procedure is absolutely sound. I entirely agree with that procedure, but I do think, speaking purely from the House of Commons point of view, that if you can carry on this procedure you will see that it is possible for a Government to set up a. considerable number of Departmental Committees, and by that means be able to block a considerable amount of Private Members' legislation. At the present moment we are in the position of having probably the best Government within the memory of man. We have undoubtedly a very excellent Ministry of Health— —
§ Commander WILLIAMS
I was rather illustrating perhaps the obvious. The point I wish to make is that I do not think the House ought to accept this Motion for withdrawal without some protest being made by some Member against the withdrawal of a Bill because a Departmental Committee has been set up. We are governed by precedents, and I raise my voice in protest against this method of withdrawal, not because I think it is wrong, but because I think it ought not to become a habit. Some of us ought to be able to say that, because we never know the iniquities that may come in the future.
§ Mr. T. SHAW
I hope there will be no attempt made to take a Division on this Bill. I am entirely in favour of the principle of the Bill, coming as I do from a county which has an industry in which eyesight is probably of more importance than in most industries, and where in some branches of the trade almost every man has at a very early age to begin to wear spectacles. It of vital importance that, in a matter of this kind, we should have the very best chances of people getting the best results. I know that the passage of this Bill will probably increase the price of spectacles, and that there will be no more very cheap spectacles sold, but I also know that every man or woman who goes to a. skilled optician will have a chance of getting to know whether there is anything seriously wrong with the eyes.
I do not think a great deal about the medical argument, not that I believe the medical argument is wrong, but because 847 although it may be the case that opticians occasionally make mistakes and do not send people to the doctor when they ought to do, we have innumerable cases where a visit to the optician results in an immediate visit to the specialist when there is something seriously the matter with the eyes and spectacles are no good. Therefore, what the doctor loses on the swings he 10 times over gains on the roundabouts. Although I know that it is likely that spectacles for the working people will cost more if this Bill becomes law, I think the fact that they will get skilled attention is worth infinitely more to them than the saving of a few coppers or a few shillings on a pair of spectacles. As one who from very early youth has had to rely on artificial aid to eyesight, I am keenly interested personally, and I am also interested because I belong to a trade where there is so much defect in eyesight owing to the nature of the trade.
The only thing which I desire for the moment is how best to advance the consideration of this matter. The Parliamentary Secretary to the Ministry of Health has spoken, and it is obvious that to force a decision against the Ministry is scarcely likely to advance the chances of the Bill. We have had a sympathetic speech from the Government bench, and a suggestion that the Government would rather the matter was considered by a Committee. As I believe that course will more quickly result in action in Parliament than by attempting to force a decision against the Ministry, I hope the House will allow the matter to rest where it is and allow the Committee to go on with its work. Possibly the Department itself, after receiving the report of the Committee, will make itself responsible for a Bill. That is the only way in which we can get a Bill through Parliament. Without the help of the Government, we cannot get time for the Bill. It seems to me so eminently reasonable to let things remain where they are without taking a Division, that I hope the House will not take a Division.
§ Commander BURNEY
I should like to support the view put forward by the right hon. Gentleman. I came here today with the intention of supporting the Bill, but it is very difficult for a person who is not an expert in these matters to 848 ascertain all the implications involved in a Bill of this kind. We in this House have to look to the welfare of the community as a whole, and we are, in a sense, the referees between the opposing interests of those who are concerned in the science of optics. The speeches which have been made, especially the speech by the Seconder, have shown me that this Bill, as drafted, would hardly effect what the promoters require. The Seconder showed us various spectacles which he had bought at a very low price, and he stated that they were quite useless. This Bill does not do anything, as it is drafted, to prevent the sale of bad spectacles. Therefore, the suggestion which has been put forward by the Parliamentary Secretary to the Ministry of Health, is one to which we should accede.
A further matter that should be taken into consideration before the House passes judgment upon the Bill is the composition of the Board. I have had a letter from a constituent, and I expect other hon. Members who represent urban constituencies find that the majority of opticians live in those districts. My correspondent raises a rather important matter. He says:Having passed the optical examinations mentioned, namely, 1, 2 and 3,I find that although I have 21 years' experience in optics and pharmacy, this Bill will class me as an unqualified optician and compel me to take a further examination to secure registration. As a pharmacist I naturally object to submitting myself to an examination conducted and held by a body of men of inferior education and no statutory qualification.It is not that he is objecting on the ground that he might not be able to pass the examination, but he is objecting to sitting for an examination conducted by persons who, according to his statement, are of inferior education, and have no statutory qualification. It seems to me from the speeches which have been made that the British Optical Association and the Spectaclemakers Company are the two societies which are wishing to forward this Bill. In all these various sections which are interested in optics, such as the College of Optics and the National Association, I would like to know to what section a man like Sir Richard Creuse, whose reputation is very high, belongs. Is that the type of man who will be concerned with the control of this body?
849 Unless the Board which is set up is one which has the full confidence not only of the medical profession but also of the optical profession, we shall not secure the object of the Bill, namely, to raise the standard of the optical profession. It is for that reason that I think the Government's attitude should be supported. There can be no doubt that the deliberations and recommendations of the Departmental Committee which has been set up, and which is now in operation, will be of great value to Members of this House and, although I came down to support the Bill, I agree that the best method of supporting it is to ask the promoters not to force a Second Reading this afternoon.
§ Mr. A. V. ALEXANDER
I should not have intervened but for the fact that the hon. and gallant Member for South-West St. Pancras (Sir R. Barnett) referred to the standard set up in the Bill, and also to the standard in the Dentists Act. I take it the standard aimed at is the standard of the Dentists Act. It is as well to make it clear that whilst I am not holding altogether the views of those who have supported the Bill, I am prepared to support the main principle if there are considerable modifications from the very Act to which the hon. Member has referred. I have had some negotiations in regard to this Bill. When it first appeared there was scarcely a word in it which was not in the Dentists Act. It then included a Clause with regard to corporate bodies practising optometry, a very restrictive Clause. That Clause is now left out of the Bill as presented for Second Reading, but there are still Clauses in it which lead many of us to suppose that unless there are specific provisions laid down, and which ought to have been in the Bill put down for Second Reading, it would be very unwise for the House to give it a Second Reading now before it has been considered by the Departmental Committee.
In order that the position may be perfectly clear before the Bill goes to the Departmental Committee, may I say that if you are going to give a corporate status to what is a new profession you you must protect the people who have been practising in that profession. We had similar legislation proposed as far 850 back as 1907– 1908 for another and much more powerful body, the Pharmaceutical Society. In that case you had the Act called the Poisons and Pharmacy Act, 1908. It is laid down there very clearly that a corporate body may carry on a profession provided its members are registered and properly qualified. We desire that we shall have the ordinary right of citizens of this country not to be precluded from carrying on a department, which does in fact professional work, simply because we may not be able to put on the management committee of the working-class body qualified members of the profession dealing with that particular business. I want to make it perfectly clear that this point must be put to the Departmental Committee, it should have been in a Bill submitted for Second Reading, as it is a question of principle, and that is why I hope the House will not take the view of the hon. and gallant Member, for whom the House has so much respect. I hope the House will not accept his advice, but the advice given by the Deputy-Speaker to the promoters of the Bill to allow it to be formally negatived. It will not prejudice the consideration of the Bill in the Departmental Committee, and at the same time it will enable the Committee to realise that we have a point of view which we want to preserve.
§ Question, "That the Bill be now read a Second time," put, and negatived.