Clause 6.—(DUTIES OF EDUCATION AUTHORITIES AS TO DENTAL TREATMENT.) (Hansard, 29 October 1956)

§ Dr. Dickson Mabon
I beg to move, in page 4, line 40, after "dental" to insert "and optical".
Some of my hon. Friends and I are concerned about an omission here. We do not know whether the omission is by accident or design, but we certainly feel that the words "and optical" should be included. As most of us are aware, it is in the early years of school life that many of the optical deficiencies in children emerge. Unless there is a very good and attentive teacher, as well as medical examinations and optical estimates, those deficiencies may not be discerned.
Among children myopia is probably the commonest of childhood complaints, and parents are greatly concerned about the care of their children in this regard. A number of my friends who today suffer from an eye condition fortunately received early treatment and ocular compensation which prevented their eyesight from be- 1138 coming much worse. I myself, for example, when I was at school, was discovered by a very attentive teacher to have slightly defective eyesight. But for that very kind teacher's discovery I might well have suffered from a more severe degree of myopia than I have at present. Fortunately, my myopia is physical in character, not like that of some of hon. Members elsewhere whose myopia is political and in an almost permanently chronic state. A great deal of ocular discomfort and defect can be prevented if proper examinations are made. It is to that end that I have moved the Amendment.

§ Mr. Henderson Stewart
If the hon. Member for Greenock (Dr. Dickson Mabon) will bear with me, he will see that this otherwise admirable suggestion is unnecessary. Provision for it is already made. On the other hand, the hon. Member, or another hon. Member, may well have a case where the present service is not working. If that be so and if they will be good enough to let me know of it, I shall make immediate inquiries. The present law and practice are adequate.

§ Dr. Dickson Mabon
I understand that the Opticians' Association made representations to the Secretary of State, and I understand that ophthalmologists are interested in this matter. If the law is adequate, why is there this concern among professional organisations as well as parents?

§ Mr. Stewart
I will deal with that in a moment.
The definition of "medical treatment" which hon. Members will find in Section 143 (1) of the Education (Scotland) Act, 1946, specifically relates to prevention and treatment by a doctor. That has always been interpreted as covering all forms of treatment given by doctors to patients, and it obviously includes treatment given by eye doctors. The definition goes on to make it clear that treatment also includes the provision of appliances recommended by a doctor as part of the treatment, for example, the provision of glasses.
All education authorities use facilities provided by regional hospital boards for examination and treatment of children's eyes. So far as we know, no local 1139 authority has found it necessary to make additional arrangements for those services at its own expense. The supply of ophthalmologists—this is the point which the hon. Member has in mind—varies in different parts of the country. It may be that facilities for the examination and testing of children's eyes in some schools are not as good as in others. If so, I should very much like to be advised about it.
It may be that the hon. Member has a particular case in mind, and if so I should like to hear about it. In his interjection the hon. Member suggested that sight testing facilities for children's eyes could possibly be improved if more use were made of the services of opticians. It has always been considered that school eye services for children should provide for the testing of children's eyesight by persons with full medical and ophthalmic qualifications, not merely opticians with a training in optics. I am advised that any departure from that principle would be bitterly assailed by the ophthalmologists. That is our difficulty.
I would add a few words for the benefit of the Committee. While the first full eye-examination of children takes place at about 7 years of age, if, before that age, school teachers noticed that a child's vision was seriously defective they would bring the case to the notice of the school nurse, who would arrange, if necessary, for the child to be seen at the clinic. In addition, each child on entry at school at the age of 5, has a general medical examination. While that does not include a full eye-examination it brings to light obvious cases of eye defect. Where many thousands of children are being examined it is always possible to miss something here and there. That is why I have asked for details.
To reduce the possibility of happenings of that kind a series of discussions is taking place among interested parties, and it may well be that some useful practical work will follow. I would ask the hon. Member for Greenock to believe me that I am advised by all those who understand this matter that the Amendment is not necessary, because the point is already fully covered in the law as it now stands.

§ Miss Herbison
We have been told by the Joint Under-Secretary of State that 1140 the Amendment is not necessary because the matter is fully covered by legislation. That may be so. The Amendment was put down for probing purposes, because the legislation is not working effectively, I am advised. The Joint Under-Secretary of State put his finger on the difficulty : professional disapproval by the ophthalmologists if the opticians were given any further work.
Surely it is our job, in safeguarding the eyesight of children, to examine these matters as objectively as we can, and if that ultimately means that we stand on somebody's professional toes, that is just too bad. Our job is to take the greatest care of the eyesight of children. The Joint Under-Secretary asked my hon. Friend to bring to his notice any individual case and said that it would get immediate attention, but that is not the job of Members of Parliament. This is something more than a question of individual cases. It is true that the opticians are seriously perturbed about the results of the lack of proper optical care of school children, and they have not been backward in making their representations to the Department of Health. They made suggestions whereby the care of the eyes of school children could be very much improved.
The Joint Under-Secretary says that a child is examined first at about 7 years of age by a doctor who, like most school doctors, probably has had a general training : few, if any, have taken a special course in ophthalmology. I suffered from this lack of care when I was a child. I have had to wear glasses since I was 10. Until I was 17 years of age, I attended school, a local authority school, where from 7 until 17 years of age I was medically examined at the stated periods. Not once was I told that I needed glasses, but I had a most observant mother who found that I needed them, and she took me to an optician. Had she been careless and not so observant I do not know what my eyesight would be like today. This is only one example.
I advise the Joint Under-Secretary of State to talk to some of the other Scottish Ministers to find out their experience in this matter. Although we have an adequate service to care for children's health in most matters, we have neither a sufficient nor an adequate service to save the eyesight of our children.
1141 We shall not press the Amendment to a Division, but we ask the Joint Under-Secretary of State to discuss the matter of children's eyes with the Joint Under-Secretary of State responsible for the Department of Health and with the Secretary of State for Scotland, to see whether they can move fast in this matter. I hope that they will tread on the toes of some ophthalmologists, and if that is necessary let it be done. Our first care is the eyesight of our children.

§ Dr. Dickson Mabon
The Joint Under-Secretary of State made an inference that I found professionally distasteful. I do not think that there is any intention in the minds of my hon. Friends and of myself to contest the main basis upon which the assessment of children's eyesight is made by ophthalmologists and treatment is accorded. There is no attempt on our part to challenge that or the emphasis on it. We are trying to ensure, as my hon. Friend the Member for Lanarkshire, North (Miss Herbison) said, that our health services are adequate.
It is our opinion that the services are not adequate. While I do not agree with the conclusions of the Opticians' Association to the Department, nevertheless they raise a very reasonable inquiry, and there is concern among the ophthalmologists. As my hon. Friend has said, if we have to fracture a few professional toes, whether of opticians or ophthalmologists, in our anxiety to get the service bettered, it ought to be done by the Government, rather than by individual hon. Members pointing out the facts and causing inter-professional rivalries.

§ Mr. Henderson Stewart
The hon. Member for Greenock (Dr. Dickson Mabon) has invited me to consult my colleagues. Of course, I agree to do that and will do so at once. Suggestions have recently been made that the routine testing of children should be at an earlier age than 7, so that any defects are ascertained at the earliest possible time. That, and other changes which may improve the eye service provided in the schools by the regional hospital boards, are under active discussion among the Department of Health for Scotland, ophthalmologists, school medical officers and ophthalmic opticians. It would appear that we are all in this now. We 1142 shall, of course, take the most serious note of what the two hon. Members have said to us, because we want the service to be adequate.