§ 3.42 p.m.
§ Commander Harry Pursey (Hull, East)
I beg to move,That this House recognises the success of the Supplementary Ophthalmic Services in providing free sight-tests and a substantial reduction in cost of spectacles to the patient; but, noting the failure of some opticians to offer the complete services available under the National Health Service, calls upon Her Majesty's Government to ensure that all necessary steps are taken to see that the full services are made available to all who need them.I do not think that the Motion needs any explanation. I have chosen this as the subject for debate in the first of the Private Members' Motions to be discussed on a Monday because of numerous complaints about the whole system of the supply of National Health Service spectacles—particularly the frames—in Hull, where I represent the East Division, and in London and surrounding areas. The hare was started by a falsely-labelled Medical Eye Centre, at Putney, where I live, where a super-salesman sold a National Health Service patient a frame for 11 guineas.
Since then, the bids have increased, until now the firm of Hudson Verity, on the other side of London from where I live, is at the top of the class with the offer of a frame to a policeman's wife at 13 guineas. It is strange how many policemen and their wives are "taken for a ride" by their opticians, because they do not know to what they are entitled. I am to write a memorandum for the Police Federation, in the hope that more information will be available to its members and their families.
Strange though it may sound to the Parliamentary Secretary, I believe that the worst racket—though, perhaps, not in numbers—occurs in the supply of children's frames by dispensing opticians, even in hospitals. The opticians not only do not show the Service frames, but show wrong frames, and non-Service frames, to bluff mothers into buying privately-supplied spectacles for four guineas. It would appear that it is easier for a dispensing optician to bluff a mother into paying four guineas for spectacles for a 10-year-old child than it is to get her to pay four and a half or five guineas for her own spectacles.
36 I have for three months been making inquiries, with startling results. My inquiries show that the opticians' racket, particularly that operated by dispensing opticians, is worst in the N.H.S. scheme. In fact, certain documented cases may be a matter for the Director of Public Prosecutions. I have no intention of taking advantage of Parliamentary Privilege, and saying here what I would not say outside. I am also quite prepared to appear before disciplinary committees and executive councils in cases of which I have personal knowledge, and I will, of course, forward the documented cases to the Minister.
I have given an undertaking to the Parliamentary Secretary that I will not mention any individual optician by name—firms are a different matter. There are doctors who are advertising all over the place, and they are, of course, wide open, as is the B.M.A. I hope that the hon. Lady the Parliamentary Secretary, on her part, will not give the names of any patients concerned, or we shall never get anyone who is prepared to complain to disciplinary committees and executive councils.
What is the general position? Parliament votes millions of pounds for the eye service, and Members of Parliament are responsible for ensuring that their constituents benefit from it, but many people do not get the service. Millions of people have had spectacles under the scheme, but what is the number who have not? The chairman of the British Optical Lens Company, Mr. E. Elliott—he has given me permission to use his name and that of his company—informs me that, on the average, over the last ten years he has supplied about 250,000 pairs of magnifying lenses to Woolworth's.
That would represent about 2½ million people but obviously some are newcomers, and some may have had two or more pairs of spectacles. I therefore do not want to argue on that figure alone. Nevertheless, all these people with Woolworth's magnifying spectacles should have been properly tested and supplied with spectacles under the scheme. The Minister should institute an inquiry as to why they have not been so tested and supplied, and decide what should be done. Let the ophthalmic opticians set out their stall to supply these people with N.H.S. frames. The 37 number of those buying these magnifying lenses will then diminish, and the opticians will do better business.
There might be something of the nature of Christmas clubs, by means of which old-age pensioners could save the necessary £1 10s. 3d. for N.H.S. spectacles. Do not let us be mealy-mouthed about opticians. In the provinces, before the war, they had to go round on Friday nights to collect 1s. here and 2s. there from poor people. It was the only way by which poor people could get their "specs."
A major complaint is that opticians divide their customers into the rich and the poor: give a 24-hour service for privately-supplied frames—particularly for breakages—but take three weeks to treat N.H.S. patients. Today, practically everyone who wears spectacles has N.H.S. lenses, so that the billiard-room remark, when a player misses a stroke, "That's your N.H.S. specs", is just nonsense. Everybody has N.H.S. lenses; it is only the decoration around them that differs.
Another complaint refers to failure on the part of the Ministry of Health to provide sufficient information and, more important still, to provide a realistic range of frames. The Ministry document that says that a wide range of frames is available is nonsense, and is treated as a joke in the trade. There are also complaints about the failure of opticians to provide a full service and, particularly, a full short-notice emergency service for breakages.
Patients are not informed by opticians of their entitlement; the range of frames is not shown—and the six colours provided by the trade are certainly not shown. The Ministry has always refused to say anything about colours. It has left this to the trade. The manufacturers can produce half a dozen alternative colours, but the opticians do not want to show them to N.H.S. patients. Patients are bluffed into buying private frames at high fees, when there is no reason to do so at all. There are others, but I leave them for further complaint and further debate over the years.
The result is that people in the know, who are getting a good income, get what they know they are entitled to and do well. On the other hand, poor people, not in the know, either do not get the 38 glasses or are fleeced. What does the Health Service Scheme provide? There are three services: first, the normal service; secondly, the hospitals; and, thirdly, the school clinics. I can leave the latter two for further debate, because I hope that, having started this spectacles question, we will get it cleared up over the years. As regards the hospitals, I can say that the eye doctors are doing a marvellous job of work. A doctor is all right as long as he is in a hospital, but once he is out in the hands of the dispensing opticians, he is wide open to exploitation, as I will show later.
There was a man with a glass eye who went to an eye doctor in a hospital for treatment of his other eye. The doctor did it quite well, put a patch on his eye, patted him on the shoulder and said "O.K., come and see me again tomorrow." The patient asked, "How do I get home, doctor?" The doctor thought that he was looking for a lift in an ambulance and said, "How do you usually get home? On your feet, by trolleybus, or have you got a car?" The man replied, "I cannot see." The doctor then took the patch off his eye, and the man went home.
I say nothing about the school service. The main scheme with which I will now deal is known as the supplementary ophthalmic service. To make it simple for myself as well as for other hon. Members, I will refer to it as the Service. Here again, it is quite simple. First, there is the test, which is paid for out of the scheme. The lenses cost 10s. each and the frames 10s., a total of 30s. The Parliamentary Secretary can give us the contributions, but the opticians' idea is that they should provide frames privately at five guineas. They tell people that, with the State having to pay for the test, and the patient getting the lenses for 10s. each, they are doing a good job for them, but that is utter nonsense.
I want to say, and I hope the Parliamentary Secretary will also say, that a pair of Health Service bifocal lenses, with a 524 H.J. frame—I have not got them, because these are old ones, which I had seven years ago—is the best spectacle proposition in the world, and more people would buy them if they knew they could get them in six colours. I hope, also, that the Minister himself will investigate this matter. I know that he cannot be here this afternoon, but it 39 would be a good advertisement for the scheme if one could see him in a National Health Service pair of spectacles at £1 10s. 3d. in one of these alternative colours.
The procedure is quite simple. There are three forms, with an alternative to one of them. One is required only when the patient sees the eye doctor for the first time. No. 2 is the prescription, and No. 2A is the prescription for breakages. No. 3 is the covering letter that goes back with the prescription. On the first of these forms, one is told on the back that one can take it to any doctor or ophthalmic optician. It does not work out like that, because doctors are either sending patients, or even putting the forms in envelopes themselves and addressing them, to dispensing opticians, with the idea that the dispensing optician then gets a doctor for the eye test. I will deal with that a little later.
When the Minister tries to say that the patient is covered by the document, I say that that is nonsense. Patients are not given the full information, and what they get in dribs and drabs does not give them the complete picture. The prescription says that it will cost 10s. each for the lenses, and the covering letter says that there is a wide range of frames, but the idea is this. One goes the first time and has the test, and nothing else happens until one gets the prescription back and Form 3. In fact, I believe it is the rule that practically every optician today does the two jobs in one, and, if so, the documents are short-circuited. I do not complain about that; it might be the best thing for the patient in not having to go twice.
When the Parliamentary Secretary argues about the patient being covered by the documents, I reply that the patient does not see the prescription form and the covering letter until after the job has been finished. Patients are wide open and are given no information at all. They are told that there is a free test, that bifocal lenses cost 10s. each and the frames another 10s. What we want to get over to the public is that, instead of talking about 5 guineas, they ought to be taking the public on at 10s. each for the lenses and 10s. for the frames, making 30s. in all. We ought to be providing spectacles for poor people at these 40 rates, instead of them being asked to pay three, four or even five guineas.
What happens in the case of a general practitioner or ophthalmic medical practitioner when the patient does not want his general practitioner to test his eyes? Is he prepared to hand over form one, or does he argue that he can do the job and that there is no reason for the patient to go elsewhere? That may be a minor point, but the idea of the scheme is that people have freedom, when, in fact, they have got as much freedom as a poor man who wants to get into the Savoy Hotel.
How does the scheme operate in regard to the ophthalmic medical practitioners, the ophthalmic opticians and the dispensing opticians? I do not want to disparage the medical profession, but so as to establish the distinction between the two classes of optician, we can quite easily call the ophthalmic optician the pukka optician and the dispensing optician the plumber. That will make it quite plain to everybody, because that is the position.
What are the figures? In 1949, the ophthalmic medical practitioners numbered 966, and at the end of last year 914, so that the number is down by 50. If that is the case, there should be a greater demand for them in hospitals, and I want them to go to hospitals, where they can be protected from the mercenary dispensing opticians. The opthalmic opticians—the pukka opticians—in 1949, numbered 5,639, and now they total 6,394. Fortunately, the numbers are going up, but let us look at the figures for the dispensing opticians. They numbered 568 in 1949, and are now 933. I will leave the arithmetic there, and say that the dispensing optician is employed only by the big firms. These are quite big optical firms which, in addition to making fortunes out of optics, now want to cash in on the frames racket on the dispensing side all over the country.
How does this scheme operate? I will deal, first, with the pukka optician, because he is the only man who does the complete job, namely, sight testing, providing the prescription, fitting the lenses and providing the frames. If there is an eye health problem, he refers the patient to his general practitioner, and the general practitoner refers him 41 to hospital. What could be better or simpler than that? Only the B.M.A. doctors and the big business optical firms would want to wreck what is an admirable scheme for patients all over the country. Moreover, the fully qualified optician with a small business, particularly in a poor area, is probably providing good service, though he could do better with better scheme frames. Naturally, he wishes to keep his customers and, unlike the big firms, he cannot risk rackets and lose his reputation.
Yet the little man, whom we all know in the provinces—and, according to the Daily Express, the Tory Party is always seeking to protect the little man—is under sentence of death by the Crook Committee and the Opticians Act, which was passed just over a year ago. It was then decided that there should be three registers and that the pukka opticians' register should eventually be closed. However, I cannot develop that argument today.
I will now turn to the question of the O.M.P. The alternative to the pukka optician is the procedure of having sight tests carried out by a doctor. Unfortunately, the plumber's shop of the dispensing optician is also brought into use by the doctors. I freely grant the choice between optician and doctor, but why go to a doctor for a sight test? The B.M.A. argument is that opticians fail to discover health defects, but little or no evidence is produced to support this argument. I suggest that many people suffer from ill-health of the eyes by not coming into the scheme to get their eyes tested because of the fear of the high cost. Whatever the position before 1948, with this set-up between doctors and plumbers, the National Health Service Act made the G.P. responsible in the first instance for eye health.
When an eye doctor sight tests and finds that eyes are in bad health he refers the patient back to the G.P. in the same way as the optician does. We must have the G.P.; we must have the hospital doctor; we must have the optician; but why should there be a third doctor with an unnecessary fee of £1 1s. 3d.? That is the doctor's fee for testing eyes. The optician doing exactly the same job, and probably making a better job of it, charges only 16s. Instead of the Minister taking money away from pukka 42 optician, let him take the odd 5s. 3d. from the O.M.P., particularly when he is carrying out mass eye tests with patients queueing up, as men line up in the Army for cough mixture. Gilbert and Sullivan, in their craziest productions, could not have produced anything more farcical than this.
Let me deal with the first occasion on which a person requires spectacles. The G.P. signs Form 1. I want the House to pay strict attention to this, because there arises a serious question whether false documents are signed. I have with me a copy of Form 1. One can obtain copies easily. It reads:I certify that I have examined you and that, in my opinion, you require to have your sight tested.On the prescription form which the patient signs to the effect that he has not had a pair of spectacles for two years there is some reference to the possibility of being sued. But what is the position about Form 1? Presumably the doctor must have examined eyes, not feet, in an eye test. I challenge the Minister, and more particularly the British Medical Association, to say whether doctors examine eyes or whether they sign false documents to be handed out by their receptionists without seeing the patients.
I must assume that the G.P. has examined eyes and found no health defect—that is his responsibility as G.P.—otherwise he would have sent the patient to hospital and there would have been no question of obtaining spectacles until the hospital had dealt with the patient. Consequently, there would appear to be no reason for a G.P. to send a patient to a doctor for a sight test. Certainly, there would be no reason for a G.P. to send a patient to a plumber's shop to arrange the test when the patient himself could make his own appointment with a pukka optician or doctor.
The function of the plumber can be summed up quite simply. He obtains the lenses and provides the frames. Obviously, as the price of lenses is controlled at 10s., his main interest is to make as much profit as he can out of the frames as the result of a psychological test of the patient's financial position. Moreover, a dispenser must always be an employee of a firm, because the ring would not allow him to set up on his own in competition.
43 I now wish to ask the Parliamentary Secretary a question to which, no doubt, she will be able to reply after getting the answer from the grape vine. In addition to the official organisation, we also have the barrow boys in the market. There one can get a frame for £1 Therefore, the only outstanding question concerns the lenses. I believe that at the moment the Ministry has control of prescriptions, and I am not suggesting anything false from the point of view of sight testing. But what will be the position with regard to lenses when the Opticians Act is implemented?
I am told that if I get a prescription I can go to an optical firm which, in view of the profit it makes, will give me the lenses for nothing. So I get the test for nothing on the level, and I can go to the optical firm and also get the lenses for nothing—whether on the level or not I do not know. Then I can go to the barrow boy and get the frame for £1 or less. That is a better proposition than the £1 10s. 3d. for the 524 H.J. frames. Is that legal or illegal? If it is illegal it should be stopped.
Now I come to another matter. Woolworth's frames do not fit National Health Service lenses. But I am told that one need not worry about that. One goes to the barrow boy who will strike a match and heat the plastic; the lenses are inserted, and "Bob's your uncle." With bifocals there is an additional problem of getting the lenses fitted in the proper place, but I am told that that is easily done. This shows what goes on in this racket which should be investigated.
I now wish to say a few words about these false medical eye centres. Anybody can set up a medical eye centre. There is a Wigmore Eye Centre and a Jones Eye Centre. There can be an Uncle Tom Cobley and all eye centre. A medical eye centre is a dispenser's plumber's shop for frames with a room for a doctor for occasional sight tests. Nobody can dispute that. But what is the arrangement? The firm engages the doctors—in the plural—and provides the staff as well as the accommodation for the doctors to attend when they are telephoned and told that there are victims to be sight tested. The old B.M.A. ethics committee of a previous generation would turn in their graves if they 44 knew that doctors were being employed by plumbers and rung up on the telephone in the same way as one rings up a taxi or district nurse.
Do not let us be mealy-mouthed about this racket. This is an immoral professional association between doctors and tradesmen, arranged by the big optical firms with B.M.A. before the National Health Service came into operation. The object is obvious. It is to try to squeeze out the pukka optician and get all the sight testing into the hands of doctors and the dispensing into the plumbers' shops. If that happens, heaven help us. The plumbers' union side, seven in London and one in Bournemouth, are all the big boys. I will not mention them by name. They are dispensing opticians and are well in the frames racket.
I am informed that in this trade the practice is to work out the price and multiply by three. So that when a woman goes in and is offered a pair of frames for £10, she ought to do the Indian market trick, offer £5 and do a deal, or have a Dutch auction and get the price down by about 50 per cent. If any one of these plumbers challenges me, let him produce his books and appointment records for the Select Committee on Estimates and myself.
An analogy to the medical eye centres on the medical side would be for Boots, the chemists, to label their shops "medical body centres" and engage a number of general practitioners and provide a room and staff for them to see patients there so that they would get all the prescriptions and the profits. There would be hell to pay for this by the British Medical Association, so why not hell to pay concerning the medical eye centres? The title "medical eye centre" is a false one, because there is nothing medical about the place and nothing medical is done there. Doctors sight test, but do no eye health work there. Moreover, the title is misleading to the public and draws in people under false pretences.
Clifford Brown's medical eye centre, in Putney, should be called the plumber's shop for Dr. Dorrington Ward and other doctors who use it. There is no reason for people to go to such a centre in Putney, because there are three eye doctors on the ophthalmic list with addresses there, one in Roehampton, the 45 second near the river and the third in the centre of the town. The proper place for an eye doctor to see patients is in a hospital or office or his home. Failing that, a room in a council building, such as the town hall, should be arranged.
To show how these Clifford Brown medical eye centres deal with the spectacles service, I will now report upon five of them which I visited. These examples will be foreshortened, because they can be amplified in reports for the London, Surrey and Middlesex Disciplinary Committees, which I am prepared to attend.
I wanted a pair of glasses—I still want a pair of glasses—but I am looking for the honest optician who has the full range and colours, who displays the proper notice and who will tell me the straight story, but I cannot find him. All I wished to ask was whether the optician was showing the notice which I was entitled to see, whether he was showing the frames and whether he would tell me a straight story.
Prior to 1948, under the approved societies scheme, the frames were shown in trays. At the beginning of the 1948 scheme, opticians showed the National Health Service range of frames. Now they argue that it is not compulsory to do so and the Ministry agrees that it is not compulsory. This is a State service run by State money. We should have proper control and the opticians should provide the proper service.
We were getting a better service and, certainly, better personal attention under the old approved societies than we are getting from opticians today. We have now a class of individual with a Prussian attitude to his patients, particularly in the case of a scheme patient for £1 10s. 3d., when such an individual could not care less and will tell a patient to go somewhere else.
None of these so-called medical eye centres displays the Ministry notice. None has the range of Service frames or colours and none has Service frames displayed in the same way as private frames. Salesmen in two shops said quite definitely that they did not sell or show Service frames. In other words, they were not fulfilling their contract.
First, Clifford Brown No. 1 branch, Putney. Scheme patient examined by Dr. A. H. Thompson, O.M.P. 223, who did it in a few minutes and certainly not 46 in half an hour, which is the basis on which payment is arranged. I am told that no optician, doctor or otherwise can properly examine a patient's eyes for everything under less than half an hour. It may well take three-quarters of an hour.
Then, high-powered salesmen of frames said that only one scheme frame was available. There was no suggestion of colours. When asked for alternatives, he offered a pair of frames at £11 11s. 0d., eventually sold a £4 4s. 0d. pair and took £1 deposit. I have the receipt and the firm's card gives confirmation. There is no dispute about these facts concerning frames.
Next day, I went into the shop. The N.O.T.B. Regulation states that it should not have a hospital atmosphere. Pale-faced men and pale-faced platinum blondes in white butchers coats gave me an impression of a mortuary. Every moment, as they moved in and out, I expected them to produce a body for identification.
I asked for the manager and said that I wanted a pair of glasses. I have had my present pair seven years, yet I was told they would not last. I inquired about scheme frames. The manager said categorically, "We never show scheme frames. Our clients would never have them. They are no good anyway." In other words, "scheme frames" is a dirty expression.
I pressed to see some scheme frames and eventually the manager produced a long tray of junk. Picking up a handful, like iron in the scrap shop, including always, of course, the nickel National Health Service frames to try to put me off, he asked, "Who wants these?" I replied, "I do." He then tried to insult me by asking, "Do you want them on National Assistance?" There is not time to give the whole of the story.
I then asked why he had charged a National Health Service patient £4 4s. the day before and taken £1 deposit. I told him to cancel the order and return the deposit. That was too simple. All he had to do was to hand the £1 back and take the receipt, but he was in a jam with his firm, so he demanded a receipt for overpayment from the patient before he would return the £1. Where does the overpayment receipt come in for a patient?
47 No. 2 branch of Clifford Brown is at Sloane Square. This is the "posh" locality where one gets the real "gen" and the M.E.C. nonsense on the window, as elsewhere. I am told that since I first put down Questions, the blatant medical health centre advertisement on the big panes of glass has been blotted out and it is now only in gold on the door. There are three doctors' names: Dr. K. F. Mathews, O.M.P.103, Dr. A. V. Stevens, O.M.P.151, and Dr. M. J. Squires, O.M.P.297. No times are given, but the notice says "By appointment". Does this comply with the contract?
The position, apparently, is that the plumbers wait until they get some victims and then, as I have said before, they ring up on the telephone and they clock in. Whether they stamp on the clock, I do not know. Scheme frames are not shown. When pressed, the man at the centre produced a handful of junk from a drawer and asked, "Who wants these?" When I asked him what I could get under the scheme, he said, "I do not know and I cannot tell you until I get the prescription back, when I will know what subsidy will be paid." That is good fiction for a Grimm's fairy tale by opticians, because that, obviously, is a false statement.
At No. 3 branch of Clifford Brown, East Sheen, again there is the medical eye centre nonsense. It is under the Surrey Executive Council. No doctors' names are shown. Why not? If there is not a doctor's name, there is nothing medical. The whole thing is a racket. Only one frame was shown. A handful were again pulled out of a drawer like a lot of junk. There was a big display of private frames, but when I asked why he did not show Health Service frames, he said that there was no room.
Then there was Clifford Brown No. 4, at Richmond. Again, there was the M.E.C. nonsense and the words "Surrey Executive Council". The first blonde I saw wanted to get my name on the book, but no luck. When I asked about the National Health Service scheme she fetched a super-saleswoman. "Now", I told myself, "I really am going to hit the glamour works," and I remembered the stories which we used to hear about certain establishments in the South of France. After being pressed to show the 48 range of Service frames she disappeared and produced a marvellous collapsible display case. "Now", I thought, "we have something". But the frames had to be produced from a drawer. The hinges of the case creaked. It was empty and obviously never used. The woman apologised for the frames being dirty and she dusted them as she put them in the case. She admitted that they did not have and did not show a range of frames and seldom sold a frame under the National Health Service scheme.
The fifth Clifford Brown branch was at Twickenham. Again, there was the M.E.C. nonsense, but here a different story. The man had all the answers to "Twenty Questions" before I even asked them. It was too obvious to be funny that he did not usually tell the story that there was a free test, lenses were £1 and frames 10s. 3d. Obviously, the "gen" had gone round on the bush telegraph that there was a Question on the Order Paper in the House. He produced some frames. Obviously, the case was not usually used. They were not a range of frames, but duplicates in different colours. One could discover quite simply what business he was doing by checking the 1959 prescriptions dispensed and the number of Service frames issued, but before coming to that I had asked the Minister to let me see the full range at the Ministry. Therefore, I knew what to look for and, moreover, I had the document "Scales of Fees and Charges" which, in addition, gives the range of frames. The Parliamentary Secretary has been good enough to place copies in the Vote Office for hon. Members.
I realised that the report had gone round that somebody was making inquiries. Therefore, there was nothing to be gained by further inquiries at Clifford Brown's plumbers' shops. If Clifford Brown wishes to challenge me, let him provide me with a pass to visit the shops at any time to check the appointments made and see what is going on. I will give him my word that I will not argue with anyone. Let him produce the 1959 prescriptions and details of Service frames supplied.
I then considered the four pukka opticians in Putney, where I have lived for twenty years. I have nothing against the opticians, dentists or doctors whose 49 names are displayed in Putney. They are all dead. None of the opticians' premises showed the National Health Service notice or displayed a range of National Health Service frames. W. N. and C. J. Jones, of Putney, is the only one to show the notice "Ophthalmic Optician" on the window. The only other notice is behind the patient's chair—rather like the notices one finds in a small hotel bedroom placed out of sight where it is hoped that no one will see it. I asked whether I could be given a copy of the prescriptions form so that I could see what I could get. But the man said, "No, I am not under an obligation to show you anything. Take it or leave it." Why make a mystery of the service provided under the National Health Service scheme?
The next place, J. W. Timmis was my own optician so I gave my own name. There was no trap, but I did not say that I was an M.P. There was some marvellous advertising here, mentioning such things as "Fellow of the Spectacle Manufacturers' Association", with a display of the arms of the City of London, and so on. This was a great attraction, but it belonged to the guy who died years ago. Therefore, that advertisement was false.
There was a marvellous ladies' dressing table in the room with a mirror in the centre and two swinging mirrors on the sides. On each there were two tiers of 12 private frames making 48 in all. When I asked about frames under the National Health Service and whether there were any on display, I was told that there were not. The man who saw me had to pull the mirror and winkle out one N.H.S. frame from behind it. He admitted that only private frames were on show. When I pressed questions about frames and colours, he eventually produced a "Statement of Fees and Charges" and said, "Here is the whole list." I said, "I know. I have a copy in my pocket, but I want to see the frames." He then admitted that he had not got a range of even available frames.
At the third place in Putney, Hudson Verity, despite restrictions on advertising, there was a marvellous illuminated mock-up of a frame in pinkish colour with the word "Consultant" on shingle. The man is not 50 a consultant at all. He is an optician. He had only one National Health Service frame and he refused to budge from a take-it-or-leave-it attitude. I asked about his qualifications and why they were not displayed on the window. He claimed that there were three categories of opticians—ophthalmic, dispensing, and himself, a consultant, which, of course, is nonsense. He argued, "Why should I put 'Ophthalmic Optician' on my window when Clifford Brown, up the road, does not put 'Dispensing Optician' on his?" Once we get them like that, fighting against one another, we shall begin to get somewhere. When asked about Health Service frames, the man said, "I don't want your business" and he ordered me out of the shop.
Optician No. 4 is the only one practising under his own name and, therefore, I will not mention it. Patients have informed me that he provides a good National Health service with some choice of frames. I will mention only one other London establishment, and that is Kays Kensington Eye Service, 39, Earl's Court Road. Kay is not the name of the man. Only one National Health frame was shown, again with "take-it-or-leave-it" attitude. When pressed about other frames or colours the man threatened to throw me out of the shop.
I pass now to the same subject matter in Hull. I spent two-and-a-half days going into the opticians' shops there. There are 33 pukka opticians' shops in the city and one dispensing optician's shop which is a branch of one of the big firms. Previously, this firm employed two qualified dispensers, but now it employs only one. I made inquiries at 16 shops, which is half the number, because two families have two shops each. Time does not allow me to record the further dialogues and fairy tales and, therefore, I will give a general summary. Only three of the shops displayed a National Health Service notice but one displayed its own notice appealing for National Health cases. Therefore, there must be business in National Health frames.
Practically all had window displays with private frames plastered everywhere, but no National Health frames. None showed the range of National Health frames. One had collections of 51 N.H.S. frames displayed on two tea-trolleys, not easily viewed, on either side of the room. One admitted that there were half-a-dozen colours in which National Health Service frames could be obtained and, therefore, he provided a better service than most. To get information about the scheme and its benefits was like getting blood out of a stone. One even refused to show any frames until after the sight test. Practically always the statement was made, "There is only one National Health Service frame," and there was always an early switch to private frames at £3, £4 and £5 each.
So it is fair to say that the main interest was to sell private frames and not to show or sell Health Service ones, and especially not to show the alternative colours. The dispensing optician was the only one who recognised me and consequently he answered my inquiries and discussed frames. I make no complaint about his service, but there was no window display and there was no range of frames shown, so that no one knew what frame he would get until it was pulled out of the drawer in a little black box.
Now a brief word about eye doctors in Hull. There are four O.M.P.s, but only one is on the Ophthalmic List. The question arises whether others are doing private work without being on the list. The Hull figures of prescriptions and frame give an idea of the position. In 1959, there were 39,000 prescriptions, but only 14,000 frames supplied, which means that two-thirds were private frames. The reasons for this I need not repeat.
The figures of the Hull Co-operative Society show a different picture. In 1959, there were 6,000 prescriptions, of which 75 per cent. were for Health Service frames. The reasons for this are twofold: a better service and members' control of all services by their committees. However, the Hull Co-operative Society begged me not to advertise for it, because it is getting the bulk of the work and does not want to get customers from other opticians, particularly those which will not provide a 24-hour service.
The 1959 figures for Doncaster are much the same. There, I was able to get the figures for children, which were 1,350 52 prescriptions and about 1,000 Health Service frames. There is no question but that if the 350 mothers who bought private frames had known that they were entitled to "brown windsors" in addition to the nickel, and in three colours, the majority would have had Health Service frames because, if a private frame is bought, the repair service is lost.
I will now give four examples of the working of the scheme in respect of four Hull cases, two of breakages in the case of a man and a woman, and two of the first-supply of spectacles to a child and a man. These give the essence of some of the rackets in the scheme. The first case is that of a man who had broken the lens of his spectacles and who needed new ones. The man wrote to me saying that he went to several opticians who said more or less the same thing, namely, no appointment for a week. So the emergency scheme for breakages which is dealt with by Form 2A is not working properly in Hull.
Eventually, this man went to shop A—I will not disclose the name—where he was told that his eyes could be tested straight away and that he could have the spectacles by the next day. So far, so good. Then came the snag. The optician said that the patient could not have them under the National Health Service scheme because it might take three weeks to get the forms through. This was quite untrue, because what can be done privately can be done under the scheme. The man stated that he chose an extra strong frame. Why should anyone want an extra strong frame when my own has lasted for seven years? So that statement was nonsense. Eventually he paid four and a half guineas instead of £1 10s. 3d.
However, there was more to come. The optician suggested that the man should have an extra pair through the National Health Service scheme. Now, this is of importance to hon. Members of this House because how many of them have two pairs of spectacles? How many have paid for one pair and have then received another pair for £1 10s. 3d. under the scheme? The House will see the point of my question a little later. That suggestion was contrary to the instructions, which are that a prescription should not be sent in if the patient has suitable spectacles, which, in this case, he would have had the next day.
53 Despite this, however, the optician sent in a prescription which the man has received but has not used. As a matter of fact, I have the prescription. It is on Form 2, whereas the optician should have used Form 2A for replacement. So let us assume that the replacement was done privately and that this prescription was for the purpose of obtaining a second pair. Where do we go from there? The point is that the optician signed the statement on the prescription, which reads "The applicant requires glasses as prescribed above". Yet the optician had just sold him a private pair for four and a half guineas.
Now, the Ministry has a different standard for the patient and the optician because there the form which the patient signs states at the top that if he makes an untrue statement he may be subject to prosecution. Why should that statement be above the patient's name when he has nothing to gain by making a false statement? Surely the statement should appear above the signature of the optician, because it is the optician's character about which we are concerned, not that of the patient. The crux of the matter is, what did the optician do first—the private sale or the N.H.S. prescription? There is no question that from the first he put himself outside the scheme, otherwise he would have used Form 2A for replacement of the spectacles.
Another important question arises: how was the four and a half guineas made up? Obviously, the man paid for the frames and he also paid the full price for the lens, instead of the scheme price of £1, because he was bluffed to go outside the scheme. Was he also charged for the test? This can only be decided by a Ministry assessor from outside Hull assessing the value of the frame, the lens and the service. The star question then will be: did the optician charge twice for the test? Certainly, he appears to have charged the National Health Service scheme improperly on Form 2, but did he also charge the man for the test?
Now I come to Case No. 2, that of a woman who had broken the bridge of her spectacles. She came to my surgery. She had no documents so I can deal with this case quickly. As she has a Service frame she was entitled to claim for repairs on Form 2A. What questions did the optician ask her? "Have you got 54 arthritis?" The woman answered, "Yes". "Do you perspire a lot?" The woman replied, "Yes". He then told her that the frame had broken through perspiration, that the scheme frame was no good and that she should have a private frame, which she did. The Parliamentary Secretary is a lady, so I will leave her to comment on that story and will simply ask this question, "What is the life of scheme frames and are specially strong ones needed for arthritic cases?"
Case No. 3 is that of a girl aged 10 who had used the school service and had been given a free test, her mother having received the prescription. Had the child returned to the school service she would have received spectacles free, and what is also important, free repair service. Unfortunately, the mother took the child to Hudson Verity, in Hull—big boys again. She was told that there were only two scheme frames and she was shown two. Now I come to the new racket. They both appear to have been wrong frames. The first was the all-nickel one, which, I understand, should be used only for a child up to 5 or thereabouts, but this child was 10. As to the second one, I quote from the letter:Steel with a little piece of pink plastic over the top of lenses …That statement is important, because that frame was not a National Health Service frame but a barrow-boy's frame.
Apparently the mother should not have been shown either of these frames, because the all-nickel one is for very young children and the second was not a National Health Service frame. I understand that she should have been shown a choice of nickel windsor frames, which are nickel covered with plastic, C.223, and available in three colours: chestnut—which is what the mother always wants to order to get away from the "tin-lizzies"—blue, and pink for girls.
As I have said, this is a new racket to me, because not only were the proper Scheme frames not shown, but wrong frames were shown to bluff the mother into having private frames. Moreover, the National Health Service Act definitely states that opticians should dissuade parents from choosing unsuitable frames. This mother was inveigled into 55 spending £4 when she should have got the child's spectacles for nothing. But even that is not the end of this story. It goes on in serial form.
The receipt was made out on a hospital eye service form, H.E.S.2, Part II, and on that it was stated, "Lens £1, frames £3."Naturally, the mother thought it was all National Health Service—who would not?—but neither the lens nor the frames were of Scheme types. I have here a drawing of the spectacles. Not only was the woman not given scheme frames, but she had dud lenses landed on her instead of National Health Service lenses.
What is important to know—if the top part of the form has been handed in, it can be checked; if it has not been handed in, there may be trouble—is what was on Part I of the form, the part at the top which the patient signs. I have the receipt, and it is interesting. It is made out by Hudson Verity to Messrs. Hudson Verity. In other words, the firm could be said to be giving the mother something which she could cash back against it. This is no laughing matter. Even if the firm laughs that off as a clerical error, how does it laugh off using a scheme receipt for an entirely private transaction?
Now comes the Oscar prize. In three months the "posh", expensive private frame, which were supposed to be superior to a National Health Service frame, broke. The mother was fed up —I am not certain whether the husband was with her at that time or not; we may get two witnesses at one stage and one witness at another, but the documents support the story—and asked for complete scheme spectacles. The optician said, "You have had all you are entitled to", which obviously appears to be wrong, but he was working a double business in the opposite direction to that in the previous case. The snag was that the child had spectacles, and, therefore, in accordance with the regulations, the optician could not send in a new prescription or there might have been trouble.
The husband claimed that the frame had a flaw, and demanded that it should be returned to the makers. But the optician said, "Private frames cannot be repaired under the scheme"—which 56 is true—"and if the maker does not replace you will have to pay £1 10s. for the repairs." But the mother can buy a set of spectacles under the scheme for £1 10s. 3d. if only she gets out of the clutches of these people. Fortunately, for them, but unfortunately for me, the argument did not go on, otherwise we should have had a good story. The firm agreed to replace the frame. Otherwise, this woman would have paid out £5 10s. unnecessarily in three months. The parents are still not entitled to the free repair service under the Scheme because the frames and lenses were private.
I had decided for reasons of time to limit examples of patients to those three, but then I received another mystery story which I must include as Case No. 4. The man has written that it was his first application, and he says:I was only shown one pair of frames at £1 10s. 3d. The second pair I was shown, which were supposed to be stronger …This is a current practice. It is said "These are no good, and they will not last. You must have a stronger pair." The ones that I have have lasted me seven years. My correspondent went on to say that the most was:£2 10s. 3d. and I chose them.In this business, when it is argued before the disciplinary committee, the customer is always wrong, because the documents are always on the optician's side, except when I go there. It can be said, "You signed for this. You knew what you were doing." People have, however, signed these forms and have not had a clue about what was happening and did not know what they were signing because they trusted the optician.
My correspondent also wrote:The form I signed had only the amount of £1 10s. 3d. on it and I was only given one receipt for £1 10s. 3d.This form should be available. The frames were private and should not have been entered on a scheme form. It would appear that the frame was priced at £1 10s. 3d. which, again, is the price of National Health Service spectacles, and the lenses were £1; but why was a receipt for only £1 10s. 3d. given? Opticians do not deal in £s. They deal only in guineas. Why was not the second pair in guineas? There is something "phoney" here. There is £1 10s. 3d., 57 apparently, on a National Health Service form, and the chances are that the transaction will appear as a National Health Service transaction and the firm will dock another £1 on the side.
Having made these serious statements I am, of course, fully prepared to pass the documents in the three cases to the Minister so that he may decide what action should be taken.
I can now sum up with regard to Hull. I have written to everybody in Hull. The Hull City Labour Party has even passed a resolution to send to the local executive council of the National Health Service. It informs me thatIt was decided to write to the local national health executive council requesting that every care should be taken to advise opticians practising under their jurisdiction that the full range of National Health Service spectacle frames should be on show and readily made available to their patients.I received a letter from my constituency Labour Party stating that it was generally felt that there was a racket going on and that members were interested to read extracts from HANSARD. I have written to the Hull and District Trades Council, which represents 80,000 members and their families. We on the Labour side in Hull will get the opticians' racket cleared up. What we want is a set of the frames, plus the scale of fees and charges, not in an optician's shop but in the reference library where all can see what they are entitled to.
I have taken up more time than I ought to have done, but I consider that this is one of the most important statements that has been made in the House of Commons about a Government service. It is a serious matter and it should be dealt with and the service cleared up before the new Opticians Act is brought fully into force. I can give advice and issue memos. It is easy to say "Avoid the medical health centres like the plague." They are not operating the Supplementary Ophthalmic Services. They ought to bear the inscription "Young men and women taken in and done for", because every time one goes in one is likely to come out £5 light in pocket.
I will quickly sum up what I have said, and the case which I want to be answered. Obviously, the whole scheme 58 must be investigated. It may not be possible to do that nationally, in which case there should be pilot investigation schemes in, say, Hull or Putney. If the Minister wants a wider investigation, he could take the Borough of Wandsworth. The name "medical health centres" should be taken off these false plumbers' shops. We have to ensure that medical practitioners hand out Form I having really tested a patient's eyes or having altered the form. That is the standard required.
I have not set out to deal with the subject in detail. I have too much material and I have come to the end of my time, but I know what is in my head. I would far rather have said this at a public meeting. It would have been easier to tell this as a fairy tale, not having to prove my case.
This Augean stable has to be cleaned out. I have been told that I have taken on a Herculean task. The chances are that I will get a flood of letters, but I guarantee that all those who write to me will have their case dealt with. This optical nonsense should be referred to the Monopolies Commission, to find out where the rackets are. It is a scandal that people with education, who should have a high standard, should rook people who are poor—and I started poor. I argued with the Army about a poor widow and a grant of 9s. She got 11s. eventually, but the first four or five weeks of that 11s. was pinched from her by an optician. This is a scandal of the first magnitude and it has to be ended. I am prepared to devote any time I have to it with the Minister, with the authorities in Hull, or with anyone else. I have not told half the stories of the racket in the National Health Service spectacle supply procedure.
§ 4.54 p.m.
§ Mr. Ronald Russell (Wembley, South)
I am very glad indeed to have an opportunity to take part in this discussion, because I had the good fortune two years ago to sponsor the Opticians Act, 1958, and I am now a member of the General Optical Council. I shall not attempt to answer all the very detailed criticisms which the hon. and gallant Gentleman the Member for Hull, East (Commander Pursey) has made. I merely want to make a few pertinent observations. In what was at times a most amusing 59 speech, he went far beyond the Motion which says:That this House recognises the success of the Supplementary Ophthalmic Services in providing free sight-tests and a substantial reduction in cost of spectacles to the patient;and then adds:… noting the failure of some opticians to offer the complete services available …From the tone and effect of the hon. and gallant Gentleman's speech one would think that the S.O.S. had had no success whatsoever. One would certainly not think it had resulted in a reduction in the cost of spectacles to patients, and one would also conclude that most opticians had failed to supply the complete service available. That is certainly not the case. The hon. and gallant Gentleman must have mentioned the word "racket" between 25 or 30 times, which again has no connection whatever with the Motion. He used the terms "pukka opticians" and "plumbers". I am the last person to criticise the honourable trade of plumbing. A good plumber is a very skilled person, otherwise the world would have many leaking pipes; but, presumably, the term was used in a disparaging sense.
The only difference between dispensing opticians and ophthalmic dispensing opticians is that the former are qualified only to supply or fit spectacles or other optical appliances, whereas the latter are qualified to test eyes as well. Both have to pass equally difficult examinations to qualify for their particular occupations. As for the Woolworth's spectacles which he mentioned, and the barrow boys in markets, I remind him that Section 21 of the Opticians Act takes care of that aspect, though that Section is not yet in force. Subsection (1) states:Subject to the following provisions of this section, a person shall not sell any optical appliance unless the sale is effected by or under the supervision of a registered medical practitioner or registered optician.When that section comes into operation—and we had a very lengthy discussion on this during the Committee stage of the Bill—the supply of spectacles by unqualified people will cease, and Woolworth's or any other firm which carries out such operations will have to employ a qualified optician. That will meet the difficulty the hon. and gallant Gentleman mentioned.
60 As far as I understand it, in twelve years of the working of the Supplementary Ophthalmic Service, more than 50 million people in England and Wales have had their eyes examined or reexamined by ophthalmic opticians or by ophthalmic medical practitioners who, until I came in contact with the optical world, I used to call occulists. Eighty per cent. of these people were examined by ophthalmic opticians and 20 per cent. by ophthalmic medical practitioners. There are stringent terms of service for both, all laid down in the National Health Service (Supplementary Ophthalmic Service) Regulations (1956), Statutory Instrument No. 1078 of 1956.
There is a high ethical standard among all the three participants in the Service—medical practitioners, ophthalmic and dispensing opticians. It is fair to say that there have been fewer recorded complaints against them than against any other part of the National Health Service—which does not tally with what the hon. and gallant Gentleman said. He said that the public were not made aware of what was available to them under the National Health Service. The notice which he mentioned, and which he referred to in a Question this afternoon, is usually displayed in an optician's consulting room or waiting room but not, possibly, in a shop, because there are restrictions on advertising, but there is also a notice, No. O.S.C.3, which tells the public exactly what to do. Again, I think that the hon. and gallant Member has seen it.
That notice, and the notice which he mentioned in his Question, are in quite plain language. I do not pretend always to be able to understand legal or medical language, but, barring one description of a kind of spectacle frame, namely P.R.O., the language is perfectly plain and most opticians ensure that the patient is shown both the National Health Service range and any other type of frame available on payment.
There were originally about 41 types of frame available under the National Health Service, but about 10 of those are no longer available because demand for them was so small that their manufacture became too costly and had to be abandoned. I understand that there are now consultations about whether they can be replaced by other types.
61 Of the remaining frames, 7 are children's standard frames and, naturally, would not be shown to any adult going into an optician's shop; 4 are of the "half-eye" type and 5 are for patients with only one good eye and would obviously not be shown to anyone with normal two-eye vision.
Patients deciding to have National Health Service spectacles are told that they have to pay £1 a pair for lenses, plus the scheduled cost of the frame, and, as the hon. and gallant Member said, the total cost could be only £1 10s. 3d.
Opticians are precluded by the terms of service from advertising their connection with the National Health Service, but the General Optical Council is charged by the Opticians Act with going into the question of advertising outside the Service. That will be done in time, when the Council has had time to do the many things with which it is charged. A professional conduct committee has been set up to deal with that matter.
The hon. and gallant Member recounted some encounters which were amusing to him and to the House, but not so a musing to the opticians concerned. He said that he had visited various opticians in Hull, Putney and other parts of the country to try to find out whether National Health Service frames were being displayed. In fairness, I must quote an account of one of the interviews with an optician in Hull.
This is what is said in a reply to a letter from the secretary of the Local Optical Committee:—We had a visit from Cmdr. H. Pursey, M.P. during the afternoon of Wednesday, 19th January. His approach to my receptionist was that he was considering having his glasses changed, and he sought advice as to procedure. He was asked as to how long ago it was since he last had his eyes examined and on replying that it was approximately three years he was enlightened as to the procedure. He then asked if he could see the frames he might select from the N.H.S. range, and he was shown 10 frames, i.e., 524, 524H.J., 423, 421, 514, 525, etc. He insisted there were others and that they should all be on display. He also asked what the position was when anyone required urgent attention, 'would we only attend to them privately in such circumstances?' His manner and his questions were such that my receptionist thought it best that I should be called to this 'awkward and extremely rude old man'.Immediately I saw him, I informed him I was aware of his identity and as to his purpose. He again repeated his views that N.H.S. 62 frames should be on display but I expressed my disagreement, he was welcome to see all the frames if he so wished, but normally when patients were being dealt with, there were many factors that had to be taken into consideration, as to which frames were suitable to their needs. He went on for a little time expounding on what he thought of opticians, and he departed with the remark that he was 'going to blow the top off this optical racket'".He has tried his best to do so this afternoon, but he has grossly exaggerated the position.
There may be a few opticians not carrying out the intentions of the National Health Service, but, as the Motion says, the vast majority are not in that position. On the whole, I think that the House will pay tribute to the work done in providing so many pairs of spectacles to so many people free of charge or at a comparatively small cost, certainly smaller than would otherwise obtain.
I leave my hon. Friend the Parliamentary Secretary to make the more detailed arguments, but the fact is worth putting on record that this is a thoroughly good Service doing a thoroughly good job.
§ 5.6 p.m.
§ Mr. Barnett Janner (Leicester, North-West)
I should not like it to go to the country that the case made by my hon. and gallant Friend the Member for Hull, East (Commander Pursey) is entirely unchallenged from this side of the House. It must be recognised that in his own Motion my hon. and gallant Friend expresses appreciation of what has been done, while bringing forward certain instances in which there have been abuses, or alleged abuses.
I am sure he will agree that we do not want to stamp the whole of the profession with the alleged misdeeds of the few. I say "alleged misdeeds" not because I doubt my hon. and gallant Friend, but because I belong to a profession in which one has to examine both sides of a question and to see that allegations are proven before eventually reaching a decision. I am sure that my hon. and gallant Friend would not want to daub the whole of the profession with the stigma of his allegations.
It appears to be the case that my hon. and gallant Friend has not submitted his complaints to the local executive council, or other bodies which have been set up by a Statute to deal with 63 complaints of this kind. I have been interested for many years in protecting the public against many kinds of abuses, in particular from abuses connected with the work of opticians.
For many years, attempts were made to persuade various Governments to introduce legislation to put practising opticians under restrictions and supervision in order to bring their status to a proper level, so that they might be subject to certain disciplinary reactions if they committed offences similar to those which have been mentioned. We strove for a long time towards that end and eventually we had the Opticians Act in whose passage the hon. Member for Wembley, South (Mr. Russell) played so important a part. The principle of that Act is now being extended to other professions ancillary to the medical profession. I hope that one day it will extend to hairdressers and others who, in their own spheres, have, as it were, the safety of the public in their hands.
It would be a pity in these circumstances if it were to go out to the world that what was intended to be something of considerable value has become subject to general abuse. It is my view—and I say this with the same sincerity as my hon. and gallant Friend gave his opinions to the House—that in the vast majority of cases this kind of complaint does not apply. After all, this is not one of those intricate matters with which we sometimes deal in the House, such as the Rent Act, which people do not understand.
A person knows the possibilities open to him for getting any defect in his eyesight attended to. He knows that there is a National Health Service and that under it he can obtain spectacles. He knows that he can go to the doctor and to the optician. I have no doubt that there are some opticians who abuse the service in the course of trade, but I am quite certain that if the abuse were as general as one would suppose from what my hon. and gallant Friend has said the number of complaints received in official circles would be vastly more than they are at present.
If the abuse were really as widespread as my hon. and gallant Friend would lead us to suppose, I cannot imagine any hon. Member on either side of the House not having someone coming along to his 64 weekly or fortnightly "surgery" and complaining about the abuse. I do not know how many complaints my hon. and gallant Friend has actually received from constituents, but I am bound to say that out of the great number of complaints which I received on every other subject I frankly cannot remember ever having received one in regard to this matter.
My constituents are very live people. They are on their toes all the time, and they frequently come to me when they want something done. I admire them for that, and I do what I can to deal with their difficulties. I am quite sure that had there been any abuse in my area of the kind cited by my hon. and gallant Friend my constituents would have brought the facts to my notice.
Of course, had any such case been brought to my notice I would have investigated it. In the first instance, however, I think I would have made certain that the optician concerned was given the opportunity to answer the charge before a tribunal prior to being exposed in the House of Commons to a charge which may or may not be true. I think that anyone so accused should have the opportunity to refute the charge or to explain the matter before some kind of tribunal which would then decide whether it thought he was in the right or the wrong.
I know that my hon. and gallant Friend is a reasonable man and will, on reflection, realise that terrific damage can be done if an accusation is made in the House against any individual or firm, even though ultimately the charge may be proved against that individual or firm, and if it is broadcast throughout the country that opticians as a whole are abusing the Service. I think it should be stated in the House that that is not the general feeling.
The hon. Member for Wembley, South referred to the question of advertising and to opticians practising under different names. Section 25 of the Opticians Act, 1958, states:Subject to the provisions of the next following subsection, the General Optical Council may make rules prohibiting or regulating—I understand that a committee has already been set up to consider these matters in the future. I am sure that my hon. and gallant Friend would do a service to the community were he to submit to that committee the complaints to which he has referred this afternoon.
- (a) the use by registered opticians and enrolled bodies corporate of any means of giving publicity, whether by advertisements or not, to their practice or business of ophthalmic or dispensing opticians;
- (b) the carrying on of practice or business by registered opticians and enrolled bodies corporate under names other than those under which they are registered or enrolled."
I do not want to cover the same ground as that covered by the hon. Member for Wembley, South, but I would point out that many millions of spectacle frames are supplied each year under the scheme. I know that the ophthalmic opticians themselves send out notices and put up posters in various places stating where these spectacles are provided. Much has been done by every reputable body in the profession to make the public aware of its rights under the Act.
I hope that the fact that my hon. and gallant Friend has raised the matter in the House today will act as a warning to those who are committing offences under the Act. I also hope that it will be fully realised that the people who have been accused today have not had the opportunity to answer the charge brought against them. After all, if one had known what the accusations were to be one could have approached the people concerned and asked them for an explanation. They have not had that opportunity. If they are guilty of the offences stated, then it is only proper that they should be scourged in the manner which my hon. and gallant Friend has suggested today.
I think that the steps taken by those organisations who pressed for the Opticians Act to be passed will be sufficient to put an end to any such abuses. These organisations pressed for the Measure against, on occasion, strong opposition on the part of the Government. I know what a job it is to try to get Governments to move. I have had four years' experience of trying to get the Government to act in a very much smaller matter than this.
§ Mr. Janner
Yes, but only after four years of trying. One can sometimes get very disheartened.
66 I hope that this matter having been raised in the House today proper steps will be taken to investigate the various cases cited. At the same time, I hope that those responsible in this profession will not feel that the House itself condemns them in anything like the manner—or, possibly at all—in which my hon. and gallant Friend did when putting these cases ex parte to the House today.
§ 5.20 p.m.
§ Lord Balniel (Hertford)
I should like to begin by congratulating the hon. and gallant Member for Hull, East (Commander Pursey) on his choice of subject, because it is not often that we have the chance to discuss a rather specialised aspect of the National Health Service. I should also like to congratulate him on the immense research he has undertaken, and the pains to which he has gone, in the preparation of his case. Clearly, he has gone from place to place visiting opticians in different parts of the country. But I must say that my congratulations end there. I cannot commend his speech, because he made a number of charges against individual persons and individual firms; charges of unprofessional conduct, charges virtually amounting to corruption, and charges very serious indeed to the individuals concerned.
I do not know if the hon. Gentleman informed my hon. Friend the Parliamentary Secretary of these facts before he raised them. If he did perhaps my hon. Friend will he able to give the case for the opticians concerned. Apart from one matter to which my hon. Friend the Member for Wembley, South (Mr. Russell) referred, we have not heard the case for the opticians. We do not know what it is.
Even if we knew what it was, I would agree with the hon. Member for Leicester, North-West (Mr. Janner). If any of us is presented by a constituent with a case of unprofessional conduct he should advise his constituent to have recourse to the defence which exists under the Opticians Act. There are special disciplinary courts specifically devised to deal with cases of unprofessional conduct. The case is heard and adjudged by those courts and if, in the view of the disciplinary committee, the matter is one of unprofessional conduct, it is open to any one of us to raise it in this House. It is a pity that the hon. and gallant 67 Gentleman did not advise his constituents to take advantage of the disciplinary provisions in the Opticians Act.
I cannot comment on the details of the cases to which the hon. Gentleman referred. From the general experience of this Service, which I think is similar to that of most hon. Members, I agree with the terms of the hon. and gallant Gentleman's Motion, which I support, rather than with the terms of his speech which was a most ferocious attack on the terms of the Motion.
I find myself in agreement with that part of the Motion which says:That this House recognises the success of the Supplementary Ophthalmic Services …It is difficult to judge the success of a social service. I suppose that one can judge it by the quantity of service, which it administers—and I believe that over 50 million persons have had their sight examined in the last twelve years. But it is not only the quantity of the service that we must examine, it is the quality. As my hon. Friend said, there are fewer complaints about this part of the National Health Service than about any other section. I believe that throughout the country there is general satisfaction with the Service. On the other hand, I am not sure that within the Service there is exactly the same form of contentment.
I should like to call the attention of my hon. Friend the Parliamentary Secretary to a resolution passed by the Hertfordshire Local Ophthalmic Committee. As my right hon. and learned Friend represents a Hertfordshire constituency I feel sure that this resolution has been brought to his attention. The resolution says:That this Hertfordshire Local Optical Committee expresses bitter opposition to the recent further reduction in the dispensing fee. It recognises that this reduction originates in the long-standing inadequacy of the current regular National Health Service dispensing fees, in that the uneconomic level of this fee caused some opticians to intermix Health Service and private dispensing (a practice which, out of loyalty to the Service and to the profession, was condemned by this Committee and eschewed by opticians throughout the county). Eventual Ministerial sanction of this practice is now seen to have been a preliminary move towards the further reduction in the dispensing fee which has now been imposed. These Ministerial tactics have sapped this Committee of all goodwill towards 68 the Ministry and the Service. Only its concern for the public and its friendliness towards the Executive Council officers and staff remain.That resolution was passed by the elected representatives of the ophthalmic and dispensing opticians in the County of Hertford.
Those are strong words to use about the Ministry with which it is connected, and I should like my hon. Friend to say a word about the proposal to reduce the dispensing fee for what are known as high-grade spectacles in which a private frame is used with a National Health Service lens. I think that hon. Members know that this is part of a tripartite agreement. It was agreed more than a year ago that the fee for sight testing should be increased by 1s. or so, that the fee for dispensing National Health Service lenses and National Health Service frames should be kept unchanged, and that the fee for dispensing National Health Service lenses in private frames should be reduced. I think that hon. Members also know that this step has been advocated on a number of occasions by the Public Accounts Committee and there are, therefore, obviously good reasons for it.
There may be good reasons, which we appreciate in the House, for the proposal to reduce the dispensing fee. Those reasons, however, are not appreciated amongst ophthalmic and dispensing opticians, and if my hon. Friend could take advantage of this debate to remove the worries and misunderstandings which have arisen she will render a good service to this part of the National Health Service.
§ 5.28 p.m.
§ Mr. Charles A. Howell (Birmingham, Perry Barr)
When the hon. Member for Wembley, South (Mr. Russell) intervened in the debate he showed his usual courtesy by declaring his interest with the General Ophthalmic Council. Unfortunately, my hon. Friend the Member for Leicester, North-West (Mr. Janner) was not as forthcoming in declaring his interest.
§ Mr. Janner
I have no interest in the matter. The only interest that I have is as an outside individual. For many years, as an ordinary Member of the House, I went into the matter and pressed for legislation.
§ Mr. Howell
I hope that the noble Lord the Member for Hertford (Lord Balniel) and my hon. Friend will get together after the debate and decide which of them is right. I said that my hon. Friend did not declare his interest, and the noble Lord said that he did. I listened carefully because it was obvious that my hon. Friend was speaking from a prepared brief. He did not tell us from whom he received the brief. It was obvious that my hon. Friend was whitewashing the whole profession, whereas the Motion does not seek to do that. Like the noble Lord the Member for Hertford, I agree with the Motion.
§ Mr. Janner
Will my hon. Friend allow me to intervene? I do not want there to be any misunderstanding on this matter at all. With the help of those whom I have consulted on this matter, I assisted in bringing in an Act which would protect the public against unscrupulous people in the profession. It is from precisely those people, the same organisation, whom I have for years been in touch with in my other capacity in an effort to wipe away a scourge—I do not represent them—that I have obtained information for this purpose, as I obtained it hitherto in order to have assistance in putting a certain Act on to the Statute Book.
§ Mr. Howell
I am not debating the Measure which my hon. Friend helped to introduce. You would rule me out of order, Mr. Deputy-Speaker, if I were to do so.
§ Mr. Howell
If my hon. Friend wants to make another intervention, I am quite prepared to give way. I recommend him—indeed, I implore him—to read HANSARD tomorrow. He will there see that he used these words, "If we had known what accusations were to be made, we could have reputed them". He did not tell us who "we" were.
§ Mr. Janner
I meant the House, obviously. Of course I meant the House. Who else could I have meant? I said "we", and I mean we who are here, including my hon. Friend.
§ Mr. Howell
The only party to whom anyone could attribute the "we" was the people whom my hon. and gallant Friend the Member for Hull, East (Commander Pursey) has been accusing.
If one reads the Motion, one finds there the word "some". That is the point. We may be guilty in this of generalisation. In my experience in the trade union and working-class movement, I have seen the tragedies which frequently occur as a result of generalisation. A scoutmaster goes off the rails, and everybody thinks that scouts are all wrong. A vicar or a curate goes off the rails, and everyone generalises. A few working-class people in a factory are involved in what is now called a wildcat strike, and everyone generalises. This Motion is designed to avoid that mistake. It welcomes the scheme but regrets that some are not playing fair. That is all it says, and that is all I intend to refer to tonight.
My hon. Friend the Member for Leicester, North-West was quite right to refer to individual cases being put before the Health Service executive council. I do not quarrel with that. As the House knows, I was a member of one from 1948. On that council, we had a few complaints. I think one has complaints in anything. I was on the ophthalmic committee and on the dental committee. I will say that we had far more complaints about badly fitting dentures than about badly fitted or wrongly made spectacles. This is, no doubt, because, even if the spectacles are not perfect, people can use them, whereas if dentures are not perfect they cannot; they keep coming back for alterations and, eventually, someone suggests that the matter should go to the executive council.
The hon. Lady the Parliamentary Secretary will probably tell us that in every post office there is a notice giving the name and address of the National Health Service executive council. My hon. Friend the Member for Leicester, North-West is very naïve if he thinks that working-class people are fully acquainted with their rights in this matter. It may be that, in Leicester, there are no complaints of this sort. I will be honest about it and say that I have heard no complaints in my constituency. All I have had is letters from opticians referring to the matter raised by the noble Lord at the end of his 71 speech, the alteration in their fees and the inclusion of certain different types of spectacles.
In other capacities, before I came to the House, I received very many complaints on the lines indicated to the House by my hon. and gallant Friend the Member for Hull, East. I was able to get most of them settled in the way suggested by my hon. Friend the Member for Leicester, North-West, through the Executive Council, but the only reason that I could do that was that trade union secretaries in Derby knew that I was a member of the council and sent people to me.
The hon. Member for Wembley, South made as good a case, though by no means as long, as did my hon. and gallant Friend. He referred to a letter certain people had written, apparently, in an effort to denigrate my hon. and gallant Friend's case. I shall not refer to the description of him. It may be true; it may not be true. I have never found him to be like that, but I can well imagine someone thinking like that about him if he thought that my hon. and gallant Friend intended to make an attack in this House and wished to write a letter in order to discredit him.
The hon. Member for Wembley, South, in reading the letter, said that my hon. and gallant Friend was shown five frames. The hon. Gentleman had just told us that there are 46 frames, 10 of which are not now in use.
§ Mr. Russell
I said that there were 41, of which 5 were children's frames and 5 were supplied to people with only one normal eye. Those 10 would not be supplied to a normal adult with normal eyesight. Also, there were 10 which had gone out of use because the demand was so small that they had become too costly. The 41 is thus reduced to about 21.
§ Mr. Howell
I beg the hon. Gentleman's pardon. If it was 41, then I will reduce my 46 to 41. I have no notes. In fact, I could have been supplied with notes. I have refused to bring them into the House. If I cannot speak on matters on which I am informed, I certainly have no intention of coming here to speak on notes supplied by other people. I do not wish to be told what to say. That is what it comes to.
72 There are 41 frames, 5 for children and 5 for people with one eye. That leaves 31. Was my hon. and gallant Friend so much out of order in saying to that optician, "Have you no more than these five which you have shown me?" Were the five he was shown the best or were they, as I have known and as other people have known, the five worst? After all, most of us have a little snobbery in our make-up. Everyone who is honest will admit that. When people go to the optician, perhaps well dressed and seeming to be reasonably well off, the optician says, very nicely, "Of course, you will not want a pair of these. You will not want to wear this type; it is identifiable as the Health Scheme type".
Many people have the idea that the only type of frame which one can have under the Health Service is the steel or metal frame. They want plastic or imitation tortoise-shell, or whatever it may be. One complaint I have had—I have no doubt that the noble Lord has had it too—has been from opticians who complain about certain other frames being introduced into the Health Service. Are these frames which the Minister wants to introduce more presentable? Will they be better for the people of this country? Will they prevent them wanting to buy their own frames? I have every sympathy with opticians if part of their income is to be, shall we say, siphoned off because they will not, perhaps, be able to sell the other frames.
My duty is to represent the public, not the opticians. If these frames which the Minister wishes to introduce into the free scheme are good frames, I welcome them. I am certain that, if they are any good at all, the opticians with whom we are concerned in this Motion will not show them to the public, in an endeavour to increase their income by selling private frames.
Some time ago, every hon. Member of the House, I think, was sent a sample pair of spectacles. I do not know whether the best frames available were chosen for that purpose, but I do know that I should not be ashamed of wearing them. Strangely enough, the pair which came to me were very small. They looked as if they might fit a child of about 12 or 14. I could read through the lenses, but I could not manage to fit the frames round the side of my head 73 or even make them reach my ears. However, I still have them in this building, and they are a presentable pair of spectacles.
There is no doubt, as was said by the hon. Member for Wembley, South, that this firm showed to my hon. and gallant Friend 5 types of frames out of a total of 31. When he asked if there were any more types, obviously the firm was not very pleased. It has become the practice to show types of frames other than those obtainable under the scheme. My hon. Friend the Member for Leicester, North-West could have told us that in Leicester opticians who operate the National Health Scheme have National Health Scheme frames in cases in their waiting rooms. He did not tell us that, and I know why. It is because they do not show them. If opticians wished to sell such frames they could display them. I speak from experience when I say that when these opticians submit an application to the executive council to come into the scheme, the council has to be satisfied that their premises and appliances are suitable. The same applies in the dental profession. I do not think it too much to ask that the opticians should display all or most of the frames from which members of the public may choose under the National Health Scheme.
§ Mr. Howell
Well, all of them. Assuming that there are 41 such frames, an optician need not put them all into one group. He could have a group of 10 such as were referred to by the hon. Member for Wembley, South—5 for one-eyed people and 5 for children—
§ Mr. Howell
I am sorry, I thought the hon. Gentleman mentioned five. Now we have gone from a total of 11 to one of 13 which is an unlucky number, although I do not know for whom it will prove unlucky.
There could be 13 frames exhibited in one group, 7 of them for children up to a certain age and others for one-eyed people, although I do not know why a one-eyed person should want a frame which is different from that of a person with two eyes. I should have thought it would be better to have identical 74 frames so that one-eyed people should not be embarrassed by their disability being indicated.
My glasses are supposed to be rimless. My hon. and gallant Friend talked about frames which cost four guineas but my glasses cost me seven guineas. They have a small rim at the top and I prefer that type. When the pair I had previously were broken, I went to the optician. He did not offer to sell me frames under the National Health Scheme. He said, "I suppose you want the same type of frame?" I said, "Yes". I was not arguing about it. Like my hon. and gallant Friend, I was not seeking to find out whether he would offer me such frames, because I knew what I wanted before I consulted him.
I wonder how many people know that the frames which they can get under the scheme are not the type—either silver steel, nickel-plated or whatever it may be—which look so cheap. I believe that people are under the impression that the types of frames they would get under the National Health scheme are similar to those issued to members of the Armed Forces. I think it rather degrading that a soldier or a sailor or an airman—although upon reflection I must admit that I have never seen a sailor wearing glasses—should have to wear glasses with metal frames. Perhaps if he wore other kinds of frames the private might look smarter than the colonel, which would not do at all. That may be why other ranks wear glasses with metal frames.
If this debate has done nothing else it may indicate to the public that there are about 31 different kinds of frames from which they can choose. When two friends meet and comment on their spectacles the cost is usually mentioned and it seems to have become universally accepted that it is necessary to pay for the lenses if one does not want the atrocious type of spectacles which are obtainable under the National Health scheme. Contrary to my general practice I am now arguing about something of which I have no knowledge. We do not get an opportunity to see these National Health Service frames. Twice in the last two years I have undergone an examination prior to obtaining a pair of spectacles and I still have not seen the type of frames available under the scheme. 75 But I am convinced from the correspondence which I have received that they must be something special if the opticians are becoming worried about them.
I sympathise with the problems of the opticians in my constituency, but I am more concerned that people in the poorer classes of society who need spectacles, but who are afraid of the cost, shall be able to get a pair for £1 10s 3d. I hope that this service will be more widely used, rather than that people should use magnifying glasses to read even the racing results, as is so often the case at present.
On two occasions I have taken up the case of a person who, because of old-age or infirmity, has been unable to visit the premises of a dispensing optician in order to undergo a sight test. On each occasion I have been successful in solving their difficulty, although their own efforts were not successful. I can imagine that if a dispensing optician has to spend time travelling from his premises to the home of such a person in order to conduct an examination, he may lose business. I wish to ask the Parliamentary Secretary if the dispensing optician can receive an additional fee for that kind of service. I have received correspondence from opticians complaining about the reduction in the fees and I am wondering whether any of my constituents will suffer from a lack of service because of the reduction. Are the fees adequate, and are they sufficient to induce dispensing opticians to visit the homes of old and infirm people in order to carry out a sight test?
I welcome the fact that we have had this debate if only for the publicity which may follow from it. But I should not like it to be thought that I consider that the profession is rotten from top to bottom. I have received the finest service possible and good service was provided for the people whom I was able to assist to obtain it. But that does not alter the fact that some members of the profession could provide a better standard of service. I hope that the opthalmic council of which the hon. Member for Wembley, South is a member, will do something to indicate to the dispensing opticians that if they wish their profession to remain respected, they must get rid of the black sheep.
§ 5.50 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I think that I should intervene at this stage to try to comment on what has been said on this Motion. The general theme advanced by the hon. and gallant Member for Hull, East (Commander Pursey), was that this is a good service, but that the general public is not sufficiently aware of it and does not always obtain it because of the deficiencies of the opticians and ophthalmic medical practitioners, and because of inadequate information.
I should like to say from my own knowledge that the general public is very well aware that spectacles can be obtained under the National Health Service at a very reasonable charge, and free in the case of children.
I think that it is fair to say that, in general, people know that if they choose a frame which is not included in the National Health Service range they have to pay the extra cost. I think, however, that many members of the public may be like the hon. Gentleman the Member for Birmingham, Perry Barr (Mr. Howell) in that they know what they want and are prepared to pay the extra for it if it is something different from what is available in the National Health Service range.
While the general public may not know all the details involved in their choice, it is a duty laid upon the opticians by their terms of service that they should inform the applicant that a full service of frames is available, and the regulations clearly state that opticians may not supply private frames except at the specific request of the applicant.
The hon. and gallant Gentleman complained that there was abuse of the service and the word "racket" occurred in his speech very frequently. He also complained that some opticians employ high pressure salesmanship methods to persuade applicants to buy expensive private frames. That may be so. I am not saying that the optical profession any more than other professions, is free from black sheep, or that it does not include in its membership some whose code of conduct leaves them open to criticism. It is, however, wrong to apply a sweeping condemnation of members of a profession who deserve their share of credit 77 for the success of the supplementary ophthalmic service, which the hon. and gallant Gentleman's Motion admits is the case.
The position is that an applicant has complete freedom of choice to go to any optician or ophthalmic practitioner for a sight test, which is itself free. The notices which are normally in the waiting rooms explain the charge for lenses and frames. After approval of the prescription by the local ophthalmic services committee, the patient is again free to take it to any ophthalmic or dispensing optician, who need not be the optician who tested the patient's eyes.
In dispensing, the optician should fit National Health Service lenses in private frames only at the patient's specific request. Deposits may be taken up to the full charge under the 1951 Act, that is, 10s. per lens and the actual cost of the frames, when the undertaking to pay is signed. There is no control over payment for any private transaction for frames. For repairs and replacement of lost or broken glasses when no sight test is needed, the work may be done immediately if carelessness is admitted and the full cost is paid, or if carelessness is not admitted but the full cost is deposited pending consideration by the ophthalmic services committee.
A handbook for ophthalmic medical practitioners, ophthalmic opticians and dispensing opticians, which was last revised in 1958, is issued to each practitioner. It has no statutory force, but it explains, in terms agreed with the profession, the arrangements under the service. Additional guidance is issued as need arises, again in consultation with the professions. For example, a note was recently issued as guidance in the matter of deposits.
Under the National Health Service regulations each executive council has an ophthalmic investigating committee to investigate allegations that a practitoner has not complied with his terms of service. It may also consider matters not involving such allegations which are referred by the council or by an authorised committee. If there is failure to observe the terms of service, action can be taken in various way, the most extreme being the removal of the practitioner's name from the list. The hon. and gallant Gentleman has made a 78 number of allegations. I shall not mention any names—
§ Dr. Edith Summerskill (Warrington)
How many cases have there been of practitioner's names being removed from the list?
§ Miss Pitt
I do not know the answer to that, but I will find out and let the right hon. Lady know. I shall be surprised if it is any. I shall come later to the number of complaints.
The hon. and gallant Member for Hull, East made a number of allegations. As I have advised him before, in reply to Questions, it is open to anyone involved in a particular instance to complain to the executive council. So far as I am aware none of the allegations made from time to time by the hon. and gallant Gentleman, including those which he has made today, has been referred to an executive council. Cases needing investigation are few—I think that this meets the right hon. Lady's point—about 25 a year and this shows a very low incidence of complaints. The hon. Gentleman the Member for Leicester, North-West (Mr. Janner) said that if he had one it was as many as he had had from the whole of his constituency.
§ Miss Pitt
Giving the information that is available to me in the Ministry, I would emphasise that the figure of 25 is against a total annual figure which has now reached over 5 million sight tests plus nearly 5 million pairs of glasses dispensed, and it is a fact that the complaints are rather fewer than in any other part of the Service.
The short answer to the hon. and gallant Gentleman's complaint is that the terms of service deal fully with the necessary obligations resting on those providing the service. There is adequate machinery to investigate allegations that particular practitioners are not complying with their terms of service. The newly formed General Optical Council, as well as the General Medical Council, have responsibilities for promoting higher standards of professional conduct. Arrangements for informing the public on the availability of the Service have been made and are always under review.
79 As I told the House, in reply to a Question recently, we are always willing to consider hon. Members' suggestions for improving the information service.
§ Mr. Howell
When talking about not getting complaints, is it not a fact that we may not get complaints from people because they do not know that they have cause for complaint? If they do not know that reasonable types of frames are available—something like those which they have actually paid for—it may be that complaints do not come in.
§ Miss Pitt
I think that if people wished to complain about a particular type of spectacle provided, they would readily come forward and complain. Whether they would complain because they have been brought under pressure to take expensive private frames rather than those available under the National Health Service range, I am not sure. As I said before—and I think that hon. Members on both sides of the House agree with me—the average member of the public is well aware that he can get a pair of frames through the Health Service.
§ Mr. Dodds
This is an important matter. I do not think that the hon. Lady has answered the question. When a person has not previously had need to see an optician about his eyesight, how can he know what is available to him unless, when he goes to an optician, he sees displayed, or has brought to his notice, what is available? Is it a requirement under the scheme that the frames which are available should be displayed? If not, how on earth can any person know?
§ Miss Pitt
It would be a most unwarranted trespass on the time of private Members to try to reply to the many detailed points raised by the hon. and gallant Member for Hull, East. I shall go through his speech later and, where I am able to add to the information, I 80 shall do so by writing to him. Meanwhile, there are some points to which I can reply.
There is the question of not exhibiting the Ministry of Health notice. These notices were introduced in 1951 and sent to all ophthalmic medical practitioners and opticians. A revised notice was issued in 1958 and executive councils arranged a supply to opticians as necessary. Most opticians are believed to display this notice, or notices provided by their associations.
In reply to a Question on 8th February, I undertook to examine the situation in the four areas mentioned then by the hon. and gallant Member and mentioned again by him today. The examination promised has taken place. In southwest London the council arranged an informal visit to 131 premises. It found 81 displayed the notice and the remaining 50 willingly accepted another copy for display. In Putney, four out of the five opticians quoted already displayed copies of the notice. As the hon. and gallant Member said they did not display it, I can only think that he did not penetrate to the waiting rooms where the notice is normally displayed. Middlesex and Surrey were found to be too large areas for a full survey but informal inquiries through the executive council confirm that most opticians display the notice. It now emerges that the hon. and gallant Member visited only three branches of the particular firm he has mentioned this afternoon. That firm has asked, during the last few days, for extra copies and there has been a demand from other firms. In Hull, of the 34 premises mentioned 22 displayed notices and copies have been requested at some of the remainder.
In reply to a supplementary question by the right hon. Lady the Member for Warrington (Dr. Summerskill), I gave an undertaking to consider whether display of the notice should be made compulsory. It would require an amendment of the terms of service, which do not generally impose such detailed requirements. While opticians may find the notice useful and welcome a reminder of its existence, I think that it would be out of keeping with their professional status to require compulsion. In many parts of the executive councils' services notices are provided explaining, for instance, dental and prescription charges, 81 but none of these is compulsory, and to single out the optical profession for compulsion—a profession newly given the status of registration—would be highly resented.
There has been considerable discussion on both sides of the House on the question of frames for children. There are seven, metal with plastic coverings. Two are specially for very young children. All these are free of charge. There is a choice of 34 other frames, of which 13 are suitable for children. Some are for very special cases and about 10 have become so little used that they are difficult for opticians to supply, as was pointed out by my hon. Friend the Member for Wembley, South (Mr. Russell).
The range of frames was last reviewed by the Standing Ophthalmic Advisory Committee, in 1957. A fresh review is being made from prescriptions given in November last, including repairs and replacements. The data collected will now be put before the Standing Ophthalmic Advisory Committee for advice. I want to make clear that the review is not intended to encroach on private trade. Since 1948, the purpose of the National Health Service has been to provide a reasonable choice in hardwearing types of spectacles capable of being mass-produced, but excluding luxury articles. The proposed review continues the principle that the Service should not follow the vagaries of fashion.
§ Mr. Kenneth Robinson (St. Pancras, North)
While I do not think that anyone suggests that the Service should follow the vagaries of fashion, does the hon. Lady appreciate that at the moment the National Health Service frames are pitifully unfashionable and, therefore, is there not a reason for changing them?
§ Miss Pitt
I am aware that there is pressure, especially from teen-agers. [HON. MEMBERS: "Oh."] That is one of the things we are prepared to accept. I am glad that at least one other colour—blue, my favourite colour—has been introduced. There are two main aspects for review, little-used frames—whether to drop or replace them—and reconsideration of children's frames.
On the question of ophthalmic medical practitioners, which was raised by the hon. and gallant Member, since 1950 executive councils have co-operated with 82 hospital authorities to ensure that no full-time hospital medical officers have their names on ophthalmic lists. The hon. and gallant Member raised the question of ophthalmic medical practitioners serving at medical eye centres, which he said were falsely labelled. That is not so. This last term is used by the National Ophthalmic Treatment Board Association. It is not part of the official terminology of my Ministry, but its use involves no breach of the terms of service. It is, in fact, part of the past history of the former National Health Insurance and a high proportion of ophthalmic medical practitioners work at these centres. I should stress that the patient is free to have a sight test by the ophthalmic medical practitioner and to take the prescription anywhere he likes for dispensing.
Advertising in connection with the National Health Service is prohibited by the terms of service. The General Optical Council will no doubt be making rules on the subject of advertising covering all professional work of opticians and the General Medical Council already has rules covering doctors. The professional associations also take an interest in blatant advertising and complaints should be addressed to them.
As I said, there may be some delay in the case of breakages if people do not discharge the charge in advance. Probably the three weeks mentioned by the hon. and gallant Member is the time needed by the ophthalmic services committee to decide whether breakage is due to carelessness and a consequent charge. Obviously, where carelessness is admitted and the patient pays the cost, the optician may proceed without delay, as in those cases where the full cost is deposited subject to refund where the committee considers it justified.
I want to say a word or two about opticians' remuneration, which was specifically raised by my hon. Friend the Member for Hertford (Lord Balniel). He quoted from reports he had had from the Hertfordshire local optical committee. The position is that the Optical Whitley Council negotiates and recommends to Ministers the fees which should be paid. I shall not go into the past history of opticians' fees. The current fees were introduced only after a fact-finding inquiry and were calculated to 83 reflect changes in the cost of living. I am aware of the feeling of opticians and the disquiet they feel at the recent reduction of 20 per cent. in fees when National Health Service lenses are dispensed in private frames, what is commonly called a hybrid fee.
I am glad of the opportunity of explaining the position. The fees payable to opticians working for the Supplementary Ophthalmic Service for sight testing and the dispensing of glasses have been the subject of negotiations on the Optical Whitley Council, and the possibility of a hybrid fee was first discussed in June, 1956. Subsequently, full consideration was given to all the relevant circumstances, including the report of the working party under the chairmanship of Mr. William Penman into the average time taken to test sight, fit and supply glasses, and the factual information obtained from a detailed inquiry undertaken in 1956 into the expenses of opticians' establishments engaged in working for the Supplementary Ophthalmic Services.
The figures obtained from the inquiry were in respect of the last year of accounts then available, and an adjustment was included in the calculation to relate the fees to the level of expenses operative at the time the first order of revised fees was made to the opticians.
Following these negotiations, an offer was made and accepted by the opticians at the end of 1958 which provided for an increase in the average sight testing fee from 14s. 2d. to 16s. 3d., for the average dispensing fee when National Health Service lenses are dispensed in Health Service frames to remain at the same level of 26s. 6d. and for the dispensing fee when private frames are used to be reviewed on the basis of a 20 per cent. cut.
§ Mr. Howell
When the hon. Lady says that it was accepted by the opticians, does she refer to the Association of Optical Practitioners, or to the Whitley Council?
§ Miss Pitt
It was accepted by the opticians represented on the Whitley Council.
There is an element in the National Health Service fees paid for dispensing which represents the time taken for the 84 selection, measurement and ordering of the frames. It is not considered right that where a private frame is chosen this element in the transaction should be paid for through the Health Service. I should point out here, although I think that it is fairly well known to opticians and to those Members who interest themselves in this branch of the Health Service, that fees are paid to opticians for sight testing and dispensing. It is these fees which contain the profit to the optician. In addition, the cost of the lenses and frames supplied is reimbursed to them based on the standard list price of the main supplying firms, plus an allowance of 5 per cent. to cover breakages and miscellaneous expenses. There is no element of profit in the reimbursement.
It should be remembered, too, that this type of hybrid dispensing, which is now attracting the reduced dispensing fees, did not exist as such during the early years of the National Health Service, when it was not the practice to fit Health Service lenses into new private frames. The matter of the abatement of the fee when Health Service lenses are dispensed in private frames was discussed by the Whitley Council on 20th February, 1959. Subsequently, the Ministers gave most careful consideration to the views put forward by the opticians' organization, but, nevertheless, they did not feel able to change their view on the principle involved or to defer the introduction of a differential fee.
Although, as I have said, remuneration is a matter for negotiation on the Optical Whitley Council, failing agreement, the final decision on what can be paid from Exchequer funds rests with the Ministers of Health who are responsible to Parliament for the proper expenditure of public funds. As my right hon. and learned Friend said, the fee for hybrid dispensing is part of a tripartite offer and that part which benefited opticians—the increased sight testing fee—came into effect on 1st January, 1959.
The hybrid fee was introduced on 1st January this year. Before any future consideration of a revision of fees can be undertaken, it is necessary to have satisfactory factual information on which negotiations can be based. The Optical Whitley Council has not yet been formally asked to submit proposals, but a series of informal discussions have 85 been held with representatives of opticians with a view to agreeing the basis of necessary inquiries, and suggestions arising from these meetings will be referred to the Optical Whitley Council.
I now turn to the point raised by the hon. Member for Perry Barr about people being visited in their own homes. If an optician visits a person in his own home, he is not paid a fee from the National Health Service. An optician is not required to make domiciliary visits, but if he decides to do so in an individual case he may make a charge privately.
§ Mr. Howell
I owe a debt of gratitude to the opticians in Birmingham who do that, apparently, without any fee. However, does the hon. Lady think that it is being fair to the old people, who have contributed so much to the prosperity of this country, that they should not have it if they cannot get out to be examined?
§ Miss Pitt
The debt which the hon. Gentleman acknowledges would be fairly widely acknowledged throughout the country. I can quote other areas of Birmingham where opticians visit old people in their homes. It is part of the credit which is due to opticians.
I now return to the Motion. To the extent that it calls upon the House to recognise the success of the Supplementary Ophthalmic Services, I welcome it. But I think that the part of the Motion referring tothe failure of some opticians to offer the complete servicesis more widely drawn than is warranted. The hon. and gallant Member amplified this by devoting a great deal of his time to wide-ranging criticism, which I must, is fairness, say is not deserved by the general body of those who have contributed to the success of the Service.
In recent months, the hon. and gallant Gentleman has devoted himself, with single-minded purpose, to the question of the supply of National Health Service spectacles.
§ Miss Pitt
His numerous Questions and the debate today will, no doubt, serve to remind the public of the facilities available, and I think that it will also serve as a reminder to opticians of 86 their terms of service, as is evidenced by the fact that we have been asked to provide fresh copies of the notice. We believe that the Supplementary Ophthalmic Services is a good one, but we are always ready, in consultation with the professions, to consider ways of making it even better.
The latter part of the Motion calls upon the Government to ensure that all necessary steps are taken to see that the full services are made available to all who need them. I hope that the hon. and gallant Member will accept my assurance that we are prepared to explore, in consultation with the profession, what can be done to improve the supply of information to the public, particularly as to the range of spectacles which they can obtain through the National Health Service. Nor would strengthening of the terms of service be excluded from this review if, in the event, it seemed desirable, but other steps must be considered first.
§ 6.17 p.m.
§ Dr. Edith Summerskill (Warrington)
My hon. and gallant Friend the Member for Hull, East (Commander Pursey) was fortunate in the Ballot and decided to give us this opportunity of speaking on the ophthalmic services. We should all be grateful to him for that. He spoke in his lusty nautical manner, and I must congratulate him on holding the attention of the House for over an hour. People who adopt a lusty nautical manner are not always popular, and the result is that some hon. Members have criticised my hon. and gallant Friend for bringing to the notice of the House certain people who he believed were infringing the regulations of the ophthalmic service.
It is, however, significant that the hon. Lady the Parliamentary Secretary, in her final remarks, said that this debate had served a very useful purpose. It has. It has focussed the attention of the House, of the country and of opticians on the terms of service of the ophthalmic service and on the rights of the poorest people to obtain spectacles at a reduced fee. For this reason, I congratulate my hon. and gallant Friend. After all, this House is a place where we endeavour to ventilate grievances.
I want to refer to only two things which the hon. Lady mentioned. She said that there had been no complaints.
§ Dr. Summerskill
She said that there have been very few complaints of the kind which my hon. and gallant Friend mentioned. This may seem a curious analogy, but I think that it is a correct analogy. The hon. Lady said that poor people who found that they were not able to obtain spectacles at 30s. and had to spend a few pounds on them have not complained. I would remind the hon. Lady that each Monday Questions are put to her and to her right hon. and learned Friend concerning, let us say, maternity accommodation. How many mothers, the people who suffer, ever complain? It is officials and the public who complain, and Members of Parliament on both sides of the House, Monday after Monday, come here and say to the hon. Lady and to her right hon. and learned Friend, "When will you make provision for women unable to obtain maternity beds?" The expectant mothers do not. The sufferers do not. It is for us to ventilate their grievances in the House.
My hon. Friend has ventilated grievances. Some of them may be proved to be unfounded, but he has nevertheless stimulated thought in the House. He has compelled Ministers to come to the Dispatch Box and answer for their Departments. I am certain that, in consequence, action will be taken. The hon. Lady told my hon. and gallant Friend that there had been no complaints. It is significant that since notice was given in the newspaper that this debate was to take place the shops to which he referred have written to her Department very quickly and asked for the notices which he complains were not shown. Can the hon. Lady say that my hon. and gallant Friend was unjustified in coming here and making these complaints in the very strong manner in which he did?
§ Miss Pitt
I intervene only to give the right hon. Lady the answer to the interjection she made during my speech. It has a bearing on what she is now saying about complaints. From 5th July, 1948, namely, the beginning of the Service, to 31st December, 1958, there were sixteen cases concerning opticians before the tribunal. In seven cases opticians were disqualified from practising. Three opticians resigned and undertook not to practise. Though complaints are few 88 in number, people who have cause to complain obviously take the necessary steps.
§ Dr. Summerskill
The hon. Lady cannot have been listening to me. I have been trying to prove—I am sure that the House has followed me—that very often the person who has a grievance is humble and poor and does not know where to complain. A housewife who goes into a little shop in one of the large London suburbs and finds that, instead of spending 30s;. on a pair of spectacles, she has spent £2 or £3, comes out and says to herself, "I have to economise in some other way". It never occurs to her that there is a body to which she can complain. If it does occur to her, she certainly does not know how to go about it. The hon. Lady's statement that there are only a certain number of complaints rather proves my point.
One statement by the hon. Lady absolutely shocked me. When my hon. Friend suggested that opticians should be compelled to put up a certain poster telling people in more detail what their rights are, the hon. Lady said—I think that HANSARD will prove me correct—that she could not ask opticians to do this as they would feel that it was unprofessional if they were compelled to do something. Does she not realise that in the great National Health Service doctors are subject to compulsion and regulation of the strictest character? If doctors fail to observe the regulations, there are disciplinary committees, both local and central, which will discipline them in the harshest manner and, in the final resort, by striking them off the register.
Can the hon. Lady from her position say that no professional person should be compelled to do something? The whole difference between a profession and a trade is that a profession has a discipline which its members must observe. It has higher ethical standards. If they are not observed, a professional person may find that he is even deprived of his livelihood. It is absurd for the hon. Lady to tell my hon. Friend that because opticians are now registered they would be hurt and offended as professional people if they were compelled to observe a regulation. She should once again look at the regulations which doctors in the National Health Service are 89 compelled to observe, and, indeed, recognise it as their duty to observe.
§ Miss Pitt
We must have this clear for the record. Perhaps the right hon. Lady did not understand what I said to the House. I said that neither pharmacists nor dentists were compelled to exhibit the list of charges and that I thought that opticians would think it unreasonable if compulsion were applied in their case. They should be compelled to abide by the other regulations of the Service, but that is a much wider point than the one about which we are now talking.
§ Dr. Summerskill
The hon. Lady has already conceded the point. A charge is stated in the leaflet which she has described as generally being put up in the waiting rooms, and that is where I have seen it. It mentions a charge of 10s. for a lens.
I shall make some constructive suggestions which I believe every honest optician in the country will welcome. If it is conceded that a leaflet mentioning a charge of 10s. for a lens is already displayed, why should not the ordinary person be told that it is possible for him to get full spectacles for 30s.?
§ Mr. Howell
Is my right hon. Friend aware that dentists exhibit notices? I went to a dentist this morning. I saw in the waiting room a notice stating that I had to pay £1 before I could receive any treatment. Dentists have to put up notices of charges.
§ Dr. Summerskill
Certainly. I have never heard a dentist object to doing that. In the world of optics and ophthalmology there are some people who do not recognise a high ethical standard. I hope the hon. Lady will examine every case that my hon. Friend has put to her this afternoon, because it is said that he has not given these cases to the Ministry before but has ventilated them in the House. He has now given particulars to the Ministry and I hope that they will all be examined.
It was originally intended that the ophthalmic service should be based on the hospitals. The present arrangement, which has been described this afternoon, of using opticians working from their own premises has proved successful, although many people said that that was the wrong way to approach the matter. 90 Also, a statutory register of opticians has now been established, and these arrangements should be made permanent. They should comprise the next step. In a few years' time we may say that there should be another approach, but for the time being this should be a permanent arrangement.
Opticians should be represented on local executive councils. Hospital ophthalmic specialists should inform opticians of their findings in cases referred to them, in the same way as they now inform general practitioners. I hope that the hon. Lady will bear that in mind. The Guillebaud Report on Medicine recommended this. Guillebaud rightly said that if an ophthalmic optician outside a hospital sent a case to a consultant at a hospital he deserved recognition just as much as a general practitioner. All these are important points, because if opticians are recognised in this way, it will raise their status.
The whole question of eye strain in industry is such that ophthalmologists and opticians should be closely associated with an industrial health centre. I detailed just now arrangements which should be made permanent, but I feel that the final objective should be a salaried service for opticians working in a health centre. Being able to see properly is a very important part of life. If we are to have a comprehensive health centre, an optician should play his part in it. This is the kind of constructive approach we want if we are to give opticians more self-respect and the feeling that they are members of a great profession and so cannot stoop to any of the infringements of which we have heard today.
We have heard of the procedure. I will remind the House how wrong the present procedure is and how it invites unscrupulous opticians to exploit the situation. After the patient has had the eyesight test, the optician sends form O.S.C.2 to the executive council for approval. At that stage, nothing should have been discussed about frames, charges, deposits or any of these material matters. There should be just the professional approach to the patient's eyes. The optician—and the ophthalmic optician, of course—is the person who can tell whether there is any pathological complaint. If there is something pathological, the patient is sent to the hospital. 91 But, at the stage when the form is sent to the Executive Council, nothing further should be done.
The patient is then told that he can have glasses. At this stage, of course, frames can be discussed. Paragraph 2 of the form that is sent to the patient says:You may now take it to any ophthalmic optician or dispensing optician who has undertaken the supply of glasses under the National Health Service.Paragraph 5 says:There is a wide range of efficient spectacle frames approved by the Minister of Health for National Health Service dispensing.On the back of the form are given the prices of lenses—but only those prices. That means nothing to the ordinary patient. To tell the ordinary patient the price of the lens conveys nothing to him or her. Patients want to know precisely the cost of the spectacles.
The patient then takes the prescription to the dispensing optician, and then, of course, costs, frames, how the spectacles are to be paid for, and so on, are discussed. I do not know whether the hon. Lady expressed herself a little wrongly, but I must confess that, listening to hon. Members, I gained the impression that they think there are literally 41 types of frame. That, of course, is not so. There are only two basic types of frame—the metal, and the tortoiseshell-type frame. All the others are combinations and permutations of these two types.
It is true that 41 frames are listed in the ophthalmic schedule, but I think that hon. Members have been misled into believing that there are a large number of frames available. These, of course, are only different fittings—different little pieces on the sides. My hon. Friend the Member for Birmingham, Perry Barr (Mr. Howell) talked of his glasses not fitting properly. Had he chosen one of the 41 they might have fitted properly. I say that there are only two basic types—and the hon. Lady does not dissent—the metal frame and the tortoiseshell-type frame.
Over the last eleven years, fashions have changed. Women's skirts have shortened, women's skirts have lengthened—they have become wider or narrower—but what has happened with spectacles? They have remained precisely the same. I ask the House: why should a State service article be dreary, 92 and unattractive and out of date? Faces and eyes are of different shapes, and complexions vary. We all have a streak of vanity. Hon. Members opposite, whether they be male hon. Members or female hon. Members, have their streak of vanity and are very sensitive about what they put on to their faces.
It would be very surprising, therefore, if people did not succumb to the high-pressure salesman who offers an attractive pair of spectacles—but having succumbed, they are called on to pay the price. We have been told today that those prices can be up to £10. I should like to know what is the costly ingredient—and these are some of the things we should have been told—in all these varieties for which people pay these large sums.
I should like the hon. Lady to visit Woolworth's some time. I visited Woolworth's last week and tried on two pairs of spectacles; one with a half rim and another in coloured plastic shaped to give the wearer that oriental appearance beloved of young women today. It may be said, "What are you asking for? We cannot keep pace with all these fashions." I would remind the Parliamentary Secretary that these delightful looking young women to whom she referred find that type of spectacles most attractive. It used to be said that men never made passes at girls with glasses, but with the new types of glasses I think the position is completely changed. The price of these frames in Woolworth's this week is 6s. 9d. Why, therefore, have the National Health Service shapes not been changed for eleven years?
Children are supposed to receive their spectacles free, but they look at these metal spectacles and find them unattractive. Children of ten or eleven years can be very sensitive about their appearance. If they choose one from the adult range, the parents must pay £1 11s. That seems grossly unfair.
The fact is that 40 per cent. of patients pay for glasses outside the National Health Service. Why is that? I expect that some people will tell me that I am asking for a luxury, but I hope that, in mentioning the prices at Woolworth's—and, incidentally, I also looked at similar glasses at a cheap little jewellery place, and those were about 12s.—I have proved to the House that 93 it would not be a luxury to provide our people with delightful-looking spectacles at the same price that they are invited to pay now.
I must confess that I share with the hon. Lady a liking for blue. No one can say that these spectacles are exotic, extravagant or very attractive. They are owl-like, but they are blue. Incidentally, her right hon. Friend wears pink spectacles—no doubt he needs them to be a little rosy-tinted. When I said that I wanted a plain pair of glasses—this frame has a simple nickel hinge—I was told that blue frames were not in the National Health Service. The whole thing is becoming ridiculous. No wonder that many opticians are tempted to exploit the service and to sell expensive glasses to many people who cannot afford them.
As I have said, I want to be constructive. I believe that if the Department will do these two things it will remove the abuses that my hon. and gallant Friend the Member for Hull, East has so ably described to the House. I want to make two specific recommendations. The great advance in frame design and colour should be recognised, and there should be more basic types—"basic types" is the term—added to the metal and the tortoiseshell-type frame now in the Schedule.
Secondly, it should be compulsory for opticians to exhibit a card in their windows for the guidance of patients. I agree that we have already heard that the Ministry has a small showcard which gives information about the dispensing of spectacles, but, while it mentions the charges payable towards the provision of new lenses, it does not include the possible charge for complete pairs.
I would suggest the insertion on this card of something in the following terms: "A selected range of spectacle frames is available to the public through the National Health Service at controlled charges. When a complete pair of spectacles is provided, the charge to the patient will range from 24s. 8d. to 42s. 2d., according to the type of frame".
I believe that every honest optician in the country will be delighted to do that, and that if, as the Minister suggests, they accept a form of words for this purpose, it would deprive those few men who exploit the public, rather mercilessly, 94 because they are playing on the vanity of the people, of their opportunities, and that we should soon find that they would change their tactics.
§ Sir John Barlow (Middleton and Prestwich)
rose in his place, and claimed to move, That the Question be now put, but Mr. SPEAKER withheld his assent and declined then to put that Question.
§ 6.40 p.m.
§ Mr. Richard Marsh (Greenwich)
I think the House very much appreciates the service rendered by my hon. and gallant Friend the Member for Hull, East (Commander Pursey) in bringing this subject before the House today. We all know that the real problem of the Walfare State is the difficulty which ordinary people have in finding out what their rights are, and, even more important, in knowing where to go with their complaints. I think it is a great pity that we should have had to have a debate based on and caused largely by the feelings and sufferings of a large number of people over a Service which is meant for all of them.
Many of us, I think it is fair to say, on both sides of the House regret the fact that since its inception, the Service has departed a very long way from its original intention. I think that one of the most tragic features of this debate is that, after twelve years of the National Health Service, we have sat here this afternoon hearing Members talking about people buying spectacles in Woolworth's and chain stores. It is generally accepted today that the self-medication which existed before the National Health Service was introduced was certainly of no value to the people who practised it, and certainly was a disgrace to this country. For that reason, it was the intention of this House that, so far as could be provided, good health was a right of every person living in this country. One of the biggest problems was that for many years people had been unable, purely because of the cost, to avail themselves of the possibilities of spectacles and enjoy the occupation of reading.
When the National Health Service came into being, there was an immediate uproar and series of complaints because the biggest part of the cost of the Service was in the field of the provision of spectacles, and there were many people 95 who complained about this, but they would have done a service if they had wondered why it should be so. It was generally accepted during the debates of 1948 that hundreds of thousands of people in this country were deprived of spectacles for no other reason than that they could not afford them.
There was an even worse side to it—one of the rather squalid and sordid sides to a commercial society—that many people were going to chain stores and were purchasing spectacles which they were prescribing for themselves which the purveyors of those spectacles knew were in fact positively harmful to the people wearing them. Money was made in this country, not only out of the normal commercial transactions which I suppose one must expect in a capitalist society, but out of the purchase and issue of these spectacles, which would not only fail to help the person's sight, but would be positively damaging. Indeed, many hon. Members with medical experience on both sides of the House are fully aware of the very severe damage which many people, particularly old ladies, have done to their eyesight by the purchase of spectacles in Woolworth's for a couple of shillings. I think it is a pretty appalling thing that people were permitted to make profits out of that type of human suffering.
§ Mr. Russell
Is the hon. Gentleman aware that the Opticians Act, passed two years ago, will prohibit this kind of thing when the relevant Section comes into force?
§ Mr. Marsh
I am grateful to the hon. Gentleman, and I think that he and I will be together in welcoming a provision of that kind. There is one important point arising out of that. There is always a tendency, I think on both sides of the House, to be frightened by unnecessary compulsion. There is always a desire to believe that the instincts of all people are basically good, and while I do not want to be accused of being a died-in-the-wool Hobbesian, it is a truism that if people are left to their own devices, if money can be made, and if the making of that money results in an increase in human suffering, there will always be some people who are prepared to make that money. It was the existence of such people which gave rise to 96 the Measure to which the hon. Gentleman opposite referred.
It is a tragedy that today, twelve years after the Act was passed, we should be talking about people prescribing spectacles for themselves in chain stores. It is a very real responsibility of hon. Members of this House that, as a result of the imperfections of the National Health Service at the present time, people are prescribing spectacles and damaging their own health. It was never the intention of the Service that a position like this should arise, and it was never our desire that it should continue.
The hon. Lady the Parliamentary Secretary went to considerable lengths to say that in her opinion the feeling against the present situation was not very widespread among the customers or clientele of the National Health Service. I do not think that is true. There is a very wide feeling among people in the country at the present time against the National Health Service in general and particularly against the methods of providing spectacles in it. This is very largely the fault of the National Health Service. Like many State industries, it has not yet become fully alive to the need to sell itself to the public. There are some people on the other side of the industrial fence who use a great deal of their clients' money in selling the industry, and it seems to me that the State should do so as well.
There is a feeling in the country that the National Health spectacles today are a cheap form of spectacles, something which one purchases when one cannot afford anything better. This is very bad, because surely it is fundamental to the Welfare State that if nothing else can be the birthright of the people in this country, the wealth of medical knowledge and the ability which we have amassed over the years should be on tap to any person who needs it without any question of money or finance entering into it.
One of the first things we should do—and I feel very strongly about this—in relation to the Service in general, is to abolish charges for spectacles in the National Health Service. It is all very well to say that people can obtain redress, or obtain assistance from the National Assistance Board, but one of the things which we have to accept is that one of the ways in which we have 97 failed is that today the feeling against obtaining Government charity or against National Assistance is almost as strong as it ever was. I think this is unfortunate. It is wrong, and it shows that we have failed in our relationship to the public. It is a fact that there are many old people in this country who, faced with the choice of either having spectacles financed by the National Assistance Board or not having spectacles at all, will go without spectacles. I think this is a great pity, and therefore I should like first of all to ask the Government to consider the abolition of all charges for National Health Service spectacles.
A great deal of play has been made about the question of different types of frames, and in many respects the frames are almost as important as the lenses, particularly in the case of small children. Only those who have gone through the horrors of being called "Four eyes", when about the age of 6, 7, 8 or 10, have realised the very real hardship which this could mean to a child in being given spectacles which are downright ugly. With the growth of scientific ability and the increased use of plastics there is no reason why any person in this country should not obtain from the National Health Service spectacles which, in appearance, at any rate, are as good as any which can be provided from private sources. There is no difficulty in providing attractive frames; neither is it very expensive. I would agree that if a person wants to purchase spectacles with gold frames and gold filigree work at the sides, that is an expense which he should bear himself. But whether we like it or not, it is a fact that many National Health Service frames today are just ugly and, even worse, they are unnecessarily ugly.
As my right hon. Friend the Member for Warrington (Dr. Summerskill) said, the impression is given that there is a wide range of frames available. Nothing could be further from the truth. The range of frames consists of plastic or tortoise-shell on the one hand, and steel on the other. The sizes and shapes of the frames vary very little indeed. Even with the differences which exist, one of the misfortunes of the present situation is that very few people know what limited range is available when they go to obtain their spectacles.
98 I have obtained a copy of the notice which one finds in an optician's, and if this is supposed to tell the patient his entitlement it does not do a very good job. First, it lays down the statutory charges and says:Persons who order glasses under the Supplementary Ophthalmic Service are required to pay the sum of 10s. per lens".That is fair enough. Then it deals with spectacle frames and lenses:Frames may be selected from the National Health Service range or the optician may provide a private frame at the applicant's request. Lenses supplied under the Supplementary Ophthalmic Service may be fitted only to a frame with a surrounding protective rim. The shape of the lens must be round, P.R.O. or contour, or half-eye or eye glasses.Can one imagine a dear old soul going into the waiting room and deciding whether or not her lenses are round, P.R.O. or contour, or whether she has got half-eye glasses?
Nothing can take the place of a display cabinet, and this is surely the simple answer. It need not take up very much room. There is no reason why there should not be a standard display cabinet setting out the varying types of frames, easily available and compulsorily displayed. I am not afraid of compulsion in matters of this kind. If a person wishes to practise and to receive an income from the State, there is no reason why he should not co-operate with the State. I do not think there is any better alternative than to display the frames so that a patient may walk into the waiting room and decide by looking at the display which type he wishes to have.
The range of frames presents a serious problem which has been very much under-estimated by the Minister of Health. The provision of fashionable frames is not only essential from the point of view of the attractiveness of the person adorned by the frames. My right hon. Friend the Member for Warrington has referred to young ladies liking upswept frames. I think it is only fair to say that not only young ladies like upswept frames; young men are rather keen on them as well. This is not new. Upswept frames have been quite common in this country for several years. Yet the National Health Service grinds steadily along, and by the time it gets round to providing upswept frames, upswept frames will be as unfashionable as hobble skirts. This is one of the sins of 99 Governmental activity. It seems to find itself quite incapable of providing that bit of humanity, that understanding of the foibles of human nature without which no society can be happy.
I am not merely worried about teenagers or young girls. I am particularly worried about young children. Many children are prescribed with spectacles which make them a laughing stock at school, so that the moment mum's back is turned little Jimmy has got his spectacles off because he does not like to be seen wearing them. This is one of those small things which are immensely important, particularly if we want a nation of people with decent eyesight.
I ask the Parliamentary Secretary to use what influence she has with the Minister—and, having fought the election with him in 1951, I know how difficult it is to influence him—to persuade the Government to consider seriously the possibility of providing a whole new range of spectacle frames in different colours and different shapes in order that people who wear them may enjoy wearing them. This will not only help the patient. It will help the nation, for we have a vested interest in ensuring that our people have good eyesight.
The Parliamentary Secretary said that people were aware that spectacles could be obtained under the National Health Service. Of course, they know that, but they do not know what spectacles can be obtained. The Government might also be a little more free in their prescription of bifocal lenses. Nowadays one has to prove almost near-blindness before it is possible to get anything other than the standard type of lenses. Bifocal lenses have a real place in the prescription of spectacles.
A number of points have been made about the financial difficulties of opticians in the National Health Service. Hon. Members on both sides of the House, I am sure, recognise that no optician can live upon his National Health Service prescription fees. This 100 is a very real problem. It means that the optician can only acquire a reasonable standard of living by propagating the use of privately-prescribed spectacles.
This problem is found not only in the prescription of spectacles; it goes much further. It is a great pity that we ever had to have in the National Health Service an arrangement whereby the persons who prescribe spectacles are the persons who sell them. This is just as silly as asking the baker to leave the amount of bread that he thinks his customers ought to have.
We ought to have a salaried optical service based on health centres. This is long overdue. The Government should consider very seriously the provision of health centres in order that spectacles may be provided not on the basis of a temptation to encourage the provision of non-National Health Service spectacles, but on the basis of providing for the patient what the patient particularly needs.
Opticians are not always the best people to prescribe spectacles. I believe that in the early days when discussions were taking place on the National Health Service it was intended that the medically qualified man should have the prime responsibility of prescribing spectacles. That was not possible, merely because of the tremendous shortage of fully-qualified professional people. But twelve years have passed since the introduction of the National Health Service, and I sincerely hope that the Government will give more thought to this matter.
§ Question put and agreed to.
That this House recognises the success of the Supplementary Ophthalmic Services in providing free sight-tests and a substantial reduction in cost of spectacles to the patient; but, noting the failure of some opticians to offer the complete services available under the National Health Service, calls upon Her Majesty's Government to ensure that all necessary steps are taken to see that the full services are made available to all who need them.