HC Deb 18 March 1964 vol 691 cc1525-47

10.24 p. m.

Dr. J. Dickson Mabon (Greenock)

I beg to move, That an humble Address be presented to Her Majesty, praying that the General Optical Council (Rules on Publicity) Order of Council 1964 (S.I., 1964, No. 167), dated 6th February, 1964, a copy of which was laid before this House on 13th February, be annulled. It is with some regret that I move this Prayer because we all hope that the General Optical Council, in its very difficult work, will be able to discharge the obligation imposed upon it by Parliament. Nevertheless, it is a matter of considerable concern not only to Members of Parliament but to the public generally and, for that matter, to some doctors that the rules which we are presently discussing are drawn as tightly as they are.

I preface my remarks by pointing out that, with the natural evolution of our democracy, we have seen more and more Statutory Instruments flowing from the Privy Council authorised by Parliament in this form of delegated legislation, a flow which has at times meant that it has been very difficult to examine Instruments properly. When hon. and right hon. Members opposite were in Opposition, they made great play of this development. Hon. Members who were in the House before 1951 will have observed that, in the years of the Labour Government, according to a report in The Times on 16th March, 8,500 new Statutory Rules and Orders were made, yet in the last five years we have had to consider 12,386. Apparently, it is beyond the wit of the great critics of Statutory Instruments, namely, the Tory Party now in Government, to stop this immense flow. This is why it is extremely important that Ministers should scrutinise Rules and Orders all the more closely. I cannot believe that the right hon. Gentlemen who form the Privy Council for this purpose undertook the full scrutiny of these rules which they merit.

In the short time at our disposal, I cannot refer to all the objections which I should like to raise, but I wish to draw attention first to a regrettable practice in which the General Optical Council is in- dulging and which ought to be corrected at once. I refer not so much to the rules themselves as to a document published by the General Optical Council which, I believe, has no merit in law but which is alleged to contain interpretations of the rules now before us. I cannot understand how a statutory body created by Parliament can have the right to issue a booklet of interpretations which, with the best will in the world, can only be read in some cases as being in direct contradiction of the rules themselves.

It must not be forgotten that, under the Opticians Act, 1958, a breach of the rules may mean that an optician is penalised by being struck off the Register. Plainly, this is a very serious matter and it is not just an argument about marginal meanings. To the practitioner, it may be a very serious matter because his livelihood depends upon his name being on the Register. Therefore, as I say, I cannot accept any suggestion that these are marginal interpretations. I shall in due course refer to a specific example in respect of which the General Optical Council in its booklet of interpretations seems to be contradicting the very rules promulgated in this Order.

The next criticism which I and many doctors have relates to Rule 7. This deals with reminders. Some of us, and many opticians, regard this as an interference in what might be termed the optician-patient relationship. Rule 7 lays down in rather restrictive fashion the number of times that an optician may communicate with a patient. The Rules are designed to curb what might be considered unprofessional publicity by opticians, but they bring into question here how often an optician may write to a patient.

This is an important matter. The person concerned is not a member of the public but a specific patient, someone who has been to the optician and has had the benefit of his professional services. After having given his services and having noted down whatever defect there may be, the optician may wish, on reviewing his notes later, to communicate with the patient and suggest that the patient ought to come for a review. In Rule 7(a) and (b) are laid down two important conditions about how often and in what discretionary space of time an optician may communicate with the patients. I think that this is unduly restrictive.

I call in support of this opinion two worthy views which must appeal to the Minister. The Standing Medical Advisory Committee of the Central Health Services Council, in September, 1962, issued a pamphlet, called, "Prevention and alleviation of blindness" in which it emphasised, inter alia, the need for careful watch of early symptoms of glaucoma by all concerned in the health services. Any attempt, therefore, by these rules to prevent the optician from having an absolute right to remind his patient that he ought to come for a check is, I think I can say without extravagance, an unwarranted invasion of the rights of that optician. There is another example I can give, this time from the Porritt Report. In its "Review of the Medical Services in Great Britain" attention was drawn to the need for earlier recognition of ocular disease. We know that ophthalmic opticians are a very important part of the ancillary medical services in this country. They are not only concerned with dispensing proper lenses to ensure correction of sight, but they are, after examination, able to recommend a patient to a doctor or ophthalmologist if necessary for further examination. There may be some basic constitutional disease of which an eye defect itself is only the presenting symptom.

Therefore, we are concerned with a very serious matter here when we come to the question of the opticians' work and the desire of an optician to bring back a patient for further review and a further check. I feel that the Minister, in replying, perhaps, on behalf of the Privy Council or on behalf of his own Ministry, ought to be very concerned about this. I really think it a bit undesirable that we should have in the various paragraphs of Rule 7 such restrictive provisions.

For example, an optician, in writing to his patient, is obliged to say nothing but what is stated in the rule. I, as a doctor, have some experience of writing to patients to call them back for review, and one of the rules in medical practice is never to alarm a patient unnecessarily. A doctor must always expect the worst, while hoping for the best, but he must always give the patient the impression that the best is to be expected. Therefore, letters of reminder cannot be cold; they must be warm. They cannot be unsympathetic; they have got to be sympathetic. And they must not be alarming. I think Rule 7(f) here is aseptic to the point of danger when it says that the reminder must say: This is to remind you that if your eyes have not been examined since you consulted me"— on such and such a date— a further examination is advisable. If the patient is a hypochondriac, or only a bit alarmed about his health, or if perhaps he has had indicated to him somehow that his eyes are not so good, that could sound like something very sinister, and such a bald warning would be taken as a cause of alarm. That would be distressing. On the other hand, I think also that in some circumstances a reminder phrased in such a non-committal way might be carelessly disregarded by the patient. That, perhaps, would be a greater danger.

Altogether, I think it is wrong, quite wrong, for the Council to go so far as to lay down what an optician shall say to his patient in reminding him, in the patient's own interests, to come to be re-examined. Therefore I insist—and I hope some of my hon. Friends will support me—that there is a considerable objection on medical grounds to the way in which Rule 7 has been framed.

I should like to refer to Rule 8, which is allied to this, but time does not permit me to deal with that at this moment, and I pass on, then, to another matter which is not really a criticism on medical grounds but rather a criticism on grounds of consumer interest. This concerns Rule 14. It can be argued—I have heard it argued recently by opticians—that the presence of Rule 14 in this Order is outwith the rights conferred by the Council and by Parliament in Section 25(1) and (2) of the Opticians Act, 1958. However, it is not my purpose tonight to argue the constitutional invalidity of Rule 14. I will concentrate on what appear to be the contradictions.

May I say in parenthesis that if these rules seem to be in contradiction to Sections of an Act of Parliament, it is the duty of members of the Privy Council and of Ministers to see that the ideas and intentions of Parliament are carried out by the Privy Council and Ministers and not the intentions of the General Optical Council, well meaning though they may be.

Rule 14 concerns the pricing of articles. It is specifically laid down in Section 21 of the Opticians Act, 1958, that the matter of pricing of articles applies only to optical appliances. Here we come into the strange realm of discussing what is an optical appliance. Does an "optical appliance" refer only to the lenses in our spectacles, or does it include also the frames which carry the lenses? The Act says: 'optical appliance' means an appliance designed to correct, remedy or relieve a defect of sight. This is very important. If an optician prescribes certain lenses which are in line with those recommended by the National Health Service Regulations, and can fit certain spectacle frames outwith the National Health Service list, then that optician can give the patient an examination service and a dispensing service within the National Health Service and can also add a private service—namely, the provision of frames not approved by the National Health Service, but nevertheless available in his own premises.

This raises a very interesting point because these rules forbid the advertisement of the price of these frames. They concede that the assistants on the optician's premises are allowed, in handling these frames, to see a small tag or indication, available to them only, of what the price is, but the idea that it should be open to the public to see what is the price of one frame as against the price of another frame is forbidden. This is quite wrong. After all, spectacle frames are to some degree a cosmetic choice. Some of us prefer this frame to that frame. Some prefer one design to another. Nevertheless, this is a matter of taste rather than a matter of optical necessity.

I concede the point that the work of ophthalmic opticians in particular should be regarded as a profession so far as examining and dispensing for patients is concerned. But there is a very narrow and important line to be drawn between these activities and their activities when they are acting as vendors of spectacle frames. We shall be engaged next week in discussing a Bill which concerns restrictive practices in certain trades. The question may arise, are there restrictive practices in the provision of spectacle frames? Some of us who have gone into this matter a little more deeply than perhaps hon. Members usually do without having it specifically drawn to their attention, are surprised to find that there are such variations in the prices of frames in different parts of the country, and we are surprised that this is allowed to continue without any public comment being made. I emphasise to the Parliamentary Secretary that he and his right hon. Friends must. take notice of this.

The Ministry of Health provides a certain choice of spectacle frames. I have here the relevant part of the regulations concerning Scotland. I have not been able to examine the English position, but I am told that it is practically the same. In the substantive lists there is a section dealing with frames other than children's standard frames, and five kinds of frames, and only five, are named as prescribable under the National Health Service for which the optician gets a recognised payment by the patient and a recognised payment by the Service.

I concede that within the five categoreis there are variants, and there may be—I have not counted them all—nearly two score of different choices. Nevertheless, it could be argued from Rule 14 that an optician does not have the right to display the official notice "National Health Service—Supply of Glasses" which we should see in every N.H.S. optician's establishment. Opticians are bound to exhibit the notice so that any patient who is being examined within the Health Service for an eye defect, and is getting Health Service, lenses dispensed to him by the optician and also getting Health Service spectacles within the regulation, is able to see from that notice, displayed on the advice of the Government, what he is supposed to pay for the category of spectacles chosen, just as the optician also knows what he gets from the State in subsidy on the spectacles. I should like the Parliamentary Secretary to comment on that. Does he see that it could be interpreted so that the Government's own official display notice might be one of the first victims if these rules were strictly applied, particularly Rule 14?

I return to my first point about the unfortunate practice which the General Optical Council has adopted of issuing rulings about the rules before the rules have been approved by Parliament. I will not go into the impropriety of this; I only hope that my remarks may be drawn to the attention of the members of the Council. I trust that I may have the support of my hon. Friends and even of the Minister in saying that it is a most undesirable practice for any statutory council to comment on rules which have not been approved by Parliament.

I draw the attention of the Parliamentary Secretary to page 6 of the booklet, and in particular to part of paragraph 2, which talks about the scope of the rules. The Council says: The Council would not regard the rules as applying to the normal use of the name and price of articles such as spectacle cases or polishing cloths supplied by registered opticians or enrolled bodies corporate. If one reads that in conjunction with the rules, particularly Rule 14, and the Act, one cannot see how the Council has any legal right to say it. Yet I would say that it is a very good defence for any optician coming before the Council to say that the note of advice was his guide in his practice, and, therefore, no one can complain that he is unfairly competing commercially with other opticians, which, as I understand it, is the whole purpose of Rule 14.

Those of us who have read these rules, while accepting that the Council has a job to do and that we want to see it doing it well, feel that perhaps it has approached this in a rather grandmotherly way and that the consequence of its over-exactness and of trying to take optical practice completely within the realm of professional behaviour ignores the fact that optical practice also involves a certain amount of commercial activity. We feel that the Council has presented us with rules which are, in some ways, self-contradictory, in other ways undesirable, which act against the consumer and which, at some time, might even be a danger to the proper and good practice of opticians.

10.46 p.m.

Sir Ronald Russell (Wembley, South)

I am a member of the General Optical Council which the hon. Member for Greenock (Dr. Dickson Mabon) has been castigating to some extent. I was very interested in what he said but a little puzzled. He is, of course, entitled, as anyone else is, to object to the rules but I wonder whether he is doing it on his own behalf only or on behalf of any members or numbers of the optical profession. He did not mention that point.

These rules have been approved by the Council and are accepted in that way by the optical profession as a whole, certainly the ophthalmic opticians as represented by the Joint Committee of Ophthalmic Opticians, which consists of representatives of every organisation of ophthalmic opticians in the country, including Scotland.

Rule 7 does not differ very greatly from the rule already voluntarily accepted by members of the optical profession and operated by them for some considerable time. Indeed, there is one slight relaxation which was previously not allowed. Under the old arrangement with the Ministry of Health, only one reminder card was allowed for any N.H.S. optician. Rule 7 makes a relaxation in that, in exceptional circumstances, which are to be left to the judgment of the optician, he can send a second reminder. That is surely a slight improvement.

Mr. Kenneth Robinson (St. Pancras, North)

The hon. Member asked for whom my hon. Friend was speaking. I am sure that the hon. Member is aware that there have been a number of representations on behalf of members of the optical profession. For example, I have here a telegram received today saying that the Birmingham branches of the Association of Optical Practitioners and the Birmingham Local Optical Committee, with the support of many other opticians in the Midlands, hope that the Prayer will succeed. So, undoubtedly, members of the profession take the same view as my hon. Friend.

Sir R. Russell

I am glad the hon. Member for St. Pancras, North (Mr. K. Robinson) brought that point out.

Rule 14 concerns prices. I am told that it is quite impossible to put a definite price on an optical appliance—a pair of spectacles for example—in a window, because it depends, first, on the type of frame, secondly, on the facial measurements and, thirdly, on the prescription of the lenses. Prices may vary according to these conditions, and to state a price might therefore be misleading. I gather that that is the main reason why this rule recommends that no prices should be shown.

The General Optical Council consists of ophthalmic opticians dispensing opticians, ophthalmologists, medical practitioners, some educational experts and five lay members, of whom I happen to be one. I can say that very careful consideration was given to these rules and that any representations made by opticians or optical bodies before the rules were passed by the General Optical Council, containing all these different representatives, were carefully considered. As they have been accepted by the optical representatives on the Council, I hope that they will be allowed to proceed and that the Motion will not be passed.

10.51 p.m.

Mr. Laurence Pavitt (Willesden, West)

I was very interested to hear the hon. Member for Wembley, South (Sir R. Russell) say that he was a member of the General Optical Council and I am sure that his comments have helped us to know what the Council had in mind. When I associated myself with my hon. Friend the Member for Greenock (Dr. Dickson Mabon) in this Prayer, my approach were merely that of the consumer. I was interested, therefore, in the intervention of my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) and I must confess that what he said came as a surprise to me. An hour ago I received what must be a similar telegram saying: The Birmingham branches of the Association of Optical Practitioners and Birmingham Local Optical Committee together with the support of many other opticians in the Midlands and throughout the country hope that the Prayer to annul Statutory Instrument Number 167 will succeed in so removing the onerous restrictions on professional liberty and preserving the rights to which the optical profession on its record is entitled. Signed on this behalf … There follows a complete sheet of names, 17 in all.

I had approached the matter from the opposite angle, that of the consumer. Suddenly to have this support from opticians, coupled with the eloquent and forceful comments of my hon. Friend the Member. for Greenock, convinces me even more than before that we were right to move the Prayer and to probe into this matter.

Most of us accept the right of professional organisations to try to preserve their professional status. It is part of the way in which they maintain their high standards of conduct. When I first saw the Statutory Instrument, I accepted that it was the right of the Council to try to do its duty towards its members. But, in the same way that the Council has a duty to its 6 000 or so members, there is a duty somewhere to protect the millions of people who are their customers and who go to them for attention to their eyes and to receive spectacles.

Like my hon. Friend, I much regret this negative procedure which means that we have to pray against something rather than have the opportunity to discuss and shape and alter it to the satisfaction of everyone, including hon. Members and the Council.

My main concern is with the two rules my hon. Friend mentioned and especially with Rule 14. The Ministry of Health's Report for 1963 shows that of the total number of lenses dispensed, 33.7 per cent., or one out of three, were for National Health Service frames. That means that two out of three people chose private frames. Those figures mean that we are not dealing with a few people. or with a small amount of money.

The same Report shows that 4½ million people were supplied with spectacles, which means that 3 million people paid for what my hon. Friend described as the cosmetic value of the frames in which the lenses were fitted.

Rule 14 says: Optical appliances and parts thereof which are displayed"— I take it that that means displayed in the consulting rooms of the ophthalmic or dispensing optician— … may be accompanied by descriptive matter, provided no statement of prices is displayed. That seems a terrifically restrictive practice. It does not seem right that when somebody is trying to decide which frames to have he has no idea of the price involved. I know of no other sphere in which one has freedom of choice, but has no idea of the prices involved.

The hon. Member for Wembley, South has been helpful in saying that there is no fixed price because there are so many variables. That alarms me even more, because it means that an optician who is not an honourable man can price his customers instead of pricing his frames. He can say, "This chap is good for £10. That chap is good for £3". The variations to which the hon. Gentleman referred will permit him to charge different people different amounts for similar articles. It could lead to an enormous amount of swingeing over-charging when a person goes to buy a pair of spectacles.

A person who has to wear spectacles should be able to make his choice after seeing what is available in a number of consulting rooms. He should be able to see what is available for 3 guineas, what is available for 4 guineas, what is available for 5 guineas, and so on. He should be able to visit a number of opticians to see whether a certain type of spectacle is being sold at a cheaper price in one shop than in another.

It may seem strange that I, as a Co-operative Member, am asking for competition between opticians. If an optician is efficient, and is able to keep down his overheads, it should be possible for him to sell his goods at lower prices than they are sold by his competitors. I see no reason why he should not pass on this saving to his customers. I do not want to refer to the "Smiths", the "Browns" and the "Robinsons" who are opticians, and get into difficulty as the previous Minister did at the end of the housing debate. If optician "A" is more efficient than optician "B", I do not see why the former should be prevented from passing on to his customers the savings that he makes by his efficiency.

I wonder whether the rules laid down by the G.O.C. go much further than was envisaged when the 1958 Act was put on the Statute Book. Section 21(1) of that Act, although controlling "the optical appliance" did not apply to parts, and I take that to mean spectacle frames. The rules, however, apply to parts, so it seems that there is a difference between the Act and the way in which the Act is being interpreted under the rules.

Section 25(2) of the Act gave no power to the G.O.C. to prohibit display, but surely display for the purpose of business should include the right to exhibit prices? But that is not clear in Rule No. 14.

I do not want to go too far, because my hon. Friend the Member for Greenock has thoroughly covered the points arising from Rule No. 7, and the reminders that may be needed as between the professional optician and his client in order to make sure that testing has been kept up to date. The two medical reports quoted by my hon. Friend have given concern to everybody interested in the National Health Service. We are appalled by the large number of people—especially elderly people brought up at a different period of health education and having a different approach to the problem of the health of their eyes—who take it for granted that as they get older they will inevitably have eye trouble, whereas we know that if they could be provided with the services which are available at the right time and in the right way many of them would be able to enjoy far better sight.

It is not clear how far advertising is permitted to go. Is it possible to overprint spectacle cases with the name of the optician? Is it possible to have cleaning pads within the spectacle case with the name of the optician, or does that go against the rule? At a time when the Government declare that they are trying to bring prices down it is wrong for them to bring forward rules of this kind. I doubt whether, in the provision of this service, opticians will get a fair crack of the whip—but that is a much larger subject than is covered by this Statutory Instrument.

I hope that we shall not get ophthalmic services on the cheap for N.H.S. patients, merely by allowing large profits to be made on private practice because these rules do not provide adequate safeguards for the consumer.

11.2 p.m.

Commander Anthony Courtney (Harrow, East)

Up to a week ago I knew very little about opticians, except that I have a very good one myself, who provides me with bifocals, but I was approached by a friend on this subject, and I have since consulted opticians in my constituency. I must tell my hon. Friend the Member for Wembley, South (Sir R. Russell) that the information I have received is, on balance, contrary to the view which he has expressed. It is a matter of particular regret for me that I must disagree to some extent with my hon. Friend, to whom this House and the country owe so much for his sponsoring of the Opticians Bill, which came before the House in 1958, prior to my entering it.

In reading the Order we must get clear in our minds, exactly what we are trying to do. We are here to approve—in a negative form, perhaps—rules on publicity resulting from powers given by the Opticians Act, 1958, and primarily that contained in Section 25 (1,a), which regulates the use … of any means of giving publicity … to their practice or business. We must note that the word "publicity" in this context is very important. We go on to the rules themselves. In Section 11(3) of the same Act we provide for the names being erased—and this is a deprivation of their livelihood—of opticians who contravene the rules in the Statutory Instrument.

We have in these rules a total prohibition of publicity, with certain detained exceptions, which are set out. When considering the word "publicity" we must go back to definitions. The Oxford Dictionary defines publicity as the business of making goods or persons publicly known. In interpreting these rules in accordance with the definition which I have given of the word "publicity," Ministers must be extremely careful, and I hope to show why. In paragraph 7 of the rules the question of reminders is covered. By a positive rule, these must be addressed to a single person and must be in a sealed envelope which contains nothing else. I wonder how a sealed envelope, containing nothing but the letter addressed to an individual, can possibly be regarded as publicity within the meaning of the word as defined in the Oxford Dictionary?

There is also the consumer standpoint. I agree heartily with the remarks of the hon. Member for Greenock (Dr. Dickson Mabon) about this. The Porritt Report of last year emphasised the importance of the early detection of ocular diseases such as glaucoma. It is very important for children. The harassed parent knows how important it is for little Johnnie to go regularly to the optician to have his spectacles adjusted, quite apart from the problems of broken frames and missing screws which occur so frequently among the young.

The rules are so strict that no reminder may be sent by an optician more than once, except in special circumstances, and presumably this is the case even if the patient asks for it. We have a right to express the view that this is going a bit far in the detailed application of rules of this kind. I think that we can draw a useful parallel from dentistry. I know of no regulation which debars a dentist from writing to his patients saying that it is time they had their teeth examined, because they have not been to the dentist for six months. I do not know that there is a higher or lower standard of conduct in professional management in the dental profession than in the profession of optician, and I think that the same conditions should apply in respect of reminders in both professions.

I turn to an aspect of paragraph 14 to which hon. Members opposite have drawn attention These rules cover publicity "at and inside" the premises of opticians. There can be no argument about publicity concerning shop windows and perhaps showcases, but a display in the interior of a shop, perhaps with prices, is surely not publicity, taking the strict definition of the word as I have given it. Outside, yes; inside, I submit, the rule is extremely arguable.

I will not go into the question of prices except to agree with hon. Members opposite that this seems to be a restrictive practice which at least we on this side of the House should deprecate in every way. It seems to me that if we take a strict interpretation of the word "publicity," a legalistic mind could take a horse and cart through these regulations. In my Service we have people described as sea lawyers. In the profession of optician, which is a very highly rated profession, there may well be one mutineer who at some time will challenge some of these rules. He may send a third reminder card which is more than 20 inches square and defy the General Optical Council to do anything about it—to strike him off the Register or anything else. I suggest that any Minister answerable would have the greatest difficulty in arguing the point.

I will take the hint given me by my hon. Friend the Parliamentary Secretary and sit down. These rules are an extension of administrative law, of which the House is rightly suspicious. I suggest that they are far too detailed to be quite healthy, and although the House will pass the rules, I urge the Minister to look at them afresh and perhaps to introduce some supplementary ones.

11.10 p.m.

Mr. W. Griffiths (Manchester, Exchange)

I shall be brief. My hon. Friends have performed a valuable service tonight in calling attention to this Statutory Instrument. Before proceeding I must declare an interest. I am an ophthalmic optician and I wish to put on record a few points about the present position.

My hon. Friend the Member for Willesden, West (Mr. Pavitt) said that he would not like to see the ophthalmic service within the National Health Service obtained on the cheap. However, that is, in fact, happening in a way. It is being subsidised every day by people who are in private practice as ophthalmic opticians. I received a Parliamentary Answer this week to a Question I put about the fees paid to ophthalmic opticians working in the National Health Service. They are certainly not making great fortunes. Indeed, their fees have not altered since 1948—except for having been reduced by 1s. on one occasion. In real terms their fees would need to be substantially increased if they were to be brought up to the value of the fees given in 1948. Thus, National Health Service patients are being subsidised by those in private service.

My hon. Friend the Member for Greenock (Dr. Dickson Mabon) expressed apprehension about the relationship between the ophthalmic optician and the patient. From my understanding of the Order I do not think that any limitation would be placed on a communication between an optician and his patient's doctor. The General Optical Council is merely trying to prevent canvassing, although I appreciate that the rules may appear to have been drawn too tightly.

My hon. Friend is a member of the medical profession and must remember that the profession to which I belong has only recently been given statutory recognition. The members of my profession have a background of rather sharp commercial rivalries against which to work. I also agree with my hon. Friend that we are supplying in some instances an appliance which has a cosmetic character. It is necessary, as one moves towards higher professional standards, to try to restrain people from behaving as they did in pre-National Health Service days. I am sure that my hon. Friend the Member for Greenock would not like to see plastic surgeons in Harley Street advertising, "Come to me for that bit of plastic surgery; I will do the job properly and a little cheaper than the surgeon around the corner or down the road."

When we consider the question of prices I think it will be agreed that the National Health Service schedule should be widened. More modern appliances should be brought in because, as my hon. Friend the Member for Willesden, West pointed out, only a small proportion of people want National Health appliances. I went to see the range within the Service improved; although, of course, the more exotic appliances can be paid for by people who really want them. However, nothing much will be done until the Government are prepared to renegotiate the fees the opticians receive, because at present they rely on that part of the trade. The House has done the right thing in considering this matter tonight and I am sure that benefit will arise from our discussions.

11.15 p.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

I have listened to what has been said with great interest. I entirely agree with the hon. Member for Manchester, Exchange (Mr. W. Griffiths) that it is right that hon. Members should probe into and inquire about these matters, although I am bound to tell the House that, apart from the Birmingham branch of the Association of Optical Practitioners, there were only three other objections to the rules submitted to the Privy Council.

The fact is that in agreeing to pass into law the Opticians Act, 1958, Parliament decided that the optical profession was ready to become self-governing, in the same way as the medical and the dental professions. The usual pattern is for Statutes of this kind to confer on the profession itself all functions in connection with registration and the maintenance of professional conduct and discipline, but it is necessary for certain supervisory and appellate powers to remain with the central Government. These include such matters as the confirmation of the more important rules made by the governing body, and the hearing of certain appeals by individuals against decisions of the governing body. These powers are mainly exercised by the Privy Council.

A decision by Parliament that a profession should be allowed self-government contains the clear implication that the profession should, as far as possible, be free to manage its own affairs independently of the central Government; and that, therefore, the supervisory powers of the Privy Council should not be lightly used. These powers exist so as to ensure that the profession does nothing that is contrary to the wider public interest; and it is, of course, important to see to it that the profession's governing body is not proposing anything that conflicts with some other statutory provisions—as, for example, in this case, with opticians' terms of service under the National Health Service—or which would be damaging to the rights of individuals or in any other way contrary to the public interest.

But where rules are made bearing solely on professional matters, and no objections arise of the kind just mentioned, there is a strong presumption that neither the confirming authority nor Parliament should seek to amend them, bearing in mind particularly that they have been made by a body representative of the profession as a whole. It is against this general background that the relevant provisions of the Opticians Act, and the recommendations of the Crook Committee upon which they are based, must be examined.

The Opticians Act, 1958, was the direct outcome of the work of the Committee, under the chairmanship of Lord Crook, which published a unanimous Report in 1952. Section 25 of the Act set out the various matters with respect to which rules could be made, and subsection (1,a) provided for rules … prohibiting or regulating … 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 … The Act provided that rules made under Section 25 should not come into force until approved by order of the Privy Council.

In considering certain special problems, the Crook Committee dealt with advertising, and said that it felt … that the General Optical Council should regard advertising as one of the subjects demanding their urgent attention. It expressed the view that, if opticians were to become truly professional men, there should be very severe restrictions on advertising, and recommended that the Council … should, at the earliest possible moment, issue guidance, both to ophthalmic and to dispensing opticians, about the form in which they are to be permitted to acquaint the public with the services they provide. The hon. Member for Greenock (Dr. Dickson Mabon) referred to the explanatory notice about the rules issued last February by the General Optical Council. These notes are entirely a matter for the Council. They are not the concern of the Privy Council. They are merely intended as a helpful guide. Parliament's power is a negative one, in the sense that it can annul rules but is not required to approve them positively. In fact, the rules could quite properly have been brought into effect the day after they were laid before Parliament, subject to Parliament's right to annul them. So it does not seem improper for explanatory notes to be issued in advance, in order to clarify the position, to a responsible profession.

The Council does not regard the rules as applying to the normal use of a name and address on articles, such as spectacle cases or polishing cloths, supplied by opticians. They are designed to cover anything intended to give publicity to a practice or business. and the Council hopes that those subject to them will use the means of publicity authorised only for the sake of giving useful information to the public or their clientele. The rules require all publicity to be —of a dignified and restrained character and free from any reference to the efficiency of, or the facilities given by, other registered opticians or enrolled bodies corporate. I suggest to the House that this general approach seems entirely reasonable. The detail into which the rules should go is for the profession to decide and it does not in principle seem to be a matter with which the approving body should concern itself, subject to what I have said about the over-riding public interest.

As for penalties, removal from the register is the normal ultimate sanction against unprofessional conduct in any profession, but the Disciplinary Committee will of course exercise its powers with good sense and discretion and will no doubt be as responsible in proposing drastic action in an alleged infringement of the rules as in any other disciplinary case. Where the Committee directs erasure from the Register Section 14 of the Act gives the optician the right of appeal to the Privy Council.

Rule 7 deals with the issuing of reminders about the testing of sight and Rule 8 with reminders about the supply of optical appliances. Hon. Members will be interested to know that ophthalmic and dispensing opticians who are under contract with the National Health Service to provide supplementary ophthalmic services are already subject to terms of service which include specific references to advertising. The hon. Member for Greenock asked about the notice which may be displayed, in a form specified by the Minister, indicating that the optician is qualified to provide services under the National Health Service Act, 1946, and that he is under contract with the local Ophthalmic Services Committee. That is totally unaffected. Otherwise, he may not advertise either directly or by implication that his name is included in an ophthalmic list or that he provides or is authorised to provide services under the Act.

The Terms of Service define the expression "advertise" in very wide terms indeed. They do not specifically refer to the issue of reminders. Nevertheless, my Department has been in general agreement with advice given on the subject by the Association of Optical Practitioners to its members. The advice is that reminders should be sent only in cases where a re-examination is clinically necessary or the patient has requested it, that the reminder should be sent only once to each patient between examinations, and that reminders are intended for use only for patients who are likely to benefit from a re-examination. This advice has been acted on for a long time by a large number of ophthalmic opticians.

Rules 7 and 8 are less restrictive than the advice of the Association of Optical Practitioners. No reference is made to clinical necessity, the optician simply having to be of the opinion that a reminder is justified by the time which has elapsed since the last occasion when to his knowledge the patient's sight was tested or the optical appliance was supplied, or by other relevant circumstances. He is allowed further latitude to send one further reminder "in exceptional circumstances". When an optician considers that a patient needs another sight test within six months, he is required by his terms of service under the National Health Service so to inform the patient's general practitioner who thus has some responsibility for seeing that the patient goes for the test. This is the safeguard which has been worrying hon. Members. It is entirely separate from any reminder that the optician may send.

Rule 14 deals with the display of optical appliances at premises at which opticians practise or carry on their business. It provides that, while descriptive matter may accompany such appliances, no statement of prices may be displayed. The General Optical Council takes the view that it is not in the public interest to attach a statement of price to an article which will not be sold in the state displayed. It is impossible to give the public an indication of the amount which they would have to pay to cover professional services and the glazing of a frame and it is accordingly in the Council's view proper to prohibit the display of statements of prices.

Let hon. Members consider the matter in a practical sort of way. A member of the public sees an attractive frame in the window. It is marked 55s. This seems reasonable and he goes into the shop and asks the optician about it. He says that he likes the 55s. frame but the optician tells him, "Yes but that is the cost of the frame; of course there will be the lens and the fitting—you can have it for £5 5s." I frankly suggest that the Council's view on this is absolutely proper. The contrary view is that to deprive the public of information as to what they will have to pay for any specific article which may be on display is to deprive them of a service to which they are entitled. There are two views to be taken about it. but I do not share the latter.

It has been suggested that Rule 7 could result in a lengthening of the interval between eye examinations, thereby hampering the medical campaign for the earlier detection of diseases of the eye.

I have a particular interest here because this is a health matter, but my Department takes the view that there is no danger in Rule 7 in this respect. The rule leaves it to opticians to decide what intervals between sight tests are justified, and provision is made for second reminders, which, in fact, is a relaxation of the practice widely adopted already. If a patient does not respond to such reminders, no useful purpose seems likely to be served by sending him any more. We, therefore, do not object to this rule on medical grounds.

It is not to be expected, of course, that the publicity rules will be wholly acceptable to all branches of ophthalmic and dispensing opticians. They have engaged the attention of the Council for a long time and, as is made clear in the explanatory notice to which the hon. Member for Greenock referred, they must be regarded as a compromise solution. Some members of the profession wish the Council to do everything possible to ensure high professional standards and would like to see the rules made even stricter. On the other hand, it is quite clear from what has been said, very sincerely, tonight that some opticians are uneasy about rules which they regard as unduly restrictive. I hope that hon. Members will, on reflection, agree that the forum for considering such differing points of view on professional matters must be the General Optical Council itself. That is what Parliament originally intended. It would have been right for the Privy Council to refuse approval of the rules only if they were clearly against the public interest. There seems to be no good reason for arguing that they are.

The issue was put very clearly in the Ophthalmic Optician for 17th August last year. The editor said: These rules will not please every optician … It is emphasised however that these rules must be, by the very nature of the diverse groups represented on the General Optical Council, a compromise. The Chairman has appealed to everyone to give them a trial … I submit, with respect, that it would be reasonable for us also to take this view.

I do not doubt that, in the light of experience and informed comment, the Council will keep the operation of the rules under review. Indeed, the notice which it issued last February indicates that this is its intention. I hope that what I have said will persuade the House that the right course is to allow the Rules to come into force on 1st April as they stand, and that the hon. Member for Greenock and his hon. Friends will think it right to ask leave to withdraw the Prayer.

11.28 p.m.

Mr. Kenneth Robinson (St. Pancras, North)

This has been a useful debate, but it has also illustrated the great difficulty which the House has when considering delegated legislation. I think that most of us agree with most of these rules, but it is obvious that a substantial number of hon. Members and a substantial body of the profession do not like certain aspects of them. Yet it is not possible for us to amend them.

It was possible for the Privy Council to amend them, and I am not satisfied with the Parliamentary Secretary's statement on this point. In my view, the Privy Council should have seen to it that these rules were not quite as restrictive as they have proved to be, particularly in the respects to which my hon. Friend the Member for Greenock (Dr. Dickson Mabon) and others have drawn attention.

None of us would wish to hamper the General Optical Council in any way in its task of establishing professional standards. We want to help. But we feel that in some respects these rules impose requirements on the profession which no other profession would tolerate—the meticulous detail as to the wording of letters, the frequency of reminders, and so on.

I suggest to my hon. Friends that they should not press the Prayer to a Division, but I hope that the General Ophthalmic Council, the Minister and the Privy Council will pay careful attention to what has been said in the debate and, perhaps, in due time provide revised rules of a slightly less restrictive nature.

Dr. Dickson Mabon

While reserving my position and that of my hon. Friends, whose criticisms, I feel, remain well founded, I accept the Minister's plea that we should give the rules a trial.

I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.