HC Deb 01 April 1968 vol 762 cc114-25

The Minister may make regulations extending the provisions of section 67 of the 1946 Act to such classes or categories of registered opticians providing general ophthalmic services, and on such terms and conditions, as the Minister may determine.—[Mrs. Knight.]

Brought up, and read the First time.

7.20 p.m.

Mrs. Jill Knight (Birmingham, Edgbaston)

I beg to move, That the Clause be read a Second time.

I shall be very brief, because the principle of the Clause was discussed in Committee. I put it forward again now only because I fear that the information which led the Parliamentary Secretary to turn down superannuation for opticians was not altogether accurate in every detail.

The Parliamentary Secretary said in Committee that the reason for the difficulty of conferring a superannuation scheme on this profession was that some opticians indulge in trading activities. Those were his precise words. Whether this rather loose phrase was meant to convey the fact that some opticians sell cameras, binoculars or microscopes, or whether the Parliamentary Secretary was thinking instead of the chemist-optician, I do not know. If he was thinking of the latter category I can tell him that the chemist-optician is a member of a fast-dying race.

I understand that when the profession of optician began it sprang from two sources—the chemist-optician and the jeweller-optician. Time has passed, and with greater knowledge has come a longer qualifying period. Those two sources have almost passed from the scene, and we almost invariably now have only the straight optician. I should have thought that very few people now enter the profession as chemist-opticians.

A small minority of opticians still sell cameras, but the vast majority are engaged solely in their professional work of sight examination and the supply of glasses or even contact lenses. The ones who still sell cameras and microscopes are dwindling in number. Ophthalmic optical practice today is almost wholly based on work for N.H.S. patients.

The number of sight tests conducted in England and Wales each year is 6¼ million, of which, as I pointed out, nearly 80 per cent. are carried out by ophthalmic opticians. Very few private tests are given. The overwhelming proportion of the work is National Health Service work. It seemed to me that there was little excuse for excluding opticians from the benefits conferred on others who care for N.H.S. patients.

I draw the attention of the House to the fact that entrants to the ophthalmic profession today come from university degree courses. The Parliamentary Secretary will remember what I said earlier about the origins of this profession, which no longer apply because the course is now very long and involved. It takes at least six years to train a modern ophthalmic optician—that is if he passes all his examinations first time. Six years of training is a long time, and he will not waste that by spending his time selling cameras, microscopes or anything of that sort.

A high proportion of the profession is in the upper age limits. I am sure that the Minister has had occasion to feel that this is rather a dangerous situation. As I understand it, not sufficient people are coming into the profession, and the Minister will recognise that it is essential to provide for the future by maintaining recruitment. The Minister's earlier refusal to recognise the right of these highly-qualified men to participate in National Health Service superannuation schemes, even though they spend their time on N.H.S. work, must be detrimental to recruitment. I should like him to examine this part of my case carefully.

7.30 p.m.

The profession has demonstrated a very usefully flexible approach to participation in providing general ophthalmic services in health centres. The whole concept of a health centre rests on all the services being maintained and provided in the centre. It is a little unfortunate that an ophthalmic optician employed by an executive council to provide ophthalmic services from a health centre will be unable to benefit from a superannuation scheme, although everyone else in the centre working with N.H.S. patients will be able to do so.

I am sure that the Minister will take the point that it is a rather unfortunate position for such ophthalmic opticians. In Committee the Parliamentary Secretary made it clear that when the opticians shook off all connections with trading the law could be amended. Amending legislation to the National Health Service is very rare. The optician has moved almost completely away from the situation that would preclude him from receiving superannuation. He has moved a long way from the time when they were trading partly in appliances and partly by sight examination.

If we lose this opportunity to amend legislation, thousands of perfectly deserving members of the profession would be excluded from any superannuation scheme. I particularly draw the Parliamentary Secretary's attention to the wording of the new Clause, which is deliberately left very wide so that a provision can be included, about the 100 per cent. conditions being fully met and a superannuation scheme being introduced. He may decide that it will be wise to have a time factor or something similar. My point is that when we have legislation of this kind it would be a great pity not to include any kind of hope for the ophthalmic profession that a superannuation scheme may be possible in future.

Mr. J. T. Price

I have no idea what my hon. Friend the Parliamentary Secretary is to say in reply to the very nicely and moderately phrased request by the hon. Lady the Member for Birmingham, Edgbaston (Mrs. Knight). I would not wilfully withhold from any professional body acting wholly within the National Health Service benefits similar to those given to other professional people. We have here a hybrid group of people who have in recent years, perhaps, divested themselves of some of the fringe commercial activities which the hon. Member has pointed out were part and parcel of their business.

I am old enough to remember that opticians were not always qualified. There were a good many people who were commercial interlopers, many of them very competent. There was a good deal of fringe activity in the optical world, not by any stretch of the imagination to be described as professional activity, because many people were as much qualified to test sight as myself.

I have often submitted myself to examination by opticians because I need to wear spectacles, but it is the patient who examines his own eyes in the long run. Unless the patient is able to tell the optician what his reactions are, the optician is largely working in the dark. I do not say that in any derogation of opticians but it has struck me as ironic that whenever one is tested by opticians, the patient tests himself by recording his own reactions—

Mr. Speaker

Order. The hon. Member must now come to the new Clause.

Mr. Price

I am sorry if I digressed, but there are apparently so few hon. Members interested in this debate, which, although it is on a small point, is interesting.

These people wish to be brought within the sphere of superannuation benefits. I know something about this because one of my hobbies is dealing with superannuation. I am a member of the Council of the National Association of Pension Funds. I have gained some technical knowledge, and have had a great deal to do with providing pensions for people. To speak with immodesty, I am about the only Member who has toured the country from Aberdeen to Penzance in a previous incarnation extolling the benefits of superannuation, properly applied to the working population. I therefore speak with some knowledge.

One of the important factors to be taken into account by actuaries advising on the financial implications of paying pensions to people at a given age, 60 or 65, is the age distribution of the people who are to get the benefits. The hon. Lady has rightly pointed out that the optical profession, like the dental profession, is unduly overloaded with elderly people approaching pension age and that recruitment is not as satisfactory as some would wish. The new Clause seeks to bring in this rather aging group of opticians who, by definition, do not contain within their numbers a sufficiently wide spread of younger people to balance the liability. This is a very important factor at which the Government must look, if not unfavourably, then at least critically, circumspectly and prudently.

It is important to know the conditions which would attach to these pensions if they became payable. For example, would there be a minimum age to qualify? To provide pensions even on the usual basis of one-eightieth for each year of service, with a maximum of forty-eightieths or, in some cases, forty-sixtieths, presents difficulties for a lifetime's service. When dealing with older people, however—those in the middle-aged group, to which I belong—one must make a vaster provision in capital funds because one does not have the advantage of a great many younger people making payments for the whole of their working lives before receiving pensions.

Mrs. Knight

I was not arguing the case for purely elderly ophthalmic opticians being able to gain some of the benefits of the superannuation scheme. I pointed out that the Clause had been drafted so widely—and in it I was attempting to do something for the profession as a whole—that the Minister could add to it if he thought that that was desirable. I drew his attention to the serious recruitment problem—

Mr. Speaker

Order. The hon. Lady cannot make a second speech as an intervention.

Mrs. Knight

I wanted to make it clear that my intention was not as limited as the hon. Member for Westhoughton (Mr. J. T. Price) supposed and that the Clause had deliberately been left very wide to enable the Minister to make whatever alterations he thought were necessary.

Mr. Price

I assure the hon. Lady that I accept that her motives are laudable. I agree that people should be encouraged to join this important profession which provides optical services to the nation. However, is it true that by superannuating people on a proper basis we necessarily provide an incentive to young people to join a profession? I remember addressing many meetings on this subject, after which some young people would ask, perhaps rather stupidly, "These pension provisions seem quite a good thing, but we are not particularly interested in pensions at our age. What is the use of making oneself miserable when young by paying contributions on the chance of enjoying the benefits when one becomes old?"

I have had a considerable amount of experience of industrial pension funds. In most of them there is a maximum age for admitting new members. Parliament has leaned over backwards to be generous in the provision of pensions, but the stipulations in industry are more severe. If I were challenged I could quote many examples of how people are not accepted into contributory pension funds if they are over 50. To accept older people obviously places a greater liability on pension funds, particularly since within 10 or 15 years they expect to receive pensions which are commensurate with their professional status.

7.45 p.m.

I assure the hon. Member for Edgbaston that I am not being the Devil's advocate in this matter. At a time when hon. Gentlemen opposite are always criticising the Government for wilfully overspending the nation's resources and for not handling the economy as it should be managed—this is the only party point I intend to make—we must be extremely careful in considering projects of this and every type. I hope that the Minister will give an assurance that if he is favourably disposed to bringing opticians within the national superannuation scheme, there will be a maximum age for admission and that other conditions will apply.

Pensions once granted by the State are subject to an escalator. That does not apply in industry. The Civil Service has a pensions review arrangement, and this takes the cost of living into account. What would be the age distribution of those who might fall within the benefits proposed in the Clause? Under what conditions would the Government be prepared to introduce such a scheme? I hope that I have not given the impression that I am against this type of proposal. I approach the matter in a broadminded, Lancashire way, and I want to see sufficient conditions imposed before the Government are criticised for taking the sort of step the hon. Lady wants them to take.

Sir Ronald Russell (Wembley, South)

I support the Clause and apologise to my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) for not being in my place at the beginning of her remarks. I think that she appreciates why I was not here. I support the Clause because I have been a member of the General Optical Council since its inception. However, I do not speak on behalf of members of the Council, although I know that I am voicing the views of many opticians, both ophthalmic and dispensing.

In Committee the Parliamentary Secretary said, when replying to an Amendment moved by the hon. Member for Manchester, Exchange (Mr. Will Griffiths), that trading activities were the main cause and he likened opticians to pharmacists. While I do not wish to say anything detrimental to pharmacists or pharmacy or make comments which might be disadvantageous to the members of that profession, I submit that the hon. Gentleman's argument was not valid, because there is all the difference in the world between the scope of the trading activities engaged in by the two professions. I therefore ask him to reconsider the matter.

Consider the average premises occupied by opticians, both dispensing and ophthalmic, and compare them with the premises occupied by pharmacists or chemists. The optician's premises are filled with optical appliances, including spectacle frames in a variety of shapes and colours in accordance with modern fashion, spectacle cases and magnifiers which may be used to supplement spectacles or are purchased by philatelists to examine the small designs on stamps. I gather that about one-tenth of 1 per cent. of opticians engage in selling other appliances such as cameras, binoculars and so on.

In a chemist's shop One sees all kinds of things on view besides drugs and medicines; perfumes, shaving materials, hair oil—often cameras and other photographic goods, and the offer of developing and printing services; electric torches—I have even seen ladies 'silk stockings in packets for sale in chemist's shops. As everyone knows, one famous firm of chemists had a library service at one time, but that was abolished because it became unprofitable. I do not think that one would find any opticians, corporate bodies or otherwise, carrying on trading activities on anything like the same scale—

Mr. J. T. Price

The hon. Gentleman is quoting the case of Boots, the largest multiple chemist in the country. What he says is quite true, but it is also true that the qualified chemists who work for Boots and for other large multiple firms do not receive their superannuation benefits from Her Majesty's Government but under the industrial pensions scheme of the firm that employs them. That is why I want some information about the distinction that is being drawn.

Sir R. Russell

I hope that the Parliamentary Secretary will be able to satisfy the hon. Gentleman on that point, which is valid. I suggest that the volume of goods, other than optical appliances, sold by opticians is far less than the volume of goods, other than medicines and medical appliances, sold by pharmacists. There is no comparison between the two professions in that respect. The majority of opticians devote most of their time to the testing of sight and to supplying spectacles.

I can testify to the fact that the optical profession, as I see it as a member of the General Optical Council, is highly professionally minded, and very conscious of the professional conduct aspect of its work. It devotes a great deal of time to this part of its work, and has rules which are very firmly enforced, governing the conduct of opticians. Anything to do with trading or advertising is frowned on.

I urge the Minister to take powers now, even if a scheme cannot yet be worked out and put into operation. Otherwise, it might mean waiting for another 10 years before a suitable Measure amending the National Health Service Acts in any way is ready to be brought forward. If the Minister has the powers in this Bill it does not matter if they are not used for three or four years, because they will be there to be brought into operation by regulation at the appropriate time. I appreciate the difficulties involved but, given good will on both sides, I believe that something can be worked out. I hope that the Parliamentary Secretary will be able to reconsider the attitude he adopted in Committee, and hold out some hope that the Clause may be accepted.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

The hon. Lady the Member for Birmingham, Edgbaston (Mrs. Knight) very fairly quoted what I said in the Standing Committee, but I am afraid that my right hon. Friend is not persuaded that he should accede to the request. I took her point that recruitment might be adversely affected if it should be seen by potential recruits that there was no proper personal security scheme within the profession, but I must say to her that the discussions that have been held with opticians' representatives have laid bare the fundamental objections which I explained in Committee, in the sense that we were aware that the representatives felt that the optical profession is rapidly evolving towards a personal practice in private consulting rooms, and moving away from the trading activities that have been mentioned.

I cannot confirm what the hon. Lady stated, that all but a minority now come within the category of opticians who are not trading. That is not quite my information. I agree with my hon. Friend the Member for Westhoughton (Mr. J. T. Price) who pinpointed the fact that the whole nub of the question is whether these opticians are wholly providing the service for the National Health Service. I followed my hon. Friend's point about the metaphysical journeys he had been taking to establish what was right and proper in this case and equivalent cases—

Mr. J. T. Price

They were not metaphysical, either.

Mr. Snow

I thought that was an expression apposite to what my hon. Friend said. In any event, there may be a very desirable trend towards this purely personal practice not involved in trading. We accept that this is the trend, and that at some future date we shall reach a stage where the profession is, generally speaking, not involved in trading, which would not be suitable for the sort of service we try to obtain under the rules of the National Health Service.

I gave an assurance in Committee that when this stage was reached we should be prepared to consider very seriously whether the best interests of the profession and of the Health Service would be served by a provision bringing opticians into the scheme, and that if it were thought, in principle, that opticians as a class should become members of the scheme the Minister would take the first opportunity to bring in the necessary legislation. I said that it was highly unlikely that there would be such a delay as that suggested by the hon. Member for Wembley, South (Sir R. Russell).

The hon. Member made the point that in Committee I had over-emphasised the similarity between this and the pharmacy profession. I accept at once that in terms of turnover and proportion of trading done by a pharmacist relative to that done by an optician it is not a very impressive argument, but it is a matter of principle here, and not so much a question of defining the actual turnover of the trading categories concerned—

Sir R. Russell

Is there not a question of principle in regard to dentists? Dentists also make dentures: is not that, to a limited extent, a form of trading?

Mr. Snow

The contractual arrangement with dentists as incorporated in the Act is that dentists work either on the National Health Service basis or in private practice. Therefore, the two things are not quite the same.

The new Clause would have the same effect as an Amendment moved in Committee would have had, expect that it seeks to give the Minister power to admit to the scheme such categories of registered opticians as he may determine. As I understand it, the hon. Lady's intention is that those individual opticians who meet our principles—that is, are solely engaged in ophthalmic practice in a personal capacity—should be brought in as an initial step. But we do not think that this would be satisfactory to the individual.

Any superannuation scheme can attempt to provide reasonable benefits only to those who remain members throughout their lives, and such an optician would find either that his freedom of movement within the profession was severely handicapped or that, on joining a limited company or commercial firm, which is very common these days, the normal course of his career would be forfeited and virtually all his accrued superannuation benefits would be lost. An individual optician might make several moves in the course of his career, and if the hon. Lady's proposal were adopted he could finish up without any real sort of superannuation protection.

The hon. Member for Wembley, South suggested that general powers should be taken now so that they would be available when they were needed. We do not think that such a step would be very proper. The Minister would not at present be prepared on principle to bring opticians or groups of opticians into the scheme, and it would be wrong to seek general powers when the Minister has not accepted the principle. The Minister would not want these powers until he could give the House a reasonable assurance that there was every prospect of their being used. A number of practical difficulties would need to be resolved before an appropriate superannuation system for opticians could begin to operate. Even after agreement had been reached in principle there would be sufficient work and negotiation to fill in the time while waiting for legislation.

All this may sound rather unsympathetic and contrary to the sort of evidence that the hon. Lady produced, but assure her that we are not dogmatic in this matter. We have to protect the whole operation of the Health Service, within the context not only of this fairly narrow element but of the other services provided. For those reasons I cannot accept the new Clause.

Question put and negatived.

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