Ophthalmic Services (Hansard, 28 November 1983)

§ The Secretary of State for Social Services (Mr. Norman Fowler)
With permission, Mr. Speaker, I shall make a statement on opticians and competition following the report of the Office of Fair Trading published earlier this year.
At the end of 1981 the Office of Fair Trading was asked to report on the effects of the Opticians Act 1958 upon competition in the supply of opticians' services. It found that the requirements imposed under that Act led to restricted competition and resulted in unnecessarily high prices. In particular, the Office of Fair Trading criticised the rules limiting opticians' advertising and the monopoly on the supply of glasses granted to opticians and doctors. The Government accept these conclusions and believe that the interests of consumers would be better served by acting upon the OFT report. Accordingly, the Government intend to bring forward legislation to deal with two main areas.
First, we propose to take action on advertising. At present, the rules made by the General Optical Council allow no general advertising of the prices of glasses or advertising on such matters as the speed of service. This handicaps the consumer who wishes to get the best value for money and also holds back the optician who can provide a better deal or wider choice. The General Optical Council reviewed its rules in the light of the report by the Office of Fair Trading, but the changes that it proposed came nowhere near to those needed. Legislation will therefore be introduced to enable the rules operated by the General Optical Council to be amended to allow freer advertising. These powers will be used carefully. In particular, we will draw a distinction between the professional function of sight testing and the commercial activity of selling glasses. The aim will be to ensure that the public are provided with more information about the prices of glasses.
Secondly we propose to take action on the monopoly to dispense and sell glasses. There is still a need for public protection in certain areas such as dispensing to children and fitting contact lenses. However, all laws which create a monopoly have to be examined to see whether, under the cloak of public protection, there is not simply too much protection for the seller. We have concluded that this is the case with opticians. The legislation which the Government will introduce will therefore allow non-opticians to sell glasses under carefully prescribed conditions. The conditions laid down will ensure that no risks are taken with people's sight. All sales will have to be made against a recent prescription, following a sight test by an appropriately qualified optician or doctor, and no one other than a qualified optician or doctor will be able to sell glasses for children or to fit contact lenses. It is our intention to maintain the present arrangement for the registration of qualified opticians and the public will therefore be able to make a choice between the services of a registered optician and those of other competitors.
The action that I have announced on advertising and the end of the dispensing monopoly will, I believe, bring down the price of glasses. This will have an effect on the general ophthalmic service. At present, it provides free sight tests by either an ophthalmic optician or a specially qualified doctor. We intend to continue this arrangement. It also provides a range of frames and lenses free to 656 children and families on low incomes. This free provision will also continue. But other people who currently buy NHS glasses will in the future be able to obtain a wider selection of non-NHS glasses at reasonable prices. Although the NHS will continue to provide free sight tests and to supply glasses to the present exempt groups, there will no longer be any need for the general supply of NHS glasses. The legislation I shall shortly introduce will give effect to this.
My right hon. Friends the Secretaries of State for Scotland and for Northern Ireland will also bring forward proposals to give effect to these changes. We believe that the changes I have announced will enable greater competition to take place, provide greater choice and, above all, have the effect of bringing down the prices of glasses for the public.

§ Mr. Frank Dobson (Holborn and St. Pancras)
I assure the House that the Opposition share the general concern about the high cost of non-National Health Service frames. However, we are worried about certain aspects of the right hon. Gentleman's statement, although we welcome the fact that the dispensing of glasses must still be preceded by a sight test carried out by a qualified practitioner. We are worried that the advertising changes and the relaxation of the rules so that non-qualified people may sell glasses will result in small business opticians, especially those in rural areas, losing out to the major multiples, who can afford the cost of advertising.
Will the staff of a shop selling glasses be properly trained to interpret prescriptions which are given them by the person who brings in the prescription? If not, mistakes could occur, and they could be serious. What procedures does the Secretary of State propose to provide a redress for customers against a shop that sells glasses that are different from those that were prescribed?
More importantly, does the Secretary of State's statement about the general supply of NHS glasses mean that there will no longer be a general supply of NHS glasses and that NHS frames and lenses will be provided only to those poor groups and under 16-year-olds who are described in the statement as exempt groups? If that is so, it is a severe curtailment of the area covered by NHS provisions and means the introduction of privatised marketing into a sphere where it does not now exist.
Does the Secretary of State agree that if that is the import of his statement it will mean that people who cannot afford to go outside the NHS because they are poor will demonstrate that they are poor, or are receiving supplementary benefit or family income supplement, by the nature of the glasses that they wear?

§ Mr. Fowler
The hon. Gentleman's last point is not a very good one. I am grateful for the limited support: that he has expressed for the measures that I have announced.
Virtually the only advertising at the moment is for frames, which appear in the windows of opticians' premises. Opticians cannot advertise in the press or on television on such matters as price and speed of service, or even on whether they are open. They cannot, for example, display an advertisement that says, "Never knowingly undersold". We believe that that area needs reform, and that is why we have brought forward these other proposals.
There will be checks and conditions on non-optician sellers. Clearly, they should be able to read the 657 prescription, and we shall consult the profession on this matter. Remedies will be open to the public under the Sale of Goods Act, but we shall have further talks about any additional protection that is required. This will become part of a Bill that will be put before the House shortly, and therefore we shall have time to go into all these aspects.
On the hon. Gentleman's point about general ophthalmic services, free sight tests are now provided and that will continue. Free glasses are provided for exempt groups—children and low income families—and that, too, will continue. It is the provision of glasses for nonexempt groups that will be withdrawn from that market. We believe that the present non-exempt customer will be able to obtain a wider range of glasses at comparable prices as a result of the proposed deregulation of the market.
The fundamental change is that we believe that the most important person is the customer. Customers should have the right to make an informed choice and to have more information and lower prices.

§ Mr. Robert McCrindle (Brentwood and Ongar)
Is my right hon. Friend aware that he seems to have found a good compromise between maintaining the professional status of the optician and opening up the benefits of competition for the consumer? Will he confirm that there is no intention of moving towards the North American system in which spectacles can be purchased without prescription over the counter of a department store? Secondly, how recent will the prescription need to be for glasses to be obtained under the new arrangements outlined in his statement?

§ Mr. Fowler
I hope that what my hon. Friend has said will be noted, as it is absolutely correct. With regard to checks, sales will be made against recent prescriptions, by which we mean prescriptions made within the last two years.

§ Mr. Willie W. Hamilton (Fife, Central)
Is the Secretary of State aware that the Opposition welcome the possible reduction in the price of glasses so long as we have an absolute and unqualified assurance that the quality of service to the patient will not be jeopardised? On the point raised by the hon. Member for Brentwood and Ongar (Mr. McCrindle), will the Secretary of State make illegal the sale of glasses by retail outlets such as Woolworth's, as anyone who has seen that kind of treatment must be appalled by it? Will he also assure the House that there will be separate Scottish legislation and that Scotland will not be tacked on to a United Kingdom Bill?

§ Mr. Fowler
The legislation covers the whole of the United Kingdom, but my right hon. Friend the Secretary of State for Scotland will make a separate statement about the position in Scotland.

§ Mr. Hamilton
When?

§ Mr. Fowler
Very soon, I hope.

§ Mr. Hamilton
In the House?

§ Mr. Fowler
The hon. Gentleman also made an important point about checks. As I have said, any sale must be made against a recent prescription and it will be a condition on the non-optician seller that he must be able to read the prescription. We shall consult the profession on that aspect. It should be pointed out, however, that 658 about two thirds of prescriptions are now made up by prescription houses where staff do not need to be qualified in the way that professional opticians are. The aim is to preserve the medical checks that both the Government and the Opposition want, while producing a better service and lower prices for the public by the introduction of competition.

§ Mr. Peter Viggers (Gosport)
Does my right hon. Friend agree that the present system has two grave shortcomings, neither of which has much to do with maintaining standards? First, the interlinking of sight testing with the sale of glasses and frames maintains high prices. Secondly, restrictions on advertising the services offered help to maintain high prices and prevent proper competition. Is my right hon. Friend aware that the measures announced today will undoubtedly reduce prices for the consumer?

§ Mr. Fowler
I am grateful to my hon. Friend for his comments. There is no doubt that the present restrictions on advertising prevent full competition and to some extent discourage new entrants. I believe that our proposals will lead to more competition, better services and lower prices.

§ Mr. Lewis Carter-Jones (Eccles)
Will the Secretary of State give a firm promise that routine examinations for possible glaucoma will in no way be reduced either for the rich or for the poor as a result of the Government's legislation?

§ Mr. Fowler
Eye tests will continue to be free, as at present. That will remain unchanged.

§ Mr. Tim Eggar (Enfield, North)
As there has been such a wide welcome for my right hon. Friend's statement, one wonders why previous Governments did not introduce similar reforms. Will my right hon. Friend consider other professions, with a view to similar reforms? In the present case, will he explain why there are to be any restrictions at all on advertising?

§ Mr. Fowler
I am grateful for my hon. Friend's comments, but I know that he would not wish to push me into areas for which the DHSS is not responsible. As for restrictions on advertising, the important distinction is between the selling activities of the optician and the sight testing function. That is the distinction that we seek to make.

§ Mr. Michael Meadowcroft (Leeds, West)
Does the Secretary of State accept that the present two-year definition of a recent prescription may not be justified if the rules are changed? Does he accept that the difficulties of having separate dispensers may be far more acute in the future, because, although two thirds of prescriptions now come from prescription houses, the position may be very different when an optician is no longer responsible for final delivery of the spectacles? Will he therefore consider registration of dispensers rather than more general proposals about bringing in certain rules to test them?
Finally, when the Secretary of State says that there may no longer be any need for the general supply of National Health Service glasses, does he agree that in some instances people may feel unable to enter general prescribing because of their lack of funds? Does he accept that there will be severe difficulties unless there is a better standard of NHS provision?
Lastly——

§ Mr. Speaker
Order. I think that three questions are plenty.

§ Mr. Meadowcroft
Perhaps I may just finish the point, Mr. Speaker. As the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, there is a danger——

§ Mr. Speaker
Order. That is unfair.

§ Mr. Fowler
We shall certainly look at the hon. Gentleman's point about the two-year definition of a recent prescription. No doubt that will be dealt with in Committee when the legislation providing for the change is considered. In view of the hon. Gentleman's comments, I hope that he supports the general thrust of the changes.

§ Mr. Meadowcroft
indicated assent.

§ Mr. Fowler
I am glad to see that the hon. Gentleman nods his assent to that.
Im making regulations for non-opticians, we shall wish to consider the matter very carefully before going along with the hon. Gentleman's suggestion. Clearly, there must be a checking process, but we do not wish to end up merely pursuing the monopoly in a different way.

§ Mr. Chris Smith (Islington, South and Finsbury)
Is the Secretary of State aware that there is an increasing tendency for small independent ophthalmic practices to be taken over by large conglomerates, many of them with other than optical interests, and in one case a tobacco company? Is he aware that that trend is a matter of great concern to professional and academic circles in the ophthalmic world? Is he further aware that his proposals may lead to an increase in that trend and cause great anxiety about the quality of service provided for the public?

§ Mr. Fowler
I am sure that it would be out of order for me to make any comments about eyesight. It is a point, however, that we shall bear in mind. It is for the public to decide. They will have a free choice. Registered opticians will be able to put their case. Many people will continue to go to registered opticians—there is no doubt about that. We are saying that there should be greater choice than there is at the moment.

§ Mr. Ioan Evans (Cynon Valley)
While we welcome this measure if it means a reduction in costs to the consumer, will the Secretary of State look more positively at the possibility of increasing the range of National Health Service spectacle frames, so that people need not go to the private sector?

§ Mr. Fowler
No, we want to go the other way. As I said in my statement, and as the hon. Gentleman recognises, we are keeping to the National Health Service supply of National Health Service frames for children and other exempt groups. We may ultimately be able to reach a position where people are reimbursed or are given a cash voucher so that they can go into the market if they choose. If that were to develop, it would be a better way of proceeding.

§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
I welcome the Secretary of State's concern for the consumer, which is plainly right, and the lower prices to which his proposals will lead, but at the end of his statement, he talked about there no longer being a need for 660 any general supply of NHS glasses. If his proposal means introducing some form of means testing, that will be a retrograde step.

§ Mr. Fowler
I have made it clear that we intend to keep the present exemptions for children and low-income families.

§ Mr. Dobson
May I remind the Secretary of State that this matter arises because of anxiety about the high cost of frames produced privately and supplied outside the National Health Service? Therefore, why has the Secretary of State announced the abolition of NHS supplies of frames and lenses, which are already the cheapest on the market? What is the average cost of a pair of NHS glasses, and the average cost of a pair of privately supplied glasses, with privately produced frames and lenses? If the right hon. Gentleman is so confident of the private sector's price-cutting abilities, why will he not allow the NHS to continue to provide glasses so that it can compete? Is it that his friends in the industry are frightened of competition from the NHS?

§ Mr. Fowler
The hon. Gentleman's first question was rather more impressive than his summing-up question. He must be aware that the DHSS does not produce frames and lenses. They are produced, under contract, by the private sector. As we have announced a change in advertising and the end of the dispensing monopoly, that clearly has implications for the general ophthalmic service. I do not believe that it is reasonable to continue in the way that we have in the past and ignore the fact that these changes will take place.
There is no way in which I can give the hon. Gentleman the average cost figure, for the good reason that there are so many differences—[Interruption.] Labour Members may laugh, but there are many differences in prescriptions. The DHSS is involved in the design of National Health Service glasses. It may be the hon. Gentleman's vision of the brave new world, but I am bound to tell him that I am not sure that a Government Department is the best body to be involved in the cosmetic design of spectacles. I believe that competition will bring the prices down, and I think that the hon. Gentleman will see that.