HC Deb 23 July 1984 vol 64 cc719-27

Lords amendment: No. 1, in page 5, line 16, after first "the" insert "taking or"

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The Minister for Health (Mr. Kenneth Clarke)

I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Speaker

With this it will be convenient to take Lords amendments Nos. 2 to 10.

Mr. Clarke

All the amendments relate to clause 3, which, as hon. Members will recall from our previous debates, is concerned with the so-called protection of certain titles. That means that we are ensuring that the titles of "optometrist" and "optician" can be used only by people with suitable qualifications when members of the general public expect to be able to know whether they have those qualifications.

The general approach that the Government adopted on the matter met with approval in both Houses because we were moving to strengthen the existing law to some extent, but there was a disagreement in another place about the exact wording of the clause that the Government had chosen to give effect to our desired policy. Lord Mottistone and others in another place said that they would prefer it if the wording of clause 3 were somewhat closer to the wording of the Opticians Act 1958, which previously protected certain titles. The wording in that Act covers both taking as well as using those titles. It also covers them being used either alone or in combination with any other words.

We have been persuaded that it is sensible to apply the formulation in connection with the protection that the Bill extends to the title "optician". It will help those who may be called upon to interpret the statute in future. I accept, upon reflection, that there was a possibility that otherwise the courts might try to look for substantive reasons behind the change in wording that was previously proposed when no substantive reasons and no substantial changes were envisaged.

The only other change arises from amendments Nos. 4 and 9. In another place, their Lordships preferred to replace the negative expression, "not have been reasonable" with the positive one, "have been unreasonable". Upon reflection, we were persuaded that that makes the intention clearer.

The result is that their Lordships have made certain drafting amendments to the Bill as it left the House that take us back more closely to the wording of the 1958 Act. The Government are content to accept that and trust that the House will agree to the amendments.

Mr. Frank Dobson (Holborn and St. Pancras)

I would not wish to argue that we did not agree with the Lords in the amendments. Having argued in Committee that some improvements were necessary to protect the title of "optician" from pseudo-opticians and various other people taking advantage of the public, we welcome both the improvements that were made on Report, which we discussed on 2 May, and what we think are improvements in the wording, which were decided upon in the Lords. I understand, however, that those improvements were made without the entire approval of the Government Benches. I suppose that the Government are getting fairly used to having amendments passed in the Lords that were not promoted by the Government. It is an experience that Labour Governments have been accustomed to over the years. It appears that this Conservative Government are having a taste of their own medicine.

In protecting the title of optician, it is intended to protect opticians and, indirectly, the public by not allowing unqualified people to claim to be opticians and to have technical knowledge that they do not possess. Ironically, that flies in the face of the whole intention of the Bill, the Government's basic intention being to downgrade the optical professions by allowing glasses to be sold by people who know nothing about the subject. It is ironic to seek in this way to protect those professions when the Bill will undermine all that they have stood for over the years, including the concept that only a qualified optician is entitled to make up and fit out spectacles. The Government have made it clear, however, that they support the concept of ignorant prescribing.

It is always difficult to know where we stand when nods, winks and half-promises are given in the Commons about changes that might be introduced in the Lords. From Second Reading onwards, right through the Committee and Report stages, we have been waiting for someone to honour the undertakings given by the Secretary of State on Second Reading to protect not just the opticians but the people who turn to them because they need glasses to be prescribed. The Secretary of State has said all along that he is prepared to consider further protection, especially for people who need extremely complicated prescriptions, against the possibility of glasses being prescribed by someone who is not up to the task.

That semi-promise has been made constantly, but it does not seem to have been honoured in any of the Lords amendments. Perhaps the Minister will explain the reason for that. I hope that the answer will be that the undertaking can be honoured in regulations even if it is not enshrined in statute. Nevertheless, I hope that on this occasion the Government will give a clear and genuine commitment rather than the vague undertakings given in Committee and on 2 May and the even vaguer undertakings given by the Secretary of State on Second Reading before Christmas.

Therefore, although we welcome the minor changes made in the Lords amendments, we look to the Minister to explain why the more major change that we had expected has not been made. Perhaps the Government intended to introduce an amendment in the other place but decided that regulations would be better in case the recalcitrant peers voted against the amendment.

Mr. Laurie Pavitt (Brent, South)

I am delighted that the Government are supporting these drafting amendments. I regret that they have not gone further in protecting both the title of optician and the public at large, but, although these are minor, drafting amendments, it is no doubt better that one sinner should be called to repentance than that 10 saints find their way to heaven.

I wish to follow two points raised by the Minister and by my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). First, in view of the Government's willingness to make the matter much clearer, I had hoped that the Bill would make clearer to the general public the vital distinction between an ophthalmic optician and a dispensing optician. Hon. Members who are familiar with such matters are aware of the distinction.

The Bill destroys 30 years of tradition among dispensing opticians. The Minister is optimistic. He hopes that eventually the public will have some protection. He maintains that even someone who goes to Woolworth's for glasses must take an incomprehensible prescription which no one but a dispensing optician will understand.

Nothing concentrates one's mind on a problem more than experiencing the problem oneself. I have just picked up the second pair of spectacles dispensed for me in the last three weeks. Thank goodness the National Health Service has a superb ophthalmic department at Westminster Hospital. The legislation is not yet on the statute book, so I am still able to use all the facilities that I have used for 30 years.

The Minister says that in protecting the optician he is also protecting the public, but the amendments for which we hoped have not been approved. I have two intra-ocular implants. I am perhaps the original bionic man with two false ears and two false eyes. I return to Westminster hospital tomorrow for a possible third pair of spectacles. The amendments passed by the Lords are acceptable and welcome, but the Government should have gone further.

Recognised opticians are able to deal with elderly people who have had cataracts removed. An elderly person might need as many as six changes of spectacles within two years of having a cataract peeled. At present, spectacles can be borrowed while the changes are made. The right hon. and learned Gentleman has answered my parliamentary questions about the system in good faith, but he did not check sufficiently. There are discrepancies between ophthalmic departments in hospitals as there are between contracting opticians. The service depends entirely upon which hospital one goes to and which contractor is employed. Elderly people who have had cataracts peeled might be involved in considerable expense under the Bill because under the old system as the cataract healed and the lens and focus changed new glasses were provided.

I thank the good Lord for small mercies, because this Bill now provides facilities nearer those offered in the Opticians Act 1958. However, we should have been more than grateful if the right hon. and learned Gentleman had seen the light further down the tunnel and if his focus had been a little more concentrated on the importance of the optician.

Mr. Charles Kennedy (Ross, Cromarty and Skye)

Throughout the progress of the legislation hon. Members from all sides have opposed what it does to the optician and ophthalmic services. We have been given repeated assurances by Ministers, particularly by the Secretary of State at the end of last year, that the complex prescriptions aspect would be re-examined and that the Bill would be redrafted.

Some changes have been made, but from exchanges in the House of Lords last week it seems that the Lords remain unsatisfied about that aspect of the Bill. They were not convinced that the amendments, although welcome, were sufficient to overcome the practical problems that the legislation will cause for those needing complex prescriptions. Even at this late stage, we hope that the Government will give an assurance that they and the Department will take further action. We have been through all the arguments, so there is no point in rehashing them now.

As I have told the Minister, areas such as mine, which include vast rural parts as well as conurbations, will face many practical difficulties with dispensing services. I am sure that the concern felt in those areas is reflected in rural areas in England and Wales. I plead with the Minister to give the House further assurances, because, frankly, the amendments in no way match the expectations raised by the promises given by the Secretary of State. Clearly, the other place was not satisfied either, although it, like us, was happy to accept the amendments.

Mr. Kenneth Clarke

The hon. Member for Holborn and St. Pancras (Mr. Dobson) hinted that this was another case of the other place forcing an unwilling Government to accept its views and change policy. However, the amendments were moved in another place by my noble Friend the Under-Secretary of State, Lord Glenarthur, on behalf of the Government. I accept that they reflect a change of view in the drafting of the clause, which came about after we listened to the arguments of the noble Lord Mottistone and others. Both this House and another place agreed with what we were trying to achieve in clause 3, and if those briefed by opticians in another place believed that a certain form of words achieved that objective rather better than the original words, it did not seem worth arguing about. We listened to the argument on drafting, just as we listened in a constructive and reasonable manner to all the arguments put to us during the passage of the Bill.

There is no inconsistency between our anxiety to protect the title "optician" in clause 3 and the general policy of the Bill. The general policy is to extend choice and competition to the general public when obtaining spectacles. Parliament, probably accidentally, gave a total monopoly to qualified opticians to sell spectacles, frames, lenses and even frames without lenses. As the Office of Fair Trading report shows, that has had an unfortunate effect on the service given to the public. The quality of dispensing and eyesight testing in Britain is extremely good, but prices have been higher than necessary for some spectacles and optical goods because of the lack of competition and choice.

However, choice exercised by the public should be informed choice. We have never denied that a qualified optician has certain skills and the benefit of certain training, which are not available to others. Therefore, a member of the public is entitled to know whether the person with whom he is dealing has those qualifications and training before he decides whether to pay extra—if there is any extra — for the services of a qualified optician rather than the services of his competitor round the corner.

We must ensure that people use the title "optician" only where it is reasonable to allow them to do so and that it is not used by unqualified persons so that members of the public are not misled into believing that they are qualified. That has been the whole point of trying to get clause 3 right, and I believe that that is what we have eventually achieved.

Having been reasonable on that point, we have been reminded of one or two other undertakings that we certainly intend to honour so that we can ensure that the public are protected in other ways.

The first relates to those who require the most powerful lenses and who have the most complicated prescriptions. Throughout the passage of the Bill, people, including the three hon. Members who have spoken today, have been concerned about the extra expense that might be imposed on some patients who need particularly powerful lenses. There has been a tendency on the part of some commentators to exaggerate the bill that might face such people.

We are removing the general subsidy under the general optical service from everybody except children and those on low incomes who at present qualify for free glasses or reduced charges. However, the general subsidy which we are removing from the rest of the public is often exaggerated. The average subsidy for a pair of spectacles is only £5. The majority of patients get a subsidy of only £2 from the general optical service when they buy NHS glasses. Those with the most powerful lenses rarely, if ever, receive a subsidy of more than £30.

For that reason, it is inconceivable that any individual could find that the increase in charges for a pair of glasses could exceed £30 above what he or she is paying at present for glasses. In fact, they will be rare and exceptional cases and I believe that the new competitive climate which the Bill introduces will so reduce the general price of spectacles that an increase of £30 is unlikely.

Amazing figures were put forward to show how spectacle prices would rise. For example, it was suggested by some that glasses at present costing £30 would go up to perhaps £90; that was about the highest estimate I ever saw. People, especially pensioners, faced inflated fears as they listened to people campaigning on behalf of opticians, who said that in future glasses would cost a fortune.

To protect against the risk that costs could escalate in that way—if we were proved wrong, which we might be; I am content to wait to see what happens in practice — we have decided that those who require the more powerful lenses, because they have the poorest sight, should continue to have access to the general optical service to obtain their spectacles at cost price to the NHS. We are proposing that that should be extended to all who at present get a subsidy of £15 or more on their glasses.

Those people will be entitled to continue to get their glasses under the GOS for the foreseeable future. They will get them at whatever it costs the NHS—and we are talking about a tiny number of people. That is in line with what the Secretary of State first said on 20 December 1983, as reported in column 297 of Hansard of that date, and I put it in more explicit terms on Report. The point laboured by all three hon. Members who have spoken today is not on the face of the Bill. That is because it can, and will, be done by regulations under clause 28.

Mr. Pavitt

The right hon. and learned Gentleman has concentrated his argument on those with low visual acuity and needing a very powerful correction of a lens. The far wider area embraces not necessarily those with low visual acuity but people who, because they have a differing form of sight, at both long and short distances, require not necessarily a powerful lens but a lens suitable to their disability. Therefore, although the right hon. and learned Gentleman has covered one sector, he has not covered a far wider sector.

Mr. Clarke

The hon. Gentleman has great expertise in these matters and will be aware that it is a simplification to talk about those with very poor sight needing the most powerful glasses. We are both talking about possible expense; that is the aspect which is worrying people. That is why the definitions which we shall use of patients who will be able to benefit from the protection that we are suggesting are patients who at present receive a subsidy of £15 or more.

That means that, regardless of the exact visual disability which causes them to need more expensive glasses, so long as the difference between the charges that they pay at present and what their spectacles cost the NHS is £15 or more, they will continue to have access to the GOS and will go on being provided with spectacles and lenses at no more than the cost to the taxpayer of those spectacles.

Mr. Dobson

Will the Minister qualify that point? Is he saying that those who already have glasses for which they pay £15 will be all right, or is he saying that people who, by some calculation made in the DHSS when they go for their glasses in future, would have been paid £15 will be all right? In other words, does the new measure include only people who have glasses now or will it include people who will need glasses in the future? Whatever the answer, will there be some provision for keeping up with the rate of inflation?

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Mr. Clarke

I am talking about the class of people who would, at the moment, be eligible for a subsidy of £15 or more. That includes people whose eyesight deteriorates, so that they become eligible for that in future. We shall make arrangements to enable people who at the moment receive glasses that require a subsidy of that level and those who require such a subsidy on glasses in future, to take advantage of our concession. By definition, that will take account of inflation and when we come to draw up the regulations, the hon. Gentleman will see that we are aiming to ensure that those who require the most expensive lenses will still be able to get them at cost under the general optical service if they so require.

Mr. Kennedy

At the risk of playing devil's advocate, I point out that the Minister is not looking terribly convinced. Will he give one further clarification? He has said that this happy position will continue in the foreseeable future. What does he mean by that?

Mr. Clarke

Eventually, as the hon. Gentleman knows, we hope to go over to a system of cash grants. We do not believe that the Government and the NHS should be in the spectacle business, offering a set range of frames and providing appliances. The problem is that the low income of some people means that they are unable to afford glasses when they wish. The state should provide the right sum of money so that those people have the benefit of choice, as everybody else does, and with the right money can get the spectacles of their preference. We propose to move over to such a cash grant system as soon as we reasonably can.

For the time being, we shall keep the general optical service for children and those on low incomes and those who, at the moment, get reduced charges. We propose, as a result of discussions on the Bill, to have this extra arrangement for those who, as things stand, will receive a subsidy of £15 or more. We are proposing that those people should have glasses, under the GOS, provided at the price that they cost the NHS, and we shall provide for that in the regulations.

I am sorry that the hon. Member for Holborn and St. Pancras (Mr. Dobson) looks so perplexed. As, at the very last moment, he and his hon. Friends, and the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), will continue to chew away at this tiny point, about which they have affected to be so concerned, they will continue to have nitpicking answers until the details arrive, when the regulations that they are so eager to see are finally put before them.

Mr. Dobson

As the Minister knows, the Secretary of State gave a wide promise on Second Reading that he would offer all sorts of protection to all sorts of people. Nobody would suffer, everybody would be better off—roughly speaking, that is the general drift of what the Secretary of State said. We pressed for detail on Second Reading, in Committee and on Report. If we had had a long Third Reading debate, no doubt we would have pressed for detail then, and the other place also asked for detail. Now the Minister comes galloping up and talks about an everybody-in-excess-of-£15 scheme and expects us to swallow it as if we were some trout that wanted to be caught. The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and I, and my hon. Friend the Member for Brent, South (Mr. Pavitt), are having to take on board a new announcement. Is the Minister saying that somebody who was paying £14.99 in the past will have to pay the full price but somebody who was paying £15.1p will get his spectacles for nothing? That sounds an odd proposal.

Mr. Clarke

The hon. Gentleman is trying, at the last moment, to breathe life into some rather boring Lords' drafting amendments. He is getting carried away in his recollection of our previous debates. He says that my right hon. Friend the Secretary of State promised the broadest possible protection for everybody. My right hon. Friend said: In the vast majority of cases I cannot believe that that subsidy is justified. He was talking about the low level of average subsidy about which I was talking. He continued: On the other hand, it has been argued that them are those with the very poorest sight who need complicated, more expensive lenses, and I am certainly prepared to consider the evidence on that to see whether they can have continued access to NHS glasses."—[Official Report, 20 December 1983; Vol. 51, c. 297.] I am not announcing this measure this afternoon for the first time. I am repeating announcements that I have made in earlier debates. My recollection is that I said the same thing on Report.

We decided that those who require the most expensive glasses will be protected by protecting those who receive a subsidy of more than £15—not those who pay £15, but those for whom the difference between what they pay and the cost to the NHS exceeds £15. Those are the people who need the most expensive glasses, and who will be offered some protection. The protection is that they will continue to have their glasses, if they wish, under the general optical service and we shall charge them the cost to the taxpayer. They can have the glasses at cost. I have announced that before, and it appears to us to be adequate protection.

My announcement does not answer all those fanciful fears that have been raised to alarm people about the Bill. People are told that the price of the more complicated glasses will go soaring into the stratosphere. Those alarmist claims greatly exaggerate the extent of the subsidy that is given now, and ignore the fact that, with more competition, prices will come down, not go up, despite the arguments of some of the lobbyists.

Mr. Pavitt

There was not much comfort in the right hon. and learned Gentleman's threat of yet another means test. He is making an important point about regulations. Before they are finally drafted, will he have consultations with the National League of the Blind and Disabled and the Royal National Institute for the Deaf? Those bodies represent the people whom he is trying to protect. There are pertinent questions, to which those who are on the receiving end need to know the answers, about the judgments being exercised and the point on the scale at which it is decided that people need more powerful lenses, and therefore get a subsidy.

Mr. Clarke

We shall have consultations before we introduce the regulations. I shall follow closely the hon. Gentleman's argument about the points that may be made on behalf of the registered blind and the registered deaf. I am sure that we shall produce regulations that live up to what I have described.

I remind the House that on 2 May on Report, in columns 391–392, in exchanges with my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) and the hon. Members for Leeds, West (Mr. Meadowcroft) and for Preston (Mr. Thorne), I set out our thinking about providing glasses through the GOS for those who need the most expensive lenses. I said that that was how we would honour the undertaking given by my hon. Friend on Second Reading.

I am glad that the amendment made in the other place on clause 3 is so readily accepted. I am sorry that hon Members find our commitment to the other things that we promised a little more difficult to follow, but it is there and it will emerge in due course in Me detail of the regulations

The hon. Member for Brent, South (Mr. Pavitt) also raised a point about cataract patients and others who have had operations. He unfortunately has difficulties with his eyes and he will know that such people have to have: frequent changes of glasses. There is no danger of people facing enormous bills as a result of that, because the present arrangement in hospitals will continue unchanged by the Bill.

Mr. Pavitt

The present arrangements are marvellous.

Mr. Clarke

The hon. Gentleman says how marvellous they are. That being so, I cannot understand why he thinks that, as a result of the passing of the Bill, which will make no difference to them they will suddenly become unsatisfactory.

Perhaps the hon. Gentleman will allow me to explain what the present arrangements are; then I shall give him an opportunity to say what he thinks they ought to be. For anyone who has had, say, a cataract operation requiring frequent changes of glasses, it is possible sometimes for the hospital to lend glasses to the patient, who carries on changing them until his eyes have settled down, and finally has the pair of glasses that he requires. But the more usual procedure is for the patient to pay for his first pair of glasses and then, as his eyes settle down, to get the next pair or pairs from the hospital free of charge. That is because the problem for such patients is their non-tolerance of the first glasses given to them. Either way, it is usually possible for a hospital to allow anyone who has had a cataract operation to have a pair of glasses and to pay for one pair only what he would expect to pay, like everyone else, under the general optical service. Those arrangements are not affected by the Bill.

Had there been legitimate fears of the kind that the hon. Gentleman expresses, we would have met them. We have met all reasonable objections throughout the Bill where they could be sustained. All these matters are vaguely related to clause 3, but not too closely. I am glad that one matter about which we remain unanimous is the drafting of clause 3 as the other place has now changed it.

Question put and agreed to.

Lords Amendments Nos. 2 to 10 agreed to.

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