§ '(1) The Secretary of State may by regulations made by Statutory Instrument make such provisions as he considers necessary for licensing persons other than registered opticians to carry out without the supervision of such opticians the dispensing, sale or supply of optical appliances, and for monitoring their efficiency in carrying out such dispensing, sale or supply.
§ (2) A Statutory Instrument under this section shall be of no effect unless approved by a resolution of both Houses of Parliament. '.—[Mrs. Jill Knight.]
§ Brought up, and read the First time.
§ Mr. Deputy Speaker (Mr. Paul Dean)
With this it will be convenient to take new clause 19—Standards of care—'The provisions of section 1 of this Act shall not come into operation until the Secretary of State has by regulations established a scheme to ensure that spectacles are dispensed only by persons capable of interpreting any prescription given by a registered medical practitioner or registered ophthalmic optician 399 following a testing of sight by him and of so fitting or checking the fitting of such lenses that the maximum optical benefit is obtained. '.
§ Mrs. Jill Knight
The title of the clause shows that its purpose is to give some protection to the public. I thought and hoped that my hon. and learned Friend the Minister for Health would recognise that it is within his power to give protection to the public, that it is right and proper to do so and that he should do so.
Many organisations outside the House are now massed in their concern about the lack of protection for the public in that in future those who are not qualified in any way will be able to dispense glasses. It has been suggested in earlier debates that the opticians are so concerned about making money that they are the only ones to object to the Bill. That is not true. The women's institute, which has nothing to gain by criticising the Bill, is extremely concerned about the lack of protection for the public following the Bill's enactment. The British Medical Association, whose support or rejection is not to be sneezed at, has similarly expressed its concern about lack of protection for the public. It is well known that family practitioner committees throughout the country have been deluging Members interested in the Bill with their concern about it.
Recently the International Optometric and Optical League met. On that occasion, 43 optical and optometric organisations from countries throughout the world met in London and, among other things, discussed the Bill. The House will be interested to hear the views of the league, bearing in mind that it is an international group of experts. I accept that it might be thought to be part of a rather sinister trade union connected with the ophthalmic profession. However, its members work to an extremely high standard. The president is professor of the school of studies in optometry of the University of Bradford and has nothing to gain from supporting or rejecting the Bill. The considered view of the league is as follows:The League views with considerable concern the proposals of the United Kingdom Government to amend the Opticians Act 1958. This measure will put the public at considerable risk of receiving inaccurate, inadequate and inappropriate optical dispensing, at a time when world standards generally in its member countries are increasing. The League further registers its concern that, when standards of dispensing in the European Economic Community are considered, the United Kingdom will now become the only member state to deregulate optical dispensing in this way and remove consumer protection from a large part of health care.Surely these are views that should be understood and considered. Surely they must weigh heavily. It seems that the United Kingdom will be the black sheep when all other countries in Europe are going forward and providing better health care and more protection for patients. However, we alone in Europe are taking a retrograde step.
It is almost 30 years now since the House, in its wisdom, passed legislation to protect the public from the dangers of allowing persons without expert knowledge to dispense spectacles. The Bill that offered that protection was not introduced by accident. It was not an afterthought and it was not taken lightly. It was introduced because it was recognised that protection for the public, when it came to caring for their sight, was a matter of great importance. At that time it was acknowledged that glasses needed to be properly fitted, centred, adjusted and checked, because otherwise the wearers would not be able to see properly.
It is a sad and sorry fact that we are now contemplating taking a retrograde step. Britain alone in Europe is contemplating throwing away the protection that is offered 400 to the public in the dispensing of spectacles. My right hon. and learned Friend says, "We are improving the choice of members of the public. Members of the public do not have to go to a bucket shop for the dispensing of their glasses and do not have to go to an unqualified person. They can go to someone who knows what he is doing if they wish, and if they do not wish to do so the decision is up to them." In other words, the standard of care for one's eyes is of such little importance that it is a matter of choice whether the individual should or should not take advantage of the expertise that we in Britain have enjoyed for so long.
If my right hon. and learned Friend takes that view, why did he support the Bill to enforce the wearing of seat belts? If he had felt that protection should be a personal choice, he would not have voted for that measure, but in fact he did. He made a wise choice in deciding to support that excellent measure, but the considerations that apply to the dispensing of spectacles and the wearing of a seat belt are to some degree on all fours.
Why do we have health and safety provisions in various Acts if people should be left to choose for themselves whether to observe safety standards? Why do we bother to say that people must by law protect themselves and others? Why do we have an obligatory test after three years to ensure that motor cars are roadworthy? If my right hon. and learned Friend is right, it should be open to the public to drive cars that are defective. If, for example, a car has defective brakes, too bad. If it is for them to decide to drive a car that has been properly tested or not to bother, why do we have legislation to force members of the public to have their cars tested?
§ Mr. Kenneth Clarke
My hon. Friend has cited examples of Acts that we both supported. They concerned activities that could result in injury or death if the public did not do the sensible thing. My hon. Friend knows that after a recent sight test, as we are requiring, the consensus of medical opinion is overwhelming that no damage can be done to adult eyes by errors made in dispensing.
§ Mrs. Knight
I ask my right hon. and learned Friend to be patient because I intend to come to that argument. If he seriously thinks that badly dispensed glasses, leading to a person's inability to see, hold no dangers for himself or others, he is quite wrong.
§ Mr. Hal Miller (Bromsgrove)
I, too, have received a number of representations on the matter. However, if I wanted to obtain treatment for a certain matter, I could choose whether to go to a doctor, an orthopaedic consultant or a homeopathist. They can all prescribe something.
§ 7 pm
§ Mrs. Knight
But that is a question of going to someone who has been trained. One does not go to the local market for treatment. Unless someone is properly trained, he cannot provide a service. My hon. Friend may claim that not a great deal of training is involved in homeopathy, but others would claim that that profession involves a great deal of training and knowledge. The right of a person to choose not to take care of himself is acceptable only until his choice affects others. There is no doubt about the danger to a person and the public around him if he cannot see properly.
My right hon. and learned Friend claims that sufficient protection is afforded by a patient having had his eyes 401 tested by an expert, but that any fool can then stick in the prescribed lenses and put the spectacles on any old nose. I know that it does not appear to involve a great deal of training — but, then, it appears easy to skate. The standards of Torvill and Dean would not easily be achieved by someone with no training.
I have found the exercise of trying to tell my colleagues that dispensing is not easy to be a rather dismal exercise. Unless people have properly prescribed glasses, they cannot see. One of my colleagues was astonished to learn that it took two years of full-time training and a year's practical experience to qualify as a dispensing optician. People may say that that is a waste of time and that patients should consult people with no training. But those two years are not wasted simply on looking at a few colours. The complexity of the knowledge of prescribing glasses correctly is something that the House should understand if it intends to pass a Bill that will have such serious consequences.
A prescription is of no value until and unless it is correctly and accurately dispensed. A prescription gives only the power of the lenses — it provides no information about the position of the lenses in relation to the eyes, and that makes a great difference to whether a person can see. The prescription takes no account of the measurement of the bridge, the eye size and length, the angle of the sides of the frame and so on. A dispensing optician must know about the materials from which the lenses are made—are they to be crown glass, hard resin plastic, high-light glass or polycarbonate? A dispenser cannot know what difference the various sorts of materials make unless he is trained.
Many people prefer tinted lenses. Perhaps their eyes are not good at taking in a great deal of light, or perhaps they think it is rather smart. The dispenser needs to know about tints, the toughening of anti-reflecting coating and a whole range of other matters with which I shall not bore the House. I could speak for a long time accurately to describe the complexity of the courses necessary before people are allowed to dispense spectacles. There is a problem of bifocal and multifocal lenses. That requires a further set of measurements, including the height and decentration of reading segments—that may appear easy, but it is not.
I accept that we have lost the battle on the main point that there should be only qualified dispensing opticians, but, if we are interested in protecting the public, we must have some standards, and they will be provided by the amendment. I am sorry to say that the Government have proposed no effective system that will ensure any safeguards for the public. My right hon. and learned Friend responded to the degree of concern expressed in Committee by saying that the Government's policy had always been not to take steps that might risk the health of those needing spectacles. Yet that is precisely what they are doing.
Wrongly dispensed spectacles may not actually damage the eyes, but many other factors must be considered. Wrongly dispensed spectacles can undoubtedly lead to persistent bad headaches that will not improve, no matter how many aspirins are taken.
Wrongly dispensed spectacles can lead to a breakdown in the ability of the two eyes to co-ordinate. If a lack of co-ordination is reflected in the lenses, the eyes will be trained not to co-ordinate with each other. That is a serious 402 matter. Wrongly dispensed glasses can also cause double vision. One might think that the person would realise that and do something about it, but they may have done a great deal of damage to themselves before the problem is put right. It would take a long time for the eyes to settle down again. I wonder how many of my hon. Friends know that wrongly dispensed glasses can turn a temporary squint into a permanent squint.
Serious problems can occur from wrongly dispensed glasses, and we must protect the public from that. Most important of all, a person wearing wrongly dispensed glasses will not be able to see properly. He may not realise that. He may think that a traffic island, a bollard or a pavement is two or three feet forward or backward of its actual position. Traffic accidents may well occur.
I recently received a letter from an optician telling me that he had been concerned about the eyesight of one of his patients. He asked the patient to come to see him again in less than the usual two year period. When the man did so, the optician found that there was a serious deterioration in his eyesight, although the man had not realised that. The optician was able to correct it. Under the proposed new laws, that man may not even pay a return visit to his optician. Even if he does, his glasses may be wrongly dispensed. That man's trade is driving a high-speed intercity train at 120 miles per hour. Let no one tell me that it is not necessary to protect the public from people driving trains when they cannot see properly.
I wish that there had been more consultation between my right hon. and learned Friend and such organisations as the ophthalmic group of the British Medical Association—which could have told him the facts.
I asked in Committee how the service given by what I could only describe as tradesmen would be monitored when the Bill became law. My right hon. and learned Friend replied that the General Optical Council would do the monitoring. But neither the GOC nor the BMA, let alone the Minister, can monitor such matters unless there is a register or licensing procedure such as the new clause envisages.
It is no good saying that there will be monitoring to see that people are behaving properly and acting in the best interests of the care of the public's eyesight if we cannot trace the people concerned. The only way to know where they are is to have a procedure which, while accepting that they are not opticians, registers them.
We are unable to debate British standards in these matters because amendments which would have enabled such debate have not been selected. There will be nothing under British standards of which we are aware to givesesprotection. The GOC will not be able to monitor or even keep a check on the service being provided unless the new clause is accepted. If there is provision in the Bill to enable monitoring to occur, I shall be delighted to be told that by my right hon. and learned Friend, who said in Committee in January last:We shall impose conditions on the supply of optical appliances which will strengthen the present position." —[Official Report, 26 January 1984; c. 44.]Having hunted for them, I cannot find such conditions. As for the present position, it is fine. I do not object to competition, but I want it to take place among qualified people who know what they are doing. I beg my right hon. and learned Friend, and my hon. Friend the Member for Bromsgrove (Mr. Miller), to accept that if people cannot see properly, they are a danger to themselves and society. 403 I ask for the support of the House for a thoroughly reasonable new clause which should appeal to all who care about preserving the standard of care for the eyes of the people
§ Mr. Dobson
I warn the hon. Member for Birmingham, Edgbaston (Mrs. Knight) about drawing attention to such matters as a British Rail driver with bad eyesight. As the Government's logic is so odd that when faced with the high price of private glasses they abolish low-priced public glasses, their answer to that driver's eye problem may be to abolish British Rail.
New clauses 3 and 19 are identical in intention if not in wording. While many of us complain about the high price of some private glasses, we have never expressed doubt about the professional competence of the optical profession. It appears that the Government do not believe that there are any benefits to the public flowing from the application of professional standards. At their best, professional standards benefit not only the profession concerned but also the public.
Professions with non-commercial standards were developed because it was generally felt that there were standards to the advantage of the public which would not result from the interplay of market forces and that there were more important things than those market forces could produce.
Whatever criticisms may have been levelled at parts of the optical profession about the prices that were charged by some of them for some private glasses, doubts were never expressed about their professional competence. We should not do anything to undermine the standards of the profession, the standards of dispensing or the faith that ordinary people have in their opticians.
The Secretary of State appeared to be aware of that when he announced his intention to introduce legislation to change the law, because he said in November last:There will be checks and conditions on non-optician sellers. Clearly, they should be able to read the 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."—[Official Report, 28 November 1983; Vol 49, c. 438–9.]No provisions of that sort were in the original draft of the Bill and no such provisions by way of amendment were accepted in Committee from the hon. Member for Edgbaston or my hon. Friends. We are now trying by these new clauses to do simply that which the Secretary of State said he would do when he claimed that checks and conditions would be imposed on non-optician sellers. The Bill contains no such checks and conditions.
We are usually told that only people with a vested interest say that skill is needed in dispensing. It is true that most of those who say that skill is needed in dispensing have a vested interest—because they are dispensers—but, in addition to a vested interest, they have more than an ordinary interest in the subject; they made representations because they were aware that changes were afoot.
We end up with two problems for the non-qualified, non-trained, non-examined dispenser. It is possible that such dispensers will not be able to read the prescription and that, even if they can, they will not properly be able to fit the frame and lenses to the face of the person for 404 whom the glasses were dispensed. On Second Reading, the Minister, whom everyone acknowledges to be an intelligent and educated lawyer, did not know the meaning of the simple prescription which I got for my eyes. I do not blame the right hon. and learned Gentleman for not having the faintest idea what it meant. But he expects people who are infinitely less intelligent and well-informed than he to be able to dispense glasses. I have my doubts about lawyers, but it is clear that such rnatters baffle them.
We have been told, and I think that everybody just about accepts, that there is not likely to be damage lo eyesight from wrongly dispensed glasses, although there could be what might be described as aberrations of the eyesight, including squint, to which the hon. Member for Edgbaston referred.
The Royal College of Surgeons asked this question in a 1981 examination paper:Give an account of the optical problems which may arise from badly fitted spectacles.I wrote to the president of the royal college asking what would have been the model answer to that question. He has sent me the model answer but has asked me not to quote it in full lest someone in a future examination, by summarising our debate, answers that question and gets full marks. He writes that the effective power of a lens depends on the distance from the eye and that fitting of glasses determines that distance. He says that if they are wrongly fitted light can be defracted and that there can be a prism effect from the lenses. He says that there can be aberrations of colour and distortions of image.
I have not checked whether the next part means what I think it does, but he says that coma can result from this sort of aberration. If coma means what I think it does, it will have a dramatic effect on someone driving a car or a train; even if it does not have that meaning, distortions of image or aberrations of colour could have a dramatic effect on the safety of the person wearing the glasses and also on the safety of other people with whom he, his vehicle or plant operated by him came into contact. Therefore, all the evidence suggests that the wrong fitting of glasses can hurt a patient and can lessen the usefulness of the glasses he is wearing and make their use unsafe at work, while travelling or at leisure.
If I had to choose between the advice of the president of the Royal College of Surgeons and the advice of the Minister for Health, who is trying to save a few bob, I would put my money on the president of the Royal College of Surgeons. He may have a vested interest in matters to do with surgeons, but he has no vested interest in this because his members do not dispense glasses. We need proper protection from the public.
§ Mr. Dobson
Sorry; we need proper protection for the public. I suspect that the Minister will require protection from the public if the measure goes through, and I shall not be there to provide that protection. We certainly need protection for the public. We need a form of protection that cannot be provided simply by the interplay of market forces and free competition. We all recognise that there are spheres where that is not the way to provide protection and most people would accept that this is one of them
If spectacles are to be dispensed and supplied by people who are not willing to subject themselves to the rigours of joining a profession, doing the training, taking 405 examinations and then adhering to the disciplinary code, it must be accepted that there will be ignorant and unscrupulous dispensers. If there are such people, we must take steps to prevent them from doing a great deal of damage.
In new clause 19, where we seek limited objectives, we accept the basic proposition of the Government that there should be a freer market in glasses. We say that we should require two simple conditions — that spectacles are dispensed only by persons capable of interpreting a prescription and that they should be fitted or that the fitting should be checked by someone who can ensure that maximum optical benefit is obtained. Those are limited and unobjectionable objectives. If Conservative Members do not accept them, they are saying that they believe that glasses may be dispensed by people who are incapable of interpreting a prescription and who are incapable of fitting glasses to the maximum benefit of the person who wants them.
Those are limited objectives, which are shared by the hon. Member for Edgbaston in her new clause, which has been presented in a different way. Whatever the ideological split between us on the rest of the Bill, I urge Conservative Members that on this new clause to do with eye care, the safety of people who get glasses and the safety of those with whom they come into contact, they should support the hon. Member for Edgbaston. These are minimal requirements which the House should support if it is being responsible.
§ Mr. Christopher Hawkins (High Peak)
I support new clause 3. My right hon. and learned Friend has made much play in recent months of the analogy with doctors. He has said that doctors face competition from herbalists, osteopaths and others and has asked why dispensing opticians should not face competition. The analogy is not fair. Herbalists and osteopaths are not allowed to carry out all the functions of a doctor. They cannot prescribe drugs under the National Health Service or send patients to NHS hospitals at state expense. The analogy is extremely poor.
Doctors do not dispense. A doctor's role is to diagnose and prescribe. If the doctor analogy is to hold at all it should be used for the prescribing optician, not the dispensing optician. If my right hon. and learned Friend believes in free competition between doctors and herbalists and osteopaths, then perhaps he should introduce a Bill to allow herbalists to prescribe drugs on the NHS and to send their patients to NHS hospitals at the nation's expense. Equally if we believe in free competition, why do we not allow anyone to prescribe glasses, not just dispense them?
The fair analogy for a dispensing optician is a dispensing chemist. Are we to allow Tesco's and others to dispense NHS drugs using unqualified staff? That would be a fair analogy. Is that to be our next move? If not, why is the logic so different?
I shall not repeat the speech I made on Second Reading when I spoke and voted against the provisions on opticians. I have no link with the optical industry other than that I am a wearer of glasses, but I should like to quote from the British Medical Association ophthalmic group committee which says:While specific harm to the eyes is unlikely to arise from the use or non-use of spectacles, there is firm medical agreement that the correct and appropriate dispensing of spectacles has very 406 significant health implications. The Committee cannot accept that after the prescription has been issued optical appliances take on the status of mere consumer durables and feels strongly that when highly skilled and expensive medical or surgical treatment has been provided under the NHS the final rounding off of such treatment with spectacles or an optical appliance must also be provided by skilled and qualified personnel".That is a view with which I wholly agree. It is a harmful and retrograde step to allow unqualified people to dispense glasses. We are dismantling here an important part of the National Health Service and we are leaving the consumers unprotected in regard to goods that they buy rarely and of whose technical attributes they know little. This is being done wrongly and in a way that is thinly disguised as a move to increase competition. I shall support the new clause.
§ Mr. Kennedy
On behalf of the SDP and the Liberal party, I should like to support the new clause. I hope that the Minister will take note of the contributions so far in this part of the debate. There has been practical and non-ideological support for the clause from all sides of the House. The point has already been made, but I reiterate it, that it not enough to wave away criticism as being purely the product of vested interests. I have received a lengthy letter, which I shall not quote extensively, from a group of consultant ophthalmologists in my constituency. The important point they made is that they have no financial interest in dispensing glasses and that they receive no fee for spectacle prescriptions issued from NHS clinics.
The consultants say:We are, nevertheless, gravely concerned about the implications of this legislation, particularly in relation to the wellbeing and satisfaction of our patients.The consultants say that the public are being "misled". They say:The patients we meet daily think that having got their prescription from an ophthalmic medical practitioner or ophthalmic optician, they will be able to proceed to the nearest outlet supplying frames for glasses (hopefully at cheaper prices) and then bring the frames back to the optician for fitting. The Government's proposal is that the patient takes the prescription to the outlet (department store or whatever) for supply of the frames and the lenses according to the prescription.In our view this is a recipe for chaos. Glasses are not supplied like windows. Dispensing is a skilled profession requiring three years' formal training with examinations and a subsequent probationary period.We heard earlier from the hon. Member for Holborn and St. Pancras (Mr. Dobson) what those involved in that training think of the provision. The consultants enclosed a typical prescription for a pair of bifocals. As the hon. Member for Birmingham, Edgbaston (Mrs. Knight) said, that would not be the most complicated prescription available.
They say of bifocals:The number of variables is complex, lens power being expressed to two decimal places. We suggest that the unskilled shop assistant employed in a 'non-professional dispensing outlet' would have no idea of the handling of this.That is clear, and anyone in the House the last time that we debated the subject would have shared my astonishment at the Minister's defence then. He said that when one goes into a shop and buys an item one can hold it up to the light to see whether it is suitable. When talking about two decimal places, one cannot expect a consumer to identify what is right and what is wrong. The 407 professionally tested and qualified person who is open to professional criticism and scrutiny, not the lay man, should be left to do that.
§ Mr. Christopher Hawkins
It is a myth that the consumer can tell whether glasses are suitable. I have had many new prescriptions and I know that, even if glasses are correctly made, they feel strange because they are different. The unskilled person cannot tell the difference between the strange glasses that are correct and the strange glasses that are incorrect. The good, qualified optician has a machine that enables him to check whether the lenses have been made to prescription. I see no provision in the Bill to ensure that lenses are made to prescription.
§ Mr. Kennedy
I agree 100 per cent. with the sentiment and substance of that intervention.
Another worrying aspect is that the Bill does not seem to contain a safeguard against negligence or damage to an individual. The individual may not be aware that damage is done to the eyesight by a wrong prescription or a prescription not being met, but such a person could do damage to someone else. There is no statutory redress if such damage occurs. The Minister should accept our criticism.
I hope that the arguments will not be dismissed on the ground that they come from vested interests. The arguments are more than that. I usually welcome the breaking of monopolies in the consumer's interest. In this case the consumer's interest is not straightforward. Even if we accept that the Bill's provisions are financially advantageous to the consumer, consumer interests go further than that.
However much this Government want to retreat from exercising more control over individuals, Government's rightful role is to take control when individuals can do harm to each other. Harm can be caused by insufficient safeguards, testing and scrutiny.
I hope that the Minister will take note of the criticisms, the objections and the spirit of the amendment. We are being constructive. I am sure that he can be magnanimous, and accept the new clause in that spirit.
§ Mr. James Couchman (Gillingham)
Both the new clauses attempt to rewrite the present register. That is wholly against the spirit of the Bill. I believe that very few people without qualifications will enter the market to sell glasses.
My hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) used the somewhat pejorative word "tradesmen", which I found offensive. I think that the people who come into the market will be technicians from prescription houses who have made up glasses for a long time to the prescriptions of ophthalmic opticians.
An interesting analogy can be made with conveyancing. I was talking the other day to the managing clerk of a solicitor's firm in Medway. He said that he carried out almost all the conveyancing which came to the office for the partners. I asked him whether his work was checked by the partners. He said "No. I know more about this than the partners, because I concentrate almost exclusively on conveyancing." It will be interesting to watch what happens next year when the Government propose changes in the solicitors' monopoly.
§ Mrs. Jill Knight
I congratulate my hon. Friend the Member for Gillingham (Mr. Couchman) on not having to 408 wear glasses. If he had to wear them he would appreciate the yawning gap between making up a prescription and fitting a pair of glasses to a person's face. If he had to wear glasses, he would appreciate the importance of having them fitted correctly. One cannot say that there is no difference between conveyancing and fitting glasses to a specific requirement.
§ Mr. Couchman
In my youth I wore glasses for about 12 years. I still have glasses, but I seldom wear them because they do not help my eyesight much.
We are talking about consumer protection. The analogy with the solicitors' monopoly and conveyancing is not out of place in that context. Wrong conveyancing can lead to as many disasters as the wrong prescription of glasses.
Selling glasses will not be a licence to print money. Those who enter the business will sell at the end of the market that is based on comparatively simple prescriptions. They will sell reading glasses, for example. Those people who need complex or complicated spectacles will continue to go to dispensing or ophthalmic opticians from whom they receive their prescriptions and whom we have already taken steps to protect.
I make no bones about the fact that I had some qualms about the Bill when it was presented, and yet more qualms when I discovered that I was a member of the Standing Committee on the Bill. However, I have, with great interest, taken the advice of an ophthalmic optician who has a more progressive view of the legislation. My hon. Friend the Member for Halifax (Mr. Galley) quoted the 30 per cent. saving which this gentleman anticipates his business will make when the Bill becomes law. I asked the optician what training he would give his staff and he sent me a training schedule. I shall read from it briefly because it demonstrates that his operation, which will use unqualified staff, will be a responsible business. He anticipates a multiple retailing operation with unqualified staff, but he will certainly train them. He proposes that they shall be trained accurately todispense spectacle prescriptions from both internal and external sources. In addition, staff should be capable of reading the prescriptions in the various forms in which they may be presented, and also to ascertain a prescription from a patient's existing glasses where appropriate. Whilst there is an obvious need to keep the technical knowledge of lenses and frames to a simple level, certain safeguards should be built into the training in order to protect the public. The approach is directed towards simple and practical procedures which develop naturally from one step to the next. It is intended that the background with the frame selection, subsequent operations, verification, dispensing of the finished prescription and any ensuing readjustments or repair are presented.It is felt that unqualified staff can be taught the rudiments of dispensing the majority of prescriptions by covering the following aspects of technical training. Frame types and parts; frame measurements and markings; frame selection; optical centre placement; multifocal height and lens blank size determination; ordering and verification; alignment and adjustment; minor frame repairs; lens types and selection.The optician continues:It is envisaged that this schedule can be carried out with intensive in-house training initially covering a period of one week. This may appear to be relatively short when compared with the time-scale necessary for the present training of opticians —but it should be borne in mind that these people will not be opticians, nor are they intended to replace opticians, but merely to supplement them, particularly in areas that relate to the commercial aspects of optical retailing.The employment of non-qualified people or rather people who are not so highly qualified will be an important factor in reducing the cost of glasses to the public. It is felt to be desirable that unqualified staff should be taught the limitation of their training 409 and therefore be able to call upon the support of qualified staff wherever the need arises, particularly in areas relating to difficult or complicated prescriptions which represent a comparatively small proportion of the total.That gentleman's operation will consist of several small stores within stores. He will have unqualified staff who will have available to them himself as a qualified ophthalmic optician and supporting qualified dispensing opticians.
§ Mr. Christopher Hawkins
We have just heard what sounds like a sensible training programme, and my hon. Friend says that qualified dispensing opticians will also be available. If that is such a commendable set-up, would it not be nice if the Bill insisted that everyone else had such a set-up?
§ Mr. Couchman
I take my hon. Friend's point. Responsible people will take advantage of the benefits of the Bill to set up operations such as I have described. Very few irresponsible and unqualified sellers of spectacles will come into the market.
§ Mr. Meadowcroft
The hon. Member for Gillingham (Mr. Couchman) seemed to argue that the Bill was fine because few people would use it. It is bizarre to suggest that we need a Bill simply to ensure that few people will wish to enter the market. If that is the case, it is absurd to suggest that we should not register the few who wish to enter the market. Those few people might be precisely those who need to be registered because they might be the cowboys who want to make a profit out of this operation but who do not have the required expertise.
The hon. Gentleman drew an analogy between this operation and the managing clerk who does conveyancing for a firm of solicitors. However, his point falls on the question of responsibility. The clerk might do all the conveyancing work, and the qualified solicitor might not oversee the work because he trusts and has a high regard for his clerk, but at the end of the day the registered solicitor, not the managing clerk, will be responsible for mistakes. The only way to ensure that the technician who does the work is responsible for it is to register him.
The hon. Member for High Peak (Mr. Hawkins) said that the Minister was keen to draw an analogy with practitioners of medicine outside the NHS. That does not compare like with like. Those who offer medical services outside the NHS are not trying to provide services comparable with those provided by the NHS practitioner. It is not a matter of saying, "I have diabetes, so will you examine me and offer me the same prescription at the end of the day?" People visit alternative medicine practitioners because they want a service different from what they are offered in the NHS. I do not object to their having that freedom. They will not visit a chiropractor because they need brain surgery, nor will they visit an acupuncturist to obtain a prescription for a drug to cure an illness. They are seeking different treatment. The Minister appears to be saying that, although a prescription may come from a registered ophthalmic optician, it can be made up by almost anyone.
We have already accepted, in a previous amendment, that the word "optician" must be protected. The registration must be set out in a form which guarantees that 410 people understand that there is some training or qualification behind it. However, that undermines the main thrust of the Bill. We are saying, "Here you have a guarantee of service and quality, but if you want to have something cheaper you can go to someone who is called an optical practitioner or anything else." But what is the patient getting at the cheaper price by not going to someone who calls himself an optician? Will the product be cheaper because of its component parts? Will a lower quality plastic be used? Opticians will clearly be forced, because of the increased competition, to use cheaper materials. The product will become cheaper because the person making it up becomes cheaper. The result will be shoddy products, because those who make up spectacles will not put in enough time to guarantee the quality of the product, and they will have no responsibility for it.
§ Mr. Christopher Hawkins
It is also possible that they will get a lower quality product. Brazilian lenses can be bought at about 30 per cent. of the price of British lenses, because they are not made to British standards, are not optically pure and do not have scratch-resistant qualities and other features. I understood that the Bill would require that lenses should be manufactured to British standard, but I have found no reference to that.
§ Mr. Meadowcroft
I am grateful for that extra evidence. The spectacles will be made differently and quicker and the untrained dispenser's labour will be cheaper. Complicated work will be done more quickly than is safe. There will be no protection against negligence because there will be no way to take action. As far as one can see, such people will not be registered. Having protected the definition of "optician" that omission would undermine the purpose of the Bill. The least one can do is have a register for the dispenser.
§ Mr. Roger Gale (Thanet, North)
I welcome the opportunity to support my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) in the principle that lies behind new clause 3. I wish to declare that I have no commercial interest in the subject but I am anxious about it. The anxiety was borne in on me by representations made by a number of opticians in my constituency. As a result of listening to what they said, I took the trouble to investigate a subject about which, until then and until the Bill was introduced, I knew nothing.
I do not, as yet, wear spectacles, although that may change. I took the trouble to visit a prescription house to see spectacles being made. I took the trouble to find out what went into an optical prescription from an ophthalmic optician. I discovered what he does. Until the Bill was introduced I, like most hon. Members probably, had no idea.
I asked my right hon. and learned Friend the Minister in a written question whether he would state exactly what went into a prescription from an ophthalmic optician. He told me that the information varied according to the patients' requirements, but that the headings on the form related to the spherical or cylindrical power of the lens, the access direction, the prismatic power and direction, and that details were recorded separately for right and left eyes, and for distance and near sight.
My right hon. and learned Friend also told me that there was also a form for the practitioner to record any other details, such as bifocals or tints, that might be necessary in an individual case.
411 That is all the information that is currently available on an optical prescription. That is important in this debate because the Minister and the Bill have laid great store by the fact that no spectacles will be available other than against a recent prescription. The information contained in the prescription is insufficient to provide a person with a pair of spectacles. The Minister is aware of that. I have no temerity in saying that in this instance, although I support the rest of the Bill, I believe him to be profoundly and utterly wrong.
With this clause, or something like it, we are seeking to maintain standards and the protection of the patient. Let me reiterate once again what a dispensing optician does to see whether I can get the message home tonight. He is the person who takes into account the nature of the frame that the patient wishes to buy. That frame may place the lens further from or closer to the eye, and the dispensing optician must make allowances for that. If he does not, the prescribing optician's information is of no value.
§ Mr. Kenneth Clarke
My hon. Friend is expanding eloquently a point that has been touched upon before—that it requires training to use a prescription to fit spectacles. As my hon. Friend the Member for Gillingham (Mr. Couchman) said, there are thousands of jobs for which one requires training. No one employs people straight off the streets to do stacks of jobs. It is possible to train people to do a part of a job in a factory. If my hon. Friend the Member for Thanet, North (Mr. Gale) watched someone operating a horizontal milling machine, working to an engineer's drawings, he would no doubt find the description of what was going on as bewildering as we find the description of a prescription, and he would no doubt accept that someone doing that work needed training. We do not have all the paraphernalia of registering and making it illegal for anyone else to do the job. Those have been the arguments of the monopolists over the ages—that legal monopoly is required to protect the consumer. To reiterate that it requires skill and training does not support the case.
§ Mr. Gale
I am grateful to my right hon. and learned Friend. He has succinctly made the case for the clause that is before him. I am not seeking, and I do not believe that my hon. Friend the Member for Gillingham is seeking, to introduce a requirement for lengthy training. I do not recall having mentioned the length of the training. What I have said, and am about to stress, is what my right hon. and learned Friend has just said—that the person doing the job needs to be trained. It is immaterial to me—as I have said, I have no vested interest in the profession—whether training takes one day, one week or one year. What matters is that the person is qualified to do the job.
My right hon. and learned Friend might like to see, here or in another place, some other provision introduced which states categorically that the person who does the job of dispensing, as well as prescribing, should be trained. That is all that most hon. Members in the Chamber tonight are seeking. The one assurance that we want is to know that the standard of supply to the patient will be maintained. I could say to my right hon. and learned Friend, "Please go and buy me a pair of blue trousers." He could not do that without knowing my waist size, my inside and outside leg measurements and various other things that are peculiar to me. Some would argue that they are very peculiar to me. To provide me with a pair of spectacles he 412 needs to know that my right ear is higher or lower than my left, and the side length. Unless he has that information, which will not appear on a prescription, as laid down in the Bill as it stands, he will not be able to provide the spectacles.
If the Bill is to work and serve the patient well, and I believe it can and will, amendments need to be made. First, the information contained in the prescription needs to be detailed more clearly to add the information that anyone would require to make up a pair of spectacles properly. Secondly, the person reading that prescription, be it a technician from a prescription house who, as my hon. Friend the Member for Gillingham said, could and should do the job, must be properly trained.
I have no particular interest in whether this new clause is accepted as long as my right hon. and learned Friend takes on board the point that is being made by virtually every hon. Member, and these amendments are introduced in some form, place and time, before the Bill reaches the statute book.
§ Mr. Richard Alexander (Newark)
I have a great deal of sympathy with the principle behind the new clause, and I shall be listening most carefully to what my right hon.. and learned Friend says against it. In their heady rush to undermine the professions generally, the Government should sometimes pause and consider what they might be doing. It is fashionable in some quarters to say that anyone can do the work of a solicitor, a brain surgeon or a dispensing optician because it might be cheaper for the public, but there is far more in it than that.
The new clause appears to provide an additional safeguard for the public against this headlong rush for equality and cheapness. When people entrust their bodies to others, they are entitled to demand and expect a level of competence. It is no good saying, "If it does not come out right you can sue." This is not the 19th century; it is the era of the caring, skilled professional practitioner. Those who are caring and skilled will be tempted to reduce their standards if they are left to compete in the market place in order to survive. Many opticians have told me and other hon. Members on both sides of the House that their very survival may be at stake if the Bill goes through unamended.
It is important, for example, that all spectacles should at least conform to the British standards applied by ophthalmic or dispensing opticians. Hon. Members have already raised that matter in the debate. I look forward to hearing what my right hon. and learned Friend has to say about it.
It is important that the public should have more protection against spectacle sellers who sell substandard spectacles to those whose eyesight demands special lenses. The way in which these are dispensed is critical and the proper knowledge and training can be given at present only by registered opticians. The new clause would go some way to protecting the public in that regard.
The Federation of Optical Corporate Bodies is an august organisation of which I had not heard until recently. It has pointed out that few members of the public know what the Bill is about and what the clause may do. When the public find out that if they go to a glasses shop—may I call it that?—they will be given a standard of care and treatment that is no higher than they would 413 receive if they bought a dozen eggs in the market place, they will be entitled to object to the legislation that Parliament passed.
For those reasons, I look forward to hearing what my right hon. and learned Friend will have to say when he argues that the new clause should not be passed.
§ Mr. Tim Smith (Beaconsfield)
I hope that you will forgive me, Mr. Deputy Speaker, for saying that I am sorry that amendment No. 1 has not been selected. The amendment would have deleted clause 1(1) from the Bill. I believe that the matter should be resolved in that way. I believe that it was considered in Committee.
The concern that underlies my amendment and new clause 3 is that the Government's proposal will provide inadequate consumer protection. I support the Government's objective of providing more competition and choice for the consumer. They propose to achieve their objective in three ways: first, by introducing advertising; secondly, by the abolition of NHS spectacles; and, thirdly, by abolishing qualifications for dispensing opticians.
I believe that the Government could achieve their objective by introducing the first two measures and leaving the third out of account. It is a matter of judgment in the end but, given the deep concern expressed throughout the Committee, would not the Government be better advised to take only the first two steps, at least to start with, and to see what effect they have on the spectacle market? If necessary, the Government have that option open to them.
I was rather amused when my hon. Friend the Member for Gillingham (Mr. Couchman) used the example of conveyancing to support his argument, as I believe that that supports the argument for new clause 3. In the case of conveyancing, the Government are not proposing that anybody should be able to act as a conveyancer, nor did the hon. Member for Great Grimsby (Mr. Mitchell) do that when he attacked the solicitors' closed shop. The Bill to be introduced next Session will propose that there should be people called licensed conveyancers, in the same way that the new clause proposes to allow licensed dispensers.
In another area of consumer protection, it is notable that the Government are moving in the opposite direction. The insolvency White Paper that was published a few weeks ago proposes to end the position whereby anybody can act as a receiver or liquidator of an insolvent company. Instead, only accountants, solicitors and those qualified by experience will be allowed to act as insolvency practitioners.
The president of the Association of Dispensing Opticians, Mr. John Baker, who is a constituent of mine, has explained to me and to my hon. Friend the Member for Thanet, North (Mr. Gale)—I was as ignorant of these matters as my hon. Friend until a few weeks ago — that the dispensing of optical appliances is not a matter of carrying out a simple set of instructions. Professional judgment is involved. If that is not exercised competently, damage can result.
For those reasons, I feel that the Government have got this wrong and should think again.
§ Mr. Alistair Burt (Bury, North)
Some months ago, I spoke in the Second Reading debate and expressed the concern of constituents who had come to see me. At that time, I was able to support the Government, based on their 414 assurance that there would be further consideration of the matter. However, I shall not be able to support the Government tonight.
It is a sad day when the hon. Member for Holborn and St. Pancras (Mr. Dobson) should have to lecture the Government on the importance and origins of professions and the need for professional conduct, as he did at the beginning of his first speech on this clause.
The main concerns that are still brought to me by constituents, including ophthalmologists, who are not involved materially in the matter, are that the Government seem content to allow a very high standard of eye care to drop. We all accept that there is no clinical danger to eyesight from the wearing of ill-fitting and incorrect spectacles, but that does not answer the charge that the Government are taking the risk of allowing more people to suffer discomfort from their glasses, which they do not suffer now. The Government continue to say that that is unlikely to happen, as market forces will regulate the good and bad shops.
I feel that such regulation is unlikely to occur. Solicitors who have tried to get redress for clients who are pursuing claims for small sums of money would not always accept the adequacy of consumer legislation. At present, if a patient has a problem with his glasses, he can take the matter before the family practitioner committee. The Bill suggests that he will now only be able to sue the shopkeeper if his glasses are poor and substandard. The question is, of course, how many people will sue for £30 or £40? If they approached their solicitor, he would say that it was not worth it.
§ Mr. Kenneth Clarke
I hope that my hon. Friend does not believe that the family practitioner committee would give back the money. It will consider a complaint that the practitioner is in breach of his contract. It will impose a penalty on the optician if he is in breach of his terms and conditions. There is no consumer redress through the route that my hon. Friend suggests. In future, redress will be identical to the existing provisions.
§ Mr. Burt
My right hon. and learned Friend has made a good point. He is suggesting that at present a sanction can be applied against an optician who fails in his duty. But nowhere in the Bill is it suggested that a proper sanction such as disqualification from practice will be available against a seller of glasses. The present sanction allowed by the family practitioner committee will be removed.
§ Mrs. Jill Knight
Has my right hon. and learned Friend considered the difficult position faced by an ophthalmic optician or ophthalmic medical practitioner who tests eyes and gives the correct prescription? If that prescription is not made out properly and the person who made it up is not on any lists, or licensed, he will not be brought to answer for his incompetence. The doctor or optician who tested the patient's eyes is likely to be called to task.
§ Mrs. Knight
My right hon. and learned Friend says that my suggestion is nonsense, but who will be called to account?
§ Mr. Burt
I think that my right hon. and learned Friend the Minister will answer my hon. Friend's point later.
415 At the moment, when an individual is provided with glasses, he may be concerned about the price that he has to pay but, by and large, he is not concerned about the quality of glass or the fact that they might not fit properly, and he might not have a chance to do anything about it. That is the last thing on his mind. In future, he may have to consider that. The problem is that what the Government are seeking to do in reducing the cost of glasses has nothing to do with any change in the quality of care that people can expect. The two things are entirely separate. As my hon Friend the Member for Beaconsfield (Mr. Smith) said, the Government could have achieved their objects without troubling the public about the quality of eye care.
A phrase with which we are all familiar is, "Why spoil the ship for a hap'orth of tar?" For a small consideration, the Government could suggest regular spot checks on those who dispense glasses. Those who dispense glasses poorly could be struck off the list and not allowed to practise. In that way the Government could convince the public that they were concerned about the quality of eye care offered to the public.
I fear that the Bill as it stands does not provide that necessary cover to the public. The shame is that many of us on the Conservative Benches defend the Government's record on the Health Service continually. We are not taken in by Opposition Members' comments about how badly we are doing. We know that the Government provide a good Health Service and are working hard. Our task is made immeasurably more difficult when a measure such as this is introduced, where the adequacy of care and concern is not truly shown. For a small consideration, the Government could say that not only are they making people's glasses cheaper but they are ensuring that the current high standards of eye care will not be affected. Nothing but the introduction of the new clause moved by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) will clear us on that point. Accordingly, I support her new clause.
§ Mr. Dafydd Wigley (Caernarfon)
What has come out of the debate is the lack of support for the Government from all parts of the House. Not only tonight, but previously, the case has not been made for the change. This is a retrograde step. We are turning the clock back unnecessarily. The Government give only two justifications. One is that there may be a benefit in cost terms, but it appears that that benefit could be achieved equally by the liberalisation of advertising for opticians, which opticians welcome and are prepared to live with. By the Government's own philosophy, that would bring a better deal for the consumer, without the dangers of unqualified people dealing with spectacles.
The other point concerns what the consumers want. Has the Bill come forward because of pressure from consumers? Over the past few years, has the Minister received hundreds of letters from consumers saying that they want the change and that they are eager and anxious to secure it when there is such a travesty in existing arrangements? The survey undertaken by the Federation of Optical Corporate Bodies showed that 92 per cent. of the public want things to continue as they are. Therefore, the proposals are for the benefit of a mere 8 per cent. Far be it from me not to concede the interest of minorities—the Government should bend 416 over backwards for minorities—but if 92 per cent. of the population are happy with things as they are, why are the Government acting in this way?
§ Mr. Kenneth Clarke
The hon. Gentleman said that so far not many hon. Members in the Chamber have supported me. May I ask him if the question asked in the survey was whether people were satisfied with the present price of spectacles and the present state of competition? I should be surprised if only 8 per cent. thought that it was unsatisfactory. I am also surprised that the hon. Gentleman has never encountered anybody who has doubts about whether the present restrictive rules do not have an effect on high prices.
§ Mr. Wigley
The question was the fundamental and basic one, addressed by many hon. Members—whether people want their eyes to be tested and spectacles provided by qualified people. If people say yes, they are accepting the implications of cost, convenience and so on. If 8 per cent. of the public is the sum total of support that the Government have for the Bill, they should consider once again whether they are doing something that is in the general interest.
§ Mr. Christopher Hawkins
It may be of interest that, while hon. Members keep talking about whether the public want the price to come down and whether opticians' profits are high, the Office of Fair Trading report, on which the Government leaned heavily in their case for introducing the Bill, states that there is no evidence that opticians' profits are excessive.
§ Mr. Wigley
I accept that. However, I also accept that there are provisions for extending advertising that can have the same effect. If there is marginal room to move, such advertising is the correct mechanism to allow a price movement to take place. The case that there is demand for the change has not been made. If there is a possibility of slightly cheaper provision, it can be met by other methods. Therefore, I ask the Minister and the Government to think again about why they need to impose this change on the country when there is no case for it.
§ Mr. John Butterfill (Bournemouth, West)
As my right hon. and learned Friend the Minister will be aware from the lengthy correspondence and discussions that I have had with him on this subject, I heartily support the Government's objectives in the Bill. It is entirely desirable that we should increase competition and restrict monopolies wherever possible. However, I do not agree that glasses should be dispensed to the general public with no protection, which is what is proposed in the Bill.
I would go a little further with the Government, as my right hon. and learned Friend knows. The dispensing of many simple reading glasses does not need the same care as more complicated prescriptions. I have suggested to my right hon. and learned Friend that simple reading glasses could be open to full competition—for example, glasses of a power of less than 1 or 2 dioptres. However, with more complicated prescriptions, where the fitting is more critical, it is essential to have the centring of the lens at the correct position on the eye; and where the distance from the eye is critical, it should be left in the hands of properly qualified people. That remains my view.
§ Mr. Kenneth Clarke
In this lively, short debate the one thing that has united us all is concern for the consumer 417 and the interests of the patient. That is the only motive that lies behind the Government's introduction of this part of their proposals. In the previous debate, we talked about the general optical service, and the hon. Member for Holborn and St. Pancras (Mr. Dobson) suggested with vigour that the measure was intended to save money and undermine the National Health Service. That is not the case. The only motive for ending the present monopoly on dispensing is that the Government believe that it is in the interests of the general public, as consumers and patients of opticians.
We were supported in that by the Office of Fair Trading report, which is charged by the House with responsibilities for consumer protection—fair trading. It analysed the problem at great length. Some of its conclusions are set out in paragraphs 9.71, 9.72 and 9.73. It stated that benefits would come to the public by admitting unregistered sellers to the market, that any dangers of accident were exaggerated, and that certainly the dangers of undetected disease and so on would be adequately guarded against by making it necessary for the sale and dispensing to take place against a recent prescription. That is precisely the balance that the Government have chosen. We believe that the Bill is a valuable piece of consumer protection which will improve the service to the public by weakening, to a marginal extent, a professional monopoly.
§ Mr. Clarke
I will give way shortly. The Government's case does not involve any rejection of the importance of professional standards in a large number of occupations or of giving legal protection to those professional standards wherever there is a case for doing so. Nothing like that is inherent in any of the Government's undertakings.
It is important to remember, in dealing with all the professions — including my own supposedly learned profession—that the purpose of professional rules and the laws which back them up is to protect the public against charlatans and abuse and to ensure that essential things are done to a certain standard. However, there is always a danger that those professional rules and laws may become a protection for the profession. No profession does not welcome a little trade protection against outside pressures—as opposed to consumer protection.
When considering any professional rules, one must make a judgment. We agree with the Office of Fair Trading that the amendment made to the Opticians Act somewhat casually a few years ago, giving a complete legal monopoly to opticians for the dispensing of glasses, was an error. It was against the public interest and is now having adverse effects.
In the case of sight testing and prescribing, we are preserving the position. That can be done only by a qualified man—a doctor or an ophthalmic optician. But we must apply the test objectively to the next step, which is the dispensing and sale of the frames and lenses and the frames without lenses. In our view, the present rigorous protection afforded by the law does not exist for the protection of the consumer.
Down the ages, there has never been a monopolist who has not defended his position by giving a moving account of the damage that will be done to the general public if competitors are allowed in to his legally guarded patch of 418 the market. Nowadays even the Liberal party seems to accept this stuff from any lobby that comes through the door. Indeed, it sounds as though it will be defending the solicitors next year.
§ Mr. Dobson
Will the hon. and learned Gentleman confirm that the Office of Fair Trading, which advocated getting rid of the requirement for a prescription, is contemplating suggesting a process of registration for jerry builders and second-hand car salesmen?
§ Mr. Clarke
First, the hon. Gentleman's comment is inaccurate. He should re-read paragraphs 9.71, 9.72 and 9.73 of the report. He will find that it is advocated that spectacles should be sold only against a prescription issued in, say, the previous two or three years. The OFT came to the same conclusion as the Government. It felt that, unless a recent prescription was required, there would be a danger that glaucoma or disease would go undetected because people were not having eye tests from qualified people. We have accepted the existence of that risk, and the Bill gives protection against it.
§ Mr. Gale
If we accept the OFT statement and the Minister's argument, will the Minister at least concede that, at present, a prescription does not contain the information necessary for the supply of a pair of spectacles? Will he therefore undertake that the prescription required under the Bill will have to include all the relevant details?
§ Mr. Clarke
I accept that, for dispensing, a prescription is not enough in itself. The dispenser needs to understand the prescription, and to know how to fit the lens in the right position and centre it on the eye at the right distance and the right angle.
§ Mr. Clarke
Several hon. Members have made it clear this evening that they have been impressed by the argument of those who have lobbied them that the Government are disparaging the skills of opticians. That is no part of the Government's case. Several hon. Members have accused us of disregard or disrespect for the skills of dispensing opticians. They are wrong.
I could not dispense a pair of glasses. Someone who walks in off the street cannot dispense a pair of glasses. It is also true that I cannot repair the carburettor of my car or many of the electrical appliances that I have at home, and that I cannot do much about my plumbing. Many people make a living from exercising skills and semi-skills for the general public, who do not possess those skills. Dispensing requires a quite high level of skill, and anyone who uses unregistered people will have to begin by training them. When carried away, most of the lobbyists and some of my hon. Friends talk as though people will be selling glasses on garage forecourts and men who yesterday were selling ice cream will be gazing at prescriptions and giving out glasses today. That is nonsense, because no one could make a living in that way for more than a couple of days.
The last deregulating Bill that I took through the House was concerned with bus licensing. I was told that dangerous vehicles would be racing from bus stop to bus stop, driving the National Bus Company, with its overriding concern for the public interest, out of business.
419 My hon. Friend the Member for Gillingham (Mr. Couchman) has suffered from the same misfortune as myself. He reflects the general public interest in and approval of the Bill, and he faces those of my hon. Friends who have been persuaded by the opticians' case. Those who wish to make a living in the optical business will be the ones who will invest and who will give the wider choice and bring prices down. I hope that they will include some reputable chain stores. They will begin by training people. They will not put someone to work who was operating a lift the day before.
§ Mr. Clarke
We have not got that far. We shall not be facing cowboys and ignorant dispensers, as the hon. Member for Holborn and St. Pancras feared, but some of the staff may be unregistered.
Some of my hon. Friends are great advocates of the free market in other areas, as the Liberal party used to be. But if my hon. Friend the Member for Gillingham goes into business, the Liberal party and even some of those on the free market wing of my own party insist that all his staff must be registered. They must all be licensed by the Minister. The amendments are remarkably vague about the checks to be required, but the general idea seems to be that someone at the Elephant and Castle must draw up a licence and that we must go around doing spot checks. That is totally unnecessary. Must we register fitters?
Driving instructors, who were given an incredible degree of protection by the House in a similar fit of enthusiasm in the past, have told me that it is quite wrong for people to be taught to drive by friends or relatives, that there should be a minimum number of lessons, and so on. No doubt a good federation of window cleaners would demand a licensing system, a six-month training course on the various qualities of window, and so on. What will determine things in the end is protection for the consumer in terms of service and satisfaction. Reputable people will train their staff and provide consumer satisfaction. Anyone who fails to do so will suffer the penalty of going out of business.
§ Mr. Hawkins
My right hon. and learned Friend should do us the credit of advancing a better argument than that. It is cheap debating, albeit well done. On that argument, we may as well allow anyone to be a doctor, a nurse, a surgeon or a barrister. We might as well abolish all professional training and all consumer protection. Will my right hon. and learned Friend answer one specific question? In what infinitesimal way would he be deprived of the objectives that he has set for himself if he said that there must be British standard lenses? He could still have competition.
§ Mr. Clarke
We tend to restrict surgeons and pharmacists because would-be practitioners in those professions are in a position to kill people, but we do not extend the restrictions to treatment in general. The only treatment restricted by law is that which requires surgery under an anaesthetic. As my hon. Friend the Member for Bromsgrove (Mr. Miller) has said, if one wishes to obtain treatment for one's back one can go to a chiropractor, an osteopath, a herbalist or a faith healer. No doubt most hon. Members who have spoken in this debate would say that 420 that should be made illegal, and they would find support among members of the BMA for restricting such treatment to qualified doctors.
§ Mr. Clarke
No, but they can give treatment. They can manipulate people's spines. Personally, I should oppose any suggestion that back treatment should be restricted to registered medical practitioners. Despite all the arguments about damage being done to people's spines by practitioners without medical training, in a free society I believe in the benefit that comes from allowing intelligent adults to choose for themselves the qualifications and skill that they demand.
§ Mr. Meadowcroft
The Minister is being unnaturally grumpy today, faced with attacks from all parts of the House. For better or worse, the monopoly has been destroyed, so it is a smokescreen to suggest that registration is an attempt to preserve the monopoly. It is an attempt to write into the Bill the safeguard contained in the standard letter sent out by the Minister, which states:The aim of our policy is to give spectacle wearers the benefit of wider choice and lower prices that fair competition can bring. At the same time, we have included safeguards to protect professional standards".
§ Mr. Clarke
Dispensing comes under the conditions. In referring to those conditions, my hon. Friend the Member for High Peak (Mr. Hawkins) has misunderstood the Bill. For the first time, there are to be British standards and legal protection for the products.
Hon. Members have waxed eloquent about present protections, but I do not know how many of them have had letters from people who have tried to complain to a family practitioner committee about the quality of an optician's dispensing service. The hon. Member for Holborn and St. Pancras does not usually leap to the defence of family practitioner committees in their handling of complaints, although they no doubt usually deal with them in a fair, reasonable and objective way. The family practitioner committees will not, however, give the patient his money back, as my hon. Friend the Member for Bury, North (Mr. Burt) suggested. They will simply impose a penalty on the practitioner if, and only if, there is a breach of the terms of service. If the complainant is not satisfied, there is an appeal to the Secretary of State. I believe that four such appeals were dealt with by the Department last year. Alternatively, the complainant can go to the General Optical Council with an allegation of unprofessional conduct. Nevertheless, very few people go to the council with complaints that their glasses do not fit or that parts have fallen off the side. It is a very cumbersome process.
Stronger consumer protection is needed. We propose to apply British standards, as my hon. Friend the Member for High Peak wishes, for both the product and the dispensing. Such a standard is to be applied for the first time to the provision of glasses by the qualified or the unqualified.
§ Mr. Burt
My point was not that the family practitioner committee would get the patient's money back but that the 421 patient would not need to try to get it back, as the optician would have to put the problem right because otherwise he would be in trouble. That sanction is being removed and it is not being replaced.
§ Mr. Clarke
It will be replaced or supplemented with the more positive consumer protection aimed at what really matters—the quality of the goods and services provided. [Interruption.] I am glad to see that the hon. Member for Ashfield (Mr. Haynes) is back in his place to assist in defending the monopoly.
All the arguments so far have been aimed at providing consumer protection by restricting the type of people who may provide the services—
§ Mr. Clarke
That creates a new restriction. What matters is the quality of the glasses and the dispensing.
§ Mr. Clarke
At present there are no rules about that. Perhaps hon. Members have constituents who have satisfactorily complained to the family practitioner committees, the Secretary of State or the General Optical Council. Here we are talking about British standards which can be revised from time to time, specifying the quality and materials of the glasses and the accuracy of dispensing. At present, there are no such rules, and qualified opticians sometimes supply products that are not up to that standard. Dispensing may also not be up to standard, although I do not wish to attack the general competence of the profession. The Office of Fair Trading relied on a Consumers Associaton survey which showed a high proportion of dispensing inaccuracies, but it was an old survey based on a small sample and I accept that standards on the whole are very high.
An order can be made under clause 1 specifying among other things the conditions subject to which the sale of optical appliances will be exempt from parts of the Opticians Act.
§ Mr. Clarke
Perhaps I may explain what I mean before my argument is rejected. The order will come out soon, so we shall have time to consult all the professional interests about the terms and conditions required to protect the consumer against anyone, qualified or unqualified, selling highly inflammable spectacles or failing to meet the British standard in dispensing. That protection does not exist in law at present. It will strengthen the position of the consumer, whereas the weakening of the monopoly will merely weaken the position of the supplier.
§ Mr. Kennedy
How does the Minister square his present priority for consumer protection with his statement last time we debated this, when he said:If any adult buys a pair of glasses, puts them on, finds that he cannot see properly and does not realise that an error has been made and point out that error to the dispenser, I should be extremely surprised." —[Official Report, 20 December 1983; Vol. 51, c. 360.]That puts the entire onus back on the layman and does not support the consumer as the Minister claims.
§ Mr. Clarke
I do not believe that large numbers of errors will be made by qualified or unqualified people. I do not believe that there will be any dramatic changes of that kind. Generally speaking, if an error is made in dispensing, whether by a registered or an unregistered parctitioner, a person who has had glasses before will notice when he puts them on if they slip off his nose or give him double vision. [Laughter.] Hon. Members may laugh. I hope that they do not misunderstand the purpose of all this measuring. I am convinced that at present, with qualified opticians, patients sometimes put on glasses and say that they do not seem quite right.
§ Mr. Clarke
I see no inconsistency between that and consumer concern. Those who have spoken have all produced arguments that they plainly obtained from the opticians.
§ Mr. Clarke
I have a high regard for the opticians. The opticians of Kent, in particular, have been vigorous in the extreme in lobbying the entire House. They are wrong to fear damage to their practices. Like the bus proprietors who campaigned two years ago, the better ones will become more prosperous. Most adults will choose to go to qualified people who advertise themselves as such. Most people can make such sensible decisions, just as they do when making many other purchases.
However, I do not believe that the arguments adduced this evening in any way counter the OFT report, or the common sense of saying that we should allow adults the same choice as they have over endless other purchases. By widening choice and increasing competition, they will get lower prices and decent glasses, and the public interest as a whole will be served.
§ Mr. Gale
When decrying those who have lobbied us, will my right hon. and learned Friend acknowledge the source of his information—which is sitting in the Box at the end of the Chamber—and also acknowledge that that is in itself just as professional a lobby, and that professional lobbying is quite proper? In this instance, it implies professional and qualified opinion—exactly the same sort that is sought from him as an advocate. However, I think that we were quite close to some sort of agreement a moment ago. Is my right hon. and learned Friend prepared to give an undertaking that he is prepared to introduce an order that requires those who sell spectacles to be properly trained and qualified with a certificate saying that that is so?
§ Mr. Clarke
I will give an undertaking to include in the conditions such things as are essential to safeguard the quality of the goods and the service given. There is nothing really between us in our desire to ensure that the consumer or patient is properly protected. However, the difference is that I think that that protection can be sought by laying down legal requirements for the first time about the goods and services, or about what the patient is getting. However, I disagree with my hon. Friend the Member for Thanet, North (Mr. Gale) and cannot quite give the undertaking that he seeks, because I do not see why the legal requirement should be on people. Ultimately, what matters to the patient is not the diploma held by the individual who gave him the glasses, but whether they 423 work and are of a decent quality. In consultation with the profession, we hope to settle those consumer protection matters when we make our final orders.
§ Mr. Deputy-Speaker (Mr. Harold Walker)
The Minister has sat down. Has he concluded his speech, or is he giving way to his hon. Friend?
§ Mrs. Jill Knight
I should like to reply briefly to what has been a very lively debate. I shall sum up what has been said and express my views as to whether the new clause should be pressed to a Division.
My right hon. and learned Friend the Minister laid great stress on the OFT report. I am perfectly sure that the consumer movement in Britain—whose Bill this is—has achieved a remarkable feat. In attempting to give a universal bargain to shoppers it has somehow succeeded in endangering a primary health care service that is used by millions of those on low incomes. The sad fact is that my right hon. and learned Friend swallowed the OFT report whole without holding proper consultations with those involved in providing spectacles. That is the point. Before the Bill came to the House there was no proper consultation with those most closely connected with providing glasses.
A moment ago my right hon. and learned Friend said that the present system was having adverse effects. What adverse effects? No one can point to any adverse effects from the expertise expended on testing and producing the right glasses for people. We are supposed to believe that a monopoly is a wicked thing, yet the Minister must admit that he lays down the most stringent rules for chemists who dispense every day. Why does he not talk about them, as my hon. Friend the Member for High Peak (Mr. Hawkins) said? That is the most relevant analogy. My right hon. and learned Friend the Minister places those strictures on people but not on the drug in the bottle. The strictures are placed on those prescribing the drug.
My right hon. and learned Friend says that he has great respect for dispensing opticians—it is just that any fool can do the job. He spoke about how many hon. Members had suggested that bus drivers would be zooming round the country causing great danger to others. However, they must not only pass a test, but must be on a list. They must jolly well adhere to very stringent regulations. That is what we are asking for.
I was slightly hurt when my right hon. and learned Friend criticised the wording of new clause 3 because it does not say exactly how things are to be done. He knows very well that such new clauses or amendments never say that. But the theory is set out clearly, and he should not criticise it. He pretended that clause 1 contains the sort of protection that we want. However, I have pored over the clause just as many others have, and there is nothing there that gives the protection that this new clause seeks.
My hon. Friend the Member for Gillingham (Mr. Couchman) says that we need not worry because everybody will be trained anyway, and nobody will dispense glasses unless he is properly trained. I just hope that he has seen some of the handbills that are already 424 being pushed out. It is clear that a whole posse of cowboys is waiting to move in on the market. Those cowboys certainly will not be trained.
The main question concerns how the sufferer from bad dispensing will obtain redress. From where is he to obtain redress? That is not in the Bill. The Minister has not told us, and we are left only with the vague suggestion that something or other will be done about British Standards. Some of those in the profession have considered how the British Standards rules can be altered, but they have had to confess themselves beaten. My right hon. and learned Friend the Minister has not given us any examples. He says—as he is entitled to do—that he will get support in the Lobby tonight, but he will only obtain the support of those who have not heard the debate. I should imagine that 90 per cent. of those who have attended the debate will support new clause 3, which I commend to the House.
§ Question put, That the clause be read a Second time:—
§ The House divided: Ayes 65 Noes 149.425
|Division No. 271]||[8.48 pm|
|Atkinson, N. (Tottenham)||Holland, Stuart (Vauxhall)|
|Barnett, Guy||Howells, Geraint|
|Beckett, Mrs Margaret||Kennedy, Charles|
|Bermingham, Gerald||Kirkwood, Archibald|
|Bidwell, Sydney||Knight, Mrs Jill (Edgbaston)|
|Biggs-Davison, Sir John||Lloyd, Tony (Stretford)|
|Burt, Alistair||Marek, Dr John|
|Butterfill, John||Meacher, Michael|
|Campbell-Savours, Dale||Molyneaux, Rt Hon James|
|Carlile, Alexander (Montg'y)||Morris, Rt Hon A. (W'shawe)|
|Carter-Jones, Lewis||Morris, Rt Hon J. (Aberavon)|
|Cocks, Rt Hon M. (Bristol S.)||Nellist, David|
|Cohen, Harry||Pike, Peter|
|Corbett, Robin||Powell, Rt Hon J. E. (S Down)|
|Cox, Thomas (Tooting)||Radice, Giles|
|Davis, Terry (B'ham, H'ge H'I)||Roberts, Ernest (Hackney N)|
|Dewar, Donald||Ross, Stephen (Isle of Wighl)|
|Dobson, Frank||Short, Mrs R.(W'hampt'n NE)|
|Dormand, Jack||Smyth, Rev W. M. (Belfast S)|
|Dover, Den||Stott, Roger|
|Dubs, Alfred||Thompson, J. (Wansbeck)|
|Dunwoody, Hon Mrs G.||Wallace, James|
|Field, Frank (Birkenhead)||Wareing, Robert|
|Fisher, Mark||Wigley, Dafydd|
|Forsythe, Clifford (S Antrim)||Wilkinson, John|
|Freeson, Rt Hon Reginald||Wilson, Gordon|
|Freud, Clement||Winnick, David|
|Gale, Roger||Winterton, Mrs Ann|
|Garrett, W. E.||Winterton, Nicholas|
|Gould, Bryan||Young, David (Bolton SE)|
|Hamilton, W. W. (Central Fife)|
|Hart, Rt Hon Dame Judith||Tellers for the Ayes:|
|Hawkins, C. (High Peak)||Ms. Harriet Harman and|
|Haynes, Frank||Mr. Michael Meadowcroft.|
|Hogg, N. (C'nauld & Kilsyth)|
|Alexander, Richard||Body, Richard|
|Alison, Rt Hon Michael||Boscawen, Hon Robert|
|Amess, David||Bowden, A. (Brighton K'to'n)|
|Ancram, Michael||Boyson, Dr Rhodes|
|Arnold, Tom||Braine, Sir Bernard|
|Ashby, David||Bright, Graham|
|Aspinwall, Jack||Brinton, Tim|
|Atkins, Robert (South Ribble)||Brooke, Hon Peter|
|Baker, Nicholas (N Dorset)||Brown, M. (Brigg & Cl'thpes)|
|Batiste, Spencer||Buck, Sir Antony|
|Bellingham, Henry||Carlisle, Kenneth (Lincoln)|
|Bendall, Vivian||Chapman, Sydney|
|Bennett, Sir Frederic (T'bay)||Chope, Christopher|
|Benyon, William||Clark, Hon A. (Plym'th S'n)|
|Berry, Sir Anthony||Clark, Dr Michael (Rochford)|
|Biffen, Rt Hon John||Clarke, Rt Hon K. (Rusncliffe)|
|Cockeram, Eric||Onslow, Cranley|
|Colvin, Michael||Osborn, Sir John|
|Conway, Derek||Ottaway, Richard|
|Coombs, Simon||Page, John (Harrow W)|
|Cope, John||Page, Richard (Hefts SW)|
|Couchman, James||Peacock, Mrs Elizabeth|
|Cranborne, Viscount||Pollock, Alexander|
|Currie, Mrs Edwina||Powell, William (Corby)|
|Dorrell, Stephen||Powley, John|
|Dunn, Robert||Prentice, Rt Hon Reg|
|Evennett, David||Price, Sir David|
|Fallon, Michael||Proctor, K. Harvey|
|Fookes, Miss Janet||Rhys Williams, Sir Brandon|
|Forth, Eric||Robinson, Mark (N'port W)|
|Fowler, Rt Hon Norman||Roe, Mrs Marion|
|Garel-Jones, Tristan||Rowe, Andrew|
|Goodhart, Sir Philip||Ryder, Richard|
|Goodlad, Alastair||Sackville, Hon Thomas|
|Gorst, John||Sainsbury, Hon Timothy|
|Gower, Sir Raymond||Shaw, Sir Michael (Scarb')|
|Grant, Sir Anthony||Shelton, William (Streatham)|
|Greenway, Harry||Shepherd, Richard (Aldridge)|
|Gummer, John Selwyn||Smith, Tim (Beaconsfield)|
|Hayhoe, Barney||Soames, Hon Nicholas|
|Hickmet, Richard||Speed, Keith|
|Hirst, Michael||Speller, Tony|
|Holt, Richard||Spencer, Derek|
|Howarth, Gerald (Cannock)||Squire, Robin|
|Irving, Charles||Stanbrook, Ivor|
|Jackson, Robert||Stern, Michael|
|Lang, Ian||Stevens, Lewis (Nuneaton)|
|Lawrence, Ivan||Stevens, Martin (Fulham)|
|Lester, Jim||Stewart, Allan (Eastwood)|
|Lewis, Sir Kenneth (Stamf'd)||Stradling Thomas, J.|
|Lilley, Peter||Taylor, Teddy (S'end E)|
|Lloyd, Ian (Havant)||Thompson, Donald (Calder V)|
|Lloyd, Peter, (Fareham)||Thompson, Patrick (N'ich N)|
|Lord, Michael||Thorne, Neil (llford S)|
|Luce, Richard||Thurnham, Peter|
|Lyell, Nicholas||Tracey, Richard|
|Macfarlane, Neil||Trotter, Neville|
|MacGregor, John||Twinn, Dr Ian|
|Maclean, David John||van Straubenzee, Sir W.|
|Major, John||Viggers, Peter|
|Malins, Humfrey||Waddington, David|
|Marland, Paul||Wakeham, Rt Hon John|
|Mates, Michael||Walden, George|
|Mather, Carol||Waller, Gary|
|Maude, Hon Francis||Wardle, C. (Bexhill)|
|Maxwell-Hyslop, Robin||Wells, John (Maidstone)|
|Mellor, David||Wheeler, John|
|Meyer, Sir Anthony||Whitfield, John|
|Miller, Hal (B'grove)||Wolfson, Mark|
|Mills, lain (Meriden)||Wood, Timothy|
|Mitchell, David (NW Hants)||Woodcock, Michael|
|Morris, M. (N'hampton, S)||Young, Sir George (Acton)|
|Moynihan, Hon C.|
|Murphy, Christopher||Tellers for the Noes:|
|Newton, Tony||Mr. Michael Neubert and|
|Nicholls, Patrick||Mr. Archie Hamilton|
§ Question accordingly negatived.