§ 3.0 p.m.
LORD MILNER OF LEEDS rose to draw attention to the Report of the Inter-Departmental Committee on the Statutory Registration of Opticians (Cmd. 8531); and to move for Papers. The noble Lord said: My Lords, I rise to move the Motion standing in my name on the Order Paper in the hope that we may secure from the Government a statement of policy on the Report of the Inter-Departmental Committee which was appointed as long ago as September 23, 1949, under the able Chairmanship of my noble friend Lord Crook. I would remind your Lordships that the terms of reference of that Committee were:
To advise, on the assumption that it would be to the public interest that provision should be made by legislation for the registration of opticians, how registration could best be carried out and what qualifications should be required as a condition of registration.
Your Lordships will appreciate that the subject matter was one of considerable controversy. There were many lively points of view and, in particular, considerable divergence between the viewpoints of medical men and opticians. The
opticians themselves were not united in their outlook. Those opticians who examine eyes comprised some five main optical bodies and they all possessed differing points of view. In respect of dispensing opticians, there were two organisations. Each of those had a different approach and they were, apparently, united only in one thing—their opposition to many of the views of the five organisations of the examining opticians. Then there were the eye specialists of the medical world, who also had a completely different point of view from the examining opticians.
§ To this Inter-Departmental Committee, therefore, the Ministers of Health and the Department of Scotland appointed, in their personal capacity, representatives of all those divergent interests, together with a representative of the hospital world and an educationalist, who was also a Member of another place. All those members were undoubtedly anxious to do something to improve the present position, but all were likely to desire to reach different conclusions by different methods. They all wished to do something because they were all conscious of the weakness of the existing position: the matter of standard qualifications; the multiplicity of examinations; the performance and function of eye-testing in surroundings which were not of the best; the sale of spectacles on sight-testing carried out by customers themselves in multiple stores or by cheapjacks in the markets. For the truth is that, surprising as it may be in these days of a great Government-sponsored Health Service, there would appear to be nothing like the control of opticians that there was in good King Charles's day over 300 years ago.
In 1629, Charles I granted a Charter to the Worshipful Company of Spectacle Makers. This Charter provided for
(1) the better rule and government of spectacle making; (2) the profit and relief of good and honest men; (3) the fear and terror of evil and wicked offenders.
That Company were given quite substantial powers. They had power
(i) to set down reasonable laws, statutes and decrees; (ii) to provide for honest trade; (iii) to arrange for the punishment of abuses and deceit.
These deceits and wrong practices were described as
uttering bad or hurtful wares whereby our loving subjects may be wronged or abused.
Powers were also given to the Worshipful Company to inspect the premises of those trading, to seize the bad wares and to fine those responsible. In the following year, 1630, the then Lord Chancellor approved by-laws for the Worshipful Company, which included provision as to training in the art of spectacle-making, the suppression of bad workmanship and the elimination of hawkers. Yet, to-day, after all that space of time, there is no provision by law or rule for training; there is no control over the quality of spectacles, and no power to suppress the hawkers who still sell spectacles, I regret to say, to simple inoffensive men and women in the market squares of my own home county of Yorkshire.
§ It would appear that the Worshipful Company exercised their powers to the full until the breakdown of the old apprenticeship system. Then, of course, the change in the economic life of the country, due to the Industrial Revolution, had some effect. Apparently the Worshipful Company then lost their original interest in controlling their craft, and the hundred years that followed were free of any control in respect of spectacle-making, to the profit of the few and the great harm of the many. Fortunately, in 1896, there was an awakening of a new spirit, and the Court of the Worshipful Company appointed a sub-committee which included two Members of another place, Sir Horatio Davies and Alderman Sir Marcus Samuel, who subsequently came to your Lordships' House as Viscount Bearsted. As a result of the activities of this committee, an examination in visual optics was established. Five years later the Worshipful Company received recommendations from Lord Kelvin, the Earl of Rosse and many other scientists of repute, including Sir William Crookes and the Astronomer Royal, urging that sight-testing be added to the scope of the examinations.
§ Under the Mastership of another Member of the other place, who was also eventually to become a Member of your Lordships' House as Lord Aldenham, such an examination was initiated in 1904. Nothing further in the nature of any attempt at control of opticians took 470 place until 1926. In that year a Joint Council of qualified opticians promoted a Bill entitled "The Optical Practitioners (Registration) Bill," and after debate in the House an Inter-departmental Committee was appointed. This was under the chairmanship of another distinguished Member of your Lordships' House, Viscount Kemsley. The Majority Report of that Committee rejected registration, although there were two Minority Reports. I will not trouble your Lordships with the relative extract from the Report of 1927, but if your Lordships are interested you can see it in paragraph 15 of the Report of the Inter-Departmental Committee which we are now discussing.
§ So it is that opticians have remained unregistered, while Bills have come before Parliament, from time to time, dealing with dentists, nurses, midwives, those responsible for drugs, solicitors, and, of course, the great medical profession. The important section of the community whose services could make or mar the eyesight and lives of the ordinary men and women remain without any legislative provision whatever. But at last there is hope, for, to the surprise of most people, and no doubt largely due to the tact of the Chairman of the Committee, my noble friend Lord Crook, all the divergent views expressed before the Committee were brought together into one unanimous Report by the Committee—a rather remarkable feat.
The Report of the Crook Committee records in paragraph 6:
We are glad that the Committee, including as it does personnel representative of the medical profession, ophthalmic opticians and dispensing opticians as well as of educationists, is able to present a unanimous Report and recommendation for action.
§ If, in the public interest, it was possible to secure this unanimous Report from those most closely interested, Parliament should surely be ready to pass legislation to secure the desired objective without undue delay. I have heard, informally, of the keen attention which the Minister of Health has given to this Report, and I hope that in the course of this debate the noble Viscount, Lord Woolton, who I understand is to speak for the Government, may be able to indicate that the Government propose to implement the Report by introducing legislation at the earliest possible date. In moving the 471 Motion standing in my name, I would only add that I am sure your Lordships will agree that our thanks are due to the noble Lord, Lord Crook, and to the Committee for the services they have rendered in what, I submit, is a most important matter, affecting, as it does, in no small degree the health and happiness of so many people. I hope that their unanimous Report will receive the prompt attention that it deserves. I beg to move for Papers.
§ 3.10 p.m.
§ LORD AMULREE
My Lords, I want to say just a few words in support of the Motion of the noble Lord, Lord Milner of Leeds, that the Report of the Crook Committee be accepted by Her Majesty's Government. Apart from being a very good Report indeed, it seems to me quite remarkable that the Report should have been signed unanimously by all the members of the Committee. One of the things I am always most pleased to see is the desire of a body of professional people to form a register and to have a council to control their activities. If there is a register not only does it mean that a very high standard can be maintained, but one also finds a good deal of continuity in that standard. My own profession has been lucky to have been in possession of a register for a great number of years, and I am sure your Lordships will all agree with me that the establishment of the Medical Register has done a lot to improve and maintain the standard of medicine in this country.
Further, I was pleased to see in the Report that the General Council which is to be set up will consist, in the main, of persons coming from the profession itself, and not front outside their sphere altogether. That is something which ought to be encouraged. From time to time one sees the type of council being set up where the majority control of the council is not vested in the profession. I am glad to see that in this particular case that that is not so.
There is one point which I wish very tentatively to put in front of the Minister. There seems to be a certain amount of difficulty with regard to one particular group of people who practise orthoptics—that is, the training of the eyes by means of exercise and not by means of glasses. It is rather uncertain from the 472 Report whether these people should come under the General Optical Council or whether they should be left to medical auxiliaries, as I believe they are at present. I hope that the Minister will be able to discuss that matter and to ensure that, on whatever side they come, they come in a contented way, and not in a spirit of discontent. I think I need have no worry about it, as I am sure that Her Majesty's Government will seee that the right thing is done. I do not wish to detain your Lordships any longer in regard to this matter. I am sure that noble Lords on these Benches, who have been much strengthened by the new edition to our ranks this afternoon, support this Motion.
§ 3.14 p.m.
THE EARL OF LIMERICK
My Lords, I rise merely as a layman in this matter, and as one of the consuming public, in support of the words of the noble Lord, Lord Milner of Leeds. Some little time ago I found myself in discussion with some friends of mine whose professions lie in the ophthalmic branches of science. They mentioned to me the subject of the Crook Report and its recommendations. At that time I had not read the Report, and in discussion with them it seemed to me, in the public interest and in the interests of the gradual upgrading of professional status, quite essential that certain things should be done; and I scribbled them down on a piece of paper. My friends then asked me, "What have you been scribbling down?", and I said, "Obviously, somebody will have to form categories"; whereupon, of course, they laughed and said, "Well, we think you had better read the Report." Finding, therefore, that the recommendations in the Report were identical with my own mental aberrations, I was naturally fortified in the assurance that we were both quite right.
It appears that, judging this profession alongside any other profession, it cannot possibly be wrong—indeed, that it is clearly much overdue in the public interest—that there should be set up a body having the power and duty to form and maintain categories of specialists in this field. It appears to me also—and I am sure that I shall find no dissent to this proposition in any quarter of your Lordships' House—that the principle of separation of professional advice from 473 any hint or possibility of financial interest in another branch of a profession which may supply things is absolutely essential, both for the protection of the public and for the self-respect and the proper control of that profession. I see that it is considered likely—I think the noble Lord, Lord Milner of Leeds, would agree—that in the natural course of events the three categories proposed should be elided and become two: the first, purely advisory, and dealing with the technical study, and the second, the supply and selling of glasses. That again, from a layman's point of view, seems wholly logical and desirable. Therefore, as I say, purely as a layman, I register my support of the words that fell from the noble Lord, Lord Milner of Leeds; and may I hope that my noble friend Lord Woolton will in due course be able to bless that Report.
§ 3.17 p.m.
§ LORD CROOK
My Lords, it was suggested to me that, as Chairman of the Committee, I ought to run the risk of boring your Lordships by making some reference to the terms of the Report and its content. May I, however, commence by thanking my noble friend Lord Milner of Leeds for initiating this debate, and also my noble friends Lord Amulree and Lord Limerick for the kindly words that they have addressed to the House with regard to the Report. I hope that when the noble Viscount, Lord Woolton, who normally smiles at me across the Table, comes to make the Government reply, he will be able to deal nearly as kindly with the Report.
When His late Majesty's Government of 1949 invited me to undertake this task I was faced with the gloomy knowledge that doctors disagreed with opticians, and that the opticians disagreed amongst themselves, not only as between dispensing and ophthalmic opticians but even amongst varied organisations representing the ophthalmic opticians themselves. When I was told, that the Committee were to include representatives of most of those interests, influential members of the medical profession, including ophthalmologists and a couple of professors, I realised that some of the gloomy forebodings were in the main true. But I should like to pay tribute to all the members of that Committee who, after two and a half years of hard work, found 474 themselves getting closer and closer together and who finally were able, in the public interest, to sign a Report which, though it did not represent to any one of them 100 per cent. of what he would have liked to achieve, enabled a unanimous document to be presented for the consideration of the Government of the day.
I believe that the members felt as I do, that it is unthinkable that a nation such as ours, which can embark upon great social and health service schemes such as we have, can live to-day in the position in which one of the great things which we possess, namely, sight, can be treated by people without any legal qualifications whatsoever. I have become ultra-eye conscious since I was made to look at these matters in 1949. I am now in the position where I should fear above all other things to lose my sight and never again to see God's sunlight and blue sky and trees. I think I always knew how great an affliction some of our colleagues suffered, but never so much as when I began to study this problem.
Yet, as the noble Lord, Lord Milner of Leeds, has made clear, nothing has been done by legislation, and over a long period of time the people of this country wanting eye service have to a large extent been entirely dependent upon the voluntary efforts of the optical people themselves. From 1895 onwards, they set up some five different organisations which had varying standards for their qualifications, standards varying not only between themselves but inside their own organisations from time to time. In those early days, many of them had little or no academic training, many had their training only by evening classes or part-time education. Indeed, part-time education exists even now, though of a very much better kind; but it is gradually on the way out. When we look at some of the diplomas granted in the past by some of the organisations we are unable to reach an effective evaluation of their work without regard to a great deal of past history, much of it not available to us.
The standards of at least three of the organisations have been carefully controlled, but in respect of two, as your Lordships will have seen from the Report of the Committee, it was found necessary to express some doubt whether, in the 475 confirmative diplomas, there was the care about academic and training qualifications that we should all like to see. I am glad to learn informally that perhaps some of the criticisms offered in the Report have already had the effect of improving that matter in at least some respects. I think the main thing is that fortunately the public has been able to rely, over a long period of time, on a very reliable body of ophthalmic opticians who in their voluntary effort have gone out of their way to try to create for themselves training and qualifications standards that were not set down by any system of legislation. One of their most recent efforts referred to in the Report, the creation of a Joint Advisory Board which has drawn up a syllabus for a common examination, represents one of the newer developments. I would not be so foolish as to suggest that when the Joint Optical Council is appointed the J.A.B. syllabus should be regarded as completely adequate for future years, but I am certain it represents a perfectly good starting place for the General Optical Council and that it is something on which the profession will be able to build. We have all to realise that opportunities of education for this profession are very limited anywhere in this country, not only because of the small number of schools but also because of the complete absence of some of the most essential parts of the training. Clinical training is fairly unknown; at any rate, not to exaggerate, it is certainly not present in any large degree.
That leads me automatically to an important point which I would press upon your Lordships—that is, the absence of co-operation so far, in the training of these opticians, of the members or the medical profession. For various reasons, many of them quite good ones, members of the medical profession, to the extent that they have taken any part in the academic education or training at all, have largely been devoting themselves to anatomical and physiological aspects, and have played little or no part in any other medical assistance in clinical studies. To date no ophthalmic optician student has ever had a chance of access to a hospital. It must be clear to all that in the eye departments of both teaching and general hospitals are to be found large numbers 476 of abnormal eye cases in respect of which training should be given. Only if the optician has the opportunity of training by medical men will he finally be as effective to do his job as I know he wants to be. I realise that hospitals are fully occupied with the large volume of work which falls to them and the teaching duties necessary in respect of the medical profession, but I feel that in the Report the close co-operation which was achieved in the Committee by the doctors and opticians and the great co-operation there was generally in that two and a half years of work between the two who had been rivals augurs well for the future, and I hope we may see the spirit that was present then and which I know has continued to be present, go on and provide the opportunity for continued co-operation in the interests of the public.
The ethical standards of the profession in general were the subject of some comment in the Report. Obviously, the only ethical standard possible is that imposed in a voluntary way by the profession upon members of its own organisations, through the possession of diplomas. While it is true you cannot create ethics by legislation, it is also true that unless an ethical standard is backed in some way by powers there is little hope that it will be completely effective. Until it is possible for a General Optical Council to insist upon the standard of ethical conduct which I am glad to say is true now of the optical profession, we cannot hope to get the complete professional standards we desire. I urge upon Her Majesty's Government that the General Optical Council, when, as I hope, it is set up, shall be given the fullest possible disciplinary powers and the fullest possible opportunity of dealing with ethical standards for the guidance and, if necessary, the control of those inside this profession Advertising, about which I will not detain your Lordships in detail, was one of the several matters which I know have worried opticians over a long period of time. I do not think it can be right that ophthalmic optics should be practised as a 10 per cent. or 15 per cent. part of one's job by a working jeweller, watchmaker or radio technician; and while I admit that Parliament in its wisdom has (I think we should all consider rightly) been chary of taking away the livelihood of people at present performing certain functions, one of the early tasks of the 477 General Optical Council ought to be to review the position for the future and to see that the profession is made one which is completely professional. It might well base itself in its general and ethical standards on the excellent standards which the medical profession has drawn up for itself and enforced so emphatically over a long period of time.
I think a good deal of the work of the General Optical Council will have to base itself, so far as its professional and standards go, on systems which the General Medical Council have evolved. I can think of nothing better than some of the advice given by way of evidence by the G.M.C., in co-operation with the doctors, dealing, for instance, with methods of inspection and the way in which, by the giving of advice and follow-up, they are able, without sanctions, although the ultimate power is there, to secure all the standards they desire. I should be the last to suggest that academic institutions should have that complete freedom which they normally like to possess taken away from them by legislation of this kind; but powers of inspection and at least of guidance and advice for the establishment of standards must be one of the least of the things that is given.
I think, however, that there stands out clearly to anyone who cares to look for himself one glaring scandal with regard to eye practice—I refer to the ability of members of the public (this is a matter to which my noble friend, Lord Milner, has already referred) to go into a chain store establishment and select glasses for themselves. During the course of this Committee's work, I took the opportunity of going into two or three of the branches of a well-known firm of chain store proprietors, in order to watch the sale of spectacles. I observed ladies going up to the counter, taking up a sheet of type, and then trying on various glasses until they found that the particular type at which they were looking could be read satisfactorily; and then they would order a pair of glasses by the number of that type. Noble Lords who, like myself, are accustomed—or apprised, as we are by the newspapers, and by inference, if not by experience—to the time a lady takes to choose a hat, may be interested to know that, according to my observation, it takes about one-hundredth part of that time for 478 a lady to choose a pair of spectacles which may ruin her eyesight for ever.
The plain truth is that examining bodies and organisations of opticians have carried these matters, so far as I can judge, as far as they can carry them by years of voluntary effort. There has been half a century of work in building up standards, trying to control ethics, trying to see that the public interest is guided and guarded by them. Voluntarily, they have gone as far as they can in this way, and unless the ultimate control of a council, with the benefit of sanctions if necessary, is made available, they cannot go further. I should not be so foolish as to suggest to the noble Viscount who is going to reply to this debate on behalf of Her Majesty's Government that he will be able to tell us now that, when legislation is advanced—as I most earnestly hope it will be—every single recommendation in the Report will be adopted, and on the lines suggested. Indeed, as I understand it (the noble Viscount and I know each other well enough for me to say this), if the Chairman of any Committee of Inquiry sees action taken while he is still alive, on anything that is in his Committee's Report, instead of knowing that it is safely interred in a Whitehall pigeonhole, he is fortunate. He will be well satisfied, at least, to be assured that there is to be any legislation at all.
I believe that I shall be able, whilst still young, hale and hearty, to see the Government put into operation the main grounds of this Report by way of legislation. I am encouraged in that belief by the unanimity of the members of the Committee, to which reference has been made, and by the way in which divergent interests have managed to get together to sign this Report and to try to help the public interest. I am further encouraged by my knowledge of the great interest which the Minister showed in the Report and by my further knowledge of the way in which the Civil Service—the "back room boys," who have been responsible for this kind of thing—have taken such a lively, intelligent and knowledgeable interest in the job. They have done their best to see that every single relevant factor has been put before all concerned. I am sure that the noble Viscount, Lord Woolton, when he comes to reply for Her Majesty's Government, will be as anxious as I am to tell the members of the Committee—who I am glad to know 479 have been afforded the opportunity of being present in our Galleries this afternoon—how much we owe to them, and how warmly we thank them for the job which they did. It was a job which meant for them "all kicks and no ha'pence." It was a job which took up a great deal of time, and I think the finest tribute they could have, and the best thanks which the noble Viscount could give to them, would be to pass to them the knowledge that not only will legislation on this matter be forthcoming but that it will be forthcoming at an early date.
§ 3.36 p.m.
§ LORD CHARNWOOD
My Lords, I venture to address your Lordships on this topic because I am myself an optician, though I practise as my noble friend on the other side of the Chamber would wish: I do not sell spectacles, I only test eyes. I also wish to urge Her Majesty's Government to bring in a Bill on the lines of the Report. I read the Report when it came out, and I have read it again since, and I agree with every word of it. I think it offers the best and the most just compromise which can be obtained. It was no small achievement to bring in a unanimous Report, and this one represents the highest common denominator of the general and professional views of those concerned. Any representations made subsequently to the Ministry strike me as being backstairs lobbying. The suggested Bill would be for the protection of the public.
It is of the false security of an inadequate eye examination that I wish to speak. I am an examiner for one of the qualifying bodies. What is the use of "ploughing" someone if he does not come up for re-examination but "gets in through a back door"? Those bodies which let people in through back doors do not let in many, but they should not let in any at all. It is true that they have very small membership but, nevertheless, in my view they keep this back door still open. Personally, I do not so much mind the trade in spectacles which is done by chain stores. A man cannot, in fact, hurt his eyes by wearing the wrong spectacles—certainly not by wearing the wrong reading spectacles—when he is in middle life. In the case of children it is different: a squint can be 480 started by fitting a child with the wrong spectacles. All the harm that one of your Lordships could do to himself by buying spectacles at a chain store would be to give himself a headache. And that would "larn him," so that he would, I should hope, go off and have an eye examination by a qualified practitioner. If he did not give himself a headache he might, in consequence of not having had an examination, be left in ignorance of something which it would be well for him to know. The eye is the one place where you can inspect blood vessels in working order. The first sign of high blood pressure is to be found in the eye.
I would welcome a prohibitive Act, but in this connection I would rather that it should be directed at sun spectacles. These are much more likely than reading spectacles to cause harm. Sun spectacles, when they are put on to children, are very habit-forming, and they retard the development of the eye. I feel very strongly, with the noble Earl, Lord Limerick, that dispensing and prescribing should be wholly divorced. I am always very glad when my own prescriptions go to a dispenser, and not to an ophthalmic optician. I do not consider that there is anything in the contention that the man who prescribes should also dispense. If there is anything important to be attended to in the dispensing it is up to the prescriber to write it on the prescription. As Lord Crook says, the present ill-qualified man must remain. Parliament will not take his livelihood away from him. But where eye-testing is only a sideline—that is in cases where the people concerned have two "rackets"—I think it would be right to insist upon a choice being made of one or the other. Anyway, there are far more opticians than the nation needs, and that condition leads only to drumming up trade, such as the recent agitation for the compulsory testing of the vision of motorists, which the trade journals favour. That sort of thing would lead to a nation of spectacle-wearers, as there is across the Atlantic. I spend my time telling people to throw their "specs" away.
My noble friend Lord Amulree touched on orthoptics. Actually, orthoptics are exercises to straighten squints in children. They also relieve headaches in adults, but that is a minor consideration. Orthoptics may, or may not, be coupled with the prescription of spectacles. And may I 481 mention to my noble friend that modern orthoptics were introduced into this country by my profession and not by his? I urge a strong Bill and urge that there should be three registers, particularly the third, that of those who prescribe and do not dispense. I also urge restrictions on multiple or chain opticians, especially those who sell cameras, barometers and "what have you." as well as testing eyes in their shops.
§ 3.42 p.m.
§ LORD OGMORE
My Lords, I am sure that all noble Lords will be grateful to the noble Lord, Lord Charnwood, for assuring us that when we next buy spectacles in a store we need expect nothing more than a headache as the result of wearing them. I feel that we owe a debt of gratitude to my noble friend Lord Crock for the work he did on this Committee, and for the excellent and clear Report that the Committee have placed before us. I had an opportunity of seeing some of my noble friend's tactful and efficient work on one of the most difficult Committees of the United Nations, the Fifth Committee—only a little less difficult than the Fourth—and I was full of admiration for the way in which he conducted the affairs of that Committee, so far as British interests were concerned, so that I am not surprised that he did so well on this Committee.
I have no knowledge whatsoever of optics or of opticians, but it happens that the President of the Association of Dispensing Opticians is a gentleman whom I know, and he has written to me and asked me to present to your Lordships the views of the Association. As the dispensing opticians are very much affected by the proposals in the Committee's Report, and will be by any proposals that the Government may make as a result of the Report, I think it only right that their views should be placed before your Lordships and, in particular, before the noble Viscount, Lord Woolton. The Association of Dispensing Opticians would like me to point out that paragraphs 66 and 69 of the Crook Report recommend that, subject to safeguards, the first dual-function register should be closed at some time in the future and that a General Optical Council, analogous to the General Medical Council, 482 should have power to effect this closure. The Association agree with that proposal. They say they wish to see the high standard of dispensing which their members practise become general throughout the country. Dispensing and sight-testing are separate entities, each entailing a full-time operation, and the Association admit that in expanding the training and examination of ophthalmic opticians, dispensing has been neglected. They feel that it is contrary to the public interest that the professional view should be influenced by the knowledge that that view can provide a further source of profit. It is felt that the opportunity and temptation of this further profit should be removed from those who might be liable to fall into the temptation. Failure to make any provision for, or even reference to, any closure perpetuates the present situation and gives no incentive for improvement.
I understand that the Government are not prepared to give a General Optical Council, or the Privy Council, or, for that matter, Parliament, the power which the Crook Committee suggested to close the first register to new applicants. It is not suggested by the dispensing opticians that old applicants should be excluded from the register. They do not even propose to have three registers, as the Report suggests, but they feel that there should be a closure of the register so far as new applicants are concerned. Roughly, and possibly inadequately, these are the reasons why the Association of Dispensing Opticians believe that the Government should carry out the recommendations of the Crook Committee which are found in paragraphs 66 and 69 of their Report.
I confess my ignorance of this problem, but I feel that it is a strong point that we should remove the temptation of further profits in the case of people undertaking sight testing. If the noble Lord, Lord Charnwood, is to be believed, most people would be better off without glasses altogether. To give people who are going to test sight the possibility of making profit from the provision of glasses appears to be running not only against common sense, but also against the advice given to your Lordships by the noble Lord, Lord Charnwood. These are all the observations that I have to make in this matter. I trust that the 483 noble Viscount, Lord Woolton, will take into account the views of the Association of Dispensing Opticians.
§ 3.48 p.m.
§ LORD KENSWOOD
My Lords, I feel certain that those who, like myself, have for a good many years taken an active interest in sight saving and the prevention of blindness, must welcome this Report. It is an excellent Report and we should all be grateful to the noble Lord, Lord Crook, and his colleagues, and to all those witnesses and assessors, who have helped to make public certain evils in our system. I must say that, although welcome, the Report seems to indicate that a great deal more research work and negotiation will have to go on. We find in Paragraph 108, on Page 27, the statement that there are far too few ophthalmologists to cope with the patients who should go to them for eye inspection. That means that opticians will have to go on for a good many years—do not let us blink at it and use other names—diagnosing and prescribing treatment. I want to know where prescription and observation begin and end, and where treatment begins. I speak from personal experience, and I know that frequently glasses are prescribed, even by ophthalmologists, not merely for correction, but as treatment to satisfy some further end. Certain opticians will do that, and I believe that means diagnosis. It means that you recognise a certain eye defect which you want to improve.
The noble Lord, Lord Charnwood—he will correct me if I have misunderstood him—has upheld the ability of opticians to test eyes and prescribe glasses. That does not seem to me to be in accord with paragraph 117, on page 28 of the Report, where it says that opticians have not had sufficient clinical training, and have not had sufficient advice and lectures from ophthalmologists to fit them for diagnosis. What happens, in general, is this. You find that you cannot see so well as you think you ought to be able to do. You therefore go to an optician, or you go to a chain store and pick up some glasses. I believe there must be millions of people wearing glasses which they have procured from hawkers or from chain stores. I remember the late Lord Passfield saying that he bought his glasses from a hawker; that he was always satisfied 484 with them, and never had to change them. It is something like a lottery: he picked on some glasses, and was lucky; and I believe many people have done the same thing and have still retained sufficient vision to help them in their trade or profession. But that is not good enough. What an examination of the eyes should reveal is something which probably a correction of refraction cannot reveal.
I do not know much about ophthalmology—in fact, my knowledge is nil—but Professor Sorsby's recent report shows that there is among the people of this country a great deal of glaucoma. That is a complaint which comes on in middle life, at the same time that your refraction changes, and it need not exist if attended to early. You go to an optician, he examines your eyes and gives you a pair of glasses which suit you and you think that your trouble is over. You do not necessarily get headaches, because if he is a skilled optician he will give you glasses with the proper correction. But what he does not see, possibly, is that there is incipient glaucoma; and unless that is treated at once, you go blind. There are no two ways about it. I feel that unless opticians can get far more training than it is possible to give them, they should not be allowed to diagnose or even to act without a prescription by an ophthalmologist. I know that is the counsel of perfection, and it cannot be implemented to-day because there are simply not enough ophthalmologists to do the examinations.
I know that I shall come in for criticism, but I do not mind that. I can quote my own case. A good many years ago, when my sight began to trouble me, I went to several of the world-famous ophthalmologists, one in London and one in Vienna. None of them noticed anything wrong with my sight, other than a certain degree of myopia, which they corrected. That was that. Three years later I was not satisfied with my sight, which got so bad that I could no longer read, and I went to two other famous ophthalmologists. They said that it was too late and they could no longer do anything for me, but that had I come earlier they could have saved my sight. Mine is not an isolated case. You cannot argue from the particular to the general. 485 I believe there must be thousands of cases similar to mine. If it is so difficult for an experienced ophthalmologist to diagnose an ailment, how much more difficult is it for an optician, who has had neither the training nor the experience?
With regard to clinical experience, I believe that patients in a hospital get a good deal of worry from the number of students who look at them and mess them around. I apologise for this statement but I feel strongly about it; and I have had three years as chairman of hospitals. After all, it is not only the students who matter; it is the patient who matters. Here in this Report we are envisaging the possibility of opticians gaining more experience by being sent into eye hospitals and being allowed to examine the patients. That may be a pis aller, but certainly it is not an ideal. The ideal we have to seek for is a sufficient number of well-trained and qualified ophthalmologists. I certainly feel it is criminal to allow hawkers or chain stores to sell glasses, and that should be stopped once.
My last point is this. If we give a special position to opticians, to a particular profession, surely, the public are also entitled to be protected against any possibility of monopoly or trust on the part of those opticians. I do not want to say anything personal about opticians as such—I think they are an honourable class of men and women, doing their best and performing a great service to the public—but it is just possible that there may be a movement towards taking advantage of their situation and getting higher prices. I know what the price of spectacles was before 1914; I know that the price of spectacles to-day is out of all proportion to the rise in the cost of living and the rise of wages. It may well be that this rise is well justified, but it does make me wonder whether we ought not to safeguard people against anybody exploiting their privileged position to the disadvantage of the public. I hope that as much as possible of this Report will be implemented by Her Majesty's Government as soon as possible. I am fully aware, as I mentioned earlier, that the Report bristles with difficulties; that a great many different points of view will have to be straightened out; and, above all, that something will have to be done to see that the service, after removing 486 hawkers and chain stores, will be adequate to supply the needs of the people who have defective vision.