Optician Services: Competition (Hansard, 28 November 1983)

§ Lord Glenarthur
My Lords, with the leave of the House, I will now repeat a Statement that is being made in another place by my right honourable friend the Secretary of State for Social Services. The Statement is as follows:
"With permission, I will make a Statement on opticians and competition following the report of the Office of Fair Trading published earlier this year.
"At the end of 1981, the Office of Fair Trading was asked to report on the effects of the 1958 Opticians Act upon competition in the supply of 450 opticians' services. They found that the requirements imposed under that Act led to restricted competition and resulted in unnecessarily high prices. In particular, the Office of Fair Trading criticised the rules limiting optician' advertising and the monopoly on the supply of glasses granted to opticians and doctors. The Government accept these conclusions, and believe that the interests of consumers would be better served by acting upon the OFT report. Accordingly, the Government intend to bring forward legislation to deal with two main areas.
"First, we propose to take action on advertising. At present, the rules made by the General Optical Council allow no general advertising of the price of glasses or advertising on such matters as the speed of service. This handicaps the consumer who wishes to get the best value for money and also holds back the optician who can provide a better deal or wider choice. The General Optical Council did review their rules in the light of the report by the Office of Fair Trading, but the changes they proposed came nowhere near to those needed. Legislation will therefore be introduced to enable the rules operated by the General Optical Council to be amended to allow freer advertising. These powers will be used carefully. In particular, we will draw a distinction between the professional function of sight-testing and the commercial activity of selling glasses. The aim will be to ensure that the public are provided with more information about the prices of glasses.
"Secondly, we propose to take action on the monopoly to dispense and sell glasses. There is still a need for public protection in certain areas such as dispensing to children or fitting of contact lenses. However, all laws which create a monopoly have to be examined to see whether, under the cloak of public protection, there is not simply too much protection for the seller. We have concluded that this is the case with opticians. The legislation which the Government will be introducing will therefore allow non-opticians to sell glasses under carefully prescribed conditions. The conditions laid down will ensure that no risks are taken with people's sight. All sales will have to be made against a recent prescription, following a sight-test by an appropriately qualified optician or doctor, and no one other than a qualified optician or doctor will be able to sell glasses for children or to fit contact lenses. It is our intention to maintain the present arrangement for the registration of qualified opticians, and the public will therefore be able to make a choice between the services of a registered optician and those of other competitors.
"The action I have announced on advertising and the end of the dispensing monopoly will, I believe, bring down the price of glasses. This will have an effect on the general ophthalmic service. At present, the general ophthalmic service provides free sight-tests by either an ophthalmic optician or a specially qualified doctor. We intend to continue this arrangement. It also provides a range of frames and lenses free to children and families on low incomes. This free provision will also continue. But other people who currently buy NHS glasses will in the future be able to obtain a wider selection of non- 451 glasses at reasonable prices. Although the NHS will continue to provide free sight-tests and to supply glasses to the present exempt groups, there will no longer be any need for the general supply of NHS glasses. The legislation I will shortly be introducing will give effect to this.
"Mr. Speaker, my right honourable friends the Secretaries of State for Scotland and Northern Ireland will also be bringing forward proposals to give effect to these changes. We believe that the changes I have announced will enable greater competition to take place; will provide greater choice; and above all will have the effect of bringing down the prices of glasses for the public."

Lord Wallace of Coslany
My Lords, first may I thank the noble Lord for repeating a very important Statement, but he need not have taken the trouble. If he had looked in the Library at the Standard he would have seen that the Government's Statement had already been made—to which I take exception because I have had to deal with this matter at very short notice, not having had time even to read this paper.
I have a number of points to put to the noble Lord, Lord Glenarthur. First, may I ask him how the Government are going to draw a distinction between the professional function of sight-testing and the commercial activity of selling glasses? Is not the provision and checking of lenses a vital professional function? Advertising in general will have to be carefully controlled. In any case, there could be the risk of loss of profitability for the small optician who is forced to provide a prescription but who is likely to lose other business arising from the provision of that prescription. This could lead to a serious decline in the optical service at present enjoyed by many people in their own areas.
Naturally, I welcome the fact that a prescription will still be needed. To put it bluntly, anybody needing glasses would be foolhardy to obtain them without a prescription. However, may I ask whether it will now be an offence for anybody to sell glasses for which there is no prescription? Will the Government include a provision to cover this point in their legislation? Furthermore, what does the Minister mean by the very important statement that there will no longer be any need for the general supply of NHS glasses? Are they to be supplied in future only to those classes which are exempt, which I believe include those aged 16 to 19 in full-time education and those on supplementary benefit? There is no mention of the old-age pensioner. Am I right to assume that they, too, are exempt? Perhaps the noble Lord will tell me. If this is not the case, a vital NHS principle will have been abandoned. I must demand from the noble Lord clarification of the phrase, no longer be any need for the general supply of NHS glasses". I take the view that this is a very severe cutback in the NHS service and means the abandonment of a principle for which many of us have fought for so long and so hard.

§ Baroness Seear
My Lords, from these Benches may I thank the noble Lord the Minister for repeating the 452 Statement. We are broadly in agreement with the general principle. Undoubtedly the price of glasses has been a great deal too high. The introduction of competition should bring about a long overdue reduction in the price of glasses. However, the Statement raises one or two queries concerning which we should like further clarification. How recent is "a recent prescription" to be? Unless care is taken, the standard of treatment for eye conditions could deteriorate. People could buy glasses which do them very little good.
Secondly, may I ask the noble Lord about free spectacles through the NHS no longer being provided except for exempted groups? Could he say how widely the exempted groups will be drawn? Who will be included in those exempted groups? The Statement refers to children and low-income families. It is assumed that the price of glasses will quickly come down. If it does not, a very heavy charge will be laid on some people just above the low income level who nonetheless need glasses and have been able to get them practically free up to the present time.

§ Lord Glenarthur
My Lords, the noble Lord, Lord Wallace of Coslany, raised a series of points not altogether welcoming what had been said in the Statement. First may I pick up the second from last point which he made, about old-age pensioners. The answer is that at present old-age pensioners are not exempt unless they qualify under the social security provisions. The noble Baroness, Lady Seear, also asked about exemptions. The answer is that all those who are presently exempt will continue to be exempt. So far as the information contained in the Standard is concerned, the noble Lord is one up on me; I have not seen it. How it got there, I do not know; but the noble Lord knows how these things happen.
The noble Lord alluded to the fact that the provisions in the Statement represent some sort of step towards a further dismantling of the NHS. This is far from the truth. The NHS is about the provision of health care. So far as eyesight is concerned, there are many who feel that this means sight-testing. We do not propose to stop sight-testing. Indeed, that is made clear in the Statement. Sight-testing will still be provided free. So far as the supply of glasses is concerned, most people are already nearly paying all the cost, anyway. Provided we can be sure that a supply of reasonably priced glasses will be available to the public, there is no need for the Government to provide them.
The noble Lord also asked whether or not it would be an offence for somebody to sell glasses when a prescription had not been made available. This is a matter for the legislation in due course, and I do not believe that I can usefully follow up the Statement which I have just repeated. The noble Baroness, Lady Seear, asked how recent "a recent prescription" would have to be. Again, this is a matter for consultation and discussion when we deal with the legislation in due course. Therefore, I do not think that I can usefully be drawn on that point now.
The noble Lord, Lord Wallace of Coslany, may have raised one or two other points with which I have not dealt. If that is so, I shall be delighted to follow them up in correspondence.

Lord Wallace of Coslany
My Lords, the noble Lord, Lord Glenarthur, made the point that the matter before us now is not one of health care but the supply of glasses. That is an amazing statement. In many cases, disease is identified when somebody applies for glasses. I could quote diabetes and many other diseases which are discovered as a result of eye tests and the provision of glasses. So it is a question of health care, not merely a question of buying glasses off the peg somewhere else.

§ Lord Glenarthur
My Lords, there has been a great deal of discussion in the medical profession about the provision of glasses. The discussions have led us to believe that it is important for us to retain the free sight-testing which I described earlier. There is, of course, divergence among the professional people involved as to exactly what sort of diseases are best found by those who look into these things. The noble Lord mentioned some, and I am sure he is quite right. The medical expertise in searching for these diseases will be maintained. The provision of the actual lenses is a matter for a much more mechanical process in many cases, and not quite so important as the sight testing, which will remain.

§ Lord Kilmarnock
My Lords, may I press the noble Lord a little further for clarification. I refer to the phrase, "There will be no longer any need for the general supply …".Does this mean that all persons needing glasses, other than the exempt groups, will have to go fully private as regards the supply of frames?

§ Lord Glenarthur
My Lords, the intention is that the duty to supply appliances will cease on 31st March 1985. However, it is quite likely that opticians will continue to stock them if they are wanted, but they will then have to be privately supplied.

§ Baroness Gaitskell
My Lords, may I ask the noble Lord the Minister—because I am a little confused about it—whether it will now be necessary, when someone gets the first prescription for glasses, to be recommended to a specialist or to an eye hospital? Is that so, or is it just that we can buy spectacles, as the Americans do, over the counter?

§ Lord Glenarthur
My Lords, at the present time anyone who wants glasses has to go to a registered optician to obtain the glasses prescribed, but the intention of the legislation to be introduced will be that one will be able to get them over the counter—that is the point—but only following a recent assessment by an optician to satisfy both himself and the person needing the glasses that that person needs such a prescription.

§ Lord Ross of Marnock
My Lords, can the noble Lord the Minister say how much he expects to save? Secondly, he expressed the belief that glasses would be cheaper, thanks to competition. Will there be any monitoring of the effect of the price of glasses, and will the Government take any reserve powers to control prices if the noble Lord's belief proves to be misguided?

§ Lord Glenarthur
My Lords, I cannot give a figure off the top of my head to answer the noble Lord's first point, but of course advertising will help to lower prices, in three main ways. First of all, the consumer will be able to choose the optician giving best value for money. At present consumers can pay as much as £50 more for the same prescription from different opticians. Advertising will also help the optician seeking to expand by offering a cheaper or quicker service. At present it is hard for the optician offering better value to let people know that he is doing that. Thirdly, advertising will help new, keener opticians who want to start up on their own. At present it is hard for them to tell the public what they offer that existing opticians do not offer.

§ Lord Somers
My Lords, speaking as one who is wholly dependent on his glasses, may I ask whether the noble Lord can give us some assurance that this will not mean that we shall get second-hand lenses? The noble Lord must know that cutting a lens is a highly expert job. I hope this will not mean that we shall be getting lenses that are not suited to us.

§ Lord Glenarthur
My Lords, as I understand it, the present arrangements are that, while some lenses have to be specially cut, the prescription houses hold stocks of the more regularly used lenses. So I do not understand that there can be any question of anybody picking up second-hand lenses.

§ Lord Ardwick
My Lords, one can see that fashionable spectacles may well be cheaper under this system, but will the kind of spectacles now prescribed under the NHS be cheaper or dearer?

§ Lord Glenarthur
My Lords, by introducing the form of competition which this system will allow, spectacles will, for some of the reasons I have described to the noble Lord, Lord Ross, and others, become cheaper.

§ Lord Donaldson of Kingsbridge
My Lords, at the moment one can buy under NHS rules spectacles on prescription for a price of something like £10 to £12, and for the same sort of thing one is apt to pay £70 to £80 through a registered optician. Does it mean that the price will go up to £35 or £40 instead of the £10 or £12 under the NHS? Secondly, may I ask the noble Lord whether he is aware that the main objection to the monopoly of the opticians has been that it is based on a false premise: that to use glasses not prescribed by a proper doctor can hurt your eyes? The general view of all competent oculists, professors of optics and others, is that it does your eyes no harm whatever to use glasses which are not the best for your eyes to see through; it is just tiresome. This is a very bad reason for a monopoly. I should like to welcome this move in the right direction but to question whether it has gone nearly far enough.

§ Lord Glenarthur
My Lords, I am well aware of the point the noble Lord, Lord Donaldson, makes about the fact that having the wrong sort of glasses does not do any damage to your eyes, but merely means that you cannot see so well, and in that case you obviously 455 go and get another pair. This is something that has been threshed out by the experts and has been raised in your Lordships' House on more than one occasion.

§ Lord Rugby
My Lords, may I ask the noble Lord the Minister whether it will now be possible for people over 50, the presbyopic people, who virtually all take the same magnification, and who break and lose their glasses fairly constantly, to get immediate replacements instead of having to be subjected to the appalling delays which the opticians have put upon them and the quite ludicrous prices they have charged for replacements? Does this Statement cover the presbyopic, like myself and many others, who simply uses simple magnification?

§ Lord Glenarthur
My Lords, as I indicated earlier, this is something which will have to be considered, but there is no intention that there should be the sort of delay to which the noble Lord refers. I think it is something which has to be discussed with the expert bodies concerned, and again when legislation goes through your Lordships' House and another place. As I understand it, there will be no difficulty in obtaining replacement glasses in the way the noble Lord describes.

§ The Earl of Onslow
My Lords, may I ask the noble Lord whether the question of contact lenses will be excluded from over the counter buying? I believe that the mark-up is considerable between wholesale and retail prices of contact lenses. I speak from a very vested interest, as I wear them and am extremely keen on them. I believe the wholesale price for a pair of soft contact lenses is something like £16, and if you go to an optician it is something in the region of £110. That does seem a marginally excessive mark-up. If these are going to be excluded from over the counter sales, plus prescription, then the privilege is going to be kept for one and only half given away in the case of spectacles.

§ Lord Glenarthur
My Lords, contact lenses can damage eyes if wrongly fitted. We shall continue to limit contact lens fitting to qualified staff. The same applies to children. which is a point mentioned in the Statement.

§ Lord Northfield
My Lords, since some of us have campaigned for 25 years for a change in the law, may we offer at least a guarded welcome for the decision to divorce the commercial aspect of selling spectacles from the medical aspect of testing eyes? That is precisely what the Government are doing today. So in that sense we can offer a guarded welcome. Does the Minister realise that there must be some room for competition? If I may give an example, I was recently able to buy fully glazed spectacles in the streets of Hong Kong, very good ones which I have as a spare pair, for £1.50. I am looking forward to the day when competition like that will occur here. May I ask the noble Lord this. There are other recommendations of the Office of Fair Trading, some of them quite important. Can the noble Lord say which recommendations have been rejected so that we shall know where the Government stand on the full body of their report?

§ Lord Glenarthur
My Lords, it would probably weary your Lordships if I were to go through the entire weighty tome which is the report produced by the Director-General of Fair Trading. The important points which I have covered deal with the meat of the question which the noble Lord asked.
In picking up one point made by the noble Lord, Lord Rugby, may I amplify what I said earlier. Those who need glasses can go anywhere to make a purchase, provided that they have a prescription, and where they believe they will get the best and, of course, the quickest service.

§ Lord Cullen of Ashbourne
My Lords, have the Government abandoned their review of the NHS general optical service which was promised about 18 months ago?

§ Lord Glenarthur
Yes, my Lords; now that we have studied and reported our views on the OFT report, that supersedes the report to which my noble friend refers.