§ 3.4 p.m.
§ Report received.760
§ Clause 1 [Supply etc. of optical appliances]:
Lord Northfield moved Amendment No. 1:
Page 1, line 11, leave out (" "or") and insert
(" "(ee) which is designed, and is sold for the purpose of being used, only to correct or relieve presbyopia; or").
§ The noble Lord said: My Lords, this amendment deals with the issue of the sale of what we have come to call reading spectacles; reading spectacle sales over the counter, also as we have come to call it; the free sale of these reading glasses for people who suffer from presbyopia. May I say right away that I am very grateful to the noble Lord, Lord Glenarthur, for getting this amendment into its correct technical form. He was kind enough to help us on that point and I am very grateful indeed.
§ We dealt with this issue at Committee stage under a different and less satisfactory amendment. The debate, if I may say so in all frankness to your Lordships, was unsatisfactory. It was frankly unsatisfactory because the noble Lord who replied to it failed to answer any of the arguments that we put up at that time. May I rehearse very briefly the arguments that we made on that occasion. We said, first of all, that presbyopia is not a disease of the eyes. We said that this was a natural condition that occurs with ageing and leads people to have a loss of ability of the eye to focus on nearby objects as they get older. This is. I understand, owing to some loss of the elasticity in the lens of the eye in adjusting in that way. The Office of Fair Trading report also makes clear that it accepts that presbyopia is not a disease. We said this to the Minister. He made no comment upon it.
§ We have made Ministers accept that wearing the wrong spectacles does not cause any harm. We have got them to agree that selling commercial frames should be looked at as a commercial activity. We now want them to go this third stage and agree that presbyopia s not a disease and should not be treated as a disease in regard to the way that these things are put on sale in the community.
§ The second point to which the Minister gave no answer at all was this. We pointed out that self-selection in shops is not the degrading process it used to be 30 or 40 years ago, rummaging about in a pile of old spectacles. Nowadays spectacles are sold in reputable shops with proper display, with proper description of the degree of correction. There is nothing degrading about this sort of self-service. He made no comment on that one, either.
§ We pointed out that in a public opinion survey conducted by the Office of Fair Trading 98 per cent. of the public said that they knew they should have sight tests when they buy spectacles, so there is no reason to think that if we allowed the open sale of these reading spectacles many people would foolishly avoid having eye tests and instead would simply buy these spectacles. Public opinion has become alerted to the need for eye tests after 30 years of the National Health Service; and a very good thing too. Again, the Minister made no comment on this point.
§ We pointed out that people should have the freedom to buy spare pairs and fashion pairs. These are simple appliances for people who need slight degrees of correction as they get older. These items are often, for women particularly, a matter of fashion. 761 Again he made no comment. We raised the issue of personal freedom. We said that paternalism was going too far; we should leave the consumer with the right to accept a lower range of service for a lower price, which would in fact be the situation in this case, if he chose to buy these cheap spectacles for a few pounds instead of the more expensive ones personally dispensed for him. Again he made no comment.
§ Finally, we raised the figures about the risk of glaucoma and I pointed out that the risk rate in our society was something of the order of 0.2 to 2 per cent. of about 3 per cent. of the population, which amounts to something like six people in a thousand—or is it six people in ten thousand? I do not know, but the figure is ridiculously small. Again, although the main force of the Government's case is the detection of disease, the Minister made no comment on the degree of risk that is entailed and which we have to balance in making a judgment on this matter. With great respect, therefore, the answer that we had to our case was very unsatisfactory.
§ What was the Government's case, such as it was, on that occasion? It was, I think, composed of three points. One step at a time is the first point; namely, the relaxation in the Bill allowing non-opticians to dispense spectacles against a prescription was one step down the road towards liberalisation. Let us see how we get on, he said, or words to that effect. The second point was that he said that sight tests before glasses—if I may abbreviate it thus—was in line with thinking and practice in most of the Western countries. I think I have quoted him virtually verbatim on that point. Frankly, that is not the case. It is untrue.
Paragraph 7.28 of the Office of Fair Trading report reads:
Fifthly, it is possible in some countries for any retailer to offer ready made spectacles for sale over the counter. Such countries include Greece, Japan, Portugal, Sweden, certain states or provinces of Australia, Canada, and the United States of America".
I could add Denmark to that and several others. There is no overwhelming list of Western countries who are on the Government's side in this matter. Frankly, the noble Lord was mistaken in that view.
§ The Government's final case was, "Oh, but there are other diseases as well as glaucoma from which people may be suffering and we want to protect them by allowing the optician to have the opportunity to diagnose them." I want to deal with that because I think it is the only case left for the Government to stand on. What a pity they do not balance that case against all the other issues we have put up and to which the noble Lord has so far given no answer.
I conclude by taking three points once again. The personal freedom issue, I think, is one of the strengths of those who agree with me on this matter. I quote from one medical practitioner. He is one of many and I do not describe him as particularly more knowledgeable than anyone else, but he puts it rather well:
It is difficult to see why this particular function of the body"—
he is talking about eyesight—
should be singled out for special attention over all others. After all, it is legal still to examine—and even to treat—all other parts of the body from the head to the feet, provided the person so doing does not pretend he is a registered medical practitioner.".
He can say that again! Near where I live, in Lambeth, there is a small shop where all sorts of certificates for
naturopathy, osteopathy, and so on, are in the window and it has plenty of clients. It is done in perfect freedom, and I have no objection to that. It is perfectly right that that freedom should exist in our society for these non-registered people to practise if people want to go to them and provided they do not make medical claims for what they are doing. The medical opinion I was quoting continues:
As to the supply of appliances and drugs these are also subject to legislation as are spectacles. The relevant Act is the Medicines Act. Here, the yardstick as to whether sales are restricted to 'prescription only' depends on the nature of the product. Any product which could do serious harm tends to be 'on prescription only' ".
There again, we have to interpolate and say that the Government have of course admitted these do no harm so why cannot spectacles be put on the same level as any other medicine of that kind that is freely available? Finally, the medical practitioner concludes:
Thus a very large number of drugs are included, all of which can be shown to have potentially harmful or even lethal effects".—
freely on sale over the counter—and adds:
Incidentally, practically no surgical appliances are restricted to prescription only. At a rough guess I should say that spectacles are the only one".
When we are back to considerations of that freedom and that many medicines are freely on sale, why are we putting spectacles into a different category? I cannot see any justification for not allowing people the freedom to choose what they do in this matter.
§ My second point—and I want to be brief—concerns the dangers we are running into with this Bill in this matter of presbyopia. I am told that it is very likely that opticians may try to frustrate the Bill in a particular way. It is well known that the eye varies in its correction needs during the day. When you wake up in the morning you need less correction than in the evening if you are suffering from presbyopia—as I do. Your need of prescription can vary by about one quarter—.25 of a diopter—depending on the time of day and, as I think Mr. Trevor-Roper says, even your nervousness when you go to the opticians can alter your correction need by .25 of a diopter.
§ What we suspect opticians will do in order to frustrate the selling of these ready made type of spectacles is to give people minutely differing prescriptions for their two eyes, so that the possibility of being able to buy spectacles with a single correction of say 1.75, 2.0, 2.25 or 2.50 will disappear because they have been given a prescription which says 1.75 in one eye and 1.85 in the other. That will be a considerable danger in frustrating the intentions of the Bill, which is to get cheaper prescriptions. Are the Government prepared to say that opticians can have the tolerance within .25 of a diopter in final dispensing? That would enable people in many cases to go into a shop where they can buy spectacles—under the Bill of course with their prescription—and for the optician then to say, "Well, I do not have ready made spectacles that absolutely fit your eyes at 1.75 and 1.85, but I have some here at 1.75 in both eyes which are very cheap. You can take your choice. Either have the very cheap ones with the simple correction and probably find no difference or I will have to charge a great deal more for spectacles specially made to suit your eyes with this minute degree of difference between the two lenses." We must 763 have more tolerance in corrections in the final delivery of spectacles before this Bill will work properly.
Finally, we come to the issue of the risk of disease. This is the only issue on which the Government has any credibility left. I want to quote what the Office of Fair Trading said on this matter when summarising its findings on the issue of disease. Paragraph 9.71 states:
It is necessary to balance the possibility that"—
I omit a few words which are of no consequence—
Some people would run the risk of not having treatable injuries and illnesses detected. It is also possible that some consumers might choose spectacles which did not give optimum visual performance and that some of these might experience minor physical discomfort.
The OFT is dealing of course with reading glasses. The summary sentence concludes:
any such disbenefits would be marginal. The argument that there would be an increase in accidents as a result of self-selection is unconvincing. Any possible danger to children's eyesight appears to be capable of resolution.
—as, of course, it is being resolved in the Bill. So the Office of Fair Trading said there is nothing in this medical argument. I have said the figures are infinitesimal and the OFT says that any effects are marginal.
§ I do not want to end this debate today on a Division if we can avoid it because that would be a sterile outcome of many years of campaigning by many of us to get this degree of personal freedom reinstated. I wonder whether the Minister could go so far today as to say, "Yes, we accept that there are very strong arguments indeed"—including those he has failed to answer so far—"and the only argument really left is the one about the danger of non-detection of disease." If the Government would then go on to say that they accept there is some conflict in the medical world about this: that there are many eminent people who feel strongly—as I do—that the Government's policy is misconceived and are prepared to back it by medical evidence and that they will agree to hold an inquiry on this pure medical point as to whether there is anything in this case about the degree and necessity of eye testing in order to prevent disease, I would be satisfied because that would be the next stage along this road of greater freedom in this respect.
§ I had to fight for this Office of Fair Trading inquiry which has brought the present reforms in the Bill. I am quite happy to wait for another inquiry by medical men along the lines that I have indicated on the issue of whether there is anything in the medical argument which is all that is now left to the Government. If the noble Lord will take this idea on board I would not wish to press this matter to a Division today. However, we think we are entitled to a better answer than we had in Committee. I beg to move.
§ 3.20 p.m.
§ Lord Bruce-Gardyne
I should very much like to support what the noble Lord, Lord Northfield, has said. I must say it is always a great joy and a pleasure to hear a Socialist extolling the virtues of individual choice and customer satisfaction. I hasten to acknowledge that the noble Lord, on this subject at least, has always been entirely consistent and I do not remotely suggest that this is a deathbed repentence or anything 764 of that sort. Nevertheless it is very nice to hear that coming from the other side of the House, and I should like to think that it would receive an answering chord from my noble friend when he comes to reply to the debate. I only want to speak briefly: I do not want again to incur the wrath of my noble friend Lord Mottistone which I incurred when we were discussing these matters at Committee stage. In any case we had a lengthy discussion at that time.
I thought, if I may say so, that the noble Lord was a little unkind to my noble friend who will be replying to this debate in the charge that he made that my noble friend had offered no response to the earlier debate. I think that is unjustified: it seems to me that my noble friend did advance one argument, to which the noble Lord referred, against the proposition contained in this amendment, and I should like to turn to that in a moment.
First, however, I should like to say that I feel the outstanding concern that one has, which still outstands, notwithstanding what I would certainly accept as a very major step forward in respect of the retailing of spectacles for reading purposes which is achieved by this Bill and one for which I am personally extremely grateful, as I am sure many other noble Lords must be also. The outstanding concern remains that we are still requiring an optician to conduct a sight test as a preliminary to the supply of spectacles for reading purposes from a retailer. I must admit that I still find it hard to resist the conclusion that the essential purpose of retaining the sight-testing stipulation for opticians is to enable them, if one may so put it, to draw the customers into their parlours. I think the point made by the noble Lord about the possibility of tolerances of diopters being abused for the purposes of preventing people taking their prescriptions to another retail outlet is an important one and it is one which I hope that my noble friend will have something to say about when he comes to reply to the debate.
When he was speaking at the Committee stage on 12th June, my noble friend Lord Glenarthur said that a change in the terms and conditions now to be discussed with optical bodies and others would "make it a positive requirement" for prescriptions to be handed over to the customer when he went for a sight test. However, this undertaking is subject to consultation with the optical bodies and, in all fairness, one has to say that one wonders how keen they will be to accept such a proposition. So again I hope that when my noble friend comes to reply to the debate this afternoon he will be able to assure us that it is the Government's firm and fixed intention that it will be an obligation on those conducting a sight test in future to hand over the prescription automatically to their customers so that their customers can choose whether or not to take the prescription elsewhere to obtain their reading glasses.
However, even if this requirement were firmly entrenched, the fact would remain that under the Bill as it stands, as the noble Lord has pointed out, the person suffering from presbyopia would still have to make an appointment for an eye test, would need to have the test and then to take the prescription, if he or she was so minded, to a point of retail sale. Meanwhile, the individual would still be relying perhaps on 765 borrowed glasses, which I would suggest might cause a good deal more temporary inconvenience and discomfort than a possible marginal mis-selection of reading glasses at the point of retail sale.
When it comes to the matter of diopter tolerances, I must tell your Lordships that subsequent to our last debate I happened to be sent (totally unsolicited, I hasten to say) a substantial consignment of assorted reading glasses, one pair of which I am wearing today, which seemed to have a wide variety of diopters. I am bound to say that most of them appeared to enable me to read perfectly satisfactorily without any disadvantage of any kind whatsoever. I think that that reinforces the point, the dubiety of the argument about diopter tolerances, and the danger of precisely the sort of obstacle which the noble Lord, Lord Northfield, referred to as being artifically erected.
The real issue remains: why are the Government still of the view that a prior test is required for the purpose of reading glasses by those who are suffering from presbyopia? If I may just remind the House of the key objection to which the noble Lord, Lord Northfield, referred—that is, the precise wording of the key objection which my noble friend Lord Caithness put before your Lordships when we discussed these matters on 12th June, he said at column 1082:sight tests perform a valuable role in ensuring that glaucoma and certain other serious eye and general diseases … are detected.I must say that I wonder very much what the substantive evidence for that proposition is. When we discussed this in Committee I ventured to draw your Lordships' attention to evidence I had seen that sight tests were not actually, and had demonstrably been shown not to be, an effective method of testing and identifying these very serious diseases. I strongly endorse the proposition made by the noble Lord, Lord Northfield, this afternoon that it would be extremely helpful if the Government could undertake to have this proposition scientifically investigated to establish whether in fact there is any genuine usefulness in the sight test, in terms of identifying these very serious diseases. I am quite sure that if it were scientifically and medically established that there was a genuine value in the sight test, as conducted up to now, as a means of identifying these serious diseases, then certainly, for my part (and I am sure that many of my noble friends would also accept this), I would accept that the case of the preliminary sight test was made out.
But, unless and until we have such an inquiry to establish the fact, I must say to my noble friend that one is left with the lingering suspicion that essentially the sight test is a form of artificial barrier to try to preserve some measure of protection for a particular interest—namely, that of the opticians—after the changes proposed by the legislation are brought through. In short, I believe that this legislation will in any case represent a major step forward towards greater freedom of choice, as the noble Lord pointed out and towards lower prices for those who need reading glasses, who happen to form a substantial section of the population. I can only join with the noble Lord in wishing that we can carry this process just one further step forward at any rate on the backing of a full inquiry to establish the facts. In the light of 766 that, I certainly support everything that the noble Lord said in defence of his amendment.
§ Lord Rugby
My Lords, I should very much like to second what my noble friend Lord Northfield has just said. It is far from being, as far as he is concerned, a deathbed change of heart because I have followed what he said in another place many years ago. He has been entirely consistent in everything he has said. It is a very great pity, for if he had not talked the debate out at that time, we would not now have this problem in front of us.
I should just like to say one word about presbyopia because it sounds such a sinister word, and people seem to get the idea it is some form of disease. Presbyopia is a rather long word made up of Greek presby meaning age, and opia meaning eye. For instance, we have the word "Presbyterian" which means a church of elders, and a presbyopia is an elderly eye. Consequently there is nothing one can do about the advance of age. You do not cure or remedy old age, and opticians certainly do not have an elixir which is going to remedy old age, especially when applicable to the muscles of the eye. For instance, an athlete can no longer run a four-minute mile after the age of about 20 or 22. He can probably cover a mile in four minutes if he is riding a bicycle. In precisely the same way, a pair of spectacles will assist the muscles of the eye at a later stage in life. They will assist in precisely the same way that a bicycle will help the muscles of the legs when one is 50 years old and therefore one can quite possibly cover the mile in four minutes at that age. These two examples are entirely parallel. There is here nothing whatever to do with anything relating to disease. The sooner that people realise that opticians are not alleviating or curing old age, they are simply providing what in other words is an appliance which will ameliorate the ageing process, then I think they will understand precisely what we are talking about when we refer to reading glasses.
§ Lord Ennals
My Lords, I shall be extremely brief. I just want to say to the Minister that I hope that he will make no concessions whatsoever to the arguments that have been put forward, even by my noble friend. Even on our side it has been known that we have differences and there is nothing disgraceful about that.
However, I want to say quite seriously that there is a powerful case for sight testing. How can someone know whether they have presbyopia or something else? The assumption that because there is something wrong with your eyesight you can diagnose it for yourself is in my view absolute nonsense and rubbish. I believe that anything that discourages people either from seeing the doctor, the dentist or the optician cannot be wise because we cannot tell for ourselves what may be wrong with our eyesight, teeth, health, or what-have-you.
The second point I want to make, which is the last one, is that I thought that the noble Lord, Lord Bruce-Gardyne, was grossly unfair when he said that the Government's Bill, and this part of the Bill, was designed simply to protect opticians. I do not believe that for a moment. There are parts of the Bill of which I am extremely critical and have voted against and spoken against. However, I am concerned with the protection of the patient. That is what this is about. 767 The noble Lords on either side who have argued their case seem to have their knives into the opticians and care little for the patients. I want to speak up for the patients and I hope that the noble Lord the Minister, when he replies, will not budge an inch.
§ Lord Orr-Ewing
My Lords, I want to support what the noble Lord, Lord Northfield, said in very brief remarks because he made out his case so well, as did my noble friend Lord Bruce-Gardyne, and others, and it would be a mistake to lengthen my remarks. However, I have been wondering, ever since this Bill came forward and I began to look at the history of it for the past 30 years, why it is that we alone have set up this cumbersome and very expensive system at the end of which many people in this country pay £50 for a pair of reading spectacles. People in other countries which have not set up this system are just as careful about the medical condition of their eyes. The majority of states in the USA and Japan—both those huge nations—where they do sometimes suffer from poor eyesight, have found it perfectly satisfactory not to set up the system which we set up 30 years ago. I wonder why the Government have taken such a tentative, tiny step forward towards liberty after 30 years of trial, after seeing the difference between costs here and those in oveseas countries where greater liberty exists. I cannot help feeling it is because there are enormous profits sloshing around in the present system.
The difference between £10 in one country and £50 here is £40 per pair of reading spectacles. If half-a-million are bought in a year there is £20 million at risk for the opticians. No wonder they are fighting from their corner. No wonder the noble Lord, Lord Cullen, who has declared his interest, puts up a tremendous case. It all rests on the medical case: just in case there is something wrong with your eyes. My God! you might as well say that you should not eat because you may get indigestion, or because you have indigestion you must stop eating until you have had every conceivable test on your stomach. These things happen to one. To suppose that we are a sort of nanny state and that if you have something, you cannot prescribe for yourself and you cannot go to the opticians of a free will because your eyes are not as clear as you wish them to be is a ridiculous state of affairs.
Of course those like the Labour Front Bench who support monopoly in every field of our life, have to support the present monopoly. But surely the rest of us must abide by a little step towards freedom. I should like to support what the noble Lord, Lord Northfield, said. The eye surgeons are the best qualified. They should set up a small investigation to see whether these tests do detect whether there is incipient disease. No doubt they would take some evidence but I suggest that such a committee should not be peopled and certainly should not be dominated by the opticians since they have such a vested interest in the outcome. So I do hope my noble friend on the Front Bench will consider very seriously and sympathetically the views put forward on this issue from both sides of the House and from the Cross-Benches.
§ Lord Mottistone
My Lords, if I may reply directly to my noble friend, we agree on most things but on this he is so fundamentally and irretrievably wrong that it is sad to hear. The various speeches have been very lengthy. I entirely support what the noble Lord, Lord Ennals, said. It was sad to hear the noble Lord, Lord Northfield, repeating what he has said so many times already. I answered (at column 1078 of Hansard at the Committee stage) what he had to say about 98 per cent., knowing they need a prescription. Noble Lords might like to read that. There were many other points the noble Lord made which other people have answered. My noble friend Lord Bruce-Gardyne's speech was splendidly shorter than last time. However, he, too, repeated much of what he said before. Two of the things that my noble friend Lord On-Ewing said require direct refutation. He said that reading specs now cost £50. I can tell your Lordships that currently reading specs cost from £10.55 from a registered optician.
§ Lord Mottistone
Well, my Lords, that is what it is, you see. We will not go into the detailed arguments because there is not time, but the specs that are unsubsidised will be cheaper under the new system. That is the first point. It gives the wrong impression that opticians are making tremendous profits. All these vicious remarks about how wicked the opticians are, are getting off the point and not ones with which your Lordships should bother.
On the question of the medical aspects, as your Lordships may well know, there was a special survey carried out in 1981 and 1982 by Public Attitude Surveys—not a biased body—on 400 practices of members of the Association of Optical Practitioners which said that 13 per cent. of the patients examined had a variety of conditions which required medical consideration. Thirteen per cent. is an extremely high number. It is also true that, at the same time, 26 per cent. were not given prescriptions. A quarter of them were not forced to have specs that they did not need. That is another point worth observing.
I could repeat the medical terms for what is wrong but I would not want to waste your Lordships' time. All that I can say is that the medical terms are ones that are strange to me, and ones that I very much doubt I would have been able to identify myself if there had been no one else to inform me. I might have gone to the doctor. But all these are cases where you do not really know what is happening and so you do not bother anyone. Maybe the first sign you get is that you cannot see as well as you want. So this is a very good check, and 13 per cent. is a very high number who would otherwise have been missed.
I hope therefore that the medical aspect of this matter is not dismissed as being so much pie in the sky and not worth bothering with. It is very important. The prices are not nearly so bad as pointed out. I hope that my noble friend on the Front Bench who is to reply will speak very much in the same terms as my noble friend Lord Caithness at column 1082 on a similar amendment at Committee stage.
§ Baroness Gaitskell
My Lords, I shall not take long. May I ask the Government please to explain to us carefully what is happening about this particular problem? It seems to me—I know a little about it, having had my eyes dealt with in the proper places—that this is a tussle between knowledge and business. It is the business aspect of selling spectacles and not the aspect of getting the proper spectacles for your eyes that needs looking into.
§ 3.42 p.m.
§ Lord Monson
My Lords, although my name is down to Amendment No. 2, I would have the greatest pleasure in going through the Division Lobby in support of either of these two amendments, which are directed towards much the same end. I cannot add much to the case expounded so eloquently by the noble Lord, Lord Northfield, supported by the noble Lord, Lord Bruce-Gardyne, and by my noble friend Lord Rugby, except to say this (I shall be briefer than the noble Lord, Lord Mottistone). The Government have now conceded that wearing the wrong glasses cannot damage your health. They could hardly do otherwise, given the great weight of medical opinion, including the testimony of some of our most eminent eye surgeons, to this effect.
The Government's sole excuse for continuing to insist on spectacle buyers undergoing periodic eye tests is that such tests may, not will, but may, accidentally uncover some ailment unconnected with the need to wear glasses. If this argument is accepted, then, logically, the Government should now introduce a Bill to require every single adult in the country to submit to a periodic eye test whether or not he or she needs glasses. The question now, if the Government resist both the amendments, is whether the Government intend to follow through their own argument to the logical conclusion.
§ Baroness Phillips
My Lords, I should like to support my noble friend on the Front Bench, Lord Ennals. Once again, we have heard the old argument about costs. We are not talking about costs today. We are talking about health. That is a totally different thing. Like many of your Lordships, I was given the doubtful present of two pairs of spectacles which one could buy presumably, if this amendment was accepted. They were described as magnifying glasses. They were accompanied by a document stating that most people over 40—that is a little frightening because I still do not have spectacles and I am a little over 40—do not suffer from any other eye defect than that given this strange name on the Marshalled List. In other words they need only to have magnifying glasses.
I have carried out a slight consumer test with these spectacles. As one young person pointed out to me, if you use a magnifying glass you do not actually keep the same position. You use it by moving it until it provides the strength that you need. If you are to put on these wretched magnifying glasses, I suspect that very quickly you would have some kind of unpleasant sensation. My plea is that we need the professional skills of people. I can recall my father describing how people took out teeth. They were unqualified. I am not talking about hundreds of years ago when people bought spectacles. Next, my Lords, we shall have a 770 do-it-yourself appendix kit. There is no limit to this. We do not want self-medication. We want skills that will protect the eyesight of our people. Even if it is only a question of one in a hundred, how do you know that you are not the one who needs the extra protection?
§ Lord Cullen of Ashbourne
My Lords, I wish only to speak briefly. Frankly, we have heard these arguments not only in Committee but over the last four or five years. I await with what patience I can muster to hear whether my noble friend on the Front Bench agrees that there should be an inquiry into the health aspects and whether the medical and ophthalmological people agree that there is danger in what the amendment proposes. I know that opticians would welcome it. At least, I think that they would. I hope therefore that my noble friend will be prepared to agree to that. The amendment, with which I disagree entirely will, I hope, be withdrawn.
§ Baroness Gardner of Parkes
My Lords, I wish to support the amendment. My reasons are probably different to those of many other of your Lordships. I very much deplore the change in regard to National Health Service opticians. I do not like what the Government are doing in terms of changing the Opticians Act. However, this amendment is one that I do go along with for the simple reason that it is very desirable, as everyone says, to have your eyes examined. In a survey into how many people needed dental treatment and how many people then said that they would go but did not, it was found that one-third never presented themselves for examination.
I believe that there are a great many people who cannot see too well who never go to the optician for an examination. Those are the people, about whom the noble Baroness, Lady Phillips, spoke, who are managing with a magnifying glass. I am sure that there is not one person in this Chamber who does not know someone who has not got glasses and who is managing with a magnifying glass.
Those people would be helped by glasses of this type. Instead of having to hang it round their neck as embroiderers do, or have it so that they can pick it up, they could be helped in the form of spectacles. I agree that they cannot be worn for any length of time. However, as the noble Baroness said, you have to move your magnifying glass. In the same way, you have to change your magnifying spectacles if your eyes change. Those who would be helped are the people who will not go for an examination. At the moment, they have nothing available to them except a magnifying glass. I believe that they would be helped by the amendment. I do not believe that the changes in the general optical pattern will help them.
§ Baroness Hornsby-Smith
My Lords, if you stay in the Mother of Parliaments long enough, you occasionally see it performing somersaults. I was in the other place and in the Ministry of Health when the legislation was brought in that we now seek to amend. The bête noire then was the unfortunate company of Woolworths. Virtually the overwhelmiing majority of the House opposed the fact that people could walk in and, for a limited amount of money, buy spectacles that might not suit their sight. It is interesting to see the complete change now being discussed by your Lordships.
771 I am at one with those who wish to see the exorbitant charge that is made for frames brought down. I had the misfortune the first day of my holiday abroad to have my spectacles stepped upon by a lively little boy, but mercifully the lens did not break. I obtained the best pair of frames that I have ever acquired in my life, which I traced back and found were made in Germany. I still keep them and have new lenses fitted in them because they are the best frames I have every had. They cost £18, compared to the £64 which I paid in England for the original frames which were nowhere near as good.
So I am all for some competition in regard to frames, but I am deeply concerned, even taking into account what my noble friend Lady Gardner has said, that there are some people who never will go to have their eyes tested. Equally there are people who, when they are ill, will not see a doctor. But should we deny those who are prepared to go for skilled aid, and should have it? I do not think we should avoid the fact that there is variation in people's sight. My eyes are not the same: for one I have an entirely different lens from the lens I have for the other. Therefore, if one buys just magnifying lenses I do not believe that one is going to get the skilled medical service required. By all means have competition in regard to the frames, but please let us keep the protection in regard to the lenses.
The Earl of Caithness
My Lords, I think the noble Lord, Lord Northfield, was a little unfair and incorrect in what he said when he opened his remarks. We have taken very seriously the suggestion of my noble friend Lord Orr-Ewing. We have considered carefully everything that has been said in another place and in this House with regard to this amendment. My noble friend Lord Glenarthur and I attempted to answer in detail all the points that he raised at Committee stage, and I think we did rather well.
With the leave of the House, I should like to speak also to Amendment No. 2. We seem to have dealt with that as well, and the arguments are very similar.Amendment No. 2: Page 2, line 2, at end insert ("; or(g) containing two lenses of equal strength and of a power not exceeding 4 dioptres for reading purposes.";").The Government have only one major reservation concerning these amendments. It is simply this—that the current link between sight testing and the sale of glasses would be broken. We can argue at length over the health benefits of retaining this link versus the economic benefits of cheap, ready-made reading glasses which it would allow. The Government see the major risk to the public as being from undetected glaucoma. Other diseases can be detected as a result of the sight test but are of lesser significance statistically. Glaucoma is a major cause of blindness. Its onset is most usual in middle age or later. Thus, it attacks the very group who in the normal way would be most likely to seek out aid for reading glasses as a result of presbyopia.
The disease affects up to 2 per cent. of the over-40 population. This may not sound a very high percentage, as the noble Lord, Lord Northfield, has said. The problem is that we do not know who will be in the 2 per cent. and who will not. Many cases of glaucoma are found during the course of a routine 772 sight test by an optician. It is true that some referrals by opticians may prove to be wrong. This is a possibility with any referral to hospital for a somewhat rare suspected condition. But the fact remains that to break the link between sight tests and the sale of glasses would be to lose an existing safeguard. We do not believe the extra advantages of ready-made glasses are sufficient to expose the public to this extra risk. A sight test is readily available under the NHS, and we are taking active steps to ensure that prescriptions following tests also become readily available.
We believe that the Bill increases competition. As my noble friend Lord Orr-Ewing wants, it does break the monopoly. It will reduce the high prices that he talks about, but it will do so without increasing risks to the public. We believe that this is the correct course and that to go further would be unwise and unacceptable to the public at large.
Turning to Amendment No. 1 on its own, I have another objection in that it would be very difficult to enforce. One person's reading glasses for presbyopia can be the same as another's distance glasses. It would be wrong for a retailer to be asked to make judgments about the purpose for which glasses are required, or the customer's opticial needs. I do not stress this argument since, even if inappropriate glasses were thereby sold, no harm could be caused to the eyes. The main objection to self-selection is the break between sight testing and sale of glasses.
The noble Lord, Lord Northfield, asked a number of questions. I take on board his point about the possibility of opticians frustrating the Act. Of course, the Government do not wish to see this. I think this can be covered in regulations; but I will look into the matter. In reply to his more substantial point about an inquiry, we do not think an inquiry is necessary. We think that our reasons for keeping the Bill as it stands are the right solution.
The noble Lord talked, too, about other countries. The experience abroad is mixed. Some countries have arrangements like the present restrictions, and some have less. But one factor that should not be overlooked in such comparisons is the ready availability of a free sight test under the NHS. The need to obtain such a test is not an onerous requirement; it is a good example of preventive medicine.
We would agree with the noble Lord, Lord Northfield, that presbyopia is not a disease but a defect of sight; I think I covered that in my earlier remarks. He talked also about freedom and self-selection. We agree that, as such, it is not wrong. Self-selected glasses cannot damage eyes; on this, we are on common ground with the noble Lord and others. However, we believe that the availability of self-selected glasses will lead to less sight testing. He mentioned the figure of 98 per cent. We are very worried that this will go down if we have free access. As I have said already, we cannot rule out so lightly the danger from glaucoma. It is true that sometimes the absolute freedom of the individual has to be tempered to prevent self-harm. As an example of that, I could quote the seat belt regulations.
My noble friend Lord Bruce-Gardyne raised a point about prescriptions and asked whether these would be handed to the customer. I recommend that he reads Hansard of 12th June, col. 1064, where my noble 773 friend Lord Glenarthur confirmed this. We have not changed our minds.
The noble Lord, Lord Northfield, raised the question of evidence to the Office of Fair Trading. No doubt he will be aware that the Faculty of Ophthalmologists, in their evidence to the OFT review and in comments to the Government, have confirmed the need for the prior requirement of a sight test to be maintained. I think these are very powerful arguments and I hope the noble Lord will accept them and withdraw his amendment.
§ Lord Monson
My Lords, before the noble Lord sits down, may I put one question to him. He claimed that anyone needing glasses was entitled to a free sight test. Every year there are millions of overseas visitors to this country. By the law of averages, some of them are bound to break or lose their glasses while they are in this country. Can he say whether these people are entitled to a free eye test?
The Earl of Caithness
My Lords, with the leave of the House, I should like to say that I think we covered this in Committee. The answer is that, provided they satisfy the appropriate requirements, of course they are; if they do not, they are not.
§ Lord Broxbourne
My Lords, I rise for only the briefest moment. As it happened, I was the Minister responsible for these matters when the principal Act—the Opticians Act—was placed upon the statute hook. I am sorry to be so old. I hope I am the last person to make any assumption, or even any plausible implication, that any product of mine, on the statute book or elsewhere, was incapable of improvement after nearly 30 years. I am sure it is, and could be improved. But I accept basically the central point of my noble friend the Minister as to the importance of the sight-testing link, and would wish to support the Government on this matter if, in the event, support is required.
But I am bound to say this to Ministers. One could support them with a greater enthusiasm and less of an element of doubt if they reinforced their central argument with a clearer definitive and pronounced determination to look very seriously at the possibility of meeting the economic argument put forward so clearly by some of my noble friends and by the noble Lord opposite, in order to reduce the cost without sacrificing the health aspect. If my noble friend would bend his efforts to that and get his colleagues to do so, then we would support him with greater enthusiasm and vigour.
§ Lord Northfield
My Lords, I shall be brief. I would say to the noble Lord, Lord Broxbourne, that I am a supporter of the Bill; let there be no doubt about that. The Bill is a step towards liberalisation. It will, in my view, bring down prices. So do not let us divide too much over this issue. I want to take the reform one stage further, but I applaud the step that is in the Bill already.
To my noble friend on the Front Bench I say simply that in 1958 I heard his predecessors say similar things, all of which we have now turned over. In 1958 his predecessors said not only did we need eye tests for glaucoma, but the wearing of wrong spectacles would do one harm. In 1958 they also said that the opticians 774 would not "rook" us as regards spectacle frame prices. We now know that to be untrue. I spent 30 years dispelling those two ideas, and I am quite prepared to go on spending another 10 years pursuing this third idea which concerns the issue of whether there should be final freedom for sales over the counter. My noble friend and his colleagues have been proved wrong on two essential points which were the backbone of the case in 1958, and I am quite prepared to go on doing battle on the third one.
We were asked, why have we our knives into the opticians? We do not. I have never mentioned the opticians. I have simply said that we are for the consumers. We ought to have freedom and we ought to have lower prices. We have seen plenty of evidence in America and other countries where the type of thing which is proposed in my amendment is allowed and where no conceivable harm results. We must go on saying that. There are examples in the Western world, in countries which are as democratic and as advanced as ours in their thinking, where this is allowed and where no conceivable harm results. We have got to go on saying it.
The noble Lord, Lord Mottistone, really fell into a very big trap. He got into the worst of difficulties. He chose some statistics which were convenient to himself, but forgot those that were not convenient to his case. He chose a tiny survey which showed that 13 per cent. of patients were referred to medical practitioners. It was a tiny survey of 16,000 sight tests. The really big survey did not involve 16,000 sight tests. Your Lordships will find it referred to in the preceding paragraph of the Office of Fair Trading's report. It was a survey of 2.5 million sight tests, which showed that only 3 per cent.—not 13 per cent.—were then referred on medical grounds to their doctors. So the noble Lord fell into the most obvious trap of using the statistics most convenient to himself and in trying to pretend that there were not others much less convenient to his case.
The last point with which I shall deal is that of the noble Earl's about glaucoma. He said that 2 per cent. of the nation are at risk and that therefore everybody should have eye tests for fear of glaucoma. That was the noble Earl's case. I see that the noble Earl is saying, "No." I am not sure what his case was if it was not that.
§ Lord Northfield
My Lords, 2 per cent. over 40. That does not alter what I am going to say. One then has to ask how many people would be at risk if this freedom were available. The Office of Fair Trading estimates that if this freedom were allowed, only 3 per cent. to 5 per cent. of the population would buy these reading spectacles. So the only people at risk would be 2 per cent. of that 3 per cent. to 5 per cent. Only 2 per cent. of that 3 per cent. to 5 per cent. who availed themselves of the freedom would be at risk of non-dectection of glaucoma. Are we going to legislate, or continue to demand, that the whole of the nation should be tested in this way for glaucoma on first referral—which is all that it is, and very often it is wrong—simply because only 2 per cent. of 3 to 5 per 775 cent. of the population may be at risk? That makes it into very much of a nonsense.
I come to what to do about the amendment. My instinct is that we have probably pushed the Government as far as they will go on this Bill. I welcome the liberalisation. Quite contrary to my noble friends on the Front Bench, I think that the Bill is a great step forward. The time will come when we shall push the Government this additional one-third of the way on the three main issues that were behind the 1958 Act. But I should not like to sour that further process of softening up and conversion of the Government that I think we can continue by forcing a Division today. We shall produce the medical evidence. If the Government will not have the inquiry, then we shall find ways of setting up a form of inquiry which will bring out in the open the medical conflict as to whether there is any real need for these tests in order to detect medical conditions. That will be the best way forward, and in those circumstances I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.