HL Deb 10 July 1984 vol 454 cc779-819

4.19 p.m.

Consideration on Report resumed.

[Amendment No. 2 not moved.]

Lord Monson moved Amendment No. 3: Page 2, line 20, leave out from ("not") to ("before") in line 21 and insert ("earlier than two years").

The noble Lord said: My Lords, some of your Lordships may remember that at the Committee stage of this Bill I introduced an amendment designed to provide that if prescriptions were to be a prerequisite for obtaining spectacles for adults—and, of course, a great many of us believe that prescriptions should not be a prerequisite, as our debate on Amendments Nos. 1 and 2 demonstrated—then, at least if my amendment had been accepted, it would not be necessary to go to the trouble, and to some extent the indignity, of having to undergo an eye test more than once in every three years. This seemed to me to be more in line with this Government's professed philosophy of extending the areas of individual freedom and choice than is the formula in the Bill, which could permit regulations to he made requiring prescriptions to be renewed at much more frequent intervals.

The Government's reply (if I may try to encapsulate it accurately) was that although there was no present intention to require prescriptions to be renewed at intervals of less than two years, nevertheless total flexibility was desirable; hence the formula in the Bill as it stands. I find this most disturbing. What it means is that under pressure from the powerful opticians' lobby this Government, or more probably a future Government, could require prescriptions to be renewed at yearly or even six-monthly intervals. Accordingly, in an attempt at compromise, in this present amendment I have reduced the three-year interval originally proposed to two years. I trust that this will be acceptable to the Government, especially as all the amendment does is to regularise the present de facto position. I beg to move.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)

My Lords, as my noble friend, Lord Caithness explained at Committee stage when the noble Lord. Lord Monson, moved a similar amendment, the view of the medical profession is that prescriptions should have a validity of no more than two years, and we expect broadly to adopt this course. But circumstances change and I think it is desirable to avoid tying our hands in primary legislation to a specific period. Should we wish in the future to relax this requirement, we would of course need to find a place for amending legislation in the Government's programme. The noble Lord will be as well aware as I am that the programmes being what they are, we could not be sure of this ever being considered important enough to justify a special place.

I can assure the noble Lord that our thinking on the matter is close to his; rather closer, I believe, than he himself thinks it is. I see no reason why the orders should not reflect the two-year validity which he seeks, and I hope I can persuade him that orders will provide the appropriate vehicle with which to reflect his requirement.

Lord Monson

My Lords, I am grateful for that reply. The noble Lord mentioned the medical profession. I think he probably meant the optical profession: I am not sure about that, but no doubt the noble Lord will correct me if I am wrong. I am glad to know that his Government's position is closer to mine than I imagined. It is future governments who I am worried about, and that is why I am not happy with his reply because it could lead to the state of affairs which I described. The only reason I do not press this amendment further is that I think I have probably conceded too much in trying to compromise with the nanny state lobby: I really feel that I should have stuck with my original three-year interval. Accordingly, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

4.24 p.m.

Lord Cullen of Ashbourne moved Amendment No. 4: Page 2, line 23, at end insert— ("; and (c) any such order shall specify that a person shall not sell or supply any optical appliance unless the sale is effected by or under the supervision of a registered medical practitioner or registered optician or a person who has reached a proper standard of competence in ophthalmic dispensing as defined in the order.").

The noble Lord said: My Lords, I shall not try your Lordships' patience by again rehearsing the arguments against allowing unqualified and untrained persons to attempt optical dispensing. Before I go further I should. I think, declare my interest as President of the Federation of Optical Corporate Bodies. Your Lordships are well aware that widespread opposition to this proposal has been evidenced throughout the Bill's progress through Parliament. Members of both Houses, the optical and medical professions, as well as organisations representing the elderly, family practitioner committees, and community health councils have all expressed fears about what I regard as the Government's misguided proposal.

We are left in the position of trying to ensure that when orders are made under the Bill the Government will take account of the view which has been strongly expressed from all sides of your Lordships' Chamber during the Committee stage that no person should be allowed to do optical dispensing who has not reached a proper standard of dispensing skill. I do not seek to introduce an unnecessarily burdensome condition into the order, nor do I seek to reverse the Government's intention to allow unregistered persons to attempt optical dispensing. I recognise, with great regret, that that battle is lost for the moment. I cannot help commenting, however, that in the not too distant future the Government may well wish that they had not gone down this road.

What I seek is a requirement as to training, not a requirement as to registration. In an age when we foresee increasing standards of control being promulgated for chiropodists, travel agents and builders, and when even the director-general of the OFT supports these steps, is it not ironic that today we have to fight not for increasing controls, but for their mere maintenance in an area where accuracy, skill and training are of paramount importance in order that ophthalmic prescriptions can be translated into efficient optical applicances for the maximum visual welfare of the wearer?

Of course, I realise that the Government are determined to adhere to this proposal, even though other countries are going in the opposite direction and bringing in controls on the lines of the Opticians Act 1958; and I refer to Hong Kong and Singapore. I find it hard to believe that Her Majesty's Government will allow people with no qualifications at all to dispense prescriptions that have been paid for by the NHS and written by ophthalmologists, doctors, or ophthalmic opticians. Surely they must realise that some training is necessary and that it would be absurd to let loose on the public dispensers who do not know what they are doing.

If my noble friend on the Front Bench tells me that the Government are going to have consultations about training and that they will clarify their views in regulations, I shall withdraw the amendment and carefully examine the regulations when they come along. If, on the other hand, they do not contemplate even minimum standards, I should be inclined to press the amendment.

Lord Northfield

My Lords, it is always difficult to disagree with the noble Lord, Lord Cullen of Ashbourne. He is such a gentle and courteous person that I should never chose him for my enemy. You always faint before someone who deals with you so charmingly. I would question the first part of the noble Lord's amendment because it simply restates the legislation; namely, that optical applicances should be sold by a qualified person. All the noble Lord is doing is trying in the latter part of his amendment to leave open the door for unregistered people, subject to certain rules being made.

This was dealt with—and this is why I rise—at the Report stage in another place by the Minister of Health. What the Minister said was—and I want to ask a question about this—that he proposed to introduce British standards for both spectacles and the skill of the people allowed to dispense spectacles. That is what he said. I repeated it myself at Committee stage. It would be helpful if, when he replies on this point, the Minister would elaborate. I am glad to see that the noble Lord, Lord Cullen, agrees with me.

Just how far will the regulations, or whatever they are, that the Minister will introduce under the British standards system cover both the appliance and the training and skill of the person doing the dispensing? It is an important safeguard for the consumer, and I am happy at this point in a sense to support what the noble Lord is saying.

Lord Somers

My Lords, I should like to support the amendment of the noble Lord, Lord Cullen, very strongly. As has been said during our arguments on previous amendments, anything affecting the eyes does not do any harm. Possibly if you do not consider your eyes as part of yourself that is quite true. But I hardly think that it is true. If your wrist is affected by some exercise or something else then it has done you harm. If your ears are affected, that has done you harm. If your eyes are affected, that has done you harm. Therefore I strongly support the idea that expert opinion should not be shelved and completely ignored for the sake of economy.

There is another point that perhaps has not been generally recognised strongly enough: that is that no person's eyes are exactly the same. This was emphasised by a previous speaker during the discussion on the first two amendments: it is a fact. I was once told, interestingly, by an artist friend of mine that nobody's face is exactly the same on both sides. I shall not venture to debate that, but it is certainly true of the eyes. Therefore to buy a pair of glasses that may suit one eye may cause strain to the other. Accordingly, I am strongly in support of this amendment.

Lord Donaldson of Kingsbridge

My Lords, I should like to take up one point of fact which the noble Lord stated. We had from the Minister a most encouraging and unqualified statement in an earlier discussion that it is now accepted by every intelligent expert that the use of a magnifying glass over one's eye, whether it is exactly tuned to the best use or not, is unable to do damage to the eye. The noble Lord spoke of doing harm to the eye. It is just like saying that if somebody wears a ready-made suit it is doing harm to his body. It is not: it may make him look awful and may be uncomfortable. It is important that we should talk about realities. I have no further axe to grind about this. The Government have come away in the right direction, I am satisfied and I have kept out of the argument. But let us have the facts clear. I hope that the Minister will restate that, unequivocally, as he did before.

Lord Ferrier

My Lords, I should like to support what my noble friend Lord Cullen of Ashbourne has said. I hope that this amendment will be accepted by the House. It represents some measure of redemption for the ground which was lost when earlier in the proceedings on this Bill we retained Clause 1(1) as part of the Bill.

In answer to what the noble Lord, Lord Donaldson of Kingsbridge, said, I remember years ago in a similar debate from those Benches, Lord Winstanley, I believe, saying "Of course it does not harm an eye to wear glasses, but it does not stop the fact that someone stepping into a street may get run over by a bus because his spectacles have prevented him from seeing the bus coming". I hope that the House will accept my noble friend's amendment.

Earl Bathurst

My Lords, regarding the amendment which the noble Lord has moved, would it not be correct that he wants people trained to a certain standard to make glasses which contain specific lenses, whereas these magnifying glasses that we are hearing about will do no damage? I understand, with respect to the noble Lord opposite, that wrongly fitted eye glasses can do considerable damage, if it is the wrong type of lens for the eye. Is that the point of the noble Lord's amendment? The noble Lord or myself could fit magnifying glasses, but spectacles lenses such as the noble Lord and I wear should be fitted by a specialist. Will the noble Lord make that clear in his reply?

Lord Energlyn

My Lords, what I find rather unacceptable in this amendment is the correlation between a medical practitioner or registered optician, or a person who has reached a proper standard of competence. I suggest that we are really talking about ophthalmologists, who are the people competent to diagnose any defect in the eye, and not a person who has been trained to select lenses in some parametric apparatus. I would not vote for this amendment on those grounds.

Lord Ennals

My Lords, I rise to say one sentence. Since we debated this at length in the Committee stage and I made quite a lengthy, and I thought totally convincing, argument in favour of a similar amendment, I shall not repeat it now, but I totally support Lord Cullen.

Lord Rugby

My Lords, would not this amendment require an inspectorate to be set up to follow up all the opticians and to make quite sure that people who go to opticians to obtain glasses were getting precisely what was required for their eyesight? At the moment there is no inspectorate of any description and I would imagine that there is a danger that if we carry this amendment to that length it will create a demand for an inspectorate.

Lord Glenarthur

My Lords, I have listened carefully to my noble friend Lord Cullen of Ashbourne. I understand and respect the strength of feeling behind his arguments. What he said and what his amendment encapsulates is the quite different perceptions of what my noble friend and the Government feel in the matter of optical appliances and their sale. He seemed to indicate that he thinks we have gone too far, yet the noble Lord, Lord Northfield, does not feel that we have gone far enough. But I do not think there is great merit in following that theme, which is basically a Second Reading theme, in much greater detail this afternoon

My noble friend is clearly wedded to the view that the only way to ensure that satisfactory glasses are sold is by placing controls over who can sell them. I respect his point of view even though I do not agree with it. The amendment loosens the present requirement that only doctors or registered opticians can sell them. However it would make us lay down alternative requirements for those allowed to sell. Nothing I have heard in this debate this afternoon convinces me that glasses require such an approach. The plain fact is that the vast majority of goods and services sold in this country are not regulated in this way. Any necessary safeguards are built around the product itself. The case has not been made out for glasses to be treated differently. The quality of the materials used in glasses can and will be regulated. The optical properties of the appliance also can and will be regulated. As many of your Lordships know, the optical properties of a lens can be quickly checked on a machine called a focimeter. The optical centration of most lenses can be assured by a simple measurement of the distance between the wearer's pupils.

What matters to the public is not whether the seller has qualifications, but whether their own glasses are satisfactory. This is the test that really matters. From listening to some of the arguments one is tempted to believe that because all sellers now have a diploma this of itself is a guarantee of the quality of the product or service. But that is something of a fallacy. Opticians are human. They make mistakes just the same as dentists—with all respect to my noble friend Lady Gardner, who I see is not here—doctors, lawyers and others as well all make mistakes. I am sure that the various bodies who arrange professional negligence insurance would wish that that diplomas did bestow infallibility, but the fact is that they do not.

The noble Lord, Lord Northfield, asked for clarification on a point about British standards and quoted my right honourable friend the Minister of Health in another place. There is no British standard on dispensing. What the British standard will provide for is that lenses must accord with prescription within an agreed tolerance. The British standard has existed for many years and can be met by all prescription houses. We also intend to ensure that the glass or plastic is of a British standard quality.

My noble friend Lord Bathurst asked about inappropriate lenses. Despite what his views may be, the fact is that there is no medical evidence that inappropriate lenses can damage or harm the eyes. This has been said dozens of times during the stages that this Bill has been through your Lordships' House. What such lenses can do is to cause temporary blurring and things like that. But it becomes evident to the wearer that this is what is happening. It is not causing damage just because one's eyesight goes blurred for a short time. If I put on anybody else's glasses, I get a terrible headache which lasts for a minute or two until I take the glasses off; and then it goes. So that it is apparent imagery.

My noble friend Lord Ferrier brought out a number of points, and one of them was the question of accidents. It is true that there is a theoretical possibility that some distance-glasses might be incorrectly centred but the eyes might accommodate the fault. At some later stage, the accommodation might break down and temporary loss of vision might occur. Such a loss of vision might happen when driving or crossing the road. The circumstances might be unpleasant in the way described. There really are an awful lot of "mights" in all this and certainly insufficient facts to justify what he proposes. The Government remain convinced that any necessary safeguards can be placed on the product rather than the seller and therefore we cannot accept the desirability of my noble friend's amendment.

Lord Northfield

My Lords, before the noble Lord sits down, may I ask whether he is saying that the protection for the consumer is to take the product to the local trading standards officer if it does not reach the British standard set down? Is that the protection that the Bill is now setting out?

Lord Glenarthur

My Lords, with the leave of the House, perhaps I may respond to the noble Lord. That is a question of the implementation of British standards in the way that I have described to the noble Lord. I do not think that I have it wrong but, as I understand it, once the regulations have been made and British standards apply the local standards people presumably can look at them.

Lord Bruce-Gardyne

My Lords, I intervene only briefly to express the hope that my noble friend will read very carefully the speech that he has just made to the House. I think that when he does so, he will see that it provides a very strong case for having accepted the earlier batch of amendments that we discussed a short while ago.

Lord Mottistone

My Lords, with regard to this amendment, as opposed to the one before, could I suggest to my noble friend that the key factor in this particular amendment is the proper standard of competence in ophthalmic dispensing? This is really requiring the Government in the order to lay down a minimum training standard for these people who are taking over from people who—if one is to believe what the noble Lord, Lord Bowden, said at Committee stage—have taken a two-year course. I should have thought that to go from that sort of standard—which, presumably, has come about as a result of satisfying a need because, initially, as I understand it, they did not have that length of course and it has been developed by people like the noble Lord, Lord Bowden, to meet a particular need—to virtually zero in training standards seems to me to be going too far.

All that this amendment talks about is the proper standard of competence which one would hope that the Government would lay down in the order. That is all it is asking, over and above other wording which is covering other sorts of events which must be covered in this area anyhow. I should have thought that the Government could think again about dismissing this so abruptly. It is not quite in the same area as many other amendments that we have dealt with. Indeed, the noble Lord, Lord Northfield, has said that he supports it—which is welcome. I hope that my noble friend might say that he will have another look at this matter and come hack at Third Reading because I am not sure that he understands the point of it.

Lord Glenarthur

My Lords, it is a little difficult to return to the Dispatch Box too often at Report stage. I do not think that the noble Lord, Lord Northfield, said that at all. I thought that he did not follow the arguments which my noble friend Lord Cullen produced on this. The fact is that every two years someone who is going to get glasses will have their eyes checked by someone who can test for the various factors and the things we discussed on the earlier amendments. Lenses will come from a prescription house. There is a perfectly sound means of testing these lenses or prescribing them according to the prescriptions available, and I do not think that I can really usefully add anything to what I said earlier. We do not share the views and the worries which have been expressed by my noble friend Lord Cullen and others. We believe that what we are adopting is the correct approach. I will certainly study what has been said but I will not promise to come back with any changes at Third Reading.

Lord Cullen of Ashbourne

My Lords, I am disappointed that the noble Lord, Lord Northfield, is not supporting this amendment. I thought that he was. Several of us had that impression. It would have been rather nice to have had one amendment on which we agreed. There is something I should like to say and I have said it before but I never seem to be able to get the point across. It is that reading glasses are not magnifiers. There is a very minute magnification factor. What the lenses do is to bend the light waves into the right position in the eyes so that you get a clear image. It confuses the issue when people say that if you can buy an ordinary magnifying glass in a shop, why can you not buy magnifiers in spectacles? They are not the same thing. If you have the right spectacles for your eyes and you then want to read something which is very small, you will need a magnifying glass in order to read. I say that once again in the hope that people will take it on board.

I find it very difficult to understand my noble friend's feelings about this amendment since for years we have had qualified dispensers doing an extremely good job. I am sure there have been one or two who have not done such a good job; and those are the ones who are sometimes referred to; but, on balance, they do an extremely good job. Most noble Lords who I see here at the moment are wearing spectacles. I doubt whether they feel that they have a lousy optician or one who does not take any trouble over the job. It seems to me very unfortunate that (as my noble friend Lord Mottistone has said) we shall go from a properly regulated system which has stood the test of time for 25 years into having people with no qualifications.

Nor do I understand how the Government can police the British standards that they talk about when we are talking about unregistered, unqualified people. They will not know who they are or where they live. How do you police it? I am afraid I am absolutely dissatisfied with my noble friend's reply, and I should certainly like to test the feelings of the House on this matter.

4.50 p.m.

On Question, Whether the said amendment (No. 4) shall be agreed to?

Their Lordships divided: Contents, 94; Not-Contents, 110.

Airedale, L. Brooks of Tremorfa, L.
Ampthill, L. Bruce of Donington, L.
Ardwick, L. Buckmaster, V.
Aylestone, L. Burton of Coventry, B.
Banks, L. Campbell of Eskan, L.
Barnett, L. Caradon, L.
Bathurst, E. Carmichael of Kelvingrove, L
Beswick, L. Collison, L.
Birk, B. Cooper of Stockton Heath, L.
Blyton, L. Cromartie, E.
Boston of Faversham, L. Cullen of Ashbourne, L. [Teller.]
Briginshaw, L.
Brockway, L. Darcy (de Knayth), B.
David, B. Mottistone, L.
Denington, B. Mulley, L.
Diamond, L. Nicol, B.
Elwyn-Jones, L. Northchurch, B.
Ennals, L. [Teller.] Oram, L.
Ezra, L. Pender, L.
Faithfull, B. Porritt, L.
Falkland, V. Prys-Davies, L.
Ferrier, L. Rathcreedan, L.
Fitt, L. Rhodes, L.
Foot, L. Robson of Kiddington, B.
Gallacher, L. Rochester, L.
Graham of Edmonton, L. Ross of Marnock, L.
Grey, E. Sainsbury, L.
Hampton, L. Serota, B.
Hatch of Lusby, L. Somers, L.
Heycock, L. Stallard, L.
Hughes, L. Stedman, B.
Hunter of Newington, L. Stewart of Alvechurch, B.
Jacques, L. Stewart of Fulham, L.
Jeger, B. Stone, L.
Kagan, L. Strathspey, L.
Kilmarnock, L. Strauss, L.
Kinloss, Ly. Taylor of Gryfe, L.
Kinnaird, L. Taylor of Mansfield, L.
Lawrence, L. Underhill, L.
Leatherland, L. Wallace of Coslany, L.
Llewelyn-Davies of Hastoe, B. Walston, L.
Mackie of Benshie, L. Whaddon, L.
McNair, L. White, B.
Masham of Ilton, B. Wigoder, L.
Mayhew, L. Winchilsea and Nottingham, E.
Milford, L.
Mishcon, L. Wise, L.
Molloy, L. Wootton of Abinger, B.
Abercorn, D. Glanusk, L.
Aldington, L. Glenarthur, L.
Allerton, L. Gormanston, V.
Avon, E. Gray of Contin, L.
Bauer, L. Greenway, L.
Belhaven and Stenton, L. Gridley, L.
Bellwin, L. Grimond, L.
Beloff, L. Hailsham of Saint Marylebone, L.
Belstead, L.
Berkeley, B. Hawke, L.
Brookeborough, V. Hayter, L.
Bruce-Gardyne, L. Henley, L.
Buccleuch and Queensberry, D. Home of the Hirsel, L.
Hood, V.
Caccia, L. Hornsby-Smith, B.
Caithness, E. Hylton-Foster, B.
Campbell of Alloway, L. Ingrow, L.
Campbell of Croy, L. Ironside, L.
Carnegy of Lour, B. Lauderdale, E.
Chelwood, L. Lloyd of Hampstead, L.
Chitnis, L. Long, V. [Teller.]
Clitheroe, L. McAlpine of West Green, L.
Coleraine, L. MacLehose of Beoch, L.
Cork and Orrery, E. Mancroft, L.
Cox, B. Mansfield, E.
Crathorne, L. Mar, C.
Daventry, V. Margadale, L.
Davidson, V. Marley, L.
De Freyne, L. Marsh, L.
De La Warr, E. Massereene and Ferrard, V.
Dilhorne, V. Maude of Stratford-upon-Avon, L.
Donaldson of Kingsbridge, L.
Drumalbyn, L. Merrivale, L.
Eccles, V. Mersey, V.
Ellenborough, L. Minto, E.
Elliot of Harwood, B. Monson, L.
Elton, L. Montgomery of Alamein, V.
Energlyn, L. Morris, L.
Erroll of Hale, L. Mowbray and Stourton, L.
Fanshawe of Richmond, L. Murton of Lindisfarne, L.
Feversham, L. Nathan, L.
Fraser of Kilmorack, L. Northfield, L.
Gisborough, L. Nugent of Guildford, L.
Onslow, E. Strathcarron, L.
Orr-Ewing, L. Sudeley, L.
Peyton of Yeovil, L. Swinton, E. [Teller.]
Polwarth, L. Terrington, L.
Rochdale, V. Teviot, L.
Rugby, L. Thorneycroft, L.
Saltoun, Ly. Tranmire, L.
Sandford, L. Trefgarne, L.
Sempill, Ly. Trenchard, V.
Sharples, B. Trumpington, B.
Shaughnessy, L. Vaux of Harrowden, L
Skelmersdale, L. Vivian, L.
Spens, L. Westbury, L.
Stodart of Leaston, L.

Resolved in the negative, and amendment disagreed to accordingly.

4.59 p.m.

[Amendment No. 5 not moved.]

Schedule 1 [Optical appliances]:

Lord Ennals moved Amendment No. 6: Page 30, line 24, leave out from beginning to end of line 13 on page 31.

The noble Lord said: My Lords, I make no apology for returning to the fundamental principle of cutting back on the National Health Service optical service. The basic principle of the National Health Service has been that contribution by taxation and other levies has produced at least some relief of charges at the time of need. We have now had 30 years during which the public, all the public, have had access to the controlled prices and the controlled quality of NHS optical dispensing.

The provision to remove NHS dispensing has been universally condemned, not just by noble Lords on this side of the House but by organisations such as the Consumers Association, Age Concern and countless other bodies in the health and consumer fields. The fact remains that, despite what the Government propose to do about people with higher prescription requirements, to which we shall come later, they will face very much higher bills than at present. They will have access to general optical services dispensing; but for the first time in 30 years they will pay the full cost of their glasses without a subsidy of any sort. For instance, under the Government's proposals a person needing post-cataract spectacles, who would pay £9.70 for the lenses today, will find when the subsidy is withdrawn that he pays at least £46, which is the current material cost and which the new NHS arrangements will require him to pay in full. If that is not a tax on the visually needy, I do not know what is.

Let us be in no doubt that this is, or is seen by many to be, the first step in the withdrawal of other family practitioner services. We inevitably ask: will the Government tell us when, for example, dentists will be subject to the same treatment? Will they also be frank with your Lordships' House and confess that, when they institute cash grants for exemption groups and finally withdraw NHS optical dispensing, the grants will fail to reach an adequate level thus further increasing the burden on the visually disadvantaged?

I am totally opposed, and so are my noble friends, to the removal of the NHS subsidy, I am particularly concerned about the effect that the removal of the NHS subsidy will have on people requiring complex prescriptions and frequent replacement lenses, who have not been reassured by the Government's answers to date. There is an amendment standing in the name of the noble Lord, Lord Kilmarnock, which deals with this; but this is all part of the scene that we are looking at at the moment.

Liberalising the market will not help people with complex eye defects, and though there are not many of them, these customers are totally dependent on expert medical advice for an accurate diagnosis of their problems. Subsequent treatment demands attention to what are sometimes complicated prescriptions. The commercial implications should be understood. Many entrepreneurs will be only too pleased to sell reading glasses to the many. Few, however, are likely to be interested in supplying complex lenses to a small minority. Problems of this kind are simply not susceptible to entrepreneurial solutions.

Secondly, it is a basic principle of the National Health Service that people who are ill do not suffer a further penalty in the form of an obligation to meet the costs of the treatment of their complaints. Clearly, if people who have complex eye defects are to be obliged to pay extra for having their conditions attended to, this will be a denial of that principle.

During the course of the Committee stage, when dealing with an amendment moved by the noble Lord, Lord Kilmarnock, I sought clarification from Government Ministers as to how the line would be drawn. Who would receive subsidy, and how would the decision be taken? I said to the noble Earl, Lord Caithness, that if it was not possible for him to reply to me before Report stage, he could write. His noble friend Lord Glenarthur wrote me a letter and I want to deal with one or two of the points that were made in that letter. I shall quote from only two paragraphs: This letter is intended to clarify the effects of the Bill so I shall not use it to rehearse again the arguments in favour of withdrawing the general supply of glasses under the GOS nor repeat the arguments in favour of abandoning indiscriminate subsidy of glasses in favour of specific subsidy reflecting financial rather than optical needs.

I believe that the Government are still insisting upon a specific subsidy reflecting financial rather than optical needs; and from these Benches we heartily deplore this attitude to the National Health Service. It is a view which we cannot accept. The eyes are as important as health in the rest of the body. But then the real explanation came in the sixth paragraph of the noble Lord's letter, where he said: Those who are in receipt of certain benefits, for example Supplementary Benefit and Family Income Supplement, will have automatic total remission of these charges, i.e., they will get their glasses free. In addition others on low incomes can be assessed by Supplementary Benefit Offices. A comparison is made between their resources and their requirements (for Supplementary Benefit purposes). Then he added this marvellous sentence: To the difference between their requirements and resources is added £2.50, and the resultant sum is multiplied by three. This is the amount which they are deemed able to contribute towards the cost of their glasses. I submit that all that paragraph does is to explain how the existing system of providing subsidies to people on low incomes actually works. It does not provide any information about how the Government intend to provide financial help to people requiring complex lenses—the point that will arise on Amendment No. 7, which is to be moved by the noble Lord, Lord Kilmarnock.

During the Committee stage debates on the Health and Social Security Bill in the Commons, the Minister of Health made a commitment which he repeated in the letter that he wrote on 16th April this year. He said: I have undertaken in Committee to find a way of helping users of these lenses who have modest incomes, without aiding those who can well afford to pay the market price.

I want to ask the Minister to tell us when he replies what action has been taken to fulfil the Minister's claim? There is nothing in the letter that was sent to me by the noble Lord, Lord Glenarthur, to indicate that the Government have done what the Minister of Health, Mr. Kenneth Clarke, undertook to do. Does the Government's commitment still hold? How is it to be realised?

In conclusion, I submit that the whole future of the health service and of the optical service would be much more soundly based if we were not embarking upon a means-tested system, saying that certain categories will get help and that certain other categories will be denied help. The Minister will not be surprised that, as I said at the very beginning, many people fear that this is the thin end of the wedge; that this will become something wider and wider, not only in the optical service but in other parts of the National Health Service.

I hope he will see that by setting up this system, whereby he has to determine on grounds of cost, not on grounds of particular eye complaints, he is setting up a bureaucratic system which it will be very difficult to deal with. Fairness will go out of the window, and certainly the letter that he sent to me and from which I have quoted would give confirmation to that. It is a system which will produce many problems. It undermines the basic principle which has been in existence for 30 years and which the Government have, for no reason other than a few million pounds, sought to change. I want to press my amendment very strongly, I beg to move.

Lord Northfield

My Lords, while I have a great deal of sympathy for what my noble friend has said, I wonder whether there may be questions to ask and positive proposals to make. The first point I should like to make is that I understand the subsidy on NHS frames to have been about £3. Faced with priority spending choices, any Minister would probably say that it is worth saving £3 on the mass subsidisation of spectacles for use in a much more direct way in order to help those who are particularly disadvantaged. There are many people—your Lordships included—who do not need the £3 subsidy on NHS spectacles. There is, therefore, the danger of exaggerating this point. The stage had been reached where the subsidy was not totally justified.

If, however, we look at what the Government are doing according to the statements made by the Minister for Health at the Report stage in another place, the Government are not being generous in what they propose to do with the savings. The Minister in another place said, under pressure from Members on both sides, "I do not want people with particularly complex spectacles to suffer, so I am prepared to say that we shall continue to subsidise everybody who has to pay more than £15 extra for their spectacles, once the £3 subsidy disappears". I believe that the Government could have been more generous than that. The strength of my noble friend's case is not the removal of the £3 subsidy generally but the unwillingness on the part of the Government to protect a great many poor people who will have some difficulty in finding £15 extra every time they need a new pair of very complex spectacles. That is a rather mean use of the savings made by the cancellation of the £3 subsidy.

There is, however, a third point. I hope that the Minister will confirm that NHS frames will not disappear. This is a common misunderstanding. NHS frames will remain on sale and will be bought by a great many people. I suspect that their price will not go up by £3. I suspect that competition will begin. Alternative spectacles will come on to the market because of the greater competition that the Bill will allow. There will be very desirable spectacles, if I may put it that way, which will be slightly under the price of NHS spectacles. Therefore the price will come down. I believe that we should beware of thinking that the frame will disappear and that good alternatives will not be available.

Finally, surely the Minister needs to add something to what he said before relating to protection for the consumer. I have looked at what the Minister said at the Report stage in another place. He indicated definitely that there would be protection for the consumer in the form of national standards relating both to the competence of the dispenser and to the lens and the frame. This is so important a point that when the Minister replies I hope he will clarify what the Minister in another place said.

Lord Glenarthur

My Lords, as the noble Lord, Lord Ennals, will know, there are two aspects to our policy on the supply of glasses under the National Health Service. Clause 1 of the Bill represents one strand. It will liberalise the private market and enable the present system of state provision of antiquated glasses, supplied at a subsidised price, to cease. The other strand is Schedule 1. It demonstrates our commitment to ensuring that there will be no financial barrier placed between vulnerable sections of the public and the glasses they need.

The noble Lord cited some examples. He mentioned, not for the first time, post-cataract patients and gave some figures. But for someone like a post-cataract patient the same conditions as apply now will be preserved. Post-cataract patients will be able to get their glasses from the hospital, because the glasses have to be changed regularly over a period of years until the eyes settle down. The same arrangements will be maintained. There is no reason, therefore, for people to fear that because they have had a cataract operation they will have to go to enormous expense to keep their eyes correctly focused. Their glasses will continue to be dispensed by the hospital. This arrangement will continue for the length of time that the eyes are settling down.

Lord Ennals

My Lords, is this point made clear in the Bill which is before us? If it is, it is a very encouraging reassurance.

Lord Glenarthur

My Lords, it is. I am unable to find it in the Bill at the moment, but perhaps I may come back to the point in a minute or two. The noble Lord, Lord Ennals, also raised a different point relating to complex lenses.

Lord Ross of Marnock

My Lords, having just left hospital after a cataract operation, I am interested in the statement that cataract patients receive their glasses from the hospital. Does this apply to Scotland, too? It is news to me.

Lord Glenarthur

My Lords, as I understand it, this provision is not contained in the Bill. It is included in existing legislation which covers the way in which these lenses are prescribed through the hospital service. If I have misled the noble Lord, that is entirely my fault and I accept that it is my fault. However, the fact is that it is for the hospital to supply what is needed to patients who have had operations to their eyes.

Lord Ross of Marnock

My Lords, with all due respect and speaking from my own very recent experience, the assessment in respect of lenses may be done in hospital but the lenses are provided by the private optician.

Lord Glenarthur

My Lords, if, with the leave of the House, I may respond again, I am not sure that the noble Lord, Lord Ross of Marnock, is entirely correct. I do not know about his particular circumstances and it would be wrong of me to go into them, but the fact is that under the National Health Service Act 1946 it is up to the hospital to continue this treatment. If the noble Lord has a particular problem because the system has not worked in his particular case, I should be very happy to look into it. However, those who have had cataract operations are provided for.

Lord Ross of Marnock

My Lords, I have no problem—only experience of what is happening.

Lord Glenarthur

My Lords, again with the leave of the House, may I say that I am in some difficulty at Report stage in having to jump up and down in order to answer a point which relates specifically to a problem experienced by the noble Lord, Lord Ross of Marnock. It seems to me that that is what I am being asked to do.

Lord Ross of Marnock

No, my Lords.

Lord Glenarthur

My Lords, I shall certainly look into any particular problem which the noble Lord has experienced. However, it does not affect people generally. The law relating to hospital services has not been changed. The Bill affects only the general ophthalmic services. Hospital eye service glasses can be dispensed by private opticians, but the health authority meets the cost. If I can help the noble Lord over a particular problem. I shall be delighted to do so.

Lord Wallace of Coslany

My Lords, this is an important point. The noble Lord, Lord Ennals, is satisfied to some extent with the answer which has been given by the noble Lord, Lord Glenarthur, about hospital glasses. In many cases, however, the hospital may give a prescription which is dispensed by a private optician. Furthermore, when the hospital service treatment has been completed, what happens then? In many cases, people need further tests every 12 months.

Lord Glenarthur

My Lords, as I understand it—I am sure that I am not wrong about this—the problems which follow an operation are dealt with in the way I have described. The noble Lord shakes his head, but I am afraid tht the noble Lord is not necessarily correct in shaking his head. The matter is covered by the provisions which I have just described. The Bill in no way affects them, because the Bill is concerned with the general ophthalmic service. It is not concerned with the law relating to the hospital services which are maintained under the National Health Service Act. Whether or not the eyes settle down after a period of one year or two years depends very much upon the eyes of the individual person. I do not think that I can usefully follow that particular point any further.

If I may revert to the amendment specifically, Schedule 1 enables us to introduce grants for or towards the cost of glasses for children and those adults who now get full or partial remission of optical charges. Schedule I will give these groups financial acccss to the glasses that they need. It will also give them the freedom of choice which the rest of the population enjoys. I do not see why children and those of limited means should be left indefinitely with the outdated range of GOS glasses which exists at the moment.

For an interim period, while the market settles down, we shall continue to supply GOS glasses. With reference to the point made by the noble Lord, Lord Northfield, in respect of National Health Service glasses, those glasses will not disappear. The point is that they must compete. The price may come down and the market for these glasses will develop and the glasses will be used in the same way as they are being used now. That point was stressed at an earlier stage in the passage of this Bill.

It would be wrong to introduce grants which might either have the result of pegging prices artificially high or not be sufficient to meet the cost. We will move to grants when prices stabilise. Grants can reflect prices rather than influence prices. It will also be necessary to give careful thought to the adminstrative arrangements, so as to minimise bureacracy and maximise convenience to the public.

We also need to play fair with those who manufacture the existing GOS models so that they can ensure continuity of supply and plan their future production of other models. Discussions have been held with those objectives in mind.

The noble Lord, Lord Northfield, asked about the implementation of British standards. I can say to him that British standards will be a contractual condition of the sale of glasses. It will also be a criminal offence to sell glasses which do not accord to the prescription. We are separately considering also safety regulations which, if made, will be enforced by trading standards officers. That is still under discussion but it is the way our minds are turning and I hope that the noble Lord finds that encouraging.

The noble Lord, Lord Ennals, asked me to confirm the action which my right honourable friend the Minister of Health had taken in another place. I can not help the noble Lord much further than my noble friend Lord Caithness did at the last stage of this Bill, when he referred to col. 508 of the Official Report of another place for 24th May, which was repeated in col. 1404 of the Official Report for this House for 15th June. In answer to a Written Question, my right honourable friend referred to proposals announced during the debate at Committee stage on 2nd May, and he went on to say: We propose to identify certain of the more powerful or complex lenses currently supplied under the GOS. People needing such lenses will be given the option of continuing to have them supplied by the GOS. The charge to the patient will reflect the cost of the lenses and their dispensing as negotiated by the Department. Those on low income will get them free or have part of the charge remitted". That was the assurance which my right honourable friend gave.

So far as financial assistance is generally concerned, the assessment will be made by supplementary benefit officers. A person on a low income has to find three times any surplus income over his assessed needs as part of the supplementary benefit rules. As a crude rule of thumb, some help will be obtained unless the surplus resources are more than one-third of the cost of the glasses. The more expensive the glasses, the more likely the assistance will be.

I will briefly revert to the point raised by the noble Lord, Lord Ross of Marnock, and which also concerned the noble Lord, Lord Wallace; the question of the ex-hospital patient. Once a patient is discharged by the hospital eye service, he has no special problems, as I understand it, and can obtain glasses at no less frequent occasions than other prople. While they are under the HES, the arrangements outlined earlier apply; that is, frequent changes will not cost the individual more than the cost of the first pair.

I am aware of the fact that I have not really set at rest the minds of the noble Lords, Lord Ross of Marnock and Lord Wallace, but I may get a chance to return to this point in due course. However, I can assure noble Lords that the situation which prevails at present will continue to do so and this Bill does nothing to change those particular rules.

I hope that with the other explanation I have been able to give, the noble Lord, Lord Ennals, will agree that we see the ending of GOS-supplied glasses and the substitution of grants for those in financial need as a positive and progressive step which will favour consumer and producer alike. I also ought to point out to the noble Lord that in any case this particular amendment would leave the power to make grants in Scotland. I do not know what his noble friend Lord Ross feels about that—I am sure he would applaud it. On the other hand, it does show that there is a defect in the amendment. I hope that the noble Lord will not press it.

Lord Ennals

I am not satisfied with the Minister's reply. He gave one or two assurances which I found helpful. One concerned post-cataract cases. Whether he satisfied my noble friend Lord Ross of Marnock I am not sure. The Minister had to admit that this provision was not in the Bill. I am always interested as to what is in the Bill and not in the statements which are made by distinguished noble Lords on behalf of their departments.

The issue before us is one of principle. It may be that the noble Lord is right when he says that my amendment is not worded well. If that be so, there are easy ways of dealing with it on Third Reading. It is often difficult from one side to arrive at a form of words that is exactly right. The noble Lord knows exactly what the purpose of this amendment is. It is to stop the Government from taking out of the general optical service a very substantial proportion of people in this country and forcing them to obtain assistance through supplementary benefit commission offices. I find that offensive.

I believe that this service is like many others in the National Health Service—such as the right to see a general practitioner. If one takes the example of the general practitioner, at what stage along the line would one start getting grants to pay for the costs of general practitioners? At what stage along the line would one start getting grants for the benefit of seeing one's dentist? At what stage along the line would one pay for the bills that one might receive for being in hospital? That is why I say that this is a fundamental principal.

The Minister says that this is a "positive and progressive step"; but my own conclusion is that it is a negative and throughly reactionary step, because it is cutting back on the entitlement of the whole of the population and limiting the entitlement to only one part of the population. I am not prepared to withdraw the amendment and I wish to see a vote upon it.

5.28 p.m.

On Question, Whether the said amendment (No. 6) shall be agreed to?

Their Lordships divided: Contents, 74; Not-Contents. 117.

Airedale, L. Grey, E.
Ardwick, L. Grimond, L.
Attlee, E. Hampton, L.
Aylestone, L. Harris of Greenwich, L.
Banks, L. Hatch of Lusby, L.
Beaumont of Whitley, L. Heycock, L.
Beswick, L. Hughes, L.
Blyton, L. Jacques, L.
Boston of Faversham, L. Jeger, B.
Brockway, L. Jenkins of Putney, L.
Bruce of Donington, L. Kagan, L.
Burton of Coventry, B. Kilmarnock, L.
Campbell of Eskan, L. Kirkhill, L.
Carmichael of Kelvingrove, L. Llewelyn-Davies of Hastoe, B.
Collison, L. Longford, E.
David, B. Lovell-Davis, L.
Dean of Beswick, L. Mackie of Benshie, L.
Diamond, L. McNair, L.
Donaldson of Kingsbridge, L. Molloy, L.
Donnet of Balgay, L. Mulley, L.
Elwyn-Jones, L. Nicol, B. [Teller.]
Ennals, L. Peart, L.
Ezra, L. Perry of Walton, L.
Falkland, V. Prys-Davies, L.
Foot, L. Rathcreedan, L.
Gallacher, L. Rhodes, L.
Graham of Edmonton, L. [Teller.] Robson of Kiddington, B.
Rochester, L.
Ross of Marnock, L. Tordoff, L.
Serota, B. Underhill, L.
Stallard, L. Wallace of Coslany, L.
Stedman, B. Walston, L.
Stewart of Alvechurch, B. Whaddon, L.
Stewart of Fulham, L. White, B.
Stone, L. Wigoder, L.
Taylor of Gryfe, L. Winchilsea and Nottingham, E.
Taylor of Mansfield, L.
Tonypandy, V. Wootton of Abinger, B.
Abercorn, D. Hornsby-Smith, B.
Ailesbury, M. Hunter of Newington, L.
Allerton, L. Hylton-Foster, B.
Ampthill, L. Ingrow, L.
Auckland, L. Kaberry of Adel, L.
Avon, E. Kilmany, L.
Bathurst, E. Kimberley, E.
Bauer, L. Kinloss, Ly.
Belhaven and Stenton, L. Lauderdale, E.
Beloff, L. Lawrence, L.
Belstead, L. Lloyd of Hampstead, L.
Brookeborough, V. Long, V. [Teller.]
Broxbourne, L. McAlpine of West Green, L.
Bruce-Gardyne, L. MacLehose of Beoch, L.
Buckmaster, V. Mancroft, L.
Caccia, L. Mar, C.
Caithness, E. Margadale, L.
Campbell of Alloway, L. Marley, L.
Campbell of Croy, L. Massereene and Ferrard, V.
Carnegy of Lour, B. Merrivale, L.
Cathcart, E. Mersey, V.
Chelwood, L. Minto, E.
Cork and Orrery, E. Molson, L.
Cottesloe, L. Montgomery of Alamein, V.
Cox, B. Morris, L.
Craigavon, V. Mottistone, L.
Crathorne, L. Mowbray and Stourton, L.
Cromartie, E. Murton of Lindisfarne, L.
Cullen of Ashbourne, L. Northchurch, B.
Daventry, V. Nugent of Guildford, L.
Davidson, V. Onslow, E.
De Freyne, L. Pender, L.
Dilhorne, V. Peyton of Yeovil, L.
Drumalbyn, L. Polwarth, L.
Eccles, V. Quinton, L.
Ellenborough, L. Renton, L.
Elliot of Harwood, B. Rochdale, V.
Elton, L. Rugby, L.
Energlyn, L. Saint Brides, L.
Faithfull, B. St. Davids, V.
Fanshawe of Richmond, L. Saltoun, Ly.
Ferrier, L. Sharples, B.
Feversham, L. Skelmersdale, L.
Fraser of Kilmorack, L. Spens, L.
Gibson-Watt, L. Stodart of Leaston, L.
Gisborough, L. Strathcarron, L.
Glanusk, L. Strathspey, L.
Genarthur, L. Sudeley, L.
Gormanston, V. Swinton, E. [Teller.]
Gray of Contin, L. Teynham, L.
Greenway, L. Tranmire, L.
Gridley, L. Trenchard, V.
Grimston of Westbury, L. Trumpington, B.
Hailsham of Saint Maryledone, L. Vaizey, L.
Vaux of Harrowden, L.
Hayter, L. Vickers, B.
Henley, L. Vivian, L.
Home of the Hirsel, L. Westbury, L.
Hood, V. Wise, L.

Resolved in the negative, and amendment disagreed to accordingly.

5.36 p.m.

Lord Kilmarnock moved Amendment No. 7: Page 30, line 37, at end insert ("including, in particular, for persons needing complex or high-powered lenses who previously received a subsidy of £15 or more under the provisions of the General Ophthalmic Service.")

The noble Lords said: My Lords, I moved a similar amendment to this at the Committee stage of the Bill. The noble Earl, Lord Caithness, was kind enough to attempt to give me a satisfactory answer. I am afraid he did not succeed. At least, I found that he had not succeeded when I very carefully read what he had said.

This amendment is on a narrower front than that moved by the noble Lord, Lord Ennals. It concerns the supply of glasses to those who require complex or high power prescriptions, who we believe will suffer under this Bill.

This matter has been, one might say, rumbling on for some time. The Secretary of State, in another place, recognised the problem here. He said: On the other hand, it has been argued that there are those with the very poorest sight who need complicated and more expensive lenses, and I am certainly prepared to consider the evidence on that to see whether they can have continued access to NHS glasses". [Official Report, Commons, 20/12/83; col. 297.] Then on 16th April the Minister for Health, Mr. Kenneth Clarke, wrote to Mr. J. Mitchell, the Director of the National Consumer Council, in rather similar terms. He said: I have acknowledged that there may remain a small group (within the small group who use the more complex lenses) who will not get help in this way. The answer to such problems is to find specific solutions, not continue with a universal system of indiscriminate subsidy. But he did not say what the specific solutions were to be.

On 2nd May, again on Report in another place, the Minister for Health referred to this and said, at column 391: Throughout, we have accepted that there is a problem and we have been considering what can be done about those who need more expensive glasses". It is my contention that what the Government are planning to do is inadequate. The noble Lord, Lord Glenarthur, has already read out, on an earlier amendment, the Government's proposal and I simply repeat what he quoted: We propose to identify certain of the more powerful or complex lenses currently supplied under the GOS. People needing such lenses will be given the option of continuing to have them supplied by the GOS. The charge to the patient will reflect the cost of the lenses and their dispensing as negotiated by the Department". Those words are very important because what they mean is that the subsidy is being removed for spectacles of this type and that the patient or customer will be charged at cost price, which is a very different matter. The final sentence of that quotation is: Those on low income will get them free or have part of their charge remitted". That, again, takes us back to the problem of the identification of those on low incomes. What criterion is to be used?

I think your Lordships will see from the history I have been trying to recall that this matter has been in the air for over six months with the Government seeming to make offers to deal with the problem but not, in fact, coming forward with anything that is at all satisfactory. The cost is by no means prohibitive. It has been calculated by the National Consumer Council, and we know that 50,000 General Ophthalmic Service patients obtain a subsidy of more than £15. A few receive a subsidy of more than £30 and no one receives a subsidy of more than £40. If we assume an average subsidy of £20 we arrive at a total figure of £1 million.

Many of these patients—we do not know exactly how many—will be entitled to free spectacles on grounds of low income. Therefore, we can say that by withdrawing the NHS subsidy from those patients requiring complex lenses the Government stand to save less than £1 million, and probably considerably less than that. If the Government persist in their present proposal it seems to me that they are simply pushing means-testing to the point of absurdity and trying to whittle down even further the ground on which free glasses can be obtained. In fact, the cost of the means-testing might well consume much of any saving which is achieved.

The noble Lord, Lord Ennals, has already quoted from the letter that the noble Lord, Lord Glenarthur, wrote to him and I also found paragraph 6 inadequate. If the Government are inclined to fall back on the argument that the provision of non-subsidised, price-controlled complex lenses under the General Ophthalmic Service, which is what they are proposing, together with the existing system of provision for people on low incomes, adequately deals with the problems then I must say, with respect, that we cannot share their view. For one thing, we can confidently predict from comparable experience that there will be problems of take-up, particularly among those who are not entitled to supplementary benefit or family income supplement.

There are no figures available for the take-up rate for the existing optical benefit but there are figures for the take-up of free milk and vitamins, which are assessed in the same way. Free milk and vitamins are available to pregnant women on supplementary benefit, family income supplement or otherwise low incomes and to children under five in given circumstances. In cash terms that is worth about £1.50 a week or £78 a year. However, take-up for those families not on supplementary benefit or family income supplement is only 4 per cent. of those eligible.

Therefore, we suggest to the Government that if they are going to put their help to the most vulnerable people—I think the noble Lord, Lord Glenarthur, used the word "vulnerable"—on to a means-tested basis a very large number of them will fall through the net and the Government's own objective will not be achieved. If, on the other hand, the Government accept the amendment, that objective would be achieved and there would be adequate protection not for the whole of the General Ophthalmic Service—which is the point of the amendment tabled by the noble Lord, Lord Ennals—but for this particular group of visually disadvantaged people. I beg to move.

5.46 p.m.

Lord Wallace of Coslany

My Lords, I support this amendment for the very simple reason that I object to paragraph (c) on page 30. I object to it being so completely and utterly vague. There is a necessity for some form of wording to be inserted to cover a section of the community that, under the Government's proposals unless something is clarified and put into the Bill, will be penalised because their eyesight is worse than others. They need special lenses, which can be expensive, and, in some cases, frames to take the lenses. Furthermore, there is possibly the frequency of change. These are the worst sort of handicapped people as far as eyesight is concerned. Unless this amendment is accepted these people will be penalised for the handicap from which they are suffering. I believe that is utterly wrong.

I hope that the Government will retreat a little from their absolute vagueness and insert the words suggested in the amendment because, if I read the amendment correctly, it still leaves another scope for them. Other cases can be dealt with subsequently as the Government may decide. This section of the community must receive some consideration. It is only just and fair.

The Earl of Caithness

My Lords, as the noble Lord, Lord Kilmarnock, made clear, this is a re-run of an amendment in Committee. It does, however, give me the opportunity to confirm to the noble Lord, as he has already pointed out, that the Government are concerned about this and we are making very serious efforts to get this particular point right.

At stake in considering this amendment is a fundamental principle: should we subside optical need by making grants to those who need expensive lenses regardless of their means; or should we only financially subsidise those with a financial need? We believe that the most vulnerable members of our society ought not to have a financial barrier placed between them and the glasses they require. However, we equally believe that it is both wrong in principle, and a poor use of scarce resources, indiscriminately to subsidise all those who need expensive lenses.

It may help the House if I explain how these patients will fare in future. For the interim period we have undertaken to ensure that they will get their lenses at the price they cost the GOS to dispense. This will guard against any localised increases in cost in the period immediately after April 1985 while the market is still adjusting to the effects of greater competition. This will, for example, guard patients against the doubling of dispensing fees for this group which the opticians have threatened in the booklet A Dubious Bargain circulated to some of your Lordships. Grants will be introduced when prices have stabilised following the injection of competition. By then we believe this group of users will, like others, have benefited from the keener competition-induced prices.

Some such users will nevertheless still find such lenses beyond their means. This group will be given the grants to which I have just referred. It is simply not true that grants will be paid only to those on supplementary benefit. The system will not work on an all-or-nothing basis. It will work similarly to the present system of partial remission of optical charges. Someone who is on a low income, but not on supplementary benefit, will be able to apply for an assessment. The assessment will compare their needs for supplementary benefit purposes, plus a margin of £2.50, with their resources. If the difference between resources and needs is negative or zero, they will get a grant covering the full cost of their glasses; otherwise they will have to make a contribution towards their glasses of three times the difference.

That is exactly what my noble friend Lord Glenarthur stated in his letter to the noble Lord, Lord Ennals, which was read out earlier. A grant will be paid to make up the balance where necessary. Obviously, the greater the cost of the lenses, the more likely it is that a grant will be payable. In other words, the system will give subsidies to those needing glasses which relate to their means, but which will also reflect the cost of the lenses. We believe that this will be fair and will concentrate resources where they are most needed.

In any event, I do not think that this amendment is needed in order to enable us to meet the objective of the amendment because the schedule already contains what I think I can describe as a "catch all" category of those who can be helped; namely, persons of such other description as may be prescribed". I would suggest to noble Lords that it would be more appropriate for them to wait until it is proposed to implement grants. It will then be possible to assess accurately how these patients will fare in the private market and the extent to which the current fears have proved justified. The regulations governing grants will have to be laid before Parliament and, as noble Lords will be aware, can be annulled by a resolution of either House. At that stage should noble Lords still feel that grants for all users of expensive lenses are required and the Government still remain unmoved, they could then pray against the regulations.

The question of take-up was mentioned, I think, by the noble Lord, Lord Ennals. The difference between optical and other examples quoted is that the cost is made known to the patients by the opticians. They are then able to be advised of the availability of help by leaflets and forms which are usually on the opticians' premises. I hope that I have persuaded noble Lords that precipitate action to introduce indiscriminate grants for users of complex lenses is both undesirable in principle and, in any case, unnecessary at this stage. I think that this is a sound argument.

Lord Ennals

My Lords, I should like to say only a few words because much of the argument in favour of this amendment I sought to set out—though without effect, or without effect for those who voted against—in connection with the previous amendment. The question is: should we run the General Optical Service on a means-tested basis, or not? The Government are saying, Yes, it must be run on a means-tested basis. We could ask precisely the same questions in regard to other services: should we run the health service on a means-tested basis? Should we run the dental services on a means-tested basis, or not? Certainly on these Benches we believe in the fundamental and original principles of the National Health Service.

This amendment seeks to do much less than I sought in connection with the previous amendment. It should therefore commend itself more substantially to noble Lords who are prepared to go down the means-tested route, but who nevertheless want to make sure that funds are made available for those in particular need and for those needing complex or high-powered lenses. I very much hope that this amendment will be carried.

In conclusion, I must make one criticism of the Government, if I may, though of course I do not have to ask whether I may do so; I shall make one. A long time has been spent in another place and here on the consideration of this Bill, but the contents of the regulations governing grants which will eventually be put before this House are not yet worked out; and to me that is a highly unsatisfactory situation. All right; if I trusted the intentions of the Government—and I have to say that I made clear in my previous speech that I do not—I should be quite happy with the fact that regulations will come forward which would be entirely to my satisfaction and entirely to the satisfaction of the noble Lord who moved this amendment. But in this connection I am afraid that I do not trust their intentions. I therefore very much hope that the noble Lord will feel that he wishes to press the amendment.

Lord Cullen of Ashbourne

My Lords, I should like very much to support what the noble Lord, Lord Kilmarnock, has said. It seems extremely unfair that people who need very complex glasses should not be given some reasonable consideration. I rather missed out at the Committee stage. I thought that the £15 subsidy would continue for those people. I was corrected on that; the 15 has disappeared. There is no doubt about it that the cost of spectacles for people who have really bad sight will be considerably higher once the Bill is passed. So I should like to support the amendment.

Lord Kilmarnock

My Lords, I must say that I think this is really squeezing the orange until the pips squeak. The noble Lord, Lord Glenarthur, and the noble Earl, Lord Caithness, have both referred in the most tender terms to vulnerable people, but that is as far as they are prepared to go. They say that keener competition will reduce general prices. We must hope that they are right, and it may well be so, but we certainly cannot guarantee that that will be the case regarding the more complex and less mass-produced prescriptions. The noble Earl says that grants will not be restricted to people on supplementary benefit and that people on other forms of low income will be taken into consideration. He then proposes setting up an extremely complicated system of assessment, which I should have thought is simply taking a sledgehammer to crack a nut.

To me, it simply means that the Government are not prepared to spend £1 million on the visually disadvantaged people of this country. Whatever may be the other merits of the Bill—and I concede that there are some, which we on these Benches accept—the fact that they have not made provision for this residual body of people who will almost certainly suffer seems to me to show a complete lack of appreciation of the problems which may result from the legislation.

The noble Earl also said it was not necessary to do anything at this stage. What he was saying was, "Let us get on with it, and then look at it again in two or three years' time, and if we see that someone is suffering, then we might do something." That was really the thrust of his remarks. I would say to him exactly the opposite: that if you have a new scheme coming in and you want to see how it is working, but you are uncertain of the effect it will have upon certain disadvantaged people, the thing to do is to protect those people during the running-in period. In other words, it leads me to take precisely the opposite view to that which was expressed by the noble Earl.

Therefore, on all these grounds—though we did not do as well as I should have liked in the Division on the last amendment which was moved by the noble Lord, Lord Ennals—I very much hope that Members from all sides of the House will rally round this much more limited attempt to protect a distinctly disadvantaged group of people and will join us in the Division Lobby.

5.58 p.m.

On Question, Whether the said amendment (No. 7) shall be agreed to?

Their Lordships divided: Contents, 78; Not-Contents, 113.

Airedale, L. Kirkhill, L.
Ardwick, L. Lloyd of Hampstead, L.
Attlee, E. Longford, E.
Aylestone, L. Lovell-Davis, L.
Banks, L. [Teller.] Mackie of Benshie, L.
Beaumont of Whitley, L. McNair, L.
Bernstein, L. Mayhew, L.
Beswick, L. Molloy, L.
Blyton, L. Monson, L.
Bottomley, L. Mulley, L.
Brockway, L. Nicol, B.
Bruce of Donington, L. Northfield, L.
Buckmaster, V. Peart, L.
Burton of Coventry, B. Ponsonby of Shulbrede, L.
Campbell of Eskan, L. Prys-Davies, L.
Carmichael of Kelvingrove, L Rathcreedan, L.
Collison, L. Renton, L.
Cox, B. Rhodes, L.
Cromartie, E. Robson of Kiddington, B.
Crowther-Hunt, L. Rochester, L.
Cullen of Ashbourne, L. Ross of Marnock, L.
David, B. Somers, L.
Dean of Beswick, L. Stallard, L.
Diamond, L. Stedman, B. [Teller.]
Ennals, L. Stewart of Alvechurch, B.
Falkland, V. Stewart of Fulham, L.
Foot, L. Stone, L.
Gallacher, L. Taylor of Gryfe, L.
Graham of Edmonton, L. Tordoff, L.
Grey, E. Underhill, L.
Harris of Greenwich, L. Wallace of Coslany, L.
Hatch of Lusby, L. Walston, L.
Hughes, L. Whaddon, L.
Jacques, L. White, B.
Jeger, B. Wigoder, L.
Jenkins of Putney, L. Winchilsea and Nottingham, E.
Kagan, L.
Killearn, L. Wise, L.
Kilmarnock, L. Wootton of Abinger, B.
Kinloss, Ly.
Abercorn, D. Brookeborough, V.
Airey of Abingdon, B. Brougham and Vaux, L.
Allerton, L. Broxbourne, L.
Avon, E. Bruce-Gardyne, L.
Bathurst, E. Buccleuch and Queensberry, D.
Bauer, L.
Belhaven and Stenton, L. Caccia, L.
Bellwin, L. Caithness, E.
Beloff, L. Campbell of Alloway, L.
Belstead, L. Carnegy of Lour, B.
Brabazon of Tara, L. Cathcart, E.
Chelwood, L. Mancroft, L.
Cockfield, L. Mar, C.
Colwyn, L. Margadale, L.
Cork and Orrery, E. Marley, L.
Cottesloe, L. Massereene and Ferrard, V.
Craigavon, V. Maude of Stratford-upon-Avon, L.
Craigmyle, L.
Crathorne, L. Merrivale, L.
Daventry, V. Mersey, V.
Davidson, V. Minto, E.
Denham, L. Molson, L.
Dilhorne, V. Montgomery of Alamein, V
Drumalbyn, L. Morris, L.
Eccles, V. Mottistone, L.
Ellenborough, L. Mowbray and Stourton, L.
Elliot of Harwood, B. Murton and Lindisfarne, L.
Elton, L. Northchurch, B.
Energlyn, L. Nugent of Guildford, L.
Faithfull, B. Orkney, E.
Ferrier, L. Orr-Ewing, L.
Fraser of Kilmorack, L. Pender, L.
Gibson-Watt, L. Peyton of Yeovil, L.
Gisborough, L. Plummer of St. Marylebone, L.
Glanusk, L.
Glenarthur, L. Rochdale, V.
Gormanston, V. Rugby, L.
Gray of Contin, L. St. Aldwyn, E.
Greenway, L. Saint Brides, L.
Gridley, L. St. Davids, V.
Grimston of Westbury, L. Saltoun, Ly.
Hailsham of Saint Marylebone, L. Sharples, B.
Skelmersdale, L.
Harmar-Nicholls, L. Stodart of Leaston, L.
Hayter, L. Strathcarron, L.
Henley, L. Strathspey, L.
Home of the Hirsel, L. Sudeley, L.
Hood, V. Swinton, E. [Teller.]
Hornsby-Smith, B. Teynham, L.
Hunter of Newington, L. Thorneycroft, L.
Hylton-Foster, B. Tranmire, L.
Ingrow, L. Trenchard, V.
Kaberry of Adel, L. Trumpington, B.
Kilmany, L. Vaizey, L.
Kimberley, E. Vaux of Harrowden, L.
Lauderdale, E. Vickers, B.
Long, V. [Teller.] Vivian, L.
McAlpine of West Green, L. Whitelaw, V.
McFadzean, L.

Resolved in the negative, and amendment disagreed to accordingly.

Clause 3 [Use of titles]:

6.8 p.m.

Lord Mottistone moved Amendment No. 8: Page 5, line 16, after first ("the") insert ("taking or").

The noble Lord said: My Lords, with the agreement of your Lordships I should like to speak also to Amendments Nos. 9 to 17. Page 5, line 16, at end insert ("(either alone or in conjunction with other words)") line 20, after ("he") insert ("took or, as the case may be,") line 20, leave out ("not have been reasonable") and insert ("have been unreasonable") line 22, after ("his") insert ("taking or, as the case may be,") line 37, after first ("the") insert ("taking or") line 37, at end insert ("(either alone or in conjunction with other words)") line 41, after first ("it") insert ("took or, as the case may be,") line 41, leave out ("not have been reasonable") and insert ("have been unreasonable") line 43, after ("its") insert ("taking or, as the case may be,"). The amendments are complementary or consequential one with another. Throughout the passage of this Bill, through all its parliamentary stages, the need to afford proper and adequate protection of title for opticians has been argued. The Government took the point when it was made in another place and came forward with the clause that is now incorporated in the Bill as Clause 3.

The case for restricting the title of optician completely to registered persons was strongly put during the Committee stage in your Lordships' House, but the Government took the view that it was not appropriate to prevent unqualified and untrained persons from describing themselves as opticians, provided they did so in circumstances which made it clear that they were not registered. What was foreseen—and I remember making the point myself during the earlier debate—was that an untrained seller would legally be able to take and use with impunity a title such as "qualified optician," followed by the word "unregistered" in brackets.

Since the Committee stage the Association of Optical Practitioners, which has advised me on this point, has taken legal advice on it. It has been confirmed to the association that such a title could be used, provided that a qualification, however minimal, or even spurious, was possessed by the spectacle seller. Thus the public's ability to distinguish between properly trained and qualified opticians and the new breed of retailer would be seriously eroded and might be even removed altogether unless a further change is made in this clause.

It is worth repeating that the intention behind these attempts to amend the Bill has been all along to ensure that when the public come to make a choice between the suppliers of spectacles, they will be able to make the free and informed choice that we all, including my noble friends on the Front Bench, see as so important.

Today in these amendments we are looking at a measure which does two things. First, it reintroduces the phrase, taking or use of the title", which is how the matter is described in the Opticians Act. Secondly, it makes it harder for the unqualified seller to misuse titles, while it still allows him to describe himself as an optician, unregistered, baldly and without misleading embellishments. Since that is all that the Government have said they wish to do, I hope that they will happily accept these amendments in this form. I suggest to your Lordships that to do otherwise would be to fly in the face of the true principles of competition and give a licence to deceive to anyone unscrupulous enough to take advantage of it. It cannot be said often enough that the public interest lies in having optical prescriptions dispensed by registered opticians. The Government's proposal will allow unqualified people to attempt the dispensing of prescriptions.

Furthermore, since your Lordships rejected Amendment No. 4, these people will also not be required to be trained to an accepted standard. Therefore, the passage of these amendments is imperative if such persons are not to attract the public away from properly qualified opticians by flying false colours in the most misleading circumstances. They must be seen for what they are. If that is achieved and this amendment succeeds, the public will have a proper and informed choice of suppliers. My noble friend Lord Caithness, in Committee at col. 1091, said there are instances where the background knowledge of a fully trained person will be required to help ensure a successful outcome, and occasions where mere technical competence in interpreting and making up the prescription may not suffice. In such cases it is open to the doctor or other prescriber strongly to advise his patient that special care is needed in the selection of his supplier". I should add that this was stated in relation to Amendments Nos. 6 and 7 in Committee.

That is the advice that the profession would applaud. By reducing the possibility of confusion in the selection of supplier, this amendment addresses and indeed supports the Minister's advice without running counter to his express wish that people who sell spectacles are allowed to use what he describes as the historically accepted word "optician". I beg to move.

Lord Monson

My Lords, having disagreed so strongly and, if I may say so, unusually with the noble Lord, Lord Mottistone, over some of the earlier amendments, I am pleased to say that I find the series of amendments to which he is now speaking entirely reasonable. I would still like to have greater freedom of choice than he is prepared to allow, but I agree with him that unqualified opticians should not sail under false colours.

Lord Glenarthur

My Lords, I have to tell my noble friend that I have no objection to his amendments on grounds of policy. They would make no material difference to the effect of the clause. The main effect would be to use in this statute the somewhat archaic, if that is the right word, drafting style of the 1958 Act with its redundant phrases. Changing the word "using" of the title optician to "taking or using" would not add any real protection since, without using the title, the taking of it would be ineffective. Similarly, adding the wording "either alone or with other words" adds nothing of substance. It merely uses several words in place of a few. Similarly the use of the positive expression "have been unreasonable" in place of "not have been reasonable" is merely, I suggest to my noble friend, a matter of taste more than substance.

My noble friend Lord Renton, during the Committee stage, urged us to try to adopt a simpler style of drafting. That is certainly what the draftsman tries to achieve here. So far as "qualified optician (unregistered)" is concerned, the amendments that my noble friend proposes would not help. However, such titles should not be outlawed. There could well be legitimately qualified opticians who, in future, choose not to register. Further, there could be legitimately qualified opticians from abroad who might practise here. There might be a few who could use dubious qualifications. The public are not quite so easily misled. They will judge by the results. If the glasses are wrong—we have been over this ground several times already—they will not return to that supplier, however many letters he might put behind his name. I do not really see why the efforts of the draftsman should be overturned unless it can be shown that there is some material advantage in doing so. I am afraid that, despite my noble friend's advocacy of his amendment, I do not see that any particular advantage lies in it.

Lord Ennals

My Lords, since the noble Lord accepted the principle behind the series of amendments which really amount to a new paragraph, proposed by the noble Lord, Lord Mottistone, and since he argued, perhaps with some cogency, that the terminology could be improved, why cannot he say—in view of the fact that he and his noble friend Lord Caithness have accepted the principle—that on Third Reading he will have put in a form of words that will meet the wishes of the noble Lord, Lord Mottistone, supported by myself and my colleagues, in order to achieve clarity.

The case for restricting the title "optician" completely to registered persons was strongly put, is strongly held and is quite incontrovertible. It is extremely important that the public should know who it is they are going to; whether a person is untrained, whether he is qualified, whether he is unregistered, or, indeed, what he is. This is what it is about. The Bill does not make it clear at the moment. Maybe the wording chosen by the noble Lord, Lord Mottistone, is not exactly right. However, if the noble Lord believes that the principle behind it is right, why does he not now say that he will look at it before Third Reading and will find a form of words that the draftsman can frame to be put into the Bill and so meet what the noble Lord, Lord Mottistone, and I believe most of your Lordships would wish to see in the Bill?

Lord Somers

My Lords, the noble Lord, Lord Ennals, has put his finger on the exact point. It is important that the public know who it is they are going to. Therefore, although I support the intention behind the amendments strongly, I should have thought it was essential for the non-registered optician to use the word "unregistered". Then the public will know exactly where they are.

Lord Renton

My Lords, my noble friend on the Front Bench was good enough to mention that I had raised a doubt about the adequacy of the drafting at Committee stage. Having looked again today at the clause as it now stands and having considered the amendments that my noble friend wishes to have made, I find myself in a dilemma. I do not think that one is any better than the other. I am sorry to have to say that because I realise that much honest endeavour has gone into the attempt to improve the clause. I am attracted by the suggestion of the noble Lord, Lord Ennals, that we might try to persuade the draftsman, under persuasion perhaps from my noble friend, to get something that really is a little more clear and that will fulfil the intentions which I think exist on both sides of the House. I am attracted by the suggestion from the noble Lord on the Cross-Benches that somehow the word "unregistered" should be brought in. That puts the matter beyond doubt.

Lord Airedale

My Lords, I was not impressed by the Minister's argument that, if the glasses are wrong, people will soon find out about this and cease to patronise the particular supplier. In the course of that procedure, tremendous wrangles will go on about trying to get money refunded for spectacles that are wrong to a certain degree, and so on. An awful lot of anguish will be stirred up before the patronage becomes withdrawn. We ought to try to avoid that sort of situation and see that the person who is going to prescribe and supply these wrong spectacles does not, in the first place, get going.

Lord Cullen of Ashbourne

My Lords, briefly, I should like to support this amendment. It would be very nice if my noble friend could say that he will look at this again and come back on Third Reading. I must say that nothing that he or his noble friend Lord Caithness have said during the passage of this Bill through the House gives me the slightest hope that he is going to do anything of the kind. It would be rather nice to have something different from what we have had all along.

This is enabling legislation. Every time we get anywhere near a point, somebody will say, "That will all come out in regulations". I can only say to the Government that, if they are just going to keep their pads on and their heads down throughout all the amendments, all the time, they have got quite a good fight coming when we come to the regulations, which must be looked at very carefully.

Lord Northfield

My Lords, before the noble Lord the Minister replies, I should like to say I am bound to register a protest. He said the consumer can be relied upon not to go back if the spectacles are wrong; he will not go back and be caught a second time. But this is the whole case on reading spectacles and all the other libertarian things we have been talking about. Today the consumer is sensible enough not to need to be patronised, led, and kept in napkins for the rest of his life. It is astonishing that the Minister can say that on this amendment and not apply the very same reasoning to the need to have, in the first place, freedom to choose whether to buy spectacles without a prescription. I am in favour of the noble Lord's philosophy. Why cannot he apply it evenly right across the board?

Lord Glenarthur

My Lords, with the leave of the House, perhaps I can respond to one or two points. The noble Lord, Lord Northfield, knows as well as I do that really we are leaving this amendment and going back to a matter of principle which has been discussed on more than one occasion. I hope your Lordships will forgive me if I do not follow him down that road.

As I said to start with, there is nothing wrong in principle with the amendment which my noble friend has moved, because the amendment does not make any change from the Government's proposals. Only those who make it clear they are unregistered can actually call themselves opticians. This is quite clear in the Bill, and this is the same sort of safeguard which applies to doctors. In answer to my noble friend Lord Cullen, I want to say that protection of title is not to be covered in regulations; that is covered only in the Bill.

I take the point which my noble friend Lord Renton makes—that there may be a form of words to meet this particular case. I do not think it will change the Bill one jot, but certainly I will take it away and look at it to see whether it is possible to come back with something. But I say to my noble friend Lord Mottistone, who moved this amendment, that there is no great change—no change at all in substance—introduced by his amendment. Nevertheless, I accept his argument that it introduces a certain clarity; I acknowledge the arguments in that sphere which have been introduced by other noble Lords. Without commitment, I will take it away and look at it. With that, I hope the noble Lord will be able to withdraw the amendment.

Lord Mottistone

My Lords, I am grateful to my noble friend the Minister for his concluding remarks. I should like to make one point—that the Association of Optical Practitioners did take legal advice. They were seeking to tighten it up a bit more to meet what my noble friend Lord Caithness had said at an earlier stage of the Bill. They were lawyers, so it was not a case of amateurs. I am an amateur.

Taking into account what my noble friend Lord Renton also said—I am most grateful to him—perhaps there is an area where it can be tightened up to the benefit of the consumer, in these early days when the consumer is going to have to move quite quickly from one situation to another. I hope that my noble friend will be able to find that something useful can be done. We have not much time to get it right again.

Lord Rugby

My Lords, may I say that I do not think this tightens it up from the point of view—

Lord Mottistone

My Lords, I have spoken, and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 9 to 17 not moved.]

6.26 p.m.

Lord Banks moved Amendment No. 18: After Clause 4, insert the following new clause:

("Partially sighted people and old age pensioners. Concessions for registered partially sighted people and for old age pensioners

. The following sub-paragraph shall be inserted after paragraph 2, sub-paragraph (1), of Schedule 12 to the National Health Service Act 1977:

"(1A) It shall be the duty of the Secretary of State to provide by regulations for payments to be made by him or by any authority established under this Act to meet, or to contribute towards, the cost incurred (whether by way of charge under this Act or otherwise) for the supply of optical appliances for which a prescription has been given in consequence of a testing of sight under this Act—

  1. (a) for any person who is on the blind or partially sighted register: or
  2. (b) who is an old age pensioner.".")

The noble Lord said: My Lords, this amendment appeared as Amendment No. 28 on the Marshalled List at Committee stage, but I did not move it at that stage in view of the discussion we had had on Amendments Nos. 16 and 20. After considering the Government's argument I felt it should be tabled again, so that we can look once more at this problem.

The amendment would add retirement pensioners and the partially sighted to the list of those for whom the Secretary of State must provide assistance with the cost of spectacles. In considering this, we have to bear in mind that 75 per cent. of the registered blind and partially sighted are over the age of 65 and 27 per cent. of all elderly people have some visual impairment. Those people will lose their right to buy National Health Service spectacles on current terms. They will have to pay the full cost and will lose the subsidy, which in the course of our debates has been stated variously to be something between £5 and £10. They will lose that unless they are on low incomes, as defined a little earlier by the noble Earl, Lord Caithness. When they lose that, what will they be faced with? Some people say—some noble Lords say—that very soon they will be faced with lower prices. Others of us are not so sure about that and think that if one increases prices at the bottom of the scale this will tend to a general rise in prices at that end.

But does the lack of the subsidy and the possibility—I put it no higher than that—of higher prices matter for the groups who are covered in this amendment? The Government say, on the one hand, that the subsidy is of no significance, and, on the other hand, that the subsidy is of such significance that those on low incomes must be protected against the loss of it. But, as I think we have gathered from what we have heard this evening, the definition of low income does not cover everybody on what most of us would consider to be a low income. It takes in people at the very bottom, and, as we heard, it does so on a rather complicated basis.

As my noble friend Lord Kilmarnock said, we know that means-tested benefits suffer from a low rate of take-up, and there is the fear that this would continue to be the case even though there are leaflets in the opticians' premises. I do not know whether there will be leaflets in the premises of those who dispense, but they may be there as well. Even so, it is likely that there will be a shortfall in the take-up.

Since we cannot be sure how prices will go, particularly at the bottom end of the scale, since we know that many people eligible for means-tested benefits do not claim them, and since so many of those with sight problems and low incomes are covered by the two categories in the amendment, would it not be sensible and right for the Government to accept this amendment? I beg to move.

Lord Glenarthur

My Lords, first, I should like to consider the case of old age pensioners. As a group, old age pensioners have never received free glasses. They have been liable to the same charges as any other users of National Health Service glasses. Entitlement to remission of charges has been linked to income since 1951. I suggest that there is even less reason for free glasses for pensioners in 1984, than in 1951. The charge for a simple pair of lenses in 1951 was £1. The pension for a single person was £1.30. In other words, it took over five days' pension to pay for those lenses. Today a simple pair of private glasses can be bought in London for £12.45. The pension is now £34.5. Such glasses therefore cost under three days' pension. There is every reason to believe that following the injection of greater competition, this will become the norm.

There is no evidence whatever to justify the scaremongering over this Bill—and it has not been entirely quenched by some of the discussions that have taken place during its passage—that most pensioners will not be able to afford their glasses. There are some for whom even £12 may be too much. There will be non-pensioners in similar financial circumstances. We intend to assist such people. It is not part of our policy to put a financial barrier—about which we have heard so often—between anyone and the glasses he needs. For an interim period those on low incomes will continue to get National Health Service glasses free, or at reduced cost. Schedule 1 gives us the power to substitute grants in the future. We therefore already have the necessary powers to aid pensioners or others who need financial help. We see no reason why all pensioners need to be given financial help with their glasses. That would surely be a waste of health resources—valuable resources at that—because, quite simply, there are many pensioners who do not require that type of financial assistance.

However, there is a small group of wearers of glasses, including pensioners, who need complex lenses. We considered the merits of giving grants to this group in our discussion on an earlier amendment. The general argument I then advanced holds good for pensioners. It is neither optical need, nor age, which should be subsidised, but financial need.

The situation of the blind and partially sighted is very similar to that of the pensioners. As your Lordships will be aware, the visually handicapped do not necessarily need complicated or even particularly powerful glasses. Often simple lenses are all that are required to aid what is left of their sight or what is called residual vision. The visually handicapped have never had NHS charges for glasses remitted. Under the private market they will be affected similarly to pensioners, who we have discussed at length. To the extent that they are on a low income they will get free or subsidised glasses, however simple or complex their needs. If they are in need of complex lenses then, as I explained in my remarks about the earlier amendment to Schedule 1, it will be more likely that they will get partial help. However, this will depend in part on the level of their income. I stress that it should be not the fact of visual handicap that attracts a financial grant, but financial need.

Lord Ennals

My Lords, I should like to say a few words in support of the amendment. First, it is not dealing only with free spectacles, because it includes the words to meet, or contribute towards, the cost incurred". That is the first point that I want to make.

Secondly, I sometimes doubt whether noble Lords—though I am sure that some suffer financial hardships—fully realise just what it means to people who have to present a case for remission because of their financial circumstances. If they need remission because of their financial circumstances, they are deprived, anyway. The visually handicapped are deprived because they are blind; and reference is made in the amendment to the blind or the partially sighted. So we are talking about people who are, in any case, deprived.

While I understand and accept that of course we must have a system of supplementary benefits and a system of assessments, I believe that it puts people into a very invidious position to have to ask for relief. That is why I hoped that the Minister would have given a more sympathetic answer than he has given.

Baroness Phillips

My Lords, I should like to raise a small point. I have not raised it before, but I shall raise it again in the future, if necessary. In the interests of accuracy I would point out that we have not actually had the old age pension for about 40 years; it is now referred to as the retirement pension. The Minister calls it the old age pension, and so does the amendment. I am sure that that term is more emotive, but it is not accurate.

Viscount Massereene and Ferrard

My Lords, as regards the retirement pension, I think I am right in saying that it has not actually been paid for the last two months because I understand that there is a strike in the computer department, or something of that nature.

Lord Banks

My Lords, I accept the correction of the noble Baroness, Lady Phillips. She is quite right, because the amendment should refer to a retirement pension, but the term "old age pension" is so embedded in the mind of the community that it is often still used, even if incorrectly. I apologise.

The noble Lord said in his reply that pensioners would not be in a position in which they could not afford to pay the cost of glasses, and he stated what was the cost. Some two million pensioners are on supplementary benefit. If one is on supplementary benefit then, as I understand it, one is entitled to some contribution towards the cost. That would seem to suggest that of itself the pension is not regarded as sufficient to put a person in a position where he has to pay the full amount.

The objection that I was expressing, and the objection which my noble friends feel, concerns having to rely entirely and exclusively on means tests. In our view there are a great many people who do not take up the benefits to which they are entitled. Under this rather complicated system which we heard described earlier, there would inevitably be many such instances in this case. Therefore, we felt that we could not rely entirely on the means test principle and that there would be many people who were below the supplementary benefit level, or who were on it, and some others not very far above it, who would not be assisted at all. Moreover, since so many of those involved are in the two categories mentioned in the amendment, we thought it sensible to make some special arrangement whereby the Secretary of State would make some provision for them. The noble Lord has unfortunately turned that down and the divide between us on this issue remains.

I do not intend this evening to press the amendment to a Division. However, what has been said during this debate, and in regard to the earlier amendments of a similar kind, on which we divided the House, has been sufficient to indicate the very considerable anxiety we feel as to how this situation will work out for the poorest people in the country. Certainly we shall be watching very carefully how it works in practice, to make sure that nobody suffers unduly under it. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 3 [Family Pracitioner Committees]:

6.40 p.m.

Baroness Cox moved Amendment No. 19: Page 44, line 9, at end insert— ("(3A) One member must be a person who—

  1. (a) is registered in the register of qualified nurses, midwives and health visitors—
    1. (i) as a nurse recorded in the register as having an additional qualification in district nursing;
    2. (ii) as a midwife;
    3. (iii) as a health visitor; and
  2. (b) has recent experience of providing services to patients (other than patients resident in hospital) in any such capacity.").

The noble Baroness said: My Lords, in speaking to this amendment I shall not rehearse all the arguments which were put forward at the Committee stage. I shall merely offer a very brief summary for the record of some of the main reasons why nurse membership of family practitioner committees should be statutorily provided for. The first is because of the major role played by nursing midwifery services in the provision of community health care. The second, following from this, is because of the contribution that nurses and midwives should be able to make to policy and planning in primary health care at the local level. Thirdly, in the interests of consistency, the current provisions for nurse membership of district and regional health authorities should be paralleled by membership of family practitioner committees. Fourthly, and finally, although I believe in the Government's sincerity of intention that nurses should be members of family practitioner committees, it is surely better for that intention to be made explicit rather than left implicit, so that it cannot be forgotten with the passage of time.

Therefore, I hope that the Government will accept what must surely be an uncontroversial amendment. If they do so, they will not only earn great appreciation from the nursing and midwifery professions, but I believe that they will also help to provide for better policy-making by the family practitioner committees themselves. I beg to move.

The Earl of Caithness

My Lords, the effect of this amendment would be to give statutory effect to what was always the clear intention: that on every FPC there should be a nurse—a health visitor, midwife or district nurse—with recent experience of providing services in the community. The Government have always acknowledged the need for a nurse member of the FPC. When my noble friend Lady Cox, together with the noble Lord, Lord Kilmarnock, and the noble Baroness, Lady Robson, raised this at Committee stage we did agree to look at this question again. Although we still believe that administrative action would be sufficient to ensure that there will always be a nurse member on the FPC, we now think it right to accept this amendment in order to put the matter clearly beyond doubt.

Lord Ennals

My Lords, as this is the very first occasion during the Committee stage and Report stage on which the noble Earl or the noble Lord has accepted an amendment, from these Benches, perhaps I may say "Hip, hip, hooray" and "Thank you very much".

Lord Kilmarnock

My Lords, I should like to add a few words, too. As the person who moved the original amendment in Committee and who listened with great care and attention to the noble Earl's reply, which I found unconvincing at the time, I am delighted to be able to congratulate him on having seen the light. It has always seemed to me to be absolutely incontestable for this very important and large section of the health professions that they should be included on FPCs as a statutory right. The Government have now acknowledged that and we congratulate them.

On Question, amendment agreed to.

Clause 6 [Finance in National Health Service]:

Baroness Robson of Kiddington moved Amendment No. 20: Page 8, line 25, at end insert ("provided that the Secretary of State or, as the case might be, the Regional Health Authority, shall not change an allotment made for a given financial year after 31st December in that financial year unless either,

  1. (i) the authority receiving the allotment consents to that change, or
  2. (ii) the allotment is changed by an order, a draft of which has been laid before and approved by Resolution of each House of Parliament.").

The noble Baroness said: My Lords, I hope that what has just happened also augurs well for my amendment. It seems that the attitude of mind on the Government Benches has changed somewhat. I make absolutely no excuse for introducing this amendment again in exactly the same form as I moved it at the Committee stage. I said then that I would carefully read and study the reply of the noble Lord, Lord Glenarthur. I have done so, and it seems to me that the main argument put forward by the noble Lord is that my amendment will introduce rigidity into the system. It would be rigidity for the period of three months, because that is all the amendment asks for. I should prefer to change the word "rigidity" to "stability", so that there would be stability for the regional health authorities for the last three months of their year when they are engaged in making certain that they meet the cash limitations imposed by the Government without having to take panic measures to change the whole of their planning programme in the very last few days of their financial allocation.

The noble Lord, Lord Glenarthur, also referred to the capital allocation adjustments between regions, where the department acts as an honest broker. That is a completely different question. In the last few months of a year one cannot change major capital allocations. When I was chairman of a health authority, I was fully aware that, because of slippages in construction and because of problems with part of the capital programme, there were occasions when the health authority was unable to take up the whole of its allocation. In such cases the department quite rightly acts as a broker and offers its remaining allocation to another authority which can take it up because it is ahead with its programme. That is carried out without any problems (and my amendment would emphasise that) and with the consent of the two authorities.

On these Benches we are much more worried about a sudden change in the revenue allocations to a region, which can have a catastrophic effect on health authorities. As I said in Committee, if one has to change one's plans and one has to take account of a reduction in the last few months of the financial year, the impact of those reductions is enormously greater than if one had known about them for a longer period, because one must come up with the right cash limitations at the end of the year.

I do not think that it is asking too much for the department to agree that the last three months of a year should be sacrosanct as regards change in revenue allocation. After all, the health authorities could be warned that this would happen, and it will be taken into account in the new year's allocations only three months later. But it would enable the health authorities to have three months in which to work out a plan on how to absorb either the cut or, as I said in Committee, the increase in allocation, which no doubt would be welcomed but which, although welcomed, is not always used to the best advantage because it is too sudden and too unplanned. I sincerely hope that, having thought about the matter, the Government can see their way to agreeing to this amendment. I beg to move.

Lord Ennals

My Lords, I should like to say a few brief words in support of this amendment. I should have liked my name to be down to the amendment—and that applies to several other amendments—but we found ourselves taking this Report stage rather earlier than expected, and so my name is not attached to it. Certainly, when I was Secretary of State for Social Services I should have been happy to have accepted this amendment, because history will certainly show that I did not make a change in allocation in the last three months of a year; nor do I think that effective planning for a health authority would ever sanction a change during the last three months.

The health service often suffers from the difficulty of planning its programme ahead. The worst thing that can happen if a programme has been planned ahead is that something comes up all of a sudden. One of the interesting things about this amendment and the reason why I support it is that it not only says that the allocation must not be cut, but also that it must not be increased. There have been occasions when additional funds have suddenly been found, and health authorities can always find ways of spending money that is made available to them on equipment that would be useful to them. But that is not planning.

The noble Baroness, Lady Robson, had a good concept when she referred to the last three months of a year being sacrosanct. She has said that during the last three months of a year no changes should be made by the Secretary of State either upwards or downwards. One cannot deny the right of a Secretary of State to make a cut if the Cabinet forces him to do so but let it be for the next year. If he is able to win some more funds for some reason, then let him use that for the next year. I strongly support the amendment which is before us.

Lord Glenarthur

My Lords, I fully appreciate the concern which the noble Baroness expresses in bringing forward this amendment again that the Government should operate the control of cash limits in a way which encourages sound financial management and value for money. I understand that. I take the point that a secure financial allocation is a sound basis for sensible financial planning and that any sudden changes in allocations, whether they be up or whether they be down, particularly towards the end of a financial year, can lead to difficulties.

The current system is that we notify health authorities of their cash limits well in advance of the start of the financial year in order that budgets can be set. We also give them resource assumptions for the two years ahead so that health authorities have a financial base for developing their short-term plans. The annual cash limit sets the authority's permitted expenditure for that financial year, and health authorities tailor their spending plans accordingly.

But health service planning is not a precise science, however much we should like it to be so. It would not be sensible to pin health authorities to a precise figure with absolutely no flexibility. From her personal experience as chairman of a health authority, the noble Baroness is probably much more aware than I am of how plans do not always come to pass in precisely the form, or at precisely the time, envisaged at the start of the financial year. I am sure she will accept that. That is why we urge on health authorities the paramount need to plan flexibly and to have plans which enable them to make effective use of more resources and to be able to cope with less. It is also why we allow health authorities considerable flexibility in the way they manage their resources.

As I mentioned in our previous debate on this issue at Committee stage, health authorities are permitted to carry forward from one financial year to another up to 1 per cent. of their revenue spending or 10 per cent. of capital spending. Similarly they are permitted to switch 1 per cent. of revenue to capital, and 10 per cent. from capital to revenue. Authorities are encouraged to take advantage of this flexibility and, with our agreement, to exceed it when this makes sense for any particular use of resources. In other words, health authorities already have a great deal of flexibility.

I do not feel that the amendment would add anything to that flexibility. The real issue posed by the amendment is whether changes in cash limits should be subject to parliamentary approval if the health authority disagrees with the change. That is the basis of it. As I said at Committee stage, that is taking a sledgehammer to crack a nut. A health authority's cash limit might be changed during the year for a number of reasons. The noble Lord, Lord Ennals, hinted at this just now. A good many of these reasons would be technical reasons or they would perhaps reflect agreements between authorities to lend, or borrow, resources between each other which, as the noble Baroness knows, is a reputable and acceptable practice, or for example to take over responsibility for different services, which is another thing that they could do.

On other occasions changes are made which affect health authorities' spending; for example, as last year, health authorities were required to contribute to reductions imposed on all cash limited services to bring public expenditure back to planned levels. That is unwelcome, I know, and no one appreciates that more than I, but it is made in the interest of keeping the economic recovery on course. This year, following the Government's decisions on the review body reports on the pay of doctors and dentists, and nurses and midwives, we have increased health authority cash limits to cover the Government's contribution to the pay awards.

Again what I am saying is common and familiar ground, and I am at one with the noble Baroness in the wish that any such changes should be agreed with the authorities concerned, and certainly any major changes in spending should be avoided in the last quarter of the financial year. Where I differ is that I see no practical grounds for any further legislative sanction where agreement cannot be reached.

There is another point. The noble Lord, Lord Ennals, described what his own views on this would be if he were Secretary of State, as indeed he was. If the amendment were accepted it would mean that any of the 192 district health authorities could, for whatever reason, have referred to parliamentary scrutiny the most minor changes in its cash limits if it did not agree the change, or even if it did not agree the precise figure for an agreed change. I wonder whether the noble Lord, Lord Ennals, would have thought that that would be an appropriate use of Parliament's time. Any issues arising are best resolved between the parties concerned. If any issues are technical, or a question of setting the precise sum, then that is surely best left to local negotiation and agreement to sort out.

If a region were seeking to impose a change on the district's spending in the last quarter of a financial year against its will, then the region will be accountable to the Secretary of State for its actions. If such action was in response to national changes, then I am sure that Parliament would not be slow to offer its voice and question the executive in this case.

I repeat my assurance that it is not the Government's intention to impose such difficulties on health authorities. It is our intention, so far as possible, to give health authorities a firm financial basis for their planning, and I am sure that, with the noble Baroness's experience, she would accept that. The amendment would not aid financial planning, and for the reasons I have mentioned might introduce an inappropriate delay and by doing so it would therefore introduce some unnecessary uncertainty. With that further explanation—expressed perhaps in a different way from the way I expressed it before—I hope that the noble Baroness will not feel it necessary to press her amendment.

Lord Ennals

My Lords, before the noble Lord sits down, may I say that I would not have wanted to be in a position in which Parliament suddenly debated the financial allocation that it had already made, but I cannot see that that could happen under this amendment. Could the noble Lord explain how that would be the case? Maybe the amendment is badly drafted, in which case I am not blaming the noble Baroness: but, as I understand it, Parliament would only come in if the Secretary of State decided to make a change which a health authority, be it region or district, was not prepared to accept. The purpose of this amendment is to stop the Secretary of State making changes upwards or downwards during the last three months of a year. Although I may be a little thick, I cannot see how the noble Lord has placed the interpretation he has upon the ability of a district authority suddenly to come before the Secretary of State as he suggested.

Lord Glenarthur

My Lords, with the leave of the House, perhaps I may explain that. The problem here is one of disagreement. If there is a disagreement on this particular matter between the health authority and the Secretary of State then it would have to come before Parliament to be resolved because that is the effect of sub-paragraph (ii) of the amendment, which says: the allotment is changed by an order, a draft of which has been laid before and approved by Resolution of each House of Parliament. That is the effect of the amendment.

Baroness Robson of Kiddington

My Lords, that is not how I read the amendment. The financial allocation of the department, or the Secretary of State, goes down to the region, and the impetus for any change between the region and the district comes from the allocation, or the allotment, or the change in allocation that is handed down through the region to the district. It would be the region who would be objecting and who might use this clause.

When the noble Lord said that my amendment would prevent, for instance, the practice of authorities borrowing money from each other and thereby stopping flexibility, that is a completely different matter. Borrowing money from each other entails repayment at some time or another. It is not the reduction in the total allocation which can happen, and has happened, to health authorities. I can see that I cannot bind a Secretary of State for a whole year—although that would be ideal if we knew for certain what we were going to do—but it is not very much to ask to leave the last three months of a financial year free of change in allocation. I am sorry: I am not convinced by the noble Lord's arguments. I should like to press the amendment.

7 p.m.

On Question, Whether the said amendment (No. 20) shall be agreed to?

Their Lordships divided: Contents, 71; Not-Contents, 113.

Airedale, L. Ewart-Biggs, B.
Ardwick, L. Ezra, L.
Attlee, E. Falkland, V.
Avebury, L. Gallacher, L.
Aylestone, L. Glenamara, L.
Banks, L. [Teller.] Graham of Edmonton, L
Bernstein, L. Grey, E.
Briginshaw, L. Hanworth, V.
Brockway, L. Hatch of Lusby, L.
Bruce of Donington, L. Heycock, L.
Buckmaster, V. Houghton of Sowerby, L.
Carmichael of Kelvingrove, L. Jacques, L.
Jeger, B.
Collison, L. Jenkins of Putney, L.
David, B. Kagan, L.
Dean of Beswick, L. Kilmarnock, L.
Diamond, L. Kirkhill, L.
Ennals, L. Lawrence, L.
Lloyd of Kilgerran, L. Stedman, B. [Teller.]
Longford, E. Stewart of Alvechurch, B.
McGregor of Durris, L. Stewart of Fulham, L.
McNair, L. Stoddart of Swindon, L.
Mar, C. Stone, L.
Mayhew, L. Taylor of Blackburn, L.
Meston, L. Taylor of Gryfe, L.
Mishcon, L. Taylor of Mansfield, L.
Molloy, L. Tordoff, L.
Mulley, L. Underhill, L.
Nicol, B. Wallace of Coslany, L.
Perry of Walton, L. Walston, L.
Rhodes, L. Wells-Pestell, L.
Robson of Kiddington, B. Whaddon, L.
Rochester, L. Wigoder, L.
Ross of Marnock, L. Winchilsea and Nottingham, E.
Seear, B.
Somers, L. Winterbottom, L.
Stallard, L.
Abercorn, D. Ilchester, E.
Airey of Abingdon, B. Inglewood, L.
Allerton, L. Ingrow, L.
Avon, E. Kaberry of Adel, L.
Bathurst, E. Kilmany, L.
Bauer, L. Kinloss, Ly.
Bellwin, L. Kinnoull, E.
Beloff, L. Lane-Fox, B.
Belstead, L. Lauderdale, E.
Birdwood, L. Lindsey and Abingdon, E.
Blake, L. Long, V. [Teller.]
Brabazon of Tara, L. Lucas of Chilworth, L.
Broadridge, L. McAlpine of West Green, L.
Brookeborough, V. McFadzean, L.
Brougham and Vaux, L. Mancroft, L.
Broxbourne, L. Margadale, L.
Bruce-Gardyne, L. Massereene and Ferrard, V.
Buccleuch and Queensberry, D. Maude of Stratford-upon-Avon, L.
Buckinghamshire, E. Merrivale, L.
Caccia, L. Mersey, V.
Caithness, E. Minto, E.
Campbell of Alloway, L. Molson, L.
Carnegy of Lour, B. Montgomery of Alamein, V.
Carnock, L. Morris, L.
Cathcart, E. Mottistone, L.
Chelwood, L. Murton of Lindisfarne, L.
Cockfield, L. Napier and Ettrick, L.
Colwyn, L. Newall, L.
Cork and Orrery, E. Norfolk, D.
Cottesloe, L. Northchurch, B.
Cox, B. Orr-Ewing, L.
Craigmyle, L. Pender, L.
Crathorne, L. Peyton of Yeovil, L.
Daventry, V. Portland, D.
Davidson, V. Redesdale, L.
De La Warr, E. Renton, L.
Drumalbyn, L. Rochdale, V.
Elliot of Harwood, B. St. Aldwyn, E.
Elton, L. St. Davids, V.
Faithfull, B. Saltoun, Ly.
Ferrier, L. Selkirk, E.
Fraser of Kilmorack, L. Shannon, E.
Glanusk, L. Skelmersdale, L.
Glenarthur, L. Spens, L.
Gormanston, V. Stodart of Leaston, L.
Gray of Contin, L. Strathcarron, L.
Gridley, L. Swinfen, L.
Grimston of Westbury, L. Swinton, E. [Teller.]
Hailsham of Saint Marylebone, L. Thomas of Swynnerton, L.
Tranmire, L.
Hanson, L. Trenchard, V.
Harmar-Nicholls, L. Trumpington, B.
Henderson of Brompton, L. Vaux of Harrowden, L.
Henley, L. Vickers, B.
Home of the Hirsel, L. Vivian, L.
Hornsby-Smith, B. Whitelaw, V.
Hylton-Foster, B. Wise, L.

Resolved in the negative, and amendment disagreed to accordingly.

7.10 p.m.

Lord Skemersdale

My Lords, I beg to move that further consideration on Report be now adjourned until 8.10 p.m.

Moved accordingly, and, on Question, Motion agreed to.