§ 6.6 p.m.
§ Lord Glenarthur
My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
§ Moved, That the House do now resolve itself into Committee.—(Lord Glenarthur.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The LORD JACQUES in the Chair.]
§ Clause I [Supply etc. of optical appliances.]
§ The Deputy Chairman of Committees (Lord Jacques)
I must inform the Committee that if Amendment No. 1 is agreed to, I cannot call Amendments Nos. 2 to 11.
Lord Cullen of Ashbourne moved Amendment No. 1:
Page 1, line 8, leave out subsection (1).
§ The noble Lord said: My noble friends on the Front Bench will no doubt regard this as a wrecking amendment. I consider it to be the reverse of that. The purpose is to prevent Her Majesty's Government from lowering or even wrecking the standards of optical services in this country. The Government's wish to increase competition and to bring down the prices of private spectacles would be achieved by subsection (2) and subsection (3) of this clause while maintaining the present high standards. With some qualifications, I support subsections 2 and 3 of the clause.
§ I have prepared quite a long speech enumerating the arguments against unqualified dispensing, but noble Lords who have taken part in, or listened to, these debates in the past will be well aware of the arguments and so I see no reason to repeat them today. However, I should like to remind your Lordships that it is not only opticians who are naturally against this idea: both the BMA and the National Ophthalmic Treatment Board Association are also opposed to it. The real issue before the Committee is whether or not it is in the public interest for those who need their vision corrected by spectacles to have their optical prescriptions properly dispensed by persons qualified to do the job. I am convinced that it is not only unnecessary but unwise to let unqualified persons 1049 loose on to the optical market, and it is against the public interest. I beg to move.
§ Lord Renton
It might help if I say at this stage, briefly, that some years ago I appeared for the prosecution in a case in which an unqualified person was convicted of obtaining money by false pretences, which consisted in his claiming to be able to test eyes and prescribe lenses for correcting vision. He had an elaborate box of filed lenses and he had books on the subject, but he had no training and no clue how to do it properly.
Therefore, two questions arise on this Bill. The first is whether unqualified people will be allowed to test eyes. I hope and assume that they will not be allowed to do so. I hope that is clear. But the next point that arises is this: will they be allowed to supply spectacles on a prescription given by a person fully qualified to test eyes? If that is so, what guarantee will there be that they were trained in the art of ensuring that the spectacles corresponded to the prescription? If the Government cannot give that guarantee, unqualified people should not be let loose on the public; it would be a retrograde step to let that happen.
§ Lord Ennals
I am most grateful to the noble Lord, Lord Renton, for the words he has just used. I believe this is a thoroughly retrograde step. One might assume from those noble Lords who support the case that somehow or other this is a step forward. It is a thoroughly bad step backwards. It is wrong in principle. It is absolutely clear that the British Medical Association, whatever the noble Lord, Lord Orr-Ewing, says—and I have had subsequent correspondence with the BMA—fully support the position of their optical committee, that optical dispensing requires a great deal more than the ability to read a prescription. It requires a knowledge—
§ Lord Orr-Ewing
I am so grateful to the noble Lord for referring to this. I wonder whether he can give us the date on which the full committee of the BMA met to consider this current Bill, because I have not been able to find out.
§ Lord Ennals
I had a letter last week from the BMA in which they said that, with the many fields they cover, they delegate the responsibility to their committees and they fully support the decision that was taken and which was referred to by me during the debate on Second Reading. I thought it was better to have that matter clear, since I had been challenged on it by the noble Lord.
I believe this is going to be very bad for the people concerned and also very bad for elderly people, who are, after all, the vast majority of those who need spectacles. I do not think the British public really knows what is coming to it. A recent survey showed that a high percentage of the public was completely unaware of the changes proposed in the Bill. The survey revealed that less than half the population were aware of any Government plans to alter the 1050 regulations for the dispensing of spectacles. Even among spectacle wearers, awareness amounted to only 48 per cent., but only 3 per cent. had realised that the Government's plans meant that unqualified persons were going to be allowed to dispense spectacles. I mentioned a moment or two ago—
§ Lord Ennals
No, I will not give way again. The noble Lord can seek to make his own speech. This Bill has been strongly condemned in other countries. Representatives of 43 national optical and optometric organisations in countries all round the world met recently in London and discussed the United Kingdom Government's proposals to permit unqualified, unregistered and untrained persons to carry out optical dispensing. They passed a resolution which said that they viewed with considerable concern the proposals of the United Kingdom Government to amend the Opticians Act 1958. They said that this measure would put the public at considerable risk of receiving inaccurate, inadequate and inappropriate optical dispensing at a time when world standards generally in its member countries are increasing. That is absolutely true: they are improving in other parts of the world. In the EEC, all countries have laws regulating optical dispensing, with the exception of Denmark. But Denmark is already discussing doing precisely that. In the United States, all states regulate ophthalmic dispensing to some degree.
§ Lord Ennals
Well, they do. Twenty-one states currently require full licensing of dispensing opticians, and more states are enacting similar legislation. The point I am making is that not only in Europe but in the United States the process is towards regulation—I repeat, "towards" it. The facts absolutely prove it to be so. Our Government are proposing action which would be retrograde; a backward step. They know it themselves, because the noble Lord, Lord Trefgarne—and he was quoted by the noble Lord, Lord Banks, during the Second Reading on 21st May this year—said at col. 1035 on 27th April 1983:Standards of dispensing in the United Kingdom are high. If the need for statutory registration was removed and untrained people could enter the field, standards would inevitably fall".I would ask the Minister, when he comes to reply to what I hope will be a short debate, to say why the Government have changed their view since the noble Lord, Lord Trefgarne, made that statement in this very Chamber.
§ Lord Northfield
I am sorry to cross swords with my noble friend, but I strongly disagree with what he is saying and I think it is high time that most of us put on record our view about this. Could I deal first with the point raised by the noble Lord, Lord Renton? I know that he is an assiduous student of what happens in another place, but I think he must have missed the debate on 2nd May 1984 in another place when the Minister of Health dealt with precisely the point he has raised today. The issue is: what sort of protection will be given to people in relation to the quality of 1051 dispensing? The Minister dealt with that directly on that date in columns. 417, 418 and 419. He said, quite bluntly, that a lot of stories were being put about, rather indicating, as he said, that people would be selling glasses on garage forecourts and men who yesterday were selling ice-cream would today be selling spectacles. All this is nonsense. What he went on to make quite clear was that the Government are to lay down British standards not just for the spectacles but for the process of dispensing.
I want to make it quite clear that the consumer is to be protected under the regulations by the issue of British standards. I am sure that the noble Lord on the Front Bench will want to add to that. So please do not let us get into hysteria about the consumer being unprotected in the future. It is no part of the case of those who support the broad thrust of this Bill to criticise opticians. They do a good service, and nobody is trying to deny that. But what this subsection is doing is to allow unregistered sellers simply to provide spectacles once a recent prescription is produced.
What are the advantages of that? They are clear enough in all the papers that have accumulated over the last 15 years. I must say that I look back into the debates of 1958 in the other place, in which I took part, and in one of which I actually moved an amendment at that time, among many other amendments, to try to get the General Optical Council to control prices and to issue some guidance about the pricing of private spectacle frames. It was turned down on the grounds that opticians would behave themselves and were far too trustworthy to need that sort of control. But what has occurred since then in those 26 years of experience, which I seem to have lived through in a sort of nightmare on this issue, is the continuously-accumulating evidence that it is not true that we can trust to the absence of competition to keep this matter under proper control. We need competition to be brought in and the unregistered seller will be able to do that, provided also, as I say, that with British Standards behind him he can be controlled in the standard of service that he gives to the consumer.
We have had the 1976 Price Commission report which showed extravagant profits; the 1979 Price Commission report which showed enormous profits made by Dollond and Aitchison who have 25 per cent. of the market; the Office of Fair Trading report, which I hope we have all read, a devastating document which was produced in 1982, showing that gross profitability is over 55 per cent. in the large firms and over 50 per cent. in the small firms. Is there not room for competition in all this? With figures like that, there must be room for competition—
§ Lord Northfield
I do not want to give way, because I shall be too long if I do. The noble Lord has his name to the amendment and he can reply to me at the end. What the Office of Fair Trading report also showed was that the other problem in the opticians' industry is that many are under-occupied. They are protected by high prices and so do a small number of prescriptions every year. The Office of Fair Trading went on to find 1052 that if we could get some competition into this industry of selling spectacles, and could then get a smaller number of opticians increasing their activity by one-third, 45 per cent. or something like that—instead of being so well below average, getting up to average and beyond—there could be a reduction of no less than 24 to 28 per cent. in the final price to the consumer. That is by letting competition act, letting it sort out the industry and providing the service that comes after that competition has taken effect.
I do not want to go any further, but I should just like to make three other points. First, I welcome this Bill because it will do one other thing. It will mean that the unregistered seller will have on his counter on display standard spectacle frames. Then, when he gets a prescription for somebody suffering from presbyopia—namely, beginning to get old and needing magnification—he will be able to say "I do not need to send away for special spectacles. I have all this range from plus 1.25 to plus 2.5 dioptres". That will mean that, provided that a prescription is produced, he can sell over the counter these spectacles which are standard and which should retail for £10 a pair. I was horrified to see that a man who was doing this in the West End was recently prosecuted and fined. He was doing exactly that, with no harm to anybody. It is a scandal that that prosecution took place and that our law allowed the prosecution to stand.
My second point is that it will be important to make this system work, as is pointed out in paragraph 9.64 of the Office of Fair Trading report. It will be important for the patient to be given his prescription—not just to be told, "I have carried out your eye test and what sort of spectacles would you like?" He must physically be presented with his prescription, so that he can then leave the optician if he wants and can go to these unregistered sellers' shops.
So I have to ask the Minister very bluntly: Will the regulations which the Government propose to introduce include a requirement—and they do not at the moment—that the optician shall hand the prescription to the patient? That is absolutely crucial in making the new system work. I may say that it is the law in the United States that a patient has to receive his prescription, and it works extremely well.
My final point is about the effect of all this on the health service. There is a lot of talk that all this will lead to the National Health Service frame being taken off the market. That is not true. It will be on the market for people who are to get free spectacles—namely, people with very low incomes and children—and there is no reason why the optician should not continue to sell them. I want to ask the Minister whether he will be kind enough to confirm that the National Health Service frame will still be available for those people who want it, and that the approximate price will be a maximum of about £2 above the present price, because the subsidy on a national health frame and the lenses together is about £2. If the noble Lord will confirm what I have asked, I think he will put to flight a lot of the nonsense that is being talked about the effect of this Bill.
I welcome this subsection unreservedly. It is the end of long campaigning, so far as I and other noble Lords 1053 are concerned. Goodness knows how many years I have been raising the matter in this House alone, and one gets tired of waiting. For goodness sake! let us put it through tonight and not listen to any further nonsense about it.
§ Lord Somers
My Lords, after what the noble Lord, Lord Northfield, has said, I hope that the Government will not decide to try bringing competition into the medical profession or any other particularly specialised profession, because it will not help them. I have recently had a good deal to do with optical specialists, as not long ago I had operations on both eyes for cataract. Therefore, I have had to have fairly accurate fitting of glasses and I can tell your Lordships that extreme expertise is needed to do it properly. Even the matter of fitting a frame is not merely a matter of grinding the lenses, making sure that they are accurate, and so on. Fitting the frame and making sure that it is in exactly the right position is a very expert job, and I entirely agree with what was said by the noble Lord, Lord Ennals. I sincerely hope that the Government will not decide to bring in this irresponsible idea of competition just for its own sake.
§ 6.28 p.m.
Lord Wallace of Coslany
I hesitate to come in at this stage, but I simply cannot understand my noble friend Lord Northfield, with his passionate desire for free glasses at any old unregistered stall, though I support him on the question of a reduction in price. But the passionate declarations of faith in cheap spectacles of those like the noble Lord, Lord Orr-Ewing, and others, appal me. It is all right for cheap reading glasses, but it is a different matter altogether where impairment of sight is concerned.
When noble Lords talk about taking a prescription to an unregistered supplier, they forget one very important and vital factor which the noble Lord who has just spoken has brought out. It applies not only to people with severe impairment—and my wife is in the same position as the noble Lord, but perhaps a little worse—it applies to anybody with an impairment of eyesight, because what people overlook is that the fitting of the spectacles is vitally important.
My optician recently had a case where a young lady came in who had had her spectacles supplied, but had not gone back afterwards for the fitting which the optician had stressed. That lady's arm was covered in bruises and the optician asked "What have you been up to?" She said "I can't help falling about". The answer was quite simple. The fitting of the spectacles on that young lady had not been checked, so she had the habit of falling about. For people with worse eyesight defects, the problem can be almost fatal. Anyone with a severe impairment of eyesight, especially difficult cataract cases, knows full well that a pair of spectacles that are slightly out of true can cause a fatal fall or some other disaster.
I am not overstressing the point. I am fed-up to the teeth with the passionate declarations about free enterprise which are made by some noble Lords. They overlook vital facts about one of the most precious gifts that we have—our sight. It is sad that doctors agree that health is not normally affected. I know for 1054 a fact that a person with a severe impairment of sight whose spectacles are slightly out of true can suffer from irritability, bad temper and mental strain which leads to bouts of depression. Therefore I warn noble Lords who are so passionate about free enterprise to be very careful about what they are doing. I strongly support the amendment. Although I support the noble Lord, Lord Northfield, on price, frames are not the whole answer: lenses are also vital.
§ Lord Orr-Ewing
May I deal with some of the arguments which have been advanced. As my noble friend suggested in his opening speech, I consider that this is a wrecking amendment. We have waited a very long time for some form of competition. As the noble Lord who has just sat down said, we are dealing mainly with reading glasses. We wish reading glasses to be more freely available on the market. Their numbers are not negligible. It is very difficult to find accurate figures but it is estimated that probably 1 million pairs of reading glasses are sold every year in this country. The average price is between £25 and £75. The noble Lord who opened the debate was wrong when he said that the majority of states in the USA do not allow some liberty over where reading glasses may be bought. The vast majority of the states within the states do allow reading glasses to be bought over the counter. They are all very carefully marked. Several samples have been sent to me. Every time I go to the USA I buy spectacles. They are beautifully wrapped and they are carefully marked. This particular pair are plus-4 dioptres, balanced glasses. We all need reading glasses at some time in our lives. There is a range in other cases I have seen, of 18 different strengths of reading glasses.
§ Lord Ennals
Will not the noble Lord accept that in the United States the trend is steadily more and more towards—
§ Lord Ennals
Oh, yes. The facts are absolutely clear. I have the figures for 1st June 1984 which show that the number of states which are now moving towards the kind of legislation we are now seeking to abolish is increasing. The noble Lord is wrong.
§ Lord Orr-Ewing
I must confess that I do not have the figures for 1st June 1984; my research assistant is not so good as the noble Lord's. However, I know from surveys and from having read and re-read the publications of the Office of Fair Trading that a very large majority of countries allow competition in this field. What a benefit this would be for a great number of people. I am speaking not for the opticians for whom my noble friend so gallantly speaks, as the chairman or president of the Opticians' Federation. I am speaking for the vast number of people over the age of 45 in this country. When you are over 45 years of age you may for the first time need a pair of reading glasses.
I do not like the idea that you will have to take a prescription with you. I may have to go along with this because it is built into the Government's legislation, but I hope that my noble friend who is to speak on this issue will agree that a prescription for reading glasses is 1055 not necessary because most eyes are balanced. Even if the eyes are not completely balanced, the eye is an extraordinarily adaptable organ. As I said in my Second Reading speech, it is amazing how God designed our eyes and our brains to adapt to slight imperfections in one eye or the other. It is not just the eye but the brain which is involved.
I support the noble Lord, Lord Northfield, who said that when there has been an eye test it ought to be mandatory for a prescription to be given to the person whose eyes have been tested. However, that still leaves many people out of the reckoning. Shall we all have to carry our blood group, our TV licence number and God knows how many printed cards in our wallets and. in addition, our prescription? What is to happen in the case of the I million or 2 million visitors who come to our country every year? All of us lose our glasses at some time or another. If these visitors break or mislay their spectacles, will they have to have an eye test and then wait for their spectacles to be made up?
Why do the Government not allow people to go into a shop and buy perfectly well marked and carefully tested reading glasses? Nobody can fault them. It is agreed that the eyes can be in no way harmed by having the wrong reading glasses. A headache is the first sign that the glasses are not right.
The noble Lord, Lord Ennals, referred to the British Medical Association and said that they have left it to their Optical Committee. But the Optical Committee has not met. Only a few executive members of the Optical Committee have met. They have therefore condemned a Bill which has never been considered by the members of the Optical Committee as a whole. The BMA say that they back the Optical Committee. They are perfectly entitled to do so; but it is wrong to say that the BMA have studied this matter, have met in full committee and condemn this Bill. Unless the noble Lord, Lord Ennals. can produce chapter and verse as to when they met, whether they considered the Bill and how many people were present, I have to say that they decentralised it to their Optical Committee.
§ Lord Ennals
Although I do not have it before me, since the Second Reading debate I have received a letter from the BMA which confirms absolutely that what I have said is right. They fully and totally support their Optical Committee in the conclusions which they have reached. They did not need to say on what date they met and how they met, but the BMA have established quite clearly their support for the Optical Committee.
§ Lord Orr-Ewing
I should like to see a copy of that letter. Since I made the challenge. I regret that they did not send a copy to me. I hope that my noble friend on the Front Bench will resist this wrecking amendment, and that we shall go on with a Bill which is not so free as I should like it to be but which will be an enormous step forward and which will be of tremendous benefit for everybody who needs reading glasses.
§ Lord Donaldson of Kingsbridge
The amendment is based upon an emotional fallacy. I speak entirely without passion. I do not care what you pay for your glasses. I buy mine in India or New York and they are 1056 perfectly all right. That is a privilege I enjoy because I have the opportunity to travel. It is an offensive fallacy that ordinary people can damage their eyes by using magnifying glasses which do not give them the best possible vision.
About a year ago I went to my oculist and asked him whether I really needed, because it is so expensive, to change my glasses. He said that I did not need to do so if I felt comfortable. He tested my eyes and said that I ought to change one pair if I wanted to have the best vision for reading. I changed one pair, though not the other—I have two pairs of reading glasses—and I cannot tell the difference between the two. However, the change cost me quite a lot of money. This oculist, one of the best in the country and also one of the best known, told me that not a single reputable oculist, whatever the BMA may say, believes that reading with a magnifying glass which is not carefully prescribed for you can do you the slightest possible harm.
My second point, which is very important, is that the noble Lord is perfectly right about the fitting of glasses. It is similar to the difference between having a good figure and going to the Fifty Shilling Tailor, as I used to do when I was that kind of age, and having a bad figure and going to an expensive tailor. I can wear any glasses, in any frame, in complete comfort. My wife paid so much for her last frames that I shall not tell the House how much they cost. However, it was worth it in her case. They are very light; she has a very difficult nose. It is a highly technical operation—nothing to do with optics—to fit them correctly. Therefore we must not believe that to wear glasses which we have picked up in the street or anywhere else—often I use other people's glasses—can do us the slightest harm. If they are uncomfortable we do not go on with them.
Let nobody under-estimate the importance of difficult lenses and the fitting of them into first-class frames. That is worth money. I object to my wife paying quite so much, but I do not mind her paying a good deal. I have never used anything except a National Health Service frame, and I shall be in a terrible state when they are taken off the market.
§ Lord Rugby
If I may refer to what was said by the noble Lord. Lord Somers, he confused the Committee by introducing a medical question with regard to spectacles when, of course, spectacles have absolutely no relationship to medicine whatsoever—and neither do the sales of spectacles. His particular prescription is probably for a major eye defect which requires very powerful lenses. It may have no relationship whatsoever to the low-power lenses, equal for both eyes, which the presbyopic person will require at about 45 years of age due to the ageing process, simply in order to magnify the printed word.
Reading spectacles are related not so much to the eye condition as to the size of the print. If the print is small, then the wearer will require a magnification of plus-2, say, at age 45. When that person is 60 or 70 years of age, he may need a 0.5 per cent. increase in magnification just in order to read. But he does not need his spectacles all the time; the question is simply 1057 related to the job which those spectacles have to perform. There is absolutely no reason at all why the elderly should, simply because of the infirmity of old age. have to carry an enormous price tag and a totally unnecessary eye test. when there are all the other various spectacles which people might need for the kind of major eye defects which come into the realm of ophthalmology.
§ Lord Molloy
Having listened to both this and the previous debate, I believe that the real issue is a simple one. I acknowledge the frustration and annoyance which one might experience when finding that a pair of spectacles costs more at one optician's shop than at another. In other words, the principle of "shopping around" seems to apply. I agree that opticians within a given area should be allowed to advertise.
How should we decide on this particular amendment? I had no idea what was wrong with my eyes. When I was about 45 years of age, I suddenly discovered that it was difficult to read. I thought that I had better have my eyes tested. Then I was told, "Aren't you lucky?". Look at me: I am purblind and have been for 20 years because, before the war, I went to Woolworth's to get my glasses for "a tanner". No one examined my eyes, and no one said there was any need: just so long as one could see, that was enough. We have to take full cognisance of that argument.
The second argument is that the unregistered suppliers of these glasses will have a vast range of prescriptions. Will that be true of every one? It seems to me absurd that there will be millions of sets of glasses. It is as if someone said to me tonight, "Do not bother to go to your opticians in Fulham—pop across to India because you will save a couple of bob by buying a pair there". It is that kind of absurdity which we have to recognise.
I do not know enough about the profession of eye-testing: all I know is that when I need glasses I consider it is wise to go to an optician. Speaking parenthetically, I, too, received a letter from a very responsible officer of the BMA stating that the comments which my noble friend Lord Ennals and I had made previously in this House on behalf of the BMA were acceptable to them and were perfectly accurate.
What should we do? The choice I have is this. I must either listen to the arguments which have been put by some of my noble friends who have no qualifications or I must decide whether I should listen to the British Medical Association and the opticians' association and take their advice. My answer is quite simple: my eyes are far too precious to dabble with and for me to take the advice of amateurs. In this instance, I will accept the decision of the experts.
§ 6.45 p.m.
§ Lord Ferrier
I do not propose to repeat what I said on a previous occasion, but I support this amendment and everything that my noble friends and the noble Lords, Lord Ennals and Lord Wallace of Coslany, have said. To my mind, the trouble is that a lot of passion has entered this argument. One has only to listen to the noble Lord, Lord Northfield, or to my noble friend Lord Orr-Ewing, to realise that this seems to be a subject that is very worrying to people.
1058 I have looked back over the years, and I am sure I am right in saying that the position today is completely changed from what it was when the noble Lord, Lord Northfield, started his campaign.
§ Lord Ferrier
The situation is not the same as it was then. This Bill makes a muddle of our approach to the National Health Service Act. It amounts to fiddling about with it. I do not like it. I have said so before, and something similar has been said in another place.
One of the aspects that interests me is the Title of this Bill. If this amendment were not to be accepted—an I hope that it will be—then we would have to address ourselves to the Title. The Bill as it now stands does not line up with the Long Title. As for the Short Title—the Health and Social Security Bill—I feel that in terms of indexing Hansard there ought to be a reference to the fact that this Bill fiddles with the opticians' legislation. If this amendment were not to be carried, we would have to address ourselves to the problem of the Bill's Title. The reason is that the Bill cannot in every way be beneficial to health. It may be beneficial to the reduction of prices, and I think that is possible: but it can in no way result in better eye examinations or better lenses, or better dispensing.
I was interested by an experience I had the other day. When I lost my wife, I did not know what to do with a large collection of spectacles. My optician said to me, "Let me have the lot and I will label them all with the correct prescriptions and send them to Oxfam". I mention this only because it was interesting to me that one could make use of possessions that are no longer needed and that one could hand over spectacles to members of an extremely sensible, responsible and expert profession, who would then dispose of them in that way.
I myself do not go so far as the noble Lord, Lord Wallace of Coslany, but I feel most strongly that we must not allow our passions to be excited by this question. The agitation which arose a few years ago was in a measure necessary, and the result has been that prices have gone down and that competition is now operating as of today. We would he very unwise to think, especially when reference has been made to the report of the Office of Fair Trading, casting back in my memory, that it had the full story from both sides. I think my noble friend will be able to support that later. I support the amendment wholeheartedly and hope that the Committee will be sensible and eliminate subsection (1).
§ Lord Prys-Davies
I wish to support this amendment, and I will be brief. The standards of dispensing in this country are high. They are high because the dispensing optician has been well trained. Last year there were 257 students who sat the final dispensing examination of the Association of Dispensing Opticians. Of the 257, only 83 passed and 174 failed. If this Bill is passed the 174 who failed can next year dispense glasses on the open market. To allow that to happen in the case of those who have failed to equip themselves with the necessary skill and knowledge will lead inevitably to the lowering of standards, and that would be a retrograde step. That is why I support the amendment.
§ Lord Mottistone
I strongly support the amendment for exactly the same reason as the noble Lord has said. This particular amendment will perhaps be more sweeping than one would particularly want, because I agree with the noble Lord. Lord Northfield, that competition should be encouraged. However, I am deeply concerned because I understand that this is a paving subsection for doing away with the requirement for qualified dispensers. As I said on Second Reading, I fear greatly that with unqualified dispensers the restraint on making sure that the proper prescription is presented, and that it is a recent one, will not be there because they will not be professional people.
My noble friend Lord Orr-Ewing, who I am sorry to see is not in his place, obviously buys spectacles by the score when he goes across the Atlantic. What he does with them I do not know, except to demonstrate to us that he can get them cheaply, but he probably pays more than he would if he obtained a simple pair here at present prices, let alone better ones. Someone like that in a hurry, or anyone of your Lordships who all carry a tremendous impression when you walk into a shop, will be able to say to the young man or woman, "Look, I want that pair". They will say, "Where is your prescription?" You will say, "Oh, I do not have it" or, "This will do".
Having a lower standard of dispensing will mean that the specs will not fit. I have a doctor friend who is very much on the side of the noble Lord, Lord Rugby, and my noble friends who support him. Not long ago he bought some specs which clearly did not fit him. I tried them on. Our heads are roughly the same size and our eyes are about the same standard. I said. "This is all very well, but they are out of focus round the corners". He said, "That does not matter". I said, "What happens if you walk round a door?" He said, "That will be all right, I will just turn my head". The point is that he was so determined to prove that he was right, having bought them from a barrow in the East End, that anything would do.
The trouble is that people who get the wrong sort of specs, or even the right specs which do not fit, will not perhaps be so much a danger to themselves—although some of them will be—as, what is worse, a danger to others. They will bump into us. They will drive their motor-cars into us. If the Government could only say with the order which this subsection gives power to the Government to raise, "We are not going to walk back on the qualifications required for dispensers", I would be very happy to live with that and hope that when we see the orders we shall be able to make sure that they are up to standard. If my noble friend cannot give the undertaking that the qualifications of dispensers are to be maintained, I very much hope that my noble friend who moved the amendment will take us into the Division Lobbies and that we shall defeat the whole subsection.
§ Lord Monson
What one or two noble Lords on the Conservative Benches may not realise is that acceptance of this amendment would be entirely contrary to the Government's stated principles. I am sure that the Minister will agree that since 1979 numerous senior Conservative spokesmen, including, I believe, the Prime Minister herself, have said time and again that it is the purpose of this administration 1060 to give ordinary people more scope to make decisions about matters affecting their own future without the interference of busybodies or bureaucrats. Acceptance of this amendment would totally fly in the face of that principle.
§ Lord Banks
It seems to me that British standards for dispensing are not really an adequate substitute for qualification. I share the misgivings expressed just now by the noble Lord. Lord Mottistone, on that point. The noble Lord, Lord Ennals, reminded the Committee that during the Second Reading debate I quoted the words of the noble Lord. Lord Trefgarne, just over a year ago in this House when speaking for the Government. I want to return to those words because they put the case for this amendment so well.
Your Lordships will remember that in the few words quoted by the noble Lord, Lord Ennals, the noble Lord, Lord Trefgarne, thought that if untrained people could enter the field standards would inevitably fall. That point has been echoed by many noble Lords tonight. I quoted the noble Lord, Lord Trefgarne, who said:Unskilled dispensing is probably not harmful to the eye. However, unskilled dispensing could well result in less than optimal improvement to sight and could perhaps act as a contributory cause to accidents".He made this pertinent comment:It may well be that this is a very small risk but I personally would not choose to be driving down the M1 behind or in front of somebody who had less than perfect eyesight."—[Official Report, 21/5/84; col. 24.]In replying to that debate the noble Earl, Lord Caithness, said that when the noble Lord. Lord Trefgarne, had made those remarks he was, in fact, opposing the total repeal of the safeguards in the Opticians Act and that because the Government were keeping the registration of opticians the remarks of the noble Lord did not apply and were no longer relevant as far as this Bill was concerned. However, if your Lordships think of the words quoted today, there is no reference to the testing of eyes and no reference to prescribing. The noble Lord was talking about unskilled or unqualified dispensing.
I feel that this amendment would prevent standards of dispensing from falling, as the noble Lord, Lord Trefgarne, feared they would. It would prevent the risk of accidents, which the noble Lord, Lord Trefgarne, feared and it would prevent the risk—however small some people may think it is—of damage being done to eyes.
§ Lord Rugby
There is a very big difference between testing eyesight and dispensing spectacles. If a person has a prescription, that prescription has to be made up and it will be made up probably by an optical manufacturers prescription house which will operate within very exacting limitations according to the prescription. The dispenser is simply the person who sends the prescription off to one of these houses and receives back the lenses which have been entirely made up according to the standards which are laid down. They could be prosecuted for producing equipment which is not within those limitations. Therefore, the dispenser is simply a dispenser of glasses which are made up by someone else. He puts them in a frame and sells them.
§ 7 p.m.
§ Lord Graham of Edmonton
I shall be very brief, although I appreciate that the debate has gone on for some time.
§ Lord Graham of Edmonton
I agree that there is plenty of time. I simply want to make the point that it appears to me that many noble Lords who have spoken against the amendment are really asking, "Why should we bother? Why do we not just leave the present situation but watered down? Why should we not leave people to look after themselves?" The noble Lord from the Cross-Benches simply said that even though that may be damaging to one's health and the nation, it should he left like that: caveat emptor—let the buyer beware. If an individual is foolish enough to manage his own affairs where his eyesight is concerned and is not prepared to show sufficient care and concern, why should we bother? I believe it is the responsibility of the Government, and certainly this House, to look very carefully at the situation.
I am no expert in these matters. I listened carefully to what was said, and I declare a small interest. Having received a journal called Insight, I see that the members of the Federation of Optical Corporate Bodies include the Guild of British Dispensing Opticians, the Society of Opticians and the Cooperative Wholesale Society. As noble Lords are aware, I declare readily my association with the Co-operative movement.
If, indeed, as the noble Lord, Lord Northfield, said, we are concerned about some distress at the manner in which the cost to the consumer has been unnecessarily inflated over the past period, surely of itself advertising will substantially help to reduce the cost. We do not know the extent to which that will happen. I imagine that advertising associations and the advertising world would say that there is advantage to be gained from the increased competition that advertising will bring.
At the end of the day, we may have a situation in which the individual trusts, first of all, the doctor and the optician. He may want to make sure that his eyes, which arc precious, get the best treatment. I have read some of the literature, and the noble Lord, Lord Prys-Davies, has pointed out the extent to which the profession takes great care to make sure that only those who pass the most stringent tests are qualified to have letters after their name. People may need three years' training and a range of skills to prove that they are qualified. Are we really saying that we can so lightly set aside that situation and give an opportunity, not to anyone or to any shop, but to many more shops and many more unqualified people to provide members of the public with what they believe is on their prescription, which the person dispensing it may not be qualified to interpret? Are we really satisfied that we can so easily move from a situation that protects the consumer? I say that we ought to think very carefully.
I very much hope that the Minister will tell us what in addition to what is on the face of the Bill he intends to do to make sure that the consumer is protected. I hope that he will have in mind that, no matter how 1062 much is written in legislation, very many people, who may be gullible, poor or simply feckless, will simply take the opportunity to buy what they can at the cheapest place that they can. They may do little damage to themselves, but the noble Lord, Lord Mottistone, made a point which was echoed by others: they may damage themselves very little, but in having this opportunity they may run the risk of damaging others. I do not believe that we should take that risk.
§ Baroness Robson of Kiddington
I wish to add just one or two words. I was very interested in what has just been said about the impact of advertising on the cost of glasses. In this Committee there seem to he some who believe that advertising will help to reduce prices; other noble Lords say that that is a minor issue and is not important. I am very concerned with the high standard of optical dispensing that exists in this country. Why do we have to do everything in one fell swoop? Why can we not let the advertising go through, leave things for a couple of years, see how that reduces the price of glasses, and, if it does not help, think again on the other issues?
§ Lord Glenarthur
I fully share with the noble Lords, Lord Wallace and Lord Molloy, their views on the precious nature of sight. I am fortunate enough at the moment not to need glasses. But perhaps it would help if I reminded the Committee of the origin of the existing restrictions on sales of optical appliances in Section 21 of the Opticians Act 1958.
This section was added to the then Bill at Committee stage in another place, and was indeed a matter upon which the noble Lord, Lord Northfield, fought tooth and nail. It might help to recall what danger that Act was aimed against. The clause was introduced in Committee in another place in response to a widespread feeling that the sale of glasses to the customers' own choice without a sight test by a qualified person was a danger. In other words, the clause was designed to prevent sales of self-selected, ready-made glasses. Nowhere in the debates on the Bill then was it suggested that empty frames were a danger. Nowhere was it seriously suggested that glasses made up by non-opticians to a prescription following a sight test were dangerous. This is because they do not pose any danger to adults.
The Government have not proposed the total repeal of Section 21, although I think this was a point that was referred to by the noble Lord, Lord Ennals, when he referred to what my noble friend Lord Trefgarne had said earlier and which was answered by my noble friend Lord Caithness at Second Reading. That speech made by my noble friend Lord Trefgarne referred to total repeal. But I understand, of course, there are some who would have preferred us to have gone rather further than we have done. We acknowledge the dangers of undetected eye disease, and the Bill requires glasses sold by non-opticians to accord with a recent prescription by a qualified prescriber. We have not stopped there. Glasses for those under 16 years of age also have to be supplied by a qualified optician, because the young developing eye needs to be carefully corrected or else permanent squints or damage in other ways can result. The medical view in the shape of the Faculty of Ophthalmologists and the leading 1063 optical professional body, the British College of Ophthalmic Opticians, confirm quite categorically that adult eyes cannot he damaged by inappropriate lenses. The noble Lord, Lord Donaldson, seemed to agree with that, and so did others.
§ Lord Bruce-Gardyne
Before my noble friend leaves that argument, may I just get this clear, because it is of relevance to the amendments that will follow? Is he therefore saying that the reason for retaining the obligation of prescription is not to prevent harm to adult eyes, as he agrees that that cannot arise, but in order to enable a test to be made for disease of the eye? Is that the proposition that he is advancing to the House?
§ Lord Glenarthur
Since a pair of glasses will not be available without the prescription in the first place, the fact that the person concerned goes to a qualified person to get the prescription means that his eyes will be tested. I hope that that will answer the point that my noble friend makes. As to the frequency of those tests, that is a matter for a regulation, on which we are consulting at the moment.
The argument is then advanced that general wellbeing, or even safety, as referred to by the noble Lords, Lord Wallace and Lord Somers, and my noble friend Lord Mottistone, would be endangered by this measure, because lenses will not be properly centred. If a lens is substantially incorrectly centred, it will indeed cause problems. What is more, in the vast majority of cases this will be obvious to the wearer through blurred vision or even headaches. Even though I do not wear glasses, I know quite well that if I put on somebody else's glasses. I get blurred vision and I get a headache after a minute or two, so that seems pretty obvious to me. This is how people today know that their glasses are not right. Of course qualified opticians do sometimes make mistakes but such a mistake comes to light because the user notices it and complains about it. This is how the public in future will know if their glasses are incorrect.
The noble Lord. Lord Graham of Edmonton, just now referred to the handout circulated by the Federation of Optical Corporate Bodies and called Insight. In that, they did say that the more powerful the prescription the worse it will be, so I think what they say in that remark goes to make my point for me.
In emphasising that there are no significant dangers arising from bad optical dispensing, I should not like that to be taken as any indication of lack of concern about whether or not the public get good glasses. A vast range of consumer goods and services is produced in this country. It is exceptional, however, for there to be legal restrictions upon who can sell them. Unlike the dangers of poor optical dispensing, those of food poisoning are very real. We do not, however, require all grocers to be qualified. Even if we did, we should not protect the public from contaminated tins of meat.
For most products and services we put all the necessary safeguards on what can be sold. We prohibit adulteration of foodstuffs, for example—although I sometimes wonder, when I read the labels stating the contents of certain tins! But we have not been persuaded that there are any inherent features in a pair 1064 of glasses that require them to be treated in a quite different way from the generality of goods and services. Of course we acknowledge the high degree of professional skill involved in arriving at the correct prescription, but we are not convinced that only a trained dispensing optician is capable of making up these prescriptions.
The noble Lord, Lord Renton, asked particularly whether there was any guarantee of training for those who supply glasses. There is a legal requirement in the Bill that glasses sold accord with the prescription. If anyone is to meet that requirement they will have to have the necessary expertise, otherwise they will not be complying with the law. This expertise is not particularly hard to acquire, either, I must tell the Committee. In fact I understand that one very reputable optician claims that it is possible to train someone to dispense the most common forms of prescription in a week.
It is a very scientific and almost a mathematically-based performance. For many prescriptions, only one or two simple facial measurements need to be added to the prescription in order to enable a technician in an optical prescription house to make the complete glasses. The accuracy of the finished product can be checked on a simple machine, a focimeter. The more complicated prescriptions require a higher degree of skill. However, any non-optician who tackles any sort of optical dispensing will be placed by this Bill under a legal obligation to supply glasses which accord with the prescription.
We are prepared to draft the subordinate legislation in ways which will further strengthen the consumers' hand. For example, we intend to ensure that unsafe frames and lenses are prohibited. We intend to define the tolerances within which the prescriptions must be met. We are prepared to consider whether requirements relating to centration of the lenses should be included—and I hope that that will satisfy the noble Lord. Lord Somers. In fact we are willing to listen to any views on how the product—that is to say, glasses—needs to be regulated.
The noble Lord, Lord Northfield, and my noble friend Lord Orr-Ewing asked particularly about a requirement that prescriptions be given to the patient after a sight test is completed. In preparation for this Bill, we have started consultations with optical bodies on changes to the terms and conditions of service of opticians providing GOS sight tests. One of these changes is to make it a positive requirement that prescriptions are given to the patient after the sight test is completed.
We believe that this is the correct way of ensuring that the public get the consumer protection they need, rather than by regulating who can sell these products. Many of the public will continue to want the different forms of reassurance that a recognised training bestows. Indeed for certain patients the additional understanding and knowledge of optical matters of the trained person will be highly desirable—for example, for many patients of hospital eye departments. We will place no barriers in the way of prescribers who, for good optical or medical reasons, wish to advise their patients of the need for a knowledgeable person to dispense their prescription. We cannot, however, continue to justify the present level of legal restrictions applied to glasses.
1065 There is no doubt that the competition of alternative suppliers will reduce pries. It is also true that glasses. Taking all reasonable safely factors into account and bearing in mind the subordinate legislation to follow, competition is the best assurance of consumer satisfaction. It is on that basis that, if my noble friend presses his amendment to a division, I ask the committee to reject it.
Loar Cullen of Ashbourne
We have had a very interesting debate and a great many people speaking on both sides. I feel that one or two points that have been raised I should try to clear up a little. One is the question of the prescription, which people seem to take rather calmly. The prescription is of course the absolutely vital matter before you get your lenses. But the specification, which I do not think has been mentioned today, is what is sent to the prescription house, and it contains all the measurement carefully made by the dispensing optician without which the prescription is of no value.
I should also like to take up one point made by the noble Lord, Lord Northfield, about the profits of optical companies, because both the two Price Commissions and the office of Fair Trading came to the conclusion that opticians were not making excessive profits. The reasons for that of course is that opticians are making losses on their National Health Service work and the only way that they can keep in business at all is by increasing the price of private spectacles. However, this price is falling and is now lower than it was in 1981. Anyhow, we have had a very interesting debate and I should certainly like to test the feelings of the Committee.
§ 7.17 p.m.
§ On Question, Whether the said amendment (No.1) shall be agreed to?
§ Their Lordships divided: Contents, 71, Not-Contents, 94.1066
|DIVISION NO. 1|
|Amherst, E.||Glenamara, L.|
|Ardwick, L.||Graham of Edmonton, L. [Teller]|
|Banks, L.||Hampton, L.|
|Bernett, L.||Houghton of Sowerby, L.|
|Bernstein, L.||Hughes, L.|
|Beswick, L.||Jeger, B.|
|Birk, B.||Jenkins of Putney, L.|
|Blease, L.||John-Mackie, L.|
|Boston of Faversham, L.||Kagan, L.|
|Bowden, L.||Kinloss, Ly.|
|Brooks of Tremorfa, L.||Kirkhill, L.|
|Carmichael of Kelvingrove, L.||Lockwood, B.|
|Cledwyn of Penrhos, L.||Loudoun, C.|
|Collision, L.||McNair, L.|
|Cullen of Ashbourne, L.||Masham of Ilton, B.|
|David, B.||Mayhew, L.|
|Dean of Beswick, L.||Merrivale, L.|
|Donnet of Balgay, L.||Molloy, L.|
|Drumalbyn, L||Mottistone, L.|
|Elwyn-Jones, L.||Mulley, L.|
|Ennals, L.||Nicol, B|
|Ewart-Biggs, B.||Oram, L.|
|Ferrier, L.||Pender, L.|
|Galpern, L.||Pitt of Hampstead, L.|
|Ponsonby of Shulbrede, L.||Stewart of Alvechurch, B.|
|Prys-Davies, L.||Stewart of Fulharm, L.|
|Rea, L.||Stoddart of Swindon, L.|
|Renwick, L.||Stone, L.|
|Robertson of Oakridge, L.||Strabolgi, L.|
|Robson of Kiddington, B. [Teller]||Suffield, L.|
|Taylor of Manfield, L.|
|Serota, B.||Underhill, L.|
|Shackleton, L.||Wallace of Coslany, L.|
|Somers, L.||Whaddon, L.|
|Stallard, L.||White, B.|
|Wilson of Rievaulx, L.|
|Airedale, L.||Kitchener, E.|
|Allerton, L.||Lane-Fox, B.|
|Avon, E.||Lawrence, L.|
|Bauer, L.||Linksey and Abingdon, E.|
|Beaumont of Whitley, L.||Long, V.|
|Belhaven and Stenton, L.||Lindsey and abingdon, E.|
|Beloff, L.||MacLethose of Beoch, L|
|Belstead, L.||Macleod of Borve, B.|
|Boothby, L.||Mar, C.|
|Brabazon of Tara, L.||Margadale, L.|
|Brougham and Vaux, L.||Marlery, L.|
|Broxbourne, L.||Marshall of Leeds, L.|
|Bruce-Gardyne, L.||Maude of Stratford-upon- Avon, L.|
|Campbell of Croy, L.||Mersery, L.|
|Carnergy of Lour, B.||Milverton, L.|
|Cockfield, L.||Minto, E.|
|Coleraine, L.||Monoson, L.|
|Colwyn, L.||Morris, L.|
|Craigavon, V.||Napier and Ettrick, L.|
|Crathorne, L.||Nathan, L.|
|Croft, L.||Northesk, E.|
|Cromartie, E.||Northfield, L.|
|Davidson, V.||Nugent of Guildford, L.|
|Denham, L. [Teller]||O'Neill of the maine, L.|
|Donaldson of kingsbridge, L.||Orkney, E.|
|Eccles, V.||Orr-Ewing, L.|
|Effingham, E,||Ranglan, L.|
|Elliot of Harwood, B.||Rankeillour, L.|
|Elton, L.||Reigate, L.|
|Fortescue, E.||Rhodes, L.|
|Fraser of Kilmorack, L.||Rochdale, V.|
|Gisborough, L.||Rodney, L.|
|Glanusk, L.||Rugby, L.|
|Glenarthur, L.||Saltoun, Ly.|
|Gray, L.||Sharples, B.|
|Grimond, L.||Skelmersdale, L.|
|Grimstone of Westbury, L.||Spens, L.|
|Hailshmam of Saint Marylebone, L.||Stamp, L.|
|Harris of High Cross, L.||Swinton, E. [Teller]|
|Hayter, L.||Taylor of Blackburn, L.|
|Hemphill, L||Teviot, L.|
|Hives, L.||Trumpington, B.|
|Holderness, L.||Vaux of Harrowden, L.|
|Hylton-Foster, B.||Vickers, B.|
|Inglewood, L.||Westbury, L.|
|Killearn, L.||Whitelaw, V.|
§ Resolved in the negative, and amendment disagreed to accordingly.
§ 7.27 p.m.
§ Lord Denham
My Lords, I think that this is probably a convenient moment to adjourn the Committee stage of the Bill. In moving that the House do now resume, I think that it is fair to tell your Lordships that we shall not be returning to this particular business before 8.30 p.m.
Moved accordingly, and, on Question, Motion agreed to.
§ House resumed.