§ 7.5 p.m.
§ Lord Northfield rose to ask Her Majesty's Government what has been the effect on prices of changes in the law governing selling of spectacles and sight tests; and what further action they propose to improve competition and choice.
§ The noble Lord said: My Lords, I ask this Question tonight so that we can assess progress in breaking down the opticians' monopoly. Those of us who have repeatedly over the last 10 years raised this issue are and always have been, asserting two main principles. We are saying first that competition is still badly needed in the commercial activity of selling spectacles. Even when National Health Service frames existed, what we might call fashion frames—the private frames—were always 70 per cent. of the market. So there has always been need for competition in this purely commercial activity.
§ Part of our case on competition has been that the cloak of professional prescribing and the sort of sanctity provided by a consulting room atmosphere have been used, sometimes quite brazenly, to cover overcharging for spectacles. The patient, as he is called, has been trapped in the consulting room, hardly able to go elsewhere. We assert that sight tests are in the main simple and mechancical and that spectacles are quite cheap applicances, as I shall show by particular examples. Our first assertion therefore is the need for competition.
The second has always been the issue of personal freedom. The Office of Fair Trading report in 1982 on opticians and competition talked of,
personal freedom to choose a lower level of service for a lower price.
§ We say that it is for the individual to choose rather than being ordered in a paternalistic way to pay more by the state.
§ Progress in asserting these two principles in the 1980s has been entirely due to your Lordships' House. We have never had help of any note from the other place. It is noble Lords here in this Chamber who, on this minor matter—yet one of considerable importance to many people and particularly the elderly—have made the running in the last 10 years. Let us see what that progress has been.
§ I began raising this issue in 1979 after periods of raising it in the other place. In the early 1980s we had as the background the Price Commission reports and the reports on one particular company which dominates the market, Dollond and Aitchison. The first step forward was to persuade the: Government to exert pressure on the General Optical Council to allow the display of prices in the shops. That could still be better. Some displays in opticians, windows still do not show prices clearly enough. People are still being enticed inside without knowing the price of the goods they are going to buy. We must press on with that.
§ The second stage was when the Government, embarrassed by charges that prices were too high, set up the inquiry by the Office of Fair Trading. Its report came out in 1982. I shall not discuss the findings at any length. But the report said that there was room for something like a 28 per cent. price reduction if a smaller number of opticians carried out more tests instead of charging high prices to remain in business doing a few tests. The report was quite firm in saying that competition had some way to go in that respect.
§ The Government chose the soft option. The report said that if the Government wanted to make at least some progress they could agree that the selling of spectacles should be allowed by non-opticians provided people produced a recent prescription. It was the soft option. Instead of freeing the market openly, they would allow non-opticians in to do the selling provided people brought along a prescription. They encouraged people to shop around. Interestingly, the Government took the powers away from the General Optical Council to make rules in this area. They gave up the General Optical Council deciding that there was no hope there of liberalisation. The Government had to take powers to make the changes by direct orders in council. So it has remained.
§ The third breakthrough occurred when this House by a free vote agreed to recommend the selling of over-the-counter reading glasses—ready glazed spectacles. That had not been easy. We had had to push the Government through two previous stages. We had to persuade them that there was no harm to sight in wearing the wrong spectacles. I remember that for years spokesmen from the Government Front Bench spoke about the harm to people's eyes if they wore the wrong spectacles. We had to get rid of that idea in the early 1980s. The Government made a complete volte face and finally agreed that they did not do any harm although they might give people headaches and it was perhaps stupid to wear 1487 the wrong ones. Secondly, we had to convince the Government that presbyopia, the kind of problem from which I suffer and which arises as one grows older, is not a disease. It means that one needs spectacles to magnify. That took a good deal of work, particularly by my noble friend Lord Rugby who has been a hero throughout the whole dispute with the opticians and with the Government during the 1980s. At last the Government conceded on that point too. Yes, presbyopia is no longer a disease; it is a wearing out of the muscles that focus. It happens to most people over the age of 40.
§ We also hoped that reading spectacles would help in another way—by showing cheap spectacles on sale in the shops, ready glazed. This would make the others look expensive, as they are in so many cases. The very cheapness ought to be showing up the exaggerated prices of spectacles made up to prescription. We hoped that that would be an added benefit of putting reading spectacles on sale.
§ Those are three stages through which we pushed the Government. We approached a fourth stage. I refer to the business on which we have had some news in the past week. The Government, full of confidence now and pushing the frontiers further, so we thought, announced that we would have two-tier eye tests. In other words, one could pay a simple fee or perhaps nothing at all for a simple refraction test, or one could pay the full fee and have the so-called medical test as well. It was an issue of personal freedom, a matter dear to the heart of myself and those who campaigned with me. However, in the past week, the Government unhappily have fallen on their face. The resistance in the Back Bench committee of the Conservative Party in another place to the proposal of two-tier testing has made the Minister run away, defeated, tail between his legs and unable to push it through Parliament. I am sad that he has shied at this fourth fence which we hoped he would mount, full of enthusiasm after the progress we had made in the 1980s.
§ We are now up against something else, which will tie in with the two-tier eye test, about which I shall say a word later. Now, in the optical world, high technology computerised machinery—the autorefractor and the autotester that goes with it—does the testing of eyes automatically without the need for the so-called professional testing. This is pushing the frontiers of technology a good deal further. It will force the pace anyway, and it will mean that we shall have to go to two-tier eye tests because progress of this kind cannot be resisted for long.
§ In the middle of all this progress—I shall come to examples of what is happening now—the Government stopped free sight tests. That was a mistake. It was absolutely premature, as the figures now show. The number of sight tests taken has fallen by 30 per cent. generally and by 40 per cent. in many areas. People are staying away from the optician. This is sad because, although those of us who believe in being able to buy reading spectacles in this way will continue to press for freedoms, we also believe passionately that everyone should have a regular sight test because it is sensible for them to do so.1488
§ How could it ever have been expected, as the Minister hoped, that the industry would begin to provide free sight tests? Free sight tests with that degree of imperfect competition? This was the chance for another fee which opticians had always been able to get in this industry by a degree of overcharging, as has been highlighted in various reports. Secondly, could we really have expected it, given good will? Would any optician give a free sight test and provide a prescription to somebody so that he could shop around, as the Minister wanted, only to find that that person had taken the prescription to another shop to have it made up? The idea was doomed from the start. It was not able to stand on its own feet as something that was likely to succeed once it was linked with shopping around and once the prescription was in the person's hand. I deplore the ending of free sight tests. The Government were hoping for a degree of competition that was not about to take place. The industry is not yet competitive enough. We have not pushed it into a new period of real competition.
§ For the rest of my remarks I want to talk not about the progress we have made in this Chamber, in Parliament and in the law, but about what is happening in the high street. I have done my own research and shopping around for reading spectacles. I have been to four or five main stores—Boots, Debenhams, Selfridges, Dollond and Aitchison and one of the new shops that specialises in making up spectacles. I should like to tell noble Lords what I found.
§ I went into Debenhams, which is part of the Burton group. I went to the optical department and saw no reading spectacles. I said to the girl, "Where are your reading spectacles?" She replied, "Oh, we just have a few but we don't put them on show". I said, "Why not?" She replied, "We haven't enough space". I said, "But these racks are half empty. You have plenty of space in this shop". She replied, "Well, I don't know, you will have to ask the manager. Anyway, I will go and find them for you. We don't put them on show. We keep them in a box in the storeroom". The girl went away and came back with a tin box from the storeroom. She opened it up and produced six, eight or perhaps 10—no more than that—sample frames. Many of them were alike so there was no real choice. I asked the price, She said, "Those are £14.95 and these are £16.95". I can tell the House that the cost to the retailer of the spectacles I saw is about £2 or £4. It is a complete racket.
§ I went on to Selfridges. I found a tiny display on the counter in the optical department. I asked, "How much are they?" The price was £15—very little. The whole point is to shore up the price as high as possible in order not to show how expensive are the others on display for private making up. Dollond and Aitchison had a poor selection, also in a tin box. It was clearly disparaged by the young lady trying to serve me. It was implied that they were no good. That was not exactly said but it was clearly hinted at, the purpose being to interest me in something much more expensive and elaborate.
§ Reading spectacles are not on proper display—I can say that from touring these shops—and their 1489 prices are too high. I have now told your Lordships—I hope it will be known outside—that the true cost to the retailer of reading spectacles of nearly all the kinds that I know now is somewhere between £2 and £4. Their price in the shops should not be more than £8 or £10. Ridiculous prices of £14.95 and £16.95 are totally unjustified.
§ I was sorry to see that one of the shops which, following the liberalisation in the middle of the 1980s, opened to do the making up without an optician present had joined in the racket. It had found, I suppose, that profits were easy to make and so had joined the act. The Glass Shop, which I praised in an earlier speech in the House, had only one or two frames on display and one or two in a drawer. Most of the shop was given over to fancy fashion frames costing £50, £70 or £80. Money is too easily made and the competition is imperfect. As far as I could see, the company had joined in the act.
§ One of the reasons for the fact that the concept of reading spectacles has not yet taken off is that the Government have issued no publicity. There has been no public education; indeed, you cannot find any indication on the walls of the doctor's surgery telling you that if you need a spare pair of spectacles you can get them as reading spectacles. People are not encouraged to know their prescription; but people should know what their prescription is. I know what mine is, as I know the size of my shoes. It is 125 dioptres for distance and 325 for reading. It is not difficult. People have been mesmerised into thinking that spectacle prescription is a highly complicated scientific business. However, for the vast majority of people—I do not say for all—that just is not so.
§ The big hope which we have is the emergence of companies such as the one called Crown Eye Glass, in which I have no commercial interest whatever. The company is selling spectacles called "Readyspecs". An interesting thing happended in that connection. The Daily Mail published a feature about the high cost of spectacles on 24th April. As a result the company sent the writer of the article a pair of "Readyspecs". She then wrote another article stating how marvellous they were. The spectacles start at £2.99 and the top price for the most elaborate fashion model is £9.99. She said that she was writing the column wearing a £4.99 pair which fitted perfectly, which were more comfortable, which gave her better vision and which looked just as expensive as the specs that she had bought two weeks previously which had cost £84. That, of course, was from another shop.
§ The result is this: I have with me the first 120 letters written to the company by people who read that column. Most of them say, "Where can I buy these spectacles? I did not know that we could buy them so cheaply. I am a pensioner and I have been conned into paying £80 for a pair of spectacles. Please, where can I buy Readyspecs? What can you do for me?"
§ The Government must do something about publicity. It should be pointed out that this is legal; people should know that they can buy spare or 1490 replacement pairs of spectacles. People should continue to have eye tests when they need them, but they should know that the freeom to buy exists. It was clear from many of the letters to which I referred that most people did not know that this freedom existed. The correct price range is that offered by Crown Eye Glass. It is the sort of range of which I approve; namely, £2.99 to £9.99.
§ The company now tells me that it has a thousand stockists; there are 90 Crown Optical Centres, as they call them; and the way they are working is not with the 300 or 400 per cent. mark-up which has been common in the optical trade, but with a 100 per cent. mark-up. In my view that is legitimate. It is competition beginning to work.
§ However, such companies then have to suffer from the dirty tricks trade. For example, people go into an optician to receive their prescription and the optician says to them. "Where will you have your spectacles made up?" The person say, "Oh a new cheap place just across the road." The optician then says, "What, are you going to those cowboys over there? You should not trust them." Therefore this company—and I suppose others like it which will come into the business—is fighting a great deal of the dirty tricks in order to get cheapness open to the public.
§ I am conscious of time so I come: finally to the price of spectacles made up to prescription. The average price of 1987 was given by the Federation of Ophthalmic and Dispensing Opticians as £58.14. I suppose that the figure must by now be well over £60. My own experience, again from shopping in the shops which I mentioned earlier—some of which were quite disgraceful—is that spectacles are still on display at ridiculous prices of £60, £80, and even £130 for the frame alone. Let me give your Lordships the true prices for them, as I did in respect of the ready-made spectacles. A plain lens, a non-complicated one of up to four dioptres costs somewhere between £2 and £4 a pair for the lens made by reputable firms such as Pilkingtons. A bifocal lens costs between £6 to £8.
§ Perhaps I may give your Lordships another example. I have with me a pair of bifocal spectacles. I broke one lens. I have taken it to various opticians during the past few weeks asking them for a quotation for replacing that one lens. The lowest quotation I have received is £24. The more general quotation I have received has been £30. Moreover, on top of that, I was told that as my prescription had run out I needed to pay £10 to have another eye test. Therefore, to replace a £4 lens in my spectacles the price would be about £40. That sort of racketeering must be stopped. We must force the pace of competition much further.
§ If you want to add on to the cost of the lens the cost of the frame, I can tell your Lordships that the most popular type of frame today costs the retailer somewhere in the region of £5 to £15. The most popular price is about £11 to £12. If you add the cost of the lens—which is £2 to £4, or perhaps a little more for bifocals—and the cost of the frame together and give a 100 per cent. mark up, which I think is fair, then the cost of a pair of spectacles made up to prescription today ought to be between £20 and £35. It should not be the £60, £80, £100 or 1491 even more about which people have written to the Daily Mail and to others. That is in line with what the Office of Fair Trading found in its report in 1982. It said that there was room for about a 30 per cent. reduction in the average price. We must get that reduction.
§ What about the future? I think that the future lies partly in the computerised machine called the autorefractor. I ask the Minister to send his officials to Sweden to see the machine operating. There, non-qualified people—that is non-opticians—are able to use it and sell spectacles. It prints automatically by computerised high technology. It prints out your prescription for you as you look into the machine when it is manipulated by the operator, who will have taken only an hour and a half to learn how to use it. It is foolproof and the president of the opticians, or one of the groups opticians, has confirmed that the machine is foolproof and says that no one should have any doubts about it.
§ The future has to be with that kind of system. We must return to two-tier testing in some form, allowing people to have a cheap test if they so wish. Then we must allow non-opticians to carry out that cheaper test, using the autorefractor and not needing the optician to do it. It is done in a matter of minutes and the computerisation of the system is a guarantee of the way that it operates in giving you a simple refraction print-out of your prescription.
§ I propose to place one of these machines on exhibition in your Lordships' House during the next few months so that noble Lords will be able to see just what these machines are and how they operate. This is the future and we cannot stop the march of scientific progress in this way. Moreover, we cannot stop the increase in competition which ought to take place. I still regard the prices of spectacles in our country as being nothing less than a scandal. We must continue to press quietly but determinedly to get those prices down.
§ 7.27 p.m.
§ Lord Mottistone
My Lords, that was a typically fierce speech given by the noble Lord, Lord Northfield. Is it not funny that he has this real bee in his bonnet, as has the noble Lord, Lord Rugby, about spectacles? Spectacles are things which we do not have to buy every week, as we do bottles of wine or food. In the ordinary course of events, even when you reach my great age, and perhaps even the noble Lord's great age, you do not have to buy spectacles more than every two years. I have had my present spectacles for about three years and they are doing me no harm. Therefore it is much more equivalent to buying, say, a motor car; it is not like buying food. There is no need to see the matter as being a scandal where people are being put in a state of penury as a result of having to spend £50 once a week in order to buy a pair of spectacles. It is not like that.
The noble Lord talked about the opticians' monopoly. That issue goes back to the early 1980s when it was pointed out how dreadful the system was. However, opticians have always been in competition. They are professionals in their 1492 business. He wants them to have to compete with someone else. I shall return to my motor car analogy. Motor cars can only be produced by professionals because, apart from anything else, in no other way can they comply with all the government regulations. The noble Lord is saying that we should be prepared to buy our motor cars from someone who makes them in a back yard.
§ Lord Mottistone
It is that type of thing. It is not unreasonable for certain types of goods to be produced by professionals who are in competition the one with the other. Opticians have been doing that all along.
The noble Lord then went on to boast—I thought rather excessively—with his great skill and experience, about how he managed in the House to get these things done by the Government.
§ Lord Mottistone
That is how it came out. The noble Lord should read what he said. Having boasted as much as he could, he then castigated the Government for not going further—but everyone does that particularly when they are in opposition. I remember it well.
The noble Lord made one or two other points. Let us come to his Question, because what he said did not bear on the Question that he asked. He said that the Government should give more publicity to the latest regulations. The Government are not in the business of publicity. If one has freed the market—I agree that it has been freed—it is up to the marketeers to publicise themselves. I am advised that widespread advertising and publicity have dispelled some of the false notions that it costs £80 to buy a pair of spectacles. If people do not read the right advertisements, that is their fault. When I read a newspaper I almost invariably skip over the advertisement pages because it is much the safer way to get on in life—not permanently to be dragged in this or that direction and persuaded to buy something. Not that I can afford to buy much. I believe that the noble Lord over-exaggerated the lack of publicity.
The noble Lord then told us some stories about retailers selling the new over-the-counter spectacles. He quoted two retailers who were not in the business previously. They have taken up the business but not as seriously as he would like them to. They are ordinary retailers selling a product in the market. If they can sell it at a price at which he says they should be able to and make a 100 per cent. mark-up, why are they not doing that? Why does it matter if they are not? Why does the noble Lord want to insist that retailers should be forced to present their products in a way that he thinks proper rather than in the way that they as professional salesmen know is necessary when they are trying to sell the product? He is exaggerating the need to do anything else at the moment.
The noble Lord did not mention NHS vouchers for people on low incomes because that did not suit 1493 his argument. They have made a great difference to such people. His argument will not affect them one way or the other. They will still obtain their spectacles cheaply. There are several million such people. Many of them require proper spectacles because they are elderly or going blind. I do not believe that he would argue with that. One million people a year are referred by optometrists to their doctors. If the noble Lord carries his story to its logical conclusion, they will not be encouraged to have tests and obtain the proper spectacles. Those people could be at risk.
What the noble Lord has done so far has made more people not want to buy proper spectacles because he persuaded the Government that the eyesight test should be charged for.
§ Lord Mottistone
It was his campaign which produced that result. Charging for eyesight tests puts people off having one. They cost £ 10 or so, which adds to the cost of the spectacles.
§ Lord Northfield
The noble Lord is mistaken. I opposed charging for sight tests. I voted for them to remain free.
§ Lord Mottistone
He might personally, but the campaign conducted by him and his colleagues led to that result. If they had never mounted their campaign, it would never have happened. That must be so. All that splendid boasting about how in the early 1980s the noble Lord went on and on and on badgering the Government and they did something is all part of it. He may not want it, but it is there.
I shall not spend as long as the noble Lord did, which was a long time for a debate of this sort, because I suspect that your Lordships would prefer that I did not. The autorefractor as an alternative to proper eye tests is a bogus argument. I shall not say much about it because I hope that my noble friend the Minister will have a few words to say about it, and I do not want to steal his thunder.
It is important to know what the machine does not do. It does not perform accurately on people, such as young children, with active focusing powers; it does not work well on people whose eyes are not entirely clear, for example, the elderly and people suffering from cataracts or other diseases which obscure the media of the eye; and, finally, it does not give a binocular result which is balanced between the two eyes and only treats each eye independently. The last point is of great importance for the comfort of the prescription and the proper functioning of the 1494 two eyes to avoid eye strain and perhaps double vision. All those factors are what one might call comfort factors.
The machine also does nothing to show whether disease is present. That is a matter which should not be neglected. We are not all subject to such problems, but that does not mean that the 1 million people who are reported every year to their doctors should not be helped in some way.
There is no evidence to answer the noble Lord's question as to what effect changes in the laws governing the selling of spectacles have had on prices. The full effect has yet to be seen. It is possible to obtain spectacles at the budget end of the market at prices comparable with those which the noble Lord believed to be reasonable. If he has not found them, I have. It is a question of whether one shops around and whether one is trying to prove one's point when one does so.
It is too early to say how the situation with regard to sight tests will settle down. It is sad if the noble Lord is right and people are frightened to have their eyes tested. They should not be because it will only cost them between £10 and £15—whether or not they obtain new spectacles, and sometimes they may not need to—every two or three years, however old they are, except for the exceptional cases. That is not a large sum of money. It is like buying one-and-a-half bottles of whisky every three years. I am sure that those who like drinking whisky would not find that nearly enough.
On the whole, it is sad that we have to have payment for tests. It will be interesting to see. I believe that the Minister's reply will be that the Government will not go for the two-tier testing system, and that suggests that he will persuade the General Optical Council to report in two years' time on the situation.
I conclude by saying that we must wait for the report. There is no point in plugging away at bees in one's bonnet on this subject at the moment. Let us wait and see what is reported in a year's time. If the report favours the noble Lord, Lord Northfield—which I hope it will not—he can be perfectly happy and pipe down. On the other hand, if he does not like the report—which I hope he will not as a matter of principle—he can renew his attack and I shall be happy to resist him.
§ 7.40 p.m.
§ Lord Rugby
My Lords, I suppose that if I were to nominate a personal subject, in the unlikely event that I were ever asked to go on "Mastermind", it would have to be "The Opticians Acts 1958 to 1988".
When I first became interested in the spectacle rackets of the post-war era, I was unaware that the noble Lord, Lord Northfield, was already giving a spirited defence of the cause of the public against a caucus of what I suppose one might call "parliamentary gerrymanderers" engaged in sequestering for themselves and their accomplices a monopoly control of the spectacle market, together with its enormous profits. At the same time they were depriving the public of their absolute right to 1495 self-determination in all matters concerning their eyesight. Without the stand which he and a few other stalwarts took in the face of the abuse which was liberally heaped upon them at that time, the cause might have been lost once and for all.
There have been various committees instigated by governments, both before and during my lifetime, in order to bring order out of a chaotic situation. There was one in 1906, one in 1922, then again one in 1927 under Neville Chamberlain, and a further one in 1949 under Nye Bevan. All these investigations were as relevant then as they are now. Not one of them can be construed as having brought about a successful conclusion to the chaos.
The 1927 committee failed because at that time the relatively high fees charged by a limited number of qualified specialist ophthalmologists could not cope with the requirements for eye examinations demanded by insurance companies and friendly societies. Indeed, the ophthalmologists could not take on the demand which was being put upon them and the friendly societies were unable to pay their fees.
The opticians therefore were asked to fill in the gap. But they had insufficient medical training, they could not offer a medical diagnosis because their trade was one of refraction only and because they carried out that particular job, they demanded commensurate fees. Refraction is not a medical discipline and it cannot be.
Running alongside that at the time were the itinerant spectacle vendors, the market stall sellers and the Woolworth emporia, all selling reading glasses to a middle-aged and elderly community. The community comprised at least half the population, for whom reading, the library, the Bible and their prayer books comprised a large part of their world for religious worship, self-education and their livelihoods. They were paying 6 pence a time for their glasses. The ones I am wearing at the moment are now £2.99 and I may say I am wearing them as a result of an autorefractor test.
As a result of the Opticians Act 1958, the opticians were able to do away with all that competition and to recoup what they regarded as their rightful financial status, and a lot more besides, by exercising exclusive control over the market, combined with compulsory eye testing against prescriptions. These prescriptions then became their own printed currency, underwritten and honoured by the Department of Health and Social Security, but without any obligation to diagnose diseases of the eye and without the training or the disciplines of medicine. In these circumstances, the British public became, optically speaking, the most disfranchised, the most deprived, the most exploited in the whole world, not to mention the most overcharged.
Perhaps I may just quote one example, which is myself. I became a victim when I needed my first pair of national health glasses. I needed them for my livelihood as a farmer and I was able to obtain the issue of one prescription. The glasses were flimsy affairs, they lasted a fortnight before one lens dropped out. I had to wait three weeks before I could 1496 obtain a replacement, although the need was vital. I was told that extra pairs would be available, but only at extortionate costs, both to myself and to the taxpayer, of further eye tests. But those glasses were unsuitable for industrial wear and tear, quite unlike the wonderful motor cars to which the noble Lord has just referred. In the end, I got my friends and my family to keep me topped up from America. I pointed out, in a similar Unstarred Question about eight years ago, that at that time it was quicker and cheaper for me to fly with Freddie Laker on his Skytrain and pick up a couple of reading spectacles off the shelf in New York than to deal with a British optician.
Anybody would think that with the population in this deprived state, with only one pair of glasses each, there would have been a good market for people repairing them. In this desperate situation there were people who tried, but what happened? They were instantly prosecuted by the General Optical Council under criminal law. They were fined and their stock in trade confiscated.
Several millions of people today are dependent on their spectacles. Had it not been such a profitable line for the opticians, I believe that those people would have been advised at an earlier stage not to have those glasses. Many millions only wish to use spectacles after middle age for reading, like myself. But for years they have been denied the right to choose and have been conned into continuous costly eye testing with extortionate price-fixing accompanying the process. There are many thousands of children whose parents have been wrongly advised to educate the eyesight of their children into permanent spectacle servitude, rather than using the orthoptics technology which trains the developing child's eye to do without glasses.
I can only summarise by saying that the verdicts of the previous committees have, in the light of experience, been proven correct. The warnings which they gave have not been heeded by the Government. It is imperative that they should be accepted and accepted soon. At least we have got back our reading spectacles after 30 years—a right of choice which should never have been removed. I thank the noble Lord, Lord Northfield, for sticking to his guns and for now bringing forward a new technology.
I shall give my reasons why that technology should not be given a restricted use warning such as we have had in regard to reading glasses in the past. An autorefractor gives an instant computer readout of the refraction of the eye. It does so with super accuracy and the operator does not have to be skilled. I understand that a sight test now costs £15 at an opticians but I have recently seen that engine drivers for British Rail will receive a full medical check-up for £10, which I may say probably also includes an autorefractor eye test.
It is highly important the customer requiring this computer information should have it available. It enables him to check his prescription; it enables him to know that he is not being cheated; it enables him to know that he no longer has to undergo an appointment system and a cross-examination and all that mumbo jumbo. The technology does not presume to offer any medical diagnosis, it informs 1497 the inquirer or customer of the physical state of his eyes. He is as much entitled to know his index of refraction—which is what the technology provides—as to know the thermal heat of his body by applying a thermometer to his mouth.
I hope that the noble Lord will not introduce any health arguments to counter the introduction of this new technology. We do not and never have gone to opticians for health checks. That has been amply demonstrated by previous reports which the Minister has it in his power to read.
§ 7.50 p.m.
§ Lord Ennals
My Lords, I wonder whether it is proper for me to intervene in this marvellous debate between these two great campaigners, the noble Lords, Lord Mottistone and Lord Northfield, one of whom has for over 30 years been campaigning for whatever it is he is campaigning for. The other joined in late but has shown no less vigour. I pay my tribute to them as campaigners. The noble Lord, Lord Mottistone, is a rugged and testy battler for the other side, whichever the side is. I feel that I am in the wrong place, and I hope that the Minister will help me out.
My noble friend Lord Northfield will understand that I do not share some of his feelings of excitement with this historic campaign for freedom of choice; this two-man campaign which has set out to change the world. Now apparently the two campaigners find their efforts have been thwarted by the brazen behaviour of opticians and their professional colleagues. However, I think my noble friend is quite right to draw attention to some examples of gross overcharging which the Government should inquire into. Some of the examples my noble friend gave should be examined very carefully.
However, I sometimes think that the two campaigners are more concerned with choice and competition than with eye health. I am concerned with the health of the nation. I realise that lots of other people are also concerned with that. I am not trying to boast. I was delighted to hear my noble friend mention his own attitude towards what I believe is the Government's iniquitous decision to impose charges for eye tests. My noble friend naturally opposed that. I did not hear the speech he made on an earlier occasion concerning that proposal, but he voted against it. I am as strongly opposed as my noble friend, and perhaps slightly more, to the decision the Government took at that time. I thought it was an appalling decision, and I do not know why the Minister embarked on that route. As I recall, no one gave him any support at the time. Everyone was unanimous in their criticism of the Minister when he proposed the two-tier system which has been referred to by my noble friend.
It took a little time before the Secretary of State recognised the lack of wisdom of his ways. Recently he has repealed that decision. The first decision by the Government, which was to impose charges for eye tests, had the consequences that some of us predicted. It has already provided a deterrent to people as regards undergoing sight tests. It is very disturbing that there has been a fall of between 30 and 40 per cent. in the number of sight tests. The 1498 noble Lord, Lord Mottistone, said that £10 or £15 was not a high charge. Nevertheless, he and I thought at the time that the charge would be a deterrent for those on very modest incomes.
If the Government remove free sight tests, one must suppose that they do not attach very much importance to sight tests as a part of the National Health Service. The very fact that they decided that they would not include sight tests as a part of the National Health Service was an indication to many people that they did not place great value on the tests. I, however, do place great value on them. That decision of the Government was a great mistake, and has now proved to be a mistake. The Secretary of State proposed another device, which was the two-tier system. That, too, has been discredited. One million people a year are referred for medical attention following eye examinations because of the presence of eye disease, or indeed other systemic diseases such as high blood pressure. The main argument we presented at the time when the decision was taken to impose charges was that we wished to do nothing to discourage, and everything to encourage, patients to undergo regular eye tests, and not just when they felt there was a need.
Eye diseases are painless, symptomless and advance to a stage where treatment is extremely difficult or impossible before the patient is sufficiently aware of them to seek referral. We argued that it is only routine eye examinations which allow the early detection of disease. We argued that it is early detection which is so important to the eventual outcome of treatment. That view is widely held by ophthalmologists and it is widely held by Members of your Lordships' House. We can already begin to see the consequences of the lack of wisdom of the Government's policies. I hope that the Minister will confirm that the proposal put forward by his right honourable friend as regards a two-tier system gained no support from any sections of the profession, nor yet from any community consumer groups which are concerned with people's health.
I hope that the Government will not come up with any more bright ideas to disrupt the professions working in the field. It is not as if many measures have not already been taken in this field. I sympathise with optometrists when they say that they have had five years of competition changes, and that perhaps it is time to let things stay as they are for a while. In 1984 the deregulation of the dispensing of spectacles took place. Optometrists were permitted to advertise, and the Government withdrew the National Health Service range of spectacles. In the next few years optometrists were subject to regulations which required them to hand each patient a copy of his prescription. Personally, I warmly welcomed that provision and I think it is good professional practice.
In the past few years optometrists have, while maintaining their professionalism, risen to the challenge of the new situation by producing a wide range of information for patients and consumers at large in order to inform them of the services which they can obtain from optometry, and to give them general information on the importance of looking after their eyes. No one can say that optometrists 1499 have not risen to meet the new situation which the Government have imposed upon them. That situation was further disrupted at the end of last year by the imposition of the privatisation of the eye test for 60 per cent. of the population. As a result of the Government's decision to withdraw the two-tier sight test, the General Optical Council is co-operating with the association of optometrists and other optical bodies in order to undertake a review over the next 12 months of the eye examination service in this country. I warmly welcome that decision.
My noble friend referred to the autorefractor, as did the noble Lord, Lord Rugby. I think that it is accepted as being an extremely useful tool for an optometrist or an eye doctor in the initial screening of a patient. However, it cannot be denied that it gives no information whatsoever about the health of the eyes. It contributes useful but inadequate information about the optical powers of the eyes, but further professional interpretation and tests must be carried out before an acceptable prescription can be provided for each patient.
The noble Lord, Lord Mottistone, said that as people get older their eyes become less clear. This piece of machinery is less effective both for the elderly and for the young. So anyone who assumes that this is a bright new piece of technology which will remove the need for eye testing is mistaken. Nevertheless, I hope there will be development of this particular piece of machinery.
I hope the Government will not embark upon new proposals like the proposals of the Secretary of State on the two-tier system. As with the rest of the health service, optometrists should be allowed to get on with their own jobs. There has been excessive interference in this field by the Government. They interfered with the system of sight tests and then proposed two-tier sight test charges. I think it is time the professions were allowed to get on with their work. I certainly agree with my noble friend that the Government should look at any examples of gross overcharging in the interests of patients. However, I think we have had enough of new proposals which, although they may have been designed to improve the health service, have proved to have exactly the opposite effect. I look forward with interest to the Minister's reply.
§ 8 p.m.
§ Lord Henley
My Lords, I think we can say that we have had a rather interesting debate this evening, with diametrically opposed views coming from different sides of the House. I am not sure that it will be possible for me to satisfy all noble Lords. I do not see how I could satisfy both the noble Lords, Lord Northfield and Lord Rugby, and my noble friend Lord Mottistone.
Nevertheless, I am grateful to the noble Lord, Lord Northfield, for bringing this matter to the attention of the House. The debate gives us the opportunity to reflect upon the success of recent legislation affecting our optical services and to acknowledge that even though the ophthalmic profession has faced 1500 a number of important changes in recent years we still see—I am confident that we shall continue to see—the same high standard of care and professionalism that we have come to expect.
Perhaps it may be helpful if I first recap and remind noble Lords of the progress and notable achievements this Government have made in reforming the optical services in recent years. In December 1984 the opticians' sole right to sell spectacles ended and the market was opened up for the first time to allow unregistered suppliers the right to supply prescription spectacles. In July 1986 the NHS spectacle scheme was replaced by the NHS voucher scheme, the new scheme providing a more effective way of targeting financial help for spectacles to those in need. On 1st April 1989 legislation was introduced to allow the sale of ready-made reading glasses without prescription to those over the age of 16. Noble Lords will recall that, as the noble Lord, Lord Northfield, mentioned, we agreed to abide by the principle of a vote in this House last summer when noble Lords concluded that it was right that reading glasses should be available without prescription to those over the age of 16.
The noble Lord asked about the effect the changes in legislation have had on prices. The change in spectacle provision has resulted in a wide range of competitively priced spectacle frames becoming available on the market. I understand that some companies are even offering free frames. But people must take advantage of the changes by shopping around to obtain the widest choice at the best prices. It may well be that competition arising from the sale of ready-made reading glasses will cause prices to reduce still further. It is of course early days yet and I am sure that noble Lords would agree that it would be unwise for me at this stage to make any firm predictions on the future direction the market may or may not take.
This leads me on to sight tests. We considered it right that those who can afford to pay for sight tests should do so, and on 1st April this year regulations were introduced restricting the NHS sight test to certain groups. Some 40 per cent. of people still get free tests under the NHS.
Again, however, it is early days and it would be unwise at this stage to make any firm judgments, but we do not accept that people will be deterred from having sight tests as a result of the introduction of charges. The noble Lord, Lord Ennals, mentioned a fall of 30 per cent. since 1st April. As I said, it is only two-and-a-half months and I believe that there was a large influx before 1st April. Speaking from my own experience, I went to an optician in March. I did not have a sight test but he advised me to rush in and have one before 1st April. That might explain some of the fall.
Similarly, I should not like to predict with any accuracy the effect that market forces are likely to have on sight test charges. I should hope that competition will mean that charges will be lower in 12 months' time. Certainly it would be unwise to make any assessments at a time when the market has undergone such major changes and needs time to settle. However, I understand from early indications that sight test charges vary enormously from about 1501 £7 to £15, with two of the larger companies settling on a fee on or marginally above the current NHS sight test fee of £10.40. In passing, I should mention to the House that in Holland, where sight test charges were also introduced, one of the large multiple optical companies broke ranks and offered free sight tests and now most of the market has followed suit. It may be that given time we may well see something similar occurring in this country.
At present we have no further plans to introduce legislation that will affect the optical services. Noble Lords are no doubt aware that following consultation the Government recently decided that it was not appropriate to lay regulations for a two-tier sight test—that is, allowing consumers in the private market the right to opt for a refraction-only sight test, one which would determine only their optical prescription and not provide any examination of the eye.
I am sorry that the noble Lord, Lord Northfield, seemed to think that we had fallen on our face; and I am sorry that the noble Lord, Lord Ennals, talked of my right honourable friend's lack of wisdom. However, I stress that we are a listening Government. The noble Lord laughs, but that is the case. We do not listen, only as the noble Lord suggested, to our honourable friends in another place.
We concluded that it was right that all sight tests should include an eye examination and any other test appropriate for the needs of the individual patient. We recognise that we must preserve the role of optometrists and ophthalmic medical practitioners in primary health care. The eye examination which can detect symptomless eye conditions, as the noble Lord, Lord Ennals, suggested, such as glaucoma as well as other medical conditions is a vital part of that role.
However, in reaching that decision it was also announced in another place that the General Optical Council, which is responsible for the professional conduct and education of opticians, has offered to undertake a programme of investigation into the optical services. Terms of reference have yet to be agreed but I expect the review to be wide-ranging and it will be carried out over the next 12 months. We shall obviously want to look closely at current regulations in the light of the council's findings.
We have heard much about the use of autorefractors this afternoon. There are two schools of thought—that of the noble Lords, Lord Northfield and Lord Rugby, and that of my noble friend Lord Mottistone. I took note of what the noble Lord said about Sweden, and I shall pass on his suggestion that we examine the experiment there. I shall be most interested, when he brings the machine here, to examine it.
My understanding is that while these instruments provide a good baseline measurement it is questionable whether they constitute an accurate refraction even when combined with auto optitesters. We have concluded, as I said earlier, that all sight tests should include an examination. Therefore we do not plan to change legislation to allow the use of automatic instruments to conduct 1502 "quickie" sight tests by unqualified people or for such instruments to be used as a screening device which will give people an indication of whether or not they need spectacles.
As I have already said, we shall of course honour our commitments to monitor the new arrangements arising from the changes in legislation. However, I must say that I expect it will be some time before the market settles down. Many people will have brought their sight tests forward as I suggested earlier, in order to avoid the charges from 1st April and therefore may well not have another sight test for at least two or three years. However, I think that we can look forward over the next five years or so to seeing competition develop in the optical field and to the consumer. I have no doubt that the profession will make full use of new technology and embrace it enthusiastically as part of the everyday equipment it needs to give a full and valuable service to the patient.
At this point it may be appropriate if I deal with one or two points raised by noble; Lords in the debate. I apologise in advance if I do not cover everything. The noble Lord, Lord Northfield, complained that we had not publicised the availability of reading glasses as widely as he would have liked. I take the same line as my noble friend Lord Mottistone. I do not accept that it is the Government's responsibility to publicise the availability of reading glasses in any massive advertising campaign. However, in leaflet G11 which is published by the Department of Health, reference is made to the availability of those glasses and people are advised that they can use National Health Service spectacle vouchers to purchase them.
The noble Lord, Lord Northfield, also complained that the cost of reading glasses was too high. Reading glasses are on sale in many outlets, as the noble Lord pointed out. My understanding is that it is possible to purchase reading glasses from as little as £2.99. That proves that competition is developing, and we hope that it will continue to do so. The noble Lord complained about reading glasses not being on display. They are on display in a number of outlets including, according to my information, some department stores. Obviously, we cannot force companies to display them.
I welcome the remarks of my noble friend Lord Mottistone about the voucher scheme, which is of great use on low incomes. I should say in passing that our evidence is that some 36 per cent. of people who choose to buy spectacles on the voucher scheme manage to buy spectacles within the voucher value. However, on the subject of overpricing—to which the noble Lord, Lord Ennals, and other noble Lords referred—if noble Lords wish to write to me on those points I shall look into the matter further.
The noble Lord, Lord Rugby, seemed to be of the view that opticians are not competent to carry out sight tests. I do not accept that line of argument. The training that opticians receive gives them the competence to be able to refer patients to their doctors where the sight test reveals an ocular or medical condition that requires diagnosis or treatment. We recognise that it is important for 1503 opticians to continue to develop their skills after they qualify. This year the Government have allocated £100,000 for that purpose. The British College of Optometrists has produced two videos which will be issued to all optometrists.
So far as concerns further changes in spectacle price and sight test arrangements charges, we propose to allow market forces to take effect and for the market to find its own level. We look forward to seeing both cheaper sight tests and cheaper spectacles without in any way seeing a reduction in professional standards and service available to the consumer. As I have aleady said, we do not believe that charges will have any deterrent effect on the number of people attending their optician and having their sight tested. I believe that we, as a country, can still claim to have one of the best optical professions in the world and one that offers high and caring professional standards to all its patients.
House adjourned at twelve minutes past eight o'clock.