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Opticians: Office Of Fair Trading Report

Volume 441: debated on Wednesday 27 April 1983

The text on this page has been created from Hansard archive content, it may contain typographical errors.

8.32 p.m.

rose to ask Her Majesty's Government what steps they intend to take in respect of the opticians' monopoly following the Office of Fair Trading Report.

The noble Lord said: My Lords, the noble Lord, Lord Donaldson, asked me to express his regret that he could not speak in this particular debate, but he wished to assure me that he was very much in support of what I have to say.

The Opticians Act 1958 was a seemingly harmless Act, concerned only with compiling a register of opticians and regulating their professional standards. The manner in which the Act has been interpreted has been more sinister. The impact of Section 21—that is, its impact on the public—has given cause for concern. That concern has been reflected in the press right across the board. The Government must surely have been aware of recurrent words in the headlines, such as, "fraud", "swindle", "rip-off", "frame-up", "scandal". These emotive expressions have reflected the defencelessness of the public in the face of what they see as a form of persecution by deprivation: they believe that there is indeed something rotten within the state.

The truth and the obvious have been constantly deployed in order to counter the sheer deviousness of this monopoly, and never more so than in the debates and Questions in the last three and a half years in your Lordships' House and another place. In the face of it all, no straight answer has ever been offered by the Government. There has been no attempt to offer a straight answer to the 23 million for whom these bits of plastic and mass-produced glass inserts spell the difference between being an able-bodied person and an incapable person in a demanding, competitive world.

Is it trite to ask whether it is not palpably obvious that it is only by the combined use of all its senses working in unison that mankind obtains its ability to survive? For centuries we have developed simple tools to compensate for physical changes and to help us to perform essential tasks. The conversion of script into mental imagery is central to civilisation. There are different ways to do this—for instance, by being read to—but mainly by scanning the lines of print and delivering the message to the brain, in a sighted person with the eyes and in a blind person with the fingertips.

Where these physiological changes occur, as they do, gradually and naturally, the scripted words need visual enlargement by magnifiers. This is in order to maintain a status quo vis-à-vis the comfortable distance for performing all manner of tasks. Different distances require different glasses. Maximum efficiency is decreed by simple trial and error. Of prime importance is the fact that both hands must be freed for co-ordinating movements and thus these magnifiers are held in a special frame. This compromise is universal and hallowed in history.

Can a task be performed better by using an optical appliance? That should be a 100 per cent. personal decision—it cannot be anything else. No person is privy to the thought processes and mental responses of another person. Sight means one thing to one person and something different to someone else. Our right to our own sight is a basic fundamental right. Likewise, the power to increase or decrease the focal length of the eyes by means of selected aids in the performance of the demands placed upon us is a basic human right. The choice of single vision lenses which achieve this purpose has been with us for centuries.

However, the Opticians Act 1958 introduced its own set of rules concerning our rights in these matters. It managed to persuade Government that oculists, by changing their name to ophthalmic opticians—which is somewhat like a farmer upgrading his style by calling himself an Alimentary Dietician—began to know better than we do; that by some indefinable knowledge they have the right to interfere in these mental visual processes; that, in order that we may continue to use these simple tools, we must make application to them. We must subject ourselves to interrogation; we must try to explain and divulge what is going on in our minds before access to a visual aid—known as an optical appliance—will be released.

It is futile to remonstrate. This is not an eye-test at all; it is a test of sanity with penalty clauses. At the mature age of 50, or thereabouts, when faced with the greatest reliance on these status quo tools, you comply or you go without, or, as many do, you go abroad to buy them. Over the years, Government have been in possession of a vast quantity of correspondence. Their vaults must be overflowing with complaints from the

public on this one issue—namely, the right to deprive people of the maximum deployment of their eyesight at a stroke by taking visual sensory aids off the market. By so doing, the efficiency of the whole nation has been impaired. The Government have been complacecent by choice, despite the violent opposition to what is now exposed as a restrictive practice concerning our eyesight and our freedom to make personal judgments about our own bodies.

My Lords, 23 million users of spectacles may have had enough, but their voice is as nothing compared with an organised lobby of a few thousand opticians ensuring that the mailbags of politicians are kept filled with their special pleading. The lobbying stems directly from the Bill itself. The tactics are the same as those used in the Private Member's Bill of 1958, and who knows it better than the noble Lord, Lord Northfield? There was barely a quorum in the House at that time. A Division on the most reasonable amendments to safeguard the public interest would have been futile when that quorum was composed of opticians and their friends in the majority. Indeed, it was by the continuous use and repetitive reference to those very words "public interest" that public interest became the first casualty.

If anyone seeks to study the archetypal method of using the democratic processes in order to secure a lucrative market, a monopoly, or, in business terms, a coup, he need only study Hansard. Read the reports of those debates and then relate the promise to the fulfilment. One is almost prepared to forgive anything in the business world when compared with cornering the market in visual sensory aids, depriving people for weeks of their natural abilities and relating the charges to an unbridled price structure. This form of Uriah Heep succour has no place in the doctrines of Hippocrates. When such methods can be and are being used by some to obtain payments out of all proportion to the intrinsic value of a vital and essential product, that, my Lords, is blackmail. The first chink showing that the Government were yielding was when Mrs. Sally Oppenheim, the Minister for Consumer Affairs, set up the first full-scale inquiry—and God bless her for it! In effect, she said that competition in the sale of spectacles must come back. The Office of Fair Trading will be charged with taking this vehicle apart and thereby enabling Parliament and the public to view it piecemeal in all its parts.

That report is a masterpiece. It says everything that is required of it without a hint of bias, with an enviable economy of adjectives and a total suppression of opinion. The Government now have in their hands the very indictment of the opticians' cartel which the Minister sought. Why is she no longer in office? Is this something to do with the lobby? The Office of Fair Trading report is of great public import and concern.

Promises were implied to me when I agreed not to go to a Division in your Lordships' House in sponsoring a Bill to repeal Section 21 of the Opticians Act. That debate was over a year ago. It was then made contingent upon the findings of the report. That Bill was entirely vindicated by the report. But the Bill remains on the Table. If the Government shrug it off now because of an impending election, I believe that this will be construed as a cover up; and if it looks like being collusion, it may well turn out to be an albatross. I hope that I am wrong in that suggested possibility. I have a letter from a retired optician of the old school who says that if all else fails, one thing that we can count on is that Mrs. Thatcher will not stand for British people being fooled.

This debate is essentially about the report of the Office of Fair Trading. But, taken in conjunction with the report of the Committee of Public Accounts, again one is confronted with unique and wholly unacceptable sources of hidden revenue for opticians. The chairman of that committee referred more than once to wool being pulled over the eyes of the Department of Health and Social Security, and unintended profits being filched out of the Exchequer. Lack of surveillance was admitted; an estimated £10 million of VAT went astray over two or three years. These figures are estimates and taken out of the top of their heads; no one really knows what the figures are; Accountability seems to be a dead duck; the department could not get at the facts and was an easy touch.

Later in the report, we find that bankrupt stocks of lenses from abroad namely, the Argentine and Brazil—were being dumped on the world's markets at 25p each. Landed here, they were qualifying for reimbursement at standard rates—all perfectly legal, or so we are informed. The world is awash with spectacle frames. Whole frames and lenses are selling abroad—in Holland, for instance—at from £2 to £6. Here, frames alone are starting at £40 before a lens has been inserted. We can find bills of £100 or more. One old lady I know was charged £450. There are no limitations. At least 85 per cent. of these frames are imported. What is the effect upon the home industry? Why should it have to compete with chicanery at this level?

In the wake of this transport of deceit, we now learn that the opticians have been impoverished to the tune of £70 million to £90 million as a result of the eye tests that they inflict upon us. I understand—although I stand to be corrected—that every optician's business in the country stands to receive an ex-gratia payment of between £10,000 and £25,000. My arithmetic suggests, therefore, that a multiple business that we all know of, owned by a tobacco company, will be in receipt of £12 million to £15 million of taxpayers' money. Yet, over the years, we know only too well that they have been recouping this alleged losses by fleecing the public on private frames.

Perhaps before I end the noble Lord may explain why, under the Health and Safety Regulations, far better frames can be bought for company operatives from £14 to £19 but are denied to the public and small businesses who are forced to buy the poorer quality product at inflated prices. How can this hypocrisy be excused? Is it because every trickle through this dam is quickly plugged with an optician's finger? The tragedy for all of us can be found as I have said in the pages of Hansard, when the noble Lord, Lord Northfield, and a few other stalwarts were prevented by smear and innuendo from securing fair play for the public.

Their predictions are self-evident and are borne out now by the consumers acting independently and getting their own report. It is also borne out by the survey of ophthalmologists who emphatically demanded the repeal of Section 21 of the Act which controls the sources of supply, the retail outlets and links them to the opticians' consultancies, which are anything but medical consultancies. The Government must now be fully aware of what is at issue. Is it not time for the Privy Council to be asked to review the conduct of the General Optical Council? So long as this cloak of respectability is available, it will be used as a shield for malpractice. The public will remain defenceless; unintended profits will remain a euphemism for milking the public purse. It will continue unabated.

8.46 p.m.

My Lords, that is a very hard-hitting speech to follow. I pay tribute to my noble friend Lord Rugby who in recent years has been fighting very hard on a trail which started 25 years ago when some of us opposed the Opticians Act at that time and forecast exactly what would happen over the years. I am delighted that not only his pressure but the pressure of other colleagues in this place is now bringing some results and I shall come to that in a moment. But what a long trail it has been!

There are really two issues and I do not start on either of them by saying that we are here dealing with a lot of sharks or dishonest men. I do not think frankly that that is the case. I think that we are all victims of Parliament's mistake in 1958 when the Opticians Act was passed, when the sanctity of professionalism was given to a commercial service, competition was totally ruled out and we are now paying the price in the shops for that mistake. If I may say so to my noble friend Lord Rugby, it was not because of dishonest men outside. I think they are all honest and I think that we are victims of the system which Parliament has allowed them to erect around their profession.

There are two issues here, as I have said. One is the degree of competition in this activity and the rules about publicity, with the possible consequent effect upon the price of spectacles. The second issue, which is highlighted in the report of the Office of Fair Trading, is the issue of the sale of ready-glazed reading spectacles outside the profession. Let me deal with them in turn.

In the case of publicity and competition we are still—is it not extraordinary?—after 25 years trying to get Governments to face up to the simple point that we were pressing from 1958 onwards; namely, that the problem arises because of the dual functions of opticians in our society. They are, on the one hand, professional people testing our eyes and, on the other hand, they have the purely commercial activity of selling spectacle frames. No Government has yet faced up to the dilemma of trying to cloak the whole of that activity under the guise of professionalism.

Let us look at what has happened since 1958, since I tried to get the Opticians Act counted out and moved all sorts of amendments to expose this expected racket; let us look at the number of reports that have littered our desks over the years: the Monopolies Commission on Professional Services of 1970, the Price Commission Report in 1976, which said that it is quite clear that dispensing private spectacles is a very profitable activity; the Dollond and Aitcheson report in 1979 which showed 300 per cent. and 400 per cent. mark-ups on frames, without real competition in the trade—for it is a trade, and that is all.

Let us consider the debates that we have had in this House. On somewhere between 10 and 20 occasions we have raised this subject since 1978; and yet we have still been put off with "Wait for another report". And, when the report is out, we have to start some more consultations. God knows when we are going to see the end of this!

The noble Lord says, "We soon shall". I hope he is correct but I have not had any hint that we are going to see the end tonight. Anyway we now have the report of the Office of Fair Trading, and let us say quite bluntly that it justifies the whole of the fight we have had over the years. It comes out totally on our side on the degree of competition and publicity. We should go back—because people do, as though it were the Bible—to the Crook Report of 1952. Over the years everybody has said "You must go back to the Crook Report because everything that has followed has stemmed from it." But reading the report, what it was saying in 1952, and in explicit terms, was that it expected the professional activity of eye-testing gradually to become dissociated from the commercial activity of selling frames. What the Crook Report wanted to do, quite properly and justifiably was to create a professional optical council for that professional activity alone. So nobody should pray in aid the Crook Report for what is going on now, which is the confusion of the two activities under the cloak of professionalism.

Today let us look at the figures to justify what I am saying about publicity. There are about 8,000 opticians. Over 7–8 million pairs of spectacles are sold per annum and over 70 per cent. of those frames are private ones. My Lords, gross this up for yourselves. We now have an activity tagged on to the professional job of testing eyes which, on my calculations, grosses well over £200 million a year and probably over £300 million. The tail is wagging the dog. This selling side of the optical profession is now more important than the revenue from testing eyes. That is where the problem has arisen, because under the cloak of the Optical Council total restrictive practices have been imposed with regard to publicity for that more dominant part of their activities.

If you read the 1981 rules on publicity, which are of course sanctified by having been passed by the Privy Council after they had gone through the Optical Council, you can see what it is all about. It is about keeping very discreet, like doctors and the very high professions, who, of course, do not soil their hands with any of this commercial activity. But it makes no allowance at all in those rules for the need for competition on this most dominant part of their activities.

We have made some progress after the pressure in this House. Let us not deny that. We can claim some credit—though, I would say to the Minister, not for his department—that we have forced at last a display of prices to be shown in the windows. The Optical Council did not want it. We kept raising it in this House until at last they were shamed into changing the rules to allow a price display in opticians' windows. I understand—I may be wrong—that it was carried by one vote on the Optical Council and at last we got a breakthrough to some signs of competitions. So at last we now prevent the problem, which I have raised many times, of the captive customer who is lured into the professional testing room and then feels he cannot walk out when it is only then that he discovers how high spectacle frame prices are. We have begun the breakthrough. What we have now to press for is the final breakthrough as recommended by the report of the Office for Fair Trading. What the report says on this issue is this. Having said that there have been these improvements on the subject of publicity, it continues:
"The remainder of the orders effectively deny patients information on available opticians in their locality, the range and prices of available products, the services which are offered by opticians in terms of opening hours, speed of dispensing, product guarantees and specialised services such as contact lens work and to a lesser extent quality. Customers are therefore denied the knowledge on which to make an informed choice of optician".
This is the next stage we have to crack and I shall make a suggestion in a moment although I do not know whether the Minister will like it. What would happen if we did open up the opticians' trade? I do not mean that offensively; I refer to opening up this side of their activities to real competition and publicity. What might happen? First—and the Office of Fair Trading's report is quite blunt about it—there would be fewer opticians. Some would be squeezed out. This is the problem the noble Lord, Lord Rugby, ought to be looking at because this report said that prices among small opticians in particular are something like 28 per cent. too high because of the low number of tests and supplies of spectacles that they handle in any one year.

So, if competition took its force we would have to face up to the loss of some opticians in small practices. I have a shop too. I have two off-licence shops. Nobody protects me from the big boys round the corner. Fifty yards from my shops—one is in a very poor district with high unemployment—is a supermarket selling liquor as a loss-leader and I have to keep my shop going in the face of this competition. There is no Optical Council or other professional body protecting me from that. Why should we protect an uncompetitive system if it means that too many small opticians are charging too-high prices because they are really uneconomic in terms of real competition?

Secondly, I should like to see what I see in America when I go into Sears Roebuck. What does one see? It is a proper commercial activity. There is a range of spectacle frames at 18 dollars; another range of frames at 34 dollars; and another at 54 dollars—real merchandise on display so that you can make your choice, and not all these fancy prices you can see in windows such as £32.62½p. That is all nonsense. These are mythical prices not based on real competition. The frames are pretty standard in their cost at wholesale prices. So we would get the customer being able to make a rational choice of different kinds of frames at fairly sensible prices.

Another thing we might see if we really let competition go a little further in this industry is something I saw on Friday. Nikon, the Japanese company, have just opened a factory in my New Town of Telford and I went to see what they are selling. They are selling this instrument, which is a totally technological, microprocessor approach for testing eyes. You simply sit at one end of this machine and there is a man at the other end who is a trained operative—he does not have to be an optician. He simply moves a handle until he gets the right result and the computer then prints out your prescription. This is happening throughout Europe. In Holland and other countries modern developments are happening. But here, because we still keep this as a "cottage industry", if you like, without real competition taking force, everybody is pretending that there is a great deal of mystique in the testing of eyes, so they say, "We must have not too many of those machines because it would give the game away".

My Lords, I wonder whether the noble Lord would allow me to ask him whether the machine he is talking about can detect the medical conditions that can exist.

My Lords, I am coming to that. I quite accept the Minister's point. But what I am saying is that this would be a good thing to take some of the mystique out of all this activity in the country. Before I come to the end of what might happen if we got a little more competition going, we would have to say to the Minister that just improving the prices of tests, the dispensing fee and all that and having better National Health Service frames—all the things which he has put to us at other times as ways of helping to get the balance right—is no substitute for competition. You cannot have competition stopped the minute it begins to bite you. That is what it is all about, in a trade. Once it begins to bite it is probably being effective. You cannot keep using gimmicks to stave off the decision on real competition.

I suspect that the Government will run away and do nothing. However, I suggest to those noble Lords who have been with me all this time that we should now draft very carefully amendments to the 1981 rules on publicity, send them to the General Optical Council and dare them to turn them down. We want to widen further the degree of competition beyond the simple display of prices in shop windows. I challenge the Minister to back us if we do that. It is a fair challenge. If the Government will not do anything, will they back us if we do something about this part of the Office of Fair Trading report? I should be prepared to draft those amendments. I am sure that the noble Lord, Lord Rugby, and the noble Lord, Lord Orr-Ewing, frustrated as they are after all these years, will join me in sending a precise suggestion to the General Optical Council about the relaxation of these rules and in daring the council to turn it down. We would not go mad. We should try to take them gently along this road of relaxation of the rules of competition.

Let me now deal with the Minister's point about testing and the sale of ready-glazed spectacles outside the optical profession. I come straight to the noble Lord's point. The issue is summarised on page 160 of the OFT report:
"Overall, therefore, the central question which Ministers will wish to consider is the balance between the benefits of greater competition and the risk, in the absence of the provisions of Section 21 of the Act, of symptoms of abnormality and disease not being discovered as a result of breaking the present link between the sale of spectacles and sight testing".
I want to face head on the issue which the noble Lord put to me. First, we have at last got Ministers to accept—but, goodness me! has it not been a long time before it has been accepted, as the noble Lord, Lord On-Ewing, who shared the burden of the correspondence with Ministers with me knows—that wearing the wrong spectacles does not do you any harm. We first of all had to disabuse Ministers of that idea. They said, "It will do terrible harm to your eyes if you wear the wrong spectacles". At last that argument has been disposed of. The only argument left is that about glaucoma. If people think they have diabetes they will sensibly go to the doctor; that disease is not normally first diagnosed through the eyes. The noble Lord shakes his head. But he has been in a room when Mr. Trevor Roper has told him that this is the case. Mr. Trevor Roper has more experience of this than either the noble Lord or his civil servants.

The real issue, if not the only issue, is glaucoma. The Office of Fair Trading estimates that if ready-glazed spectacles were put on sale, about three to five per cent. of spectacles would be sold in this way. Specialists like Mr. Trevor Roper estimate that when eye tests are carried out, about 0·2 per cent. and up to 2 per cent. of people might have some signs—nearly always wrongly diagnosed signs—of glaucoma. If we allowed the sale of ready-glazed spectacles, whom should we be putting at risk? We should be putting at risk between 0·2 per cent. and 3 to 5 per cent. of people. Therefore the figure, as the Office of Fair Trading report says, is so marginal that it is ridiculous to make it the prime point of public policy. It is absolute nonsense to say that 0·2 per cent. and up to 2 per cent., or 3 to 5 per cent. of people is such a big figure that we have got to make a big issue of it.

I would urge wider considerations on the Minister. People are sensible enough nowadays to go to opticians to have their eyes tested. We are not back in the dark ages of the 1930s when people were unable to think about how to get their eyes tested properly. People know that there is a National Health Service. We have had 40 years of it. If people think that their eyes are defective in some way, they know that they should go to a doctor or an optician to have a proper test. Times have changed, compared with 40 years ago. Other matters are now more at issue.

First, why should I be forced to go through an optician to buy a spare pair of spectacles, with all the costs which that implies for the public purse, in testing and the rest? As for glaucoma, as the British Medical Journal said, if you really believe that the only people who should be allowed to sell spectacles should be opticians, then you should say that the only people allowed to sell toothbrushes should be dentists. It is as simple as that. It is an appliance which can do you no harm. The case is totally parallel with the selling of toothbrushes. Therefore, I beg the Minister to have something to say to us tonight.

When I go to America, I am always being asked by Members of this House to bring back pairs of spectacles for them. It is ridiculous that we in this country have reached the stage where a pair of spectacles can cost up to £90. I have been stopped in the corridors of this House and been asked to bring back spare pairs for 12 dollars. The wind of competition in this trading activity really must be allowed to blow. We must at last persuade the Government to recognise that we are not chasing charlatans or crooks. We are trying to criticise a system which we as parliamentarians have wrongly allowed to happen.

9.6 p.m.

My Lords, when the noble Lord, Lord Rugby, attempted in his Private Member's Bill to repeal Section 21 of the Opticians Act, I was Government spokesman at the Department of Health and Social Security and responsible for replying on behalf of the Government. Although I no longer occupy this position, I have by no means lost my interest in optics, since I was recently appointed President of the Federation of Optical Corporate Bodies. It is in this capacity that I want to make a few observations.

The first point I should like to make is that there are two important aspects to be considered by your Lordships when giving consideration to the desirability or otherwise of repealing Section 21. The first is the all-important aspect of the freedom of the individual. This has been very fully examined in the OFT report. I should like, if I may, to pay tribute to Sir Gordon Borne and his colleagues on the thoroughness of that report. I would remind your Lordships that the OFT was asked in its terms of reference not to make recommendations or come to conclusions which would affect the public interest. My own quarrel with the report is that the authors did come to conclusions—some of which seemed to take scant account of the evidence that had been so painstakingly presented by such eminent bodies as the Faculty of Ophthalmologists, the International Glaucoma Association, and the National Ophthalmic Treatment Board Association.

The second aspect is, of course, the health of the population. It was this aspect which lay behind the inclusion of Section 21 in the Act. However much noble Lords may like to play down the importance of this, it is obvious that it would be folly to ignore it. In fact, I believe the reason why the OFT were asked not to come to conclusions or to make recommendations was because they were required to look only at one side of the coin. Quite rightly, however, the OFT did acknowledge the importance of the health aspect in their report.

Now that this report has been publicised, I trust that the review by the DHSS of general optical services will soon get under way. Personally, I hoped that this review would have been undertaken concurrently with the OFT review since, considering the amount of controversy that has taken place in recent years on this subject—both in your Lordships' House and in the media—it is just as much in the interests of opticians to conclude this long running saga as it is for the public, the Government, and noble Lords who have shown such an interest in this subject.

I know there are some noble Lords who are impatient to have Section 21 of the Act repealed, but it must be the duty of the Government to consider very carefully the value of the health checking service that arises from sight testing as it is performed in this country. This consideration is clearly impossible until the DHSS review has been completed. I would suggest to the noble Lord, Lord Rugby, and his supporters that they will have to possess their souls in patience for, I would guess, at least a year.

My Lords, it is indeed a pity that the Government have taken such an unconscionable time in getting started on the DHSS review. It transpires now that the process of selecting a chairman and members is "under way" and that the terms of reference are being revised.

I will now turn to a very important point, which is either ignored entirely by the newspapers or is sometimes alluded to in passing without emphasising the crucial part that this point has played in the cost of private spectacles. As many of your Lordships are aware, opticians provide three categories of spectacles. These are NHS spectacles; hybrids, which are NHS lenses in private frames; and private spectacles. It is well known that NHS spectacles and NHS lenses have had to be subsidised from private sales. Unfortunately, the fees payable to opticians for NHS work, despite the inflation that has occurred in recent years, remained substantially unchanged between 1978 and 1982. The effect of this was that the DHSS underpaid opticians by some £100 million. It was only on 1st February this year that increased levels of sight testing fees and dispensing payments finally came into operation. The sum of £ 100 million is a very large figure. In December 1981 there were 6,037 ophthalmic opticians and 2,661 dispensing opticians on the GOC register. Opticians were, therefore, owed about £12,000 each on average, or about one year's earnings.

That is the reason why opticians increased the prices of private spectacles, in order to remain in business; and the reasons why the increases were substantial is because NHS spectacles on which they were losing money, amount to no less than 32·4 per cent. of the market. So opticians have found themselves in a very difficult situation since 1978.

It is generally accepted that we enjoy optical services of a very high order. The OFT review concluded that opticians have not been making excessive profits. They have been owed huge, mounting sums by the DHSS. Yet they are accused of rip-offs, frame-ups, and the like. I thought it was high time that somebody gave a little of the background to that which has been happening. I should now like to tell the House how the prices of private spectacles have been falling—not rising—over the past 12 months.

In April 1982—four years after the last adjustment—the DHSS introduced an interim increase in sight testing and dispensing payments. As a result, the optical companies were advised by the federation in April 1982 to reduce private prices—and a significant number of individual opticians also reduced their prices. A substantial proportion of the company reductions then made were up to 20 per cent. Subsequently, since the final increase in NHS payments came into effect on 1st February 1983, many companies have reduced further the prices of prescription spectacle frames by percentages ranging from 15 to 20 per cent. So we are now, and have been for about 12 months, in a period of falling private spectacle prices. So far as I am aware, the only time this has been mentioned in your Lordships' House was when in June last year I asked Her Majesty's Government if there were any signs of a fall in prices, and my noble friend Lord Trefgarne replied that falls of up to 20 per cent. had been reported. Nor, as far as I am aware, have many newspapers drawn attention to these falling prices. Prices have fallen for the simple reason that, after a four-year delay, the NHS fees have been raised to a more sensible and realistic level, despite the fact that even now the new NHS payments do not enable opticians fully to recover their overhead costs on NHS work.

My Lords, may I ask the noble Lord to go on from that, because what the report also says is that on top of those kinds of price reduction you could obtain a further 28 per cent. price reduction if the smaller optician disappeared, or at least did the level of trade that competition brings in the more prosperous optician companies?

My Lords, I think the noble Lord is really talking about Section 25.

My Lords, perhaps the noble Lord would explain a little further; I do not quite understand.

My Lords, the noble Lord is quite right to say that prices have gone down. But the report says that, if real competition took place and the very small optician disappeared or at least got more business at that sort of level of economic activity, prices could then be reduced by a further 28 per cent.

Well, my Lords, the noble Lord is obviously never satisfied. I have told your Lordships that we have had two lots of reductions, at last, after reasonable fees were paid, of 15 to 20 per cent. and then another 15 to 20 per cent. This, at least, is something in the direction which no noble Lord, as far as I know, has ever suggested in this House before.

I was going to say that, had these matters been attended to in one year instead of four, the distortion in private spectacle prices would never have taken place, though no doubt they would have risen in line with inflation. I suggest to your Lordships that, if it had not been for the four-year logjam which held NHS fees down during a very inflationary period and triggered the rise in private spectacle prices, now being reversed, there would have been no call for a return to the days when ready-made spectacles were made available without prescription. I find it difficult to believe that the Government would seriously contemplate such a retrograde step as deregistering dispensing or allowing ready-glazed spectacles to be sold by unqualified people.

My Lords, would my noble friend allow me to intervene? I am most grateful. I think a point that should be made is why should the Government not come in line with what every other free nation already does? Is there some sin in copying other free economies and therefore advantaging consumers?

My Lords, I was just about to say that it might be of interest to the House to know that both Hong Kong and Malaysia are at the moment considering legislation to go along the lines of our Opticians Act 1958, in the very reverse of what has been suggested.

My Lords, would the noble Lord consider that to be an Englishman's disease, that they should go along with the 1958 Act?

My Lords, I think I will just carry on with my speech. I enjoyed hearing the noble Lord, Lord Northfield, who has been absolutely consistent on this over 25 years. He knows a great deal about the subject, and I always used to feel slightly cagey about arguing with him in the days when I was on the Front Bench. However, I did enjoy his speech. I cannot say that I enjoyed the speech of the noble Lord, Lord Rugby, who I thought was quite unreasonably exaggerated in his remarks about the opticians. I look forward very much to hearing what my noble friend Lord Trefgarne has to say in reply to the debate.

9.20 p.m.

My Lords, like other noble Lords I am mindful of the lateness of the hour. I have also not forgotten that I have already been on my feet three times in your Lordships' House today, and I fully recognise that in some things enough is more than enough. In any case, much of what I wish to say has already been said in a powerful speech by the noble Lord, Lord Northfield. I could have listened to him all night. In fact, for a time I thought I was going to have to. I make no complaint. The noble Lord is a great expert, and he put the arguments forcefully.

However, I cannot allow this occasion to pass without offering some support to the noble Lord, Lord Rugby, in his efforts. I support him not just as a noble Lord who happens to sit on these Benches and who is therefore automatically, by inclination, opposed to monopolies, be they private, public or professional: I support him as a doctor. In that capacity I must choose my words with extreme care. I am anxious not to be misunderstood. When a member of a profession which some will say has a very powerful monopoly of its own is talking about colleagues in another profession, he must be careful.

The point has already been made clearly by the noble Lord, Lord Northfield, that we are talking about two different activities. We are talking about the very necessary and important business of the care and maintenance of the health of the eyes. That is a vital activity. We are also talking about the rather separate business of selling spectacles. The poblem that faces us arises from the entanglement of those two separate and different activities. I want to make it utterly clear as a doctor that I have no wish at all to place any obstacles in the way of patients and people having regular and proper ophthalmic examinations at regular and proper intervals. That is important and valuable for public health in general.

In practice over many years as a general practitioner I have relied heavily on a local optician for advice and guidance on many occasions. Having said that, I must say—and I hope I am not misunderstood—that there are opticians and opticians. There is the kind of optician who gets to know a patient and his family and who takes a continuing interest in the optical health of that person during that person's life. That kind of optician seems to be in a slightly different position from the qualified optician who is merely an employee of a big multiple firm, who may be there for a short time and then gone and who does not have a continuing interest in the welfare of the individual patient.

So I greatly value the work of the opticians and I share the view expressed by the noble Lord, Lord Cullen of Ashbourne, that the longer this kind of wrangling continues the more damage is done to very well-intentioned and able members of a very distinguished profession. It is, therefore, in the interests of the opticians themselves that some of these matters should be dealt with.

I have always felt, and still do, that the provisions of the Opticians Act 1958 create a monopoly that is sometimes so rigid that it acts against the interests of the consumer, and that means the patient. There is a continuing pressure on patients always to buy their spectacles from the persons who test their eyes. That is not necessarily logical or proper. Over the years there has been an inadequate explanation of the National Health Service provisions and what is available, to whom and for how much. There has certainly been inadequate information in the past about prices, about the different kinds of prices and about choices. In my view there has quite often been an insistence on totally unnecessary optical tests purely for the sake of doing them. The case was referred to of a person who wants a second pair of glasses merely because he wants to keep a pair at home as well as in his office or another place, and so on.

There have, of course, already been many welcome changes. That has been referred to by many noble Lords. Those changes have come about in part as a result of debates which have taken place from time to time in your Lordships' House. There have been welcome changes in the display of prices, and reference has already been made to that. There has also been an increase in competition. That competition has begun to operate in the interests of the consumer rather than in the interests of the person selling spectacles. As the noble Lord, Lord Cullen of Ashbourne, has reminded the House, prices have come down. That, surely, is a benefit, and it is one which we should welcome. But many problems and difficulties remain, and it is high time they were dealt with. I make that point again. The longer they are left, and the more wrangling there is about these matters, the more damage is done to reputable people in a very reputable profession.

Let me conclude by making just one or two points and, perhaps, dispelling one or two myths. I would just say again, as a doctor, that there really seems to me to be no danger in elderly people suffering from presbyopia purchasing magnifying lenses without a test. I do not see any danger in that. Nor do I think that there is any particular danger in people getting a second pair of glasses without a further eye test when they may have had one very recently. Certainly there is no danger in an individual having total freedom to have his optical prescription dispensed by any one of a whole number of people and having a choice, instead of, as at the moment, often having almost no choice at all. But let me ask your Lordships to look at what actually—

My Lords, I understand that there is no difficulty about that at the moment. You can get your prescription and go to any optician you wish.

My Lords, the noble Lord may say so now, but I wish he would go and say it to the thousands and thousands of people in areas that I know who are perhaps not sufficiently aware of that point and who have often been misled. The fault may be theirs, but there are misunderstandings about that. There is an assumption that that is what they must do.

Look what happens now. In my experience in general practice glasses are handed down through members of the family, particularly now that spectacles have become so expensive. It happened in my own family. My wife is younger than I am, and much less decrepit, but despite that she has already grown up through two pairs of my old spectacles. But now, at long last, as I have developed a different kind of refractory error and have had to resort to bifocals, I have totally rumbled her and she will have to go and get her own glasses in the end. What I am saying is this. We really must get away from this delusion that wearing the wrong glasses damages people's eyes. All that happens is that you cannot see. You may get run over, or something unpleasant like that, but the idea that it does some terrible damage to the eyes is one which we should forget about.

I accept that there are these problems about the detection of very serious matters like glaucoma, but I would also remind the House that a safeguard, to be a genuine safeguard, must be wholly safe. I think it is a fact that sometimes, and not infrequently, conditions of that kind are missed by opticians. It is regrettable—and I do not say that critically. It is understandable. I think that public reliance on a safeguard which is sometimes not wholly safe is unhelpful. Let me give your Lordships an example. It is not very long ago that a previous Government got rid of the mass miniature X-rays. Why? It was because it was found that they were not cost-effective—but it was for another reason as well. They very often missed things. But they also instilled in people a false sense of security. A person with a chest complaint would say, "I do not need to worry; I have had an X-ray". What had he had? He had just had a mass miniature X-ray which could very well have missed the thing. It was a good thing, in a way, that we got rid of that safeguard which was not really a safeguard.

All I am saying is this. If we were to rely totally on the fact that people have fairly regular optical tests by opticians as the only way of detecting glaucoma in our community, we should be in a very dangerous situation indeed. I think we must be aware of many other steps that have to be taken. That having been said, I as a doctor am in favour of encouraging people to have regular optical tests and regular eye tests. I should not like it to be thought for a moment that I take a contrary view. I merely say that I do not think that the Government should swallow this document lock, stock and barrel, every bit of it; but I do say that it is high time that some action was taken on some of these points. If action is not taken, further damage will be done to a profession which has already been seriously damaged.

9.30 p.m.

My Lords, I join with other speakers in warmly congratulating my noble friend Lord Rugby on his persistence, courage, and single-mindedness in pursuit of a quarry which I begin to sense we have at bay. It was a splendid example of the indefatigable in pursuit of the indefensible, and I rejoiced to hear for the first time the noble Lord, Lord Northfield, denouncing sin and upholding market competition from the Labour Benches. I welcomed that as much as I did hearing the noble Lord, Lord Winstanley, speaking in those liberal accents for which I often listen in vain from the Liberal Benches. I wish that I could say anything more agreeable of the noble Lord, Lord Cullen of Ashbourne, than that it was certainly a brave effort in a bad cause, and I think that we should warn the Minister, the noble Lord, Lord Trefgarne, that if he does not do better he cannot expect in the future to escape as lightly.

The Office of Fair Trading report in January confirmed the prediction of standard economic analysis that restrictions on competition in both the advertising and the sale of spectacles must raise prices to the consumer. I should like at once to acknowledge that economists are not always right—I would add especially when they are Left. They are seldom in perfect harmony. Indeed, there are in this House half a dozen admitted, professional economists, and I find that they are fairly impartially scattered over the Conservative, Labour, Social Democrat, and Cross-Benches. Yet I dare say that they would be in broad agreement that monopoly—if not in every case wrong, or even avoidable—always has great potentiality for evil.

The confusion of counsels that we hear arises from wanting to have it both ways. Thus every businessman, every trade union leader, I would say every professional spokesman, will denounce monopoly in general, but is not above striving to suppress competition in the particular product or service that he supplies. Adam Smith said it all in 1776, in a celebrated passage that I have previously quoted. It reads as follows:
"People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices".
The truth is that all monopoly power enables a producer to exploit the customer by cutting him off from alternative sources of supply. But, where the monopoly power is exercised by a private supplier to raise prices, the resulting prospect of higher profits will invariably attract new entrants or imported products, or it will provoke substitution from competing products. The deeply objectionable feature of a state-entrenched monopoly is that none of these correctives is permitted by law. That is why I would argue that the power of the voluntary OPEC cartel is as nothing compared with the statutory opticians' cartel under the 1958 Act.

It must be admitted that in the Second Reading debate in February last year on the Bill of my noble friend Lord Rugby to repeal Section 21, the majority of speakers upheld the present arrangement whereby the sale of spectacles is monopolised by opticians and made subject to compulsory testing of eyes. We found that in every case the defenders of monopoly pleaded a high-minded concern for the nation's eyesight. In particular, one noble Lord, speaking with all the lofty authority of a past president of the British Medical Association, the General Medical Council, and other seemingly impartial interest groups, argued that we must defer not only to his opinion but to the opinion of the president of the Faculty of Ophthalmologists. There was much blinding talk of professionalism, objectivity, and freedom from sordid commercial interests.

I found it all very suspicious. After all, the Repeal Group which had encouraged my noble friend Lord Rugby to bring forward his Bill, had consulted equally distinguished specialists, who had enthusiastically supported our attack. We had collected leading articles from both The Lancet and the British Medical Journal in favour of the uncompromising stand that the noble Lord, Lord Rugby had taken. We were thus confronted with a direct clash of opinion between what appeared to be equally qualified experts.

It was to try to resolve this conflict that the Repeal Group decided to ask the Ophthalmological Society at the end of last year for a list of its United Kingdom members so that we could circulate a questionnaire in terms that we offered to discuss with it. It took three months for the same president of the faculty, who was lauded for his objectivity in this House, to refuse outright any co-operation in this endeavour to find out what his members really believed. Since the Ophthalmological Society is not a secret organisation, we had no difficulty in getting a list of members and writing to invite the 650 living in the United Kingdom to complete a postal ballot giving their opinion anonymously on the following question:
"Should the present statutory monopoly for opticians (or doctors) to sell simple reading spectacles be repealed?".
They were invited to vote Yes, No, or to say that they were undecided. Of the 350 expressing a direct reply, 200 said "Yes" against 150 saying "No". This clear 57 per cent. majority in favour of ending the monopoly contrasts sharply with the published opinion of the president of the Faculty of Ophthalmologists that what he had earlier called this
"direct attack on the optical profession"
was, he said,
"without the support of any more than a very few vociferous doctors".
Thus, we find, like some medical Arthur Scargill or BL shop steward, the exalted president of the Faculty of Ophthalmologists was shown to be completely out of touch with those he claims to represent.

From the mountain of letters accompanying the voting slips, it was clear that the key difference in judgment arises over the possibility that an optician's test for glasses may discover more serious defects. So it might. The 6,000 retail opticians, as has been stated, perform a useful function, but they lack the training and clinical experience necessary to diagnose serious abnormalities and are likely to miss as much as they spot. They certainly cannot be relied upon to diagnose glaucoma, which is estimated to affect between 1 and 0·1 per cent. of the population. So there is the real danger, touched upon by the noble Lord, Lord Winstanley, that this hit or miss approach will bring a false sense of security.

The issue is put beyond doubt by a letter in the current BMJ from Mr. Redmond Smith, who is senior consultant in charge of glaucoma at Moorfields. He writes:
"If the wrong spectacles could damage a person's eyes there would be some justification for the optician's monopoly—rather along the lines of the wrong drugs being harmful justifying the doctor's monopoly of prescribing many medicines. But the wrong glasses do not damage eyes, at least no well informed person now seriously believes they do. Hence, the original grounds cited for a monopoly no longer exist. An attempt is now being made to perpetuate the monopoly by inventing new grounds: the non-detection of diseases which might result from people being able to buy spectacles over the counter".
This authoritative source concludes:
"The present law, which leads to the absurd position that it is legal to buy a pair of racing binoculars but not a pair of spectacles, should be scrapped".
The abolition of the optician's monopoly would not put the opticians out of business. Most people would continue to have periodic eye tests. But the competition for replacement glasses and simple magnifiers would bring prices down, often to a fraction of the present costs, and so would set limits to the exactions levied by the statutory opticians' cartel on what has been called their "captive" customers. The noble Lord, Lord Rugby, has on his side the Consumers' Association, the National Consumer Council and now the majority of specialist ophthalmologists. Against us are ranged only phantom fears and vested interests. If the Government will not act in this matter, I very much hope that my noble friend Lord Rugby will again table his Private Member's Bill to sweep this offensive monopoly from the statute book.

9.41 p.m.

My Lords, I should like to follow the noble Lord, Lord Rugby, and congratulate him on his initiative in having this short debate and also all those other noble Lords who have spoken from representative Benches. We opened with a Cross-Bencher, followed by a Labour supporter, a Liberal supporter, another Cross-Bencher and now I am speaking in favour of some competition from the Conservative Benches—a very natural place from which to make such a plea.

I should like to endorse the view of the noble Lord, Lord Winstanley, drawn from his professional life. He speaks with great experience and humorously, too, which is something very pleasant in this House. I believe like him, that one needs to separate the testing of eyes, which should be honourably and professionally carried out, from the marketing of eyes. This Government were elected to oppose monopolies, to introduce price competition wherever it could be introduced and, at the same time, to protect the consumer—we have a Minister for Consumer Protection—and also of course the poor and needy who had to have some special circumstance which would help them to buy such essential things as spectacles. This monopoly has existed now for some 25 years and from all the experience surely it is time that we set about doing something, and doing something rather more quickly than we have in the past.

We have had all-party meetings. We have seen two Ministers. Indeed, many noble Lords speaking in this debate have been part of those assemblies. The noble Lord, Lord Northfield, led us to a meeting with the Minister, Mr. Kenneth Clarke, who was accompanied also by the noble Lord, Lord Trefgarne, who is to reply. One thing which all those present would agree emerged was that the civil servants were still under the impression that this whole set-up, this monopoly, was essential to preserve the health of the examination of people's eyes. That idea was exploded because we had with us a most senior consultant at Moorfields, Professor Trevor Roper. The Minister seemed startled that all the advice he had received from people was contrary to the professional advice received from Professor Trevor Roper.

One has to be a little suspicious about those who desire to preserve the status quo. Something like between 7 million and 8 million pairs of spectacles are marketed each year. Many people have to have two pairs. I broke my spectacles recently and I had to go today to get some new ones and I will talk about that later. Very large sums of money are at stake although the cost of the frame cannot be more than perhaps £3 unless—God forbid!—it is made of tortoise-shell which, apart from anything else, would be illegal but also very expensive. A frame costs about £2 or £3. Yet when I went today I was told that it would cost £24 and that it would last much longer. That was the type of argument that was put forward. Maybe they are right. But perhaps spectacles are accidently broken or changed because one's eyes change over a period. I am not sure that one needs one's spectacle frame to last 30, 40 or even 50 years because they are almost always invariably broken long before that time has expired.

I had my eyes tested today and it was an interesting experience. I had not had them tested for some three years. When I visited Mr. Clive Kay of Warwick Way, conveniently on my route to this House, I was told that if I wanted National Health Service spectacles I could not have them, and I could not have the lenses either, unless I had my eyes tested. I said that I really did not need to have them tested because I did not want to put any extra burden on the poor taxpayer. I said that I knew roughly what I wanted and that I am +3 on each eye, and I suspected, as it is three years since I last had my eyes tested, that 3·25 would probably be very satisfactory for me. He said "I am very sorry, but we cannot supply these unless you undergo a test." So I underwent a test. He seemed to be extremely well trained. A nice young lady took me into a back room and tested my eyes very thoroughly. After all these tests she came out and said "Yes, you were quite right, you do want 3·25." I then said "What will the taxpayers have to ante-up for that, or do I pay?" They said "No, the taxpayer will pay. It is an improved rate now", as my noble friend pointed out. They said that it would be £8, which seemed to me to be fairly good value for money for the taxpayers.

However, when I asked about all the other beautiful frames that were scattered around and where they all came from, they said that they were all imported. This brings out a point that we have made all the way along. We have said that if one goes on grossly over-charging in this country compared with every other free nation in the world, there can be only one inevitable consequence, which is that there will be wholesale importation, and in this case from Taiwan. Every single one of those demonstrated in the shop—apart from the national health ones, which comprised a very small minority—had been imported from Taiwan and had thus done away with the jobs of people in this country, valuable jobs which everyone in this House would wish to see preserved. So not only have we charged the consumers grossly more than is desirable, but we have actually destroyed jobs in this country because we are no longer competitive.

Two arguments have I think been destroyed over these many presentations, debates and Questions that we have had. Secondly, there is the question which was dealt with by a previous speaker, that to some extent to use wrong spectacles would harm the eyes. Trevor Roper dealt with this perfectly. He said that if you are using the wrong spectacles, you would very quickly get a headache and realise that a mistake had been made. Therefore, neither on the medical grounds of finding glaucoma nor on the grounds that you are harming your eyes does the argument for the continued monopoly stand up.

It is a great shame that we are about to start on yet another round of investigation. The one way in which to delay justice, to prevent the consumer getting value for money, is to have investigation on investigation. No one investigation goes on in parallel. We took a year over the last one. It was a very good investigation by the Office of Fair Trading. It was set up in December 1981, but it did not report until December 1982 because there were only part-timers on it. Now we are told that they are looking for a new team of people to set up yet another investigation.

I should like to remind my noble friend that this Government were elected on a manifesto which said that they would protect the consumers and they would increase competition so that, so far as conceivably possible, everyone received value for money. I ask my noble friend for early action so that we honour that promise.

9.49 p.m.

My Lords, I do not know quite where to begin because, when my noble friend Lord Orr-Ewing asked if I minded him taking the place of the noble Lord, Lord Donaldson, I said that I did not mind at all because I think that that ends the range of noble Lords who are inclined to become rather outspoken and almost hysterical on this matter, to the great distress of a number of us who are ordinary men in the street.

I am not happy at all about this criticism of the word "monopoly". The noble Lord, Lord Winstanley, is a doctor. He has a monopoly. There are monopolies in medicine, in the law and in dentistry. Of course there must be such monopolies. My noble friend Lord Orr-Ewing said that this Government was elected to protect the consumer: it is also elected to protect the customer and the people whose eyes have to be attended to; they must be properly protected in that respect. I am not happy about this nonsense with regard to the monopoly. After all, the report that we are supposed to be discussing, although we have heard very little about it, says clearly on page 157:
"The evidence of the survey of opticians' costs, profits and margins discussed in Chapter 8 does not suggest that opticians' profits were excessive".
However, as we shall hear from the Minister when he winds up and as has already been mentioned, the Government have found it necessary to repay to the opticians something in excess of £70 million.

If you do not want a monopoly here, what do you suggest? Is the suggestion that the supply of spectacles should be a purely business proposition, leaving eye care behind as a piece of old history? To me, eye care is an integral part of our precious National Health Service which it is our duty to nurture, and about which in a previous debate this very day we heard an outspoken expression of view on behalf of the Government that they intend to nurture the National Health Service, of which the ophthalmic services are an integral part.

After all, an independent survey of ophthalmic practice in 1981 revealed that 13 per cent. of the patients of opticians required referral for medical attention. This is where my personal interest lies. From astigmatism as a schoolboy, to the need for reading glasses after malignant malaria and massive doses of quinine in my younger days, to the advance of years requiring glasses for driving or for looking at television, I have relied on regular attention to my precious eyes, my windows on the world.

It was thus, at a fairly recent visit to an optician, that I was recommended to get my doctor to refer me to a specialist lest I might be liable to glaucoma. I lost no time in following this up, whereupon the specialist, after careful examination, said he congratulated my optician for being suspicious but that I was not likely to suffer from that condition. The suspicion which had been aroused in my optician was due to many long years in tropical sunshine.

I know that skilled medical advice is necessary. Incidentally, to my noble friend Lord Harris of High Cross, I suggest that he visits his optician and gets his frames to fit his nose properly so that he can hold them easily. It is no use suggesting that this is not a matter for specialised medical knowledge. It is such a matter. I look forward to the Minister's reply. I expect that we shall hear that the Government have the matter well in hand. I hope and pray myself that it will be many years before this debate is reimposed upon this House. I am pretty sure that the Government will take steps to try to provide against that.

I remember that in one of the previous debates one of the objections hurled at the opticians was that nobody could repair their spectacles. I happened to mention this to my secretary. The next time she came she brought me an eye glass repair kit bought at a petrol station with a key ring for 50p. So we get back to what really is at the background of all this, the old Latin tag, caveat emptor. If anything can come out of this debate it might well be that, as my noble friend Lord Colwyn suggested in the last debate, some publicity should be given to people to guide them in how they can, as buyers, take care.

9.55 p.m.

My Lords, I find myself very puzzled by what has been said in this debate. The point is that I know a great many opticians, and I find it incomprehensible that the description I have heard of them as grasping and unscrupulous people can in fact be applied to those men that I know and like. I felt that many of Lord Rugby's strictures were quite incomprehensible. I should like to introduce him, if he would allow me to do so, to some of those opticians, particuarly those who are running the Eye Hospital in Manchester, to those who are running the ophthalmic optics department in my own institution, and who are very dedicated professional men. It is most worrying to me, because the very first degree course which was ever given to ophthalmic optic students was given in my institution and was given because we were promised the opportunity to expose the students to clinical tests being performed in the Manchester Eye Hospital.

I was speaking today to the man now responsible for organising these contacts, and he said that they were in fact increasing them and that the students got a great deal of practical experience from observing eye defects. He said that many of the students saw more diseased eyes than the medical students did at a corresponding stage in their career; so they are very well able to tell when something is wrong with the eye. They are not under any circumstances expected to treat it themselves, but they can arrange for the person concerned to be referred to a consultant, usually through the general practitioner. This has led to a slight distortion of the statistics, because I believe that of all the referrals to consultants, more than half now come through general practitioners, but they have been asked to do the job by the opticians themselves.

The whole of the profession is most concerned to do what it can to preserve the eyes of those for whom it has assumed responsibility. This is what I find so extremely offensive in some of the remarks which have been made this evening in regard to their irresponsibility and the grasping sort of way in which they have seized on any available source of cash. We have already had it explained to us by Lord Cullen of Ashbourne that they were something like £70 million light at one stage in the fees due to them from the National Health Service—and what could they do? Everyone realises that it is an indefensible anomaly that the payment for eye testing should have to come out of the profits made by selling spectacles. The DHSS has now increased the fee for eye testing, and I think it is £8. The noble Lord, Lord Orr-Ewing, said that he had just had his eyes tested and he thought that the lady who did it was very well paid for her time. Has he ever tried to have half an hour of a good solicitor's time; and, if so, how much was he charged for that?

I cannot but believe that the fees they charge are reasonable. The average income of an optician is in my experience not excessive, and no one has said that it is. I cannot accept that this report which has been published by the Office of Fair Trading is a good report. Much of what it says was based on inadequate evidence, and much of the inadequate evidence was misinterpreted. They did not consult a representative body of the Ophthalmic profession; they took evidence from only one person, and he was opposed to the plan.

This is not simply a case of good versus evil: it is a case of a profession which has been struggling to be born for many years and which is doing a very good job. When people speak of the possibility of handing down spectacles, I can remember when false teeth used to be handed down. When I was a child you could go and buy false teeth in some secondhand shops in the district, and many people did this; but no one would recommend this as a good policy. It was the only thing that people could afford. The concept that spectacles can be handed down is about as sensible. It may work out that your jaws are the same shape as your father's jaws, and you can wear his false teeth. If you do so, I am sure that it will not hurt your jaws; but I do not believe that it is a policy to be commended in normal operating practice.

My Lords, if the noble Lord will allow me to intervene, since I think he referred to my remarks, may I make it clear that not for a moment did I recommend that glasses be handed down? I said that because they were so expensive they were handed down. I said that being handed down did no actual harm to anybody's eyes; but I did not recommend it.

My Lords, I am glad about that. Conversely, I would not recommend the handing down of false teeth on the grounds that it would not damage your jaws. What I am trying to say is that we have heard bitter attacks on what seems to me to be basically a very responsible, sensible and caring profession. Much of the problem has been due to the fact that they were for a long time unable to survive because the fee for eye testing was inadequate and a great deal had not been paid. It is true, as has been said, that the price of spectacles has been dramatically reduced in the last few years, and even on the occasions when it has not been reduced it has not been raised, as might have been the case when, for example, the price of lenses was raised about three or four months ago.

I think the best thing I could arrange to do, if I may say this to the noble Lord, Lord Rugby, is to introduce him to some of the people who are now in Manchester arranging for the teaching of students. I should like him to get to meet some of the students and to see the conditions in which, in hospitals, they are introduced to those defects of vision so that they can spot them and cause some action to be taken to save the sight of those who might otherwise go blind.

I speak with feeling on this because my sight is going, very badly. I cannot claim to be a success story in the treatment I have had from either the medical profession or the opticians. No one was able to save my eyes, which have gone for other reasons and which are beyond medical help. I feel strongly that, despite my own difficulties, the profession is a supremely effective method of helping the general population at a relatively small price. Even the Office of Fair Trading, prejudiced as it was, did not think that the incomes that the opticians achieved were excessive. It may be that, by forcing a few out of business, the competition might come down. But, similarly, if solicitors were to advertise more, if barristers and architects were to advertise more, this might reduce the prices. But would that do anything but harm to the professions concerned? Let us remember that this profession is struggling to be born. It is not long since the dentists first acquired a charter—it was in 1923, I think—and it ceased to be possible to set yourself up in dental practice with no other tools than a pair of pincers and a chair. People were not compelled to have any medical qualifications until the Dentists Act 1923. Let us remember, too, that when the Duke of Wellington was dying he said: "Send for the apothecary!" In those days there were no physicians. Let us also remember there was a time when the barbers had to separate themselves from the surgeons in order that the surgeons could become an independent profession and achieve their present distinction.

All these professions have grown against opposition, and all are now part of society. I believe strongly that the ophthalmic opticians, beset as they are by all the difficulties canvassed this evening, are an important, worthwhile and responsible profession of both men and women who, in many cases, are the first and best people to help other people to see better.

10.5 p.m.

My Lords, I do not think any of us could fail to admire my noble friend Lord Rugby for his persistence in trying to put right something which he firmly believes is wrong, and which many people likewise believe is wrong. In listening to the various contributions to this debate, I suggest that one thing has come out quite clearly: that is, that there are two different subjects here. One is a medical subject and the other is a commercial subject; and it is the combination of these two subjects which has led to the substance of this debate.

The reason we are debating it this evening is because of the clumsy, badly-worded, ambiguous and contradictory statements in the Act. It is an extraordinary Act, full of ambiguities and misunderstandings, and although I have a great affection for the noble Lord, Lord Cullen of Ashbourne, his speech—his heartrending speech—on behalf of the opticians did not touch me at all, because the 14th Report of the Public Accounts Committee, says:
"We are glad to note the willingness of opticians concerned to repay promptly the £3 million involved for that period."
They rushed to pay back £3 million to the DHSS. What does it mean? It means that they were not entitled to it. This is what the Public Accounts Committee are saying—that throughout the whole plexus of this commercial enterprise are what they describe in very careful terms as "unintended profits". They have not been able to unearth sufficient evidence to provide accurate figures as to what these unintended profits might be. The best they can do is to suggest that they are somewhere between £3 million and £5 million per annum. If the opticians are pleading poverty, it is an extraordinary situation that they are suddenly able to repay £3 million for unintended profits. That is the first point I should like to make.

My Lords, may I ask the noble Lord this question: is it not also true that the Public Accounts Committee had to admit that they owed £70 million and if they paid them a bit in excess of the £70 million they then had to repay £3 million of that?

My Lords, that is quite correct and it rather pinpoints the fact that these opticians are apparently entitled to their £70 million, by virtue of Section 21. The question before us is: is Section 21 an admissible monopolistic section? I challenge that really, because if you read Section 21 carefully—and I do this as a scientist—how can you get away from the simple language, ambiguous though it is, of subsection (3) which says:

"Subsection (1) of this section shall not apply to the sale of an optical appliance"?
In other words, the monopolistic part which involves the medical professions of Section 21(1) does not apply to four following categories. Category (b) says that subsection (1) shall not apply
"to a manufacturer of or a dealer in optical appliances for the purposes of his business;".
His business is to manufacture spectacles and his business is to sell spectacles. So, as I read that Act, there is no difficulty about anybody manufacturing and selling spectacles. That is what the simple, Queen's English tells me. It is emphasised by the fact that if he is not allowed to do that, he can, under subsection (3)(e), ignore subsection (1) for the purposes of export. In other words, he can manufacture spectacles for anybody abroad, but according to subsection (1) he cannot sell them in this country. I could therefore argue that under subsection (3) there is no argument; it is just a misunderstanding. But you get hooked when you come to subsection (4), under which the General Optical Council can fine you and put you out of business if you sell spectacles, unless they are antiques. Therefore subsection (4) contradicts subsection (3). These are the kinds of contradictions that one finds.

Without going into the question of the merits or otherwise of the subdivision between the mechanical and the medical aspects of his profession—and I think I can claim to speak with some authority as I once was a professor of optical mineralogy and I have invented a number of so-called optical appliances—there is a clear distinction between testing eyes for focal length and dispensing ophthalmology. They are two entirely different things. As many noble Lords have pointed out, you can borrow somebody's glasses and it will do you no damage whatsoever.

This introduces two quite fascinating repercussions. Ready-to-wear shoes are selected by the wearer. He decides whether or not they fit. Similarly, with ready-to-wear glasses, which you could buy before the Act, it was the purchaser who decided whether or not he had got sufficient magnification. The report states quite clearly that no damage can be done to your eyes as a result of these ready-to-wear spectacles. If you talk about industry and the competition from Taiwan, why is it that you have glass lenses placed into frames? Commercially, it is a very good idea, because the Department of Health and Social Security will pay for the glass lenses and you can charge whatever you like for the frames. Furthermore, why is it that you are kept waiting three or four weeks for a pair of spectacles? The commercial reason is that a person who is handicapped to this extent will buy two pairs of spectacles. One pair is for contingencies. So this increases sales. It is very subtle.

To go a little further, I would say, in support of the noble Lord, Lord Northfield, that many of us could suggest to the Minister several quite minor amendments which would bring the whole matter into line—for example the clarification of subsection (3). This means that you now look at the activities of the General Optical Council. Are they above reproach? Or are they above criticism? They are the people who determine who goes on to the register and who does not. What enables you to get on to the register? A certain number of qualifications, but above all you must be a person of good character. That is absolutely clear in the Act.

Under the clauses relating to erasure, I would ask the Minister how many cases he could quote—I choose my words very carefully—of dispensing opticians and corporate bodies who have been erased from the register by virtue of their character. I wonder whether the noble Lord can tell us how many, because I have not been able to find a single case.

That is an important point because it highlights the fact that, unlike the Pharmaceutical Society and the pharmacists, there is no inspectorate in the General Optical Council. In other words, there is no jurisdiction over or inspection of the standards of an optician. Yet these gentlemen have access to drugs and all kinds of things. There is no means of deciding whether an optician is behaving properly or otherwise, unless he is reported to the GOC.

Who will report someone to the General Optical Council? It would have to be one optician reporting another. What would he be reporting the other optician for? He would not know. He would not be reporting him for commercial malpractice. But if one of the opticians commits a criminal offence, then the picture is entirely different. And a criminal offence was perpetrated in 1979. I hate to use this kind of argument, but I have to use it in order to emphasise the behaviour of the General Optical Council.

In 1979 there was a certain gentleman named Mr Brian Harris, who was committed for the misuse of drugs and sexual offences. He owned nine optical firms in Blackpool. He was committed. The police reported him to the General Optical Council but the council took no action. His name was on the register after he came out of prison. This means that the GOC is prepared to ignore the primary qualification of good character. One might think that this was an isolated incident—but not a bit of it.

In March of this year, this same gentleman was caught by the police again perpetrating the same criminal offence. He was convicted. But because he has nine businesses, even if he is struck off the register, he can still take the profits out of his business. Be that as it may, his name is still on the register and the General Optical Council have taken no action.

I come rapidly to the point of trying to establish that it is time—as the noble Lord, Lord Orr-Ewing, has said—to do something. It is high time for the noble Lord the Minister to assure us that he is prepared to accept our assistance in modifying the Act so that this discussion can cease and the public can get value for money.

10.18 p.m.

My Lords, I understood from the Order Paper that we were supposed to be discussing what action the Government propose to take in respect of the opticians' monopoly following the publication of the report of the Office of Fair Trading. I must admit that many speeches have seemed totally irrelevant to this, and that is a matter for some regret to those of us who have studied this report carefully and who hoped that it was to be the subject of tonight's debate. Those of us who have survived many debates on this subject will regret that the matter does not seem to have been taken much further forward. We have to agree that there must be some revision and some changes in this set-up. This report should have taken us a step forward on that way. I hope that the noble Lord the Minister will be able to point us in the direction that the Government have in mind.

Because of the lateness of the hour, I will only say that we are grateful to the noble Lord, Lord Rugby, for giving us an opportunity to discuss this important matter. I should like to refer also to the involuntary absence of my noble friend Lord Crook, who very much regrets that, owing to ill health, he is not able to be with us tonight. Your Lordships will remember that he was chairman between 1949 and 1952 of the committee which did try to set out how the optical services could be made an integral part of the National Health Service. This I think is the position which many of us would want to keep: that optical services are part of the National Health Service and not part of a marketing set-up. Many of us regret that quite rightly when the Government wanted some investigation into the situation, the matter was referred to the Office of Fair Trading rather than to the DHSS, because many of us do not think that the question of eyesight is a matter for trading practices.

I would only say this to my noble friend Lord Northfield, whose views I well understand, that there is one point I do not understand. He referred to the fact that many noble Lords ask him to bring back cheap spectacles from the United States. I find that when I go to the United States all my friends envy my NHS glasses and ask me if I can get them some of these, with an eye test thrown in for nothing. I really think the United States has nothing to teach this country in terms of public health care in any sphere whatever, and anyone who calls in aid practices of the non-national health service in the United States really is going backwards in history, and I am only very sorry about them. In the United States the question of health care, including eye care, is purely one of merchandising. I think that is perfectly unacceptable.

The noble Lord, Lord Northfield, also suggested that the figure of people at risk is negligible. My Lords, I say to you that if one person loses their eyesight through changes in our procedures that is one too many. For those noble Lords who mentioned the difficulty of getting a spare set of spectacles—and I refer particularly with all understanding to the noble Lord, Lord Orr-Ewing—anyone can ask their optician for a spare prescription. That cannot be refused. I hope that because this matter has been raised in the debate tonight there will be more public information about this fact.

I will say to the noble Lord, Lord Orr-Ewing, that I am glad that when he went and had to have his compulsory eye test he came out with a clean bill of health and felt that he need not have had it. But I can tell him about a friend of mine who happens to work in this House who was in the same position. He came out from what he thought was a routine eye test to get a spare pair of spectacles with a letter to his GP, and he ended up with a diagnosis of cancer of the eyeball. If that optician had not insisted on doing what was thought to be a purely routine examination that man would probably have lost his sight, if not his life. I am informed that 13 per cent. of patients who go to opticians are referred to general practitioners for all sorts of problems. They may turn out to be not serious at all. But how much better that the optician sends the patient to the GP, even if the GP says that there was not any need for it.

My Lords, had we discussed the matter on the Order Paper more fully, I think some noble Lords might have noticed, even if they had not bothered to read the report, that it does suggest that in matters concerning children and in contact lens cases the present situation should continue, that there should be no buying and selling over the counter of contact lenses or in dealing with children.

I must suggest to your Lordships that if one takes away from an optician in a small town or village everything except contact lenses and dealing with children one will destabilise his business. How can he pay his rates and how can he meet his overheads if people are all rushing to Woolworths to buy their ordinary spectacles and he is told that he must stay and pay his overheads because someone might want contact lenses or to bring their child to him? That makes it very difficult for opticians to carry on their businesses.

I do not know why there has been so much talk tonight about profiteering. I know many opticians and none of them seems to be exactly a fat cat living very high on the hog, if I may mix my zoological metaphors. The DHSS guidelines suggest that about £12,000 a year would be pretty fair earnings for opticians, but research shows that about 60 per cent. of opticians over 45 earn less than 10,000 a year. If we take it on a purely commercial basis, there will be a reduction in income for rural practitioners, and for people who try to do domiciliary work and who look after children.

I honestly believe that we must get away from this commercial approach. Some noble Lords blame the opticians for having a commercial approach, but some of the speeches tonight have been a matter of real marketing commercialism. We have to consider the benefit, if any, of greater trading competition against the risk of undiscovered ocular abnormality. I have already said that I wish the Government had asked the DHSS to look into this and I understand that they are doing so.

No, my Lords, it is too late and the noble Lord spoke a great deal longer than I intend to speak. He has often taken longer than I intend to speak.

Let us never lose sight of the fact that the Opticians Act was put on the statute book to safeguard the most precious of our senses. Although we have talked a great deal about the cost of spectacles tonight I trust that your Lordships will give fair consideration to the cost of eyesight, which is a price beyond reckoning. However small might be the number of people whose eyesight would be at risk by breaking the present relationship between diagnosis and prescription, one person's loss of sight would be one too many. A single case of preventable blindness, or even partial loss of vision, would be too heavy a price to pay for cheaper, jazzier spectacle frames.

10.29 p.m.

My Lords, it would be as well for me to say at the outset that I have no major announcement to make to your Lordships' House this evening. I suppose I could sit down at that but perhaps I should go a little further. I am sorry to say that the Government are not yet ready to reach firm conclusions on this aspect of the report by the Office of Fair Trading.

Your Lordships may wonder why it is that we have not yet reached firm conclusions on a report published in January. It may help to recall the genesis of this report and the nature of its conclusions. The review undertaken by the Office of Fair Trading had its origins in public concern at the high cost of private spectacles. Indeed, the noble Lord, Lord Rugby, and other noble Lords, have been unstinting in their efforts at articulating public concern on this matter. It was felt that among the possible factors leading to this high cost were the restrictions on competition which arose from the provisions of the Opticians Act 1958. The Director General of Fair Trading was accordingly asked to review the effect upon competition of two aspects of that Act: first, the statutory monopoly to sell optical appliances conferred by Section 21 of that Act upon registered medical practitioners and registered opticians; secondly, the rules of the General Optical Council made under Section 25 of the Act concerning advertising by opticians.

I would remind your Lordships that the director was not asked to come to any conclusions on whether the Act should be revised in any way, since this raised questions of public interest which went wider than the competition aspects to be dealt with by his review. In my opinion, the report by the Office of Fair Trading has been very helpful in providing a clearer picture of the ways in which the Act operates with regard to competition and therefore prices. Indeed, it makes out a strong case on competition grounds for some relaxation of the present restrictions. With regard to those on advertising, my honourable friend Dr. Vaughan announced in another place on 19th April that he had taken up with the General Optical Council the need to take early steps to reconsider those of its rules which affect competition and can be changed under Section 25 of the Opticians Act. This has already borne some fruit, as I shall mention in a moment. But it does show that the Government have taken the report seriously.

As regards the removal of the statutory monopoly, the central question which the Government are addressing is the balance between the benefits of greater competition and the risk, in the absence of Section 21 of the Act, of symptoms of abnormality and disease not being discovered as a result of breaking the present link between the sale of spectacles and sight testing. This is an important question and full weight must be given to the health care factors involved and not merely to considerations of competition or price.

Your Lordships may be aware that one of the individuals invited to submit evidence to the Director General of the OFT was the distinguished ophthalmologist, Dr Trevor-Roper. Indeed, a good deal of weight was attached in the report to his views. Your Lordships will be familiar with that illustrious family name and will, I am sure, understand that determining the validity of evidence on complex issues is a delicate and difficult matter; and your Lordships will appreciate the Government's wish to give the most careful consideration to the arguments on all sides regarding the question of opticians and competition.

I would therefore ask your Lordships to bear with us a little longer while we continue to evaluate the evidence and receive further advice. I can assure you that this is not being done for any reason other than the desire to be as positive as we can that we are not exposing the sight of vulnerable members of the public to unnecessary risk. Your Lordships may well ask whether the same risk is attached to patients taking a recent prescription obtained from an ophthalmic medical practitioner or ophthalmic optician to an unregistered person for dispensing. Changing the Opticians Act to allow unregistered dispensers to sell glasses against a prescription from a registered ophthalmic medical practitioner or registered ophthalmic optician would retain the link between sight-testing and the supply of glasses, and therefore would not open the public to the risk of undetected eye disease. Could we not perhaps proceed more speedily in this way by freeing dispensing and obtaining the benefits of competition without incurring these same risks to health?

Even on dispensing, however, the arguments are not all in one direction. 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. 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. 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. I recall also that before I came to your Lordships' House I was a pilot. I had on my licence an endorsement to the effect that I had to wear "approved correction to defective vision". I imagine that those of your Lordships, if there are any, who had the misfortune to fly with me would have preferred that the glasses that I was wearing were the correct ones.

The report makes it clear at paragraph 9.31 that the OFT
"did not seek evidence on the question of disease".
They merely
"reported the arguments that were put to"
them and acknowledged that
"they may not represent the comprehensive range of views upon clinical matters".
That is why we are continuing to evaluate the available evidence and receiving advice.

The noble Lord, Lord Harris of High Cross, referred specifically to the poll of Ophthalmological Society members. I fear that the poll cannot be regarded as disposing of informed medical opinion on this matter. The question was a little naïve in referring to repealing the monopoly to "sell simple reading spectacles". Those polled may not have realised the problems in defining reading glasses. As the OFT says,
"One person's reading glasses could well be identical to another person's prescription for distance vision, and a cut-off in terms of lens power would be arbitrary and difficult to apply".
The results are also ambiguous. Out of 654 members polled, only 55 per cent. replied. It is simply invalid, I believe, to ascribe to the missing 45 per cent. the views of those who did reply —

My Lords, will my noble friend allow me to intervene? While throwing distrust on that survey, has my noble friend noticed that there has been published a survey undertaken by the optical bodies themselves, who have an interest in this matter? My noble friend has not commented on the veracity of that. Perhaps they, too, have gained a distorted impression as a result of their examination of those who wish to see an improvement in the supply arrangements.

My Lords, I am trying to demonstrate that the arguments in these matters are not all in the same direction, and those who come before your Lordships seeking to rely on one particular set of arguments need, I think, to have those arguments questioned. I am quite prepared to agree that the other arguments that have been adduced are of equal validity, though maybe they are 100 per cent. in the opposite direction.

Several noble Lords referred to the question of glaucoma referrals. One risk to health of breaking the link between sight testing and the supply of spectacles is that of glaucoma. Evidence on the value of screening the population for this eye disease is, I admit, mixed. We cannot however totally dismiss the fact that recent studies show that four-fifths of referrals of glaucoma patients to eye hospitals were made following a supposedly routine eye test for spectacles by an ophthalmic medical practitioner, or ophthalmic optician.

These are weighty questions, which need to be carefully evaluated. I agree that we are not in general talking about risk to the sight of individuals. We are however talking about the future shape of a service which contributes to the general optical welfare of the public as a whole. Again, I would ask for patience while we weigh the costs and benefits on this score, also. My noble friend Lord Cullen suggested that these matters should await the review of the General Ophthalmic Service. That review is to start in the near future, and is expected to take some 18 months to complete—

My Lords, the process of selecting a chairman and members is under way. Interested bodies, including the Federation of Optical Corporate Bodies, have been consulted on the terms of reference, and these are being revised in the light of the comments received. While the proposed terms of reference for the review include a review of the Opticians Act, it is not the Government's intention to delay consideration of the Office of Fair Trading Report on this account.

In the meantime, we are not unmindful that public concern at the cost of private spectacles has not diminished. As I mentioned earlier, the General Optical Council is undertaking a thorough revision of its rules on publicity with a view to deciding what relaxation of the rules will allow fuller information to be given to the public. We expect that this will be completed within the next two months, that we shall see some real progress on this front, and that this will result in cheaper spectacles for the public. Even now, however, the price of private spectacles is falling, as my noble friend Lord Cullen has observed.

It is true that the OFT found evidence that some opticians had increased the profitability of their private work as partial compensation for the decline of the profitability of their NHS business, as a result of NHS fees not having been changed for some years. Others may even have been able to compensate fully. Agreement has now been reached, and new fees levels and substantial back-payments have been implemented. This has given scope for some reduction in the price of private spectacles. Indeed, as the OFT observes, without such reductions profits would become excessive. There has been evidence of reductions. Nevertheless, the Government share the OFT's pessimism that without action to increase competition these reductions will not be as significant or as widespread as they could be. I cannot therefore share my noble friend's view that the increase in NHS fees obviates the need for the Government to give serious attention to the conclusions in the report in favour of improving competition among opticians.

The Government take extremely seriously the public's concern about the cost of private spectacles. However, they also have to take extremely seriously both health risks for the public and the long-term future for the general ophthalmic service provided by the NHS. I hope that your Lordships will be content to wait a little longer for our definitive views on the future of the opticians' monopoly.