(8 years, 10 months ago)
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Lord Newby
To ask Her Majesty’s Government whether they will amend the Opticians Act 1989 to allow certain adjustable-focus eyewear to be sold over the counter as is already the case with reading glasses.
Lord Newby (LD)
My Lords, adjustable-focus eyewear are pairs of glasses that allow consumers to adjust the focus of each lens separately. They achieve the desired focus for each eye by turning a dial located at the side of each lens. The quality of definition achieved is extremely good, and to demonstrate this I am wearing a pair of these glasses this evening.
Noble Lords
Lord Newby
They are produced by Adlens, an Oxford-based company. They are sold in some 57 countries worldwide, but the largest markets are Japan, where some 650,000 units have been sold, and the US, where some 500,000 units have been sold, many without a prescription. They are particularly valuable for people whose eyesight varies from day to day—for example, diabetics or those who have had cataract surgery—but they have many other uses, such as emergency substitutes for glasses that have been lost or damaged until permanent replacements are produced, or as a spare pair while travelling. They sell for approximately the same price as a pair of high-end ready-to-wear reading glasses—a few tens of pounds.
The concept of an individual adjusting the power of the lens in glasses until it reaches an optimal level is already the way in which we decide on the strength of the glasses that we get, the only difference being that, if I go to an optician, it is the optician who presents a series of lenses before my eyes and asks, “Which is better, lens one or lens two?”. With these glasses, I physically make the adjustment myself. So we are talking about a product that is quite cheap, of extremely high quality and for which there is an obvious demand. So far—but only so far—so good.
The logical next step for Adlens would be to sell its glasses in pharmacies and supermarkets in the UK in the same way in which reading glasses have now been sold for 27 years. In order for this to happen, an exemption needs to be specified under the Opticians Act 1989 to allow them to be sold without a prescription. Framing such an exemption is relatively straightforward and so, having seen a demonstration of the Adlens glasses, I suggested while in government that an amendment to that effect might be made to what is now the Deregulation Act 2015. I contacted the right honourable Oliver Letwin, the Minister in charge of the Bill. He, in turn, contacted the General Optical Council for its advice. The GOC is the standard setter for the optical sector. Its response was stark. The risks to the public of allowing adjustable eyewear to be sold without prescription was so grave, it believed, that it claimed:
“We do not believe that the proposed changes warrant further consideration”.
The council formed this view without seeking or obtaining any expert evidence whatever.
Undeterred, Adlens sought a meeting with the GOC staff, which took place in June last year. The GOC agreed at the meeting to commission an expert report on the Adlens glasses and Dr Charman of the University of Manchester was duly appointed and reported last October. His conclusions were broadly that the glasses worked well; that the risks were the same as for over-the-counter sales of fixed-focus spectacles with similar powers; and that there was no fundamental reason why Adlens glasses with the same characteristics as reading glasses should not be made available over the counter. However, he also made the point that Adlens needed to rebut the argument that such sales might result in fewer people having a full eye examination where they needed one on health grounds.
The GOC standards committee met on 8 October to consider Dr Charman’s paper. It turned a very balanced and positive assessment into a litany of objections, some of which were, frankly, ludicrous. My favourite was the following:
“It was noted that these products were originally developed for use in the developing world – it was felt that a solution for a developing world problem was not transferable for the UK”.
This statement was made, despite the fact that more than 1 million pairs of the glasses have been sold in Japan and the USA. However, buried among the criticisms, the GOC agreed that,
“if the product were restricted to 0 to +4 D”—
the D is for dioptres—
“(as ‘ready readers’ currently are) the view of the Committee was that this might be acceptable, as it would reflect the parameters of the current legislation”.
The GOC objections have subsequently been endorsed by the Optical Confederation, the trade body for the sector. Its concerns, when boiled down, essentially amount to two. First, if sold over the counter, the product would reduce the number of people who have eye tests and that therefore a number of eye diseases would go undiagnosed. Secondly, if used for driving, they would be unsafe.
On the first objection, the evidence shows that, since over-the-counter reading glasses became available in 1989, the number of eye tests has been on a steadily rising curve and has continued to rise steadily over the past 15 years, despite the growth of online contact lenses and online glasses. The GOC basically believes that restricting access to eyewear will force the public to have their eyes tested more regularly. However, this approach has failed in almost every public health initiative to which it has been applied, whether for the management of hypertension, obesity, diabetes or alcohol abuse. If we want people to have their eyes tested more often, the evidence suggests that the way to do so is by consumer education programmes such as the National Eye Health Education Programme, the Think About Your Eyes campaign and the EyeSmart campaign.
As for the second objection, there is no evidence that the product is unsafe to use while driving. There have been literally zero reported cases of driving accidents in Japan and the USA involving the million-plus consumers who wear variable focus eyewear. Indeed, when this issue was contested in court in Arizona in a case brought last year by the State Board of Dispensing Opticians, evidence submitted by Adlens persuaded the Assistant Attorney-General to support its arguments and the board of opticians to abandon their action. The case was lost simply because the evidence did not support it.
If I were a cynical type, I would think that some of the arguments put forward by the GOC and the Optical Confederation were designed to maintain the current rules in order to require people to go to an optician who did not need to do so. That may be harsh, but throughout my discussions with the industry there seems to be a distinct lack of interest in putting the interests of consumers first. There is certainly no appetite for reform and without a big push from the Government, reform simply will not happen.
The judgment which now needs to be taken boils down to what I think of as the paracetamol test. Paracetamol is a product which can be purchased cheaply over the counter to treat pain in a manner which is effective for the vast majority of its users. It can however, if abused, kill you and, as the instructions helpfully point out, it can cause many other potentially harmful side effects. We tolerate this situation because we believe that, on balance, over-the-counter purchase of paracetamol is hugely beneficial to consumers. There is no evidence whatever that adjustable eyewear can have the same deleterious effects as paracetamol if abused. I therefore believe that they do pass the paracetamol test and that it is in the consumer interest for them to be sold in the same way as reading glasses.
Can the Minister confirm that a decision about the type of amendment to the Opticians Act which I am seeking is at the discretion of the Government and cannot in effect be vetoed by the General Optical Council? Secondly, will the Department of Health now review the matter? Thirdly, subject to their being satisfied that the risks of making the proposed change are greatly outweighed by the disadvantages, will the Government agree to bring forward at an early legislative opportunity the amendment to the Opticians Act which I seek?
Lord Faulkner of Worcester (Lab)
My Lords, I congratulate the noble Lord, Lord Newby, on securing this debate. He has raised a number of interesting and very important points, and I hope that the Minister—if this is how he responds to the debate—will be able to offer some convincing reasons for not acting in the way the noble Lord proposes.
The only interest I have to declare is that I am someone who is very short-sighted. I have worn glasses continuously since the age of seven, apart from a brief and unsatisfactory period in middle age when I tried contact lenses.
Like the noble Lord, Lord Newby, I have visited the Adlens operation in Oxford, and got to know a number of its senior people. He has described very well what the product is, how it works, and how an amendment to the Opticians Act 1984 allowing adjustable-focus glasses to be sold over the counter without a prescription would be of immense value to the millions of people who need to wear spectacles. It would give them the chance to buy a back-up pair and put them in the glove box of the car for emergency use—the noble Lord pointed out that they are safe when driving. People would also regard them as a reassuring presence about the house, perhaps offering different pairs for different tasks, such as reading in bed or working on the computer.
I found the account of the noble Lord, Lord Newby, of how he attempted as a Minister to get the law changed particularly interesting. It seems to me that the arguments used by the General Optical Council in blocking the change and repeated in the briefing it has sent us for this debate are examples of protectionism of the very worst kind. I understand that they are similar to the arguments it employed when it attempted to block the removal of restrictions on the sale of reading glasses in supermarkets and pharmacies nearly 30 years ago.
The GOC is right in stressing the importance of encouraging customers regularly to take eye tests. These tests not only identify the strength of glasses that may be needed to correct sight, but are also an important way of spotting incipient eye diseases such as glaucoma and other life-threatening conditions such as brain tumours and high blood pressure.
The GOC’s case against amending the Opticians Act to allow retail sales of adjustable-focus glasses could have some validity if the number of eye tests carried out following the deregulation of reading glasses in 1989 had fallen. However, as the noble Lord, Lord Newby, has correctly observed, they have been rising steadily. I have no doubt that this would continue to be the case following the change we are debating this evening. What matters is that eye tests are promoted as part of an essential health screening and education programme, not as the manifestation and continuation of a restricted practice which is no longer of much benefit to consumers.
Before I conclude—I am speaking very briefly tonight—I would like to say a word about one particular market in the world where Adlens glasses can be bought over the counter. The noble Lord, Lord Newby, referred to the huge sales in Japan and the United States, and there is also a strong market for them in Mexico and Norway. Its briefing says:
“Adlens has supplied over 1.5 million products to consumers in 57 countries around the world”.
There is a remarkable philanthropic side to the company as well. Alongside the commercial operation is a charity called Vision for a Nation, started in 2009 by one of Adlens’s co-founders, James Chen, whom I met on my visit to the company in Oxford. This is a programme which aims to address the unmet need for affordable glasses in low-income countries.
The first pilot study was in Rwanda, a country where, Mr Chen estimated, up to 1 million of the 11 million population need glasses. Most of them will require standard reading glasses but between 5% and 10% will benefit from the Vision for a Nation adjustable lenses. Over 18,000 have been supplied free to the Rwandan health authorities and the charity is also funding a training programme for nurses to conduct eye tests. I gather that the plan now may be to expand the service to Bhutan. It will make a real difference if these services can become a central component of a nation’s non-communicable disease strategy.
In echoing the call from the noble Lord, Lord Newby, for an amendment to the Opticians Act 1989, I make the additional point that if Adlens were able to develop a successful retail business in the UK, comparable to that in Japan or the United States, not only would British consumers benefit from increased customer choice but the profits generated would allow the company’s marvellous work through its Vision for a Nation charity to be expanded into more third-world countries. I find that a pretty irresistible argument and I hope that the Minister will agree when he replies.
Lord Stoneham of Droxford (LD)
My Lords, I speak in this debate not as a health expert but in my capacity as business spokesman for these Benches and as somebody who is interested in encouraging innovation, improving the export potential of our country and encouraging science-based university innovation centres of excellence. I also spend quite a bit of time discouraging practices which suggest or encourage unfair competition.
To me, this is a restraint of trade issue. As the noble Lord, Lord Faulkner, said, exactly the same arguments were used against the sale of reading glasses in 1989 as are now being made against adjustable-focus glasses. The Minister would do well to read the report at that time as a way of convincing himself that the arguments in this debate should be answered.
Health and regular eye tests are things that I am not expert at discussing. As I said, I am more interested in the competition aspects, but I think that by freeing up the market a little, a bit more competition might increase the number of eye tests, as was shown in the case of the sale of reading glasses.
I am one of those who finds it convenient to go into an optician for regular eye tests, and I use one. I do not use it purely because it is the cheapest way of getting glasses but because there is the convenience of fitting and getting regular maintenance, for which it is good to have a relationship with a local optician. Glasses in this country are about variety, style and fashion, however we might think of them as items for improving our health and eyesight. Until recently I went to one optician for 20 years, mainly because the lady who used to serve me always used to tell me how good I looked in the pair of glasses she was trying to sell me.
It is a competitive market and cost is very important. I accept that opticians have to earn a profit. However, I recently changed my optician. The nice lady had gone. When I went to get my spectacles repaired, I was told that they could not be repaired because they had got bent and there was a danger that they would break. I was assured that I needed a new pair. I went to another optician and got the old pair repaired in five minutes. I subsequently bought a new pair when the lenses needed to be upgraded. We should not hide behind health issues in protecting opticians unless they are really warranted. We should encourage competition and choice.
This is a patented British product and I do not believe that it will be what I call a real blockbuster that puts all our opticians out of business. As I said, fashion, style and brands will still rule as the country becomes more affluent. Despite all the arguments, as we have already heard, the threat of selling reading glasses did not undermine the opticians’ business. However, there will be a market from these glasses among people who want to buy a second or spare pair and among diabetics who need to adjust their lenses regularly. There will also be a demand for sunglasses and so on in the leisure market. I think that there will be a huge market in the third world, where there is no network of opticians and price can be critical. We have heard that 1 million pairs are being sold in the US and Japan. If this company wants to sell these glasses in other markets, how convincing will it be when it has to admit that it cannot sell them in its home market? It must go with its hands tied behind its back when it goes into those sales opportunities. Frankly, the Department for Business, Innovation and Skills and the Department for International Development should be jumping up and down encouraging this product and pioneering further development.
I have several questions for the Minister. First, will he reread the documentation of the 1989 review, when reading glasses was the issue under discussion, and will he perhaps reflect on how similar the arguments are in relation to these glasses? Secondly, does he intend to have discussions with the Department for Business, Innovation and Skills on how we can encourage competition in this area? That would, I believe, lead to even more eye tests being carried out by opticians. Thirdly, will he also engage the Department for International Development to look at the great potential for this product in developing countries?
Baroness Walmsley (LD)
My Lords, first, I apologise to my noble friend Lord Newby for missing the first half-minute of his speech. I am afraid that I was not informed that this debate was to start 15 minutes early; I thought that I was 10 minutes early.
I thank my noble friend for explaining what this debate is all about and for putting the case for looking at this issue again so comprehensively that there is no need for me to repeat it. To me, there are three principles that should apply when considering this matter.
First, the best interests of the patient must come first, so we must ask ourselves whether changing the law would or could do any harm to patients. Secondly, we need to consider whether availability of this new eyewear would deter people from getting a full eye test from a qualified ophthalmologist. Thirdly, would the state of the current law prevent patients receiving any additional benefits that might be available to them through the over-the-counter availability of this new product? We should bear in mind that, when the law went through Parliament, there was no such thing as self-adjustable eyewear, so perhaps it is time to review it.
In considering this matter, we must be impartial to both those already in the optical services business and to those who want to get into it. Could the briefings we have received amount to vested interests? Some noble Lords think so. I am afraid that I think that those who have provided the briefings might have vested interests, although it is perfectly reasonable for them all to make their case and I am sure that they are all providing legitimate information. That is why I ask the Minister whether the Government will set up a completely independent impartial investigation to receive evidence from both sides of the argument and make a truly impartial recommendation, and then will they act on it at the earliest opportunity?
The evidence we have received from the manufacturer Adlens suggests several benefits and no harms. Like the noble Lord, Lord Faulkner of Worcester, I really must congratulate it on its charitable work in Rwanda and other places. It is doing some very important and worthwhile work, which will benefit the economy of that poor country enormously, as well as individual patients. However, it stands to make money in the UK if the law is changed, so we should be aware of that. Mind you, it would probably be a very small amount compared to what companies make in the USA and Japan where these glasses are already allowed to be sold off prescription.
On the other side of the argument is the General Optical Council, the Optical Confederation, the professionals and the retailers who have a financial interest in selling the fixed-prescription spectacles which they prescribe. Of course, they also have a professional duty to put the patient’s eye health first, and I am sure that is their priority.
There would be a very strong argument for refusing to change the law if clear evidence existed that the availability of these adjustable spectacles over the counter deterred people from having a proper eye test—but I have seen no such evidence. We must bear in mind that eye tests are not just done to diagnose and correct vision but also, as the noble Lord, Lord Faulkner of Worcester, pointed out, to screen for eye health and indicators of other types of ill-health. They are very important, which is why we give them free to children and older people.
The fact is that we have been choosing our own vision correction for years. When I go to the optician, I select “red” or “green” and lens 1 or lens 2 all the time. I am selecting my own correction. What, therefore, is the difference between doing that and twiddling a little screw on your own spectacles to get the correction that you need? I accept that these may not be suitable for people with serious astigmatism, but those people probably would not choose them anyway because the quality of vision would not be as good as that from their correct fixed-lens prescription.
Concerns have been expressed about the safety of driving in self-corrected glasses. I was impressed by the study done by the University of Michigan Transportation Research Institute, which showed that there is no statistically significant difference between US drivers wearing prescription glasses and those wearing self-adjusted glasses in their ability to see a hazard ahead. I have seen no evidence to the contrary but, of course, it would be the task of the independent committee that I am calling for to see whether there is any.
As I said earlier, I would be concerned if ownership of these glasses were to deter regular eye examinations, but, again, the evidence I have seen is to the contrary. When over-the-counter reading glasses became available, there was no evidence that this deterred people from getting their eyes tested. Indeed, they need to do so in order to determine what strength to buy from the local chemist. Rather, government agencies and professionals alike believe that the best way to persuade people to look after their eyes and get them tested regularly is by public information and education. A number of these programmes have been mentioned, and they have been around in the UK for years; I am sure Governments would not spend money on them if they did not work.
These new products would have considerable value as a temporary solution for three groups of people: older people may need three different pairs of glasses for different tasks—I know I do—and many find it difficult to afford three pairs; people who have had cataract operations have a period during which their eyesight is settling down and might find these useful then; and new diabetics, whose eyesight may vary while they are working out the right dose of medication to control their blood sugar, may also find these a useful temporary solution. In the last two cases, it is very unlikely that an optometrist would prescribe several pairs of glasses just for a few months. Of course, it is vital that people get their eyes checked regularly, particularly diabetics as there are a number of risks to vision associated with diabetes. However, a pair of these new glasses could be part of their solution.
The fact is that we are already in charge of our own eye health. I recently had to apply for a new driving licence and, as part of the process, had to confirm that I have an appropriate level of vision to drive a car safely. Nobody asked me to get an optician to verify that, although I am in the habit of having regular eye tests and would recommend that everybody do so. In addition, correction prescriptions do not have a finishing date on them, so you can buy contact lenses on the internet using a prescription that is years old if you want to, even though that may no longer be the correct prescription for you. This solution would be a great deal better than that.
I am inclined to allow people to take responsibility for their own eye health, and I thought that a Conservative Government, being in favour of the free market, would be inclined to allow these glasses to be sold without prescription and to give people a choice. However, the cautious thing to do is to set up a truly independent inquiry. I hope the Government will do that, and then the evidence can speak for itself, as can the patients.
Lord Hunt of Kings Heath (Lab)
My Lords, it has been a riveting debate and noble Lords have expressed a very clear view, although the Minister will be aware that we have had written submissions that express very different views, which are potentially bound up with financial interests. So we are all looking forward to the adjudication that the Minister will, I hope, give us in a few minutes.
I start with a point about innovation and adoption, because I know that the Minister is concerned about this. On the face of it, here we have an innovative UK-based company doing very well abroad but not in this country because of this dreadful healthcare issue of slowness to adopt. I know that eyes are precious and, clearly, in the end, a precautionary principle must be applied. However, I worry that, one way or another, the healthcare establishment is putting barriers in the way of what appears to be a really innovative company. I hope the Minister will pick up that argument.
From the documentation, it is clear that the paper by Dr Charman is an important one. The question I put to the Minister is whether he is satisfied that the GOC and its standards committee actually discussed that paper appropriately. I have seen annexe 4 of the paper we have been sent: notes of the standards committee discussion. This does not seem to be a scientific examination of the report by Dr Charman. Rather, it looks like—how can I put it kindly?—a group of prejudices looking for an argument to put across. It comes across as a very paternalistic approach. First of all, it makes the statement that the market for this product in this country was,
“not thought to be significant”.
Of course it is not significant at the moment, because it is not allowed to develop. Having been sent these adjustable spectacles—although I was not brave enough, as the noble Lord, Lord Newby, was, to wear them—I know that they are clearly very easy to use and to adjust.
The second argument, which was raised by the noble Lord, Lord Newby, is about the developing world issue. The third argument, which I find puzzling, is the statement that:
“It was not clear what benefit the product would bring”.
It is patently clear what benefit the product would bring to the public. The final point, and one that really interests me, is point 12:
“The Committee raised the fact that it has been documented in the academic literature that ‘self-adjustment’ by patients is very subjective”.
Well, “subjective” is a word I would use to kindly describe the paper by the standards committee.
The noble Lord knows that one has to be cautious here. The noble Baroness, Lady Walmsley, is right: perhaps a way through is to ask an independent adjudicator to look into this. The situation is clearly unsatisfactory and it does not look as though the GOC response has been rigorous enough.
I hesitate to move on to the issue of regulation, but we did debate the General Dental Council two weeks ago. I have been in correspondence with dentists and the GDC, and it seems to me that they are still in denial about the criticisms made of them by the PSA. On the one hand, we see huge improvement in regulators, and I pay tribute to the GMC and the work that has been done there. But on the other hand, there seem to be question marks about how some of these professional regulators operate. I suggest to the Minister that the PSA, which I have great confidence in, be asked to look at this matter, particularly the governance arrangements within the GOC. That might warrant careful examination.
Finally, is the Minister satisfied that the PSA has enough powers of intervention? From what I have seen in relation to the GDC, I am not entirely sure that it has. This is an important issue in itself, but it also raises questions about regulation and the way it is undertaken. Having read the GOC paper, I have doubts about how rigorously that body approaches its task.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I thank the noble Lord, Lord Newby, for bringing this subject, which is a new one for me, to our attention. I tried on a pair of adjustable-focus glasses a few days ago, and they are easy to use. The noble Lord is wearing some this evening, and although they may not be as fashionable as some pairs of glasses, I can see that they are perfectly serviceable.
It is odd for us on this side of the House—it is certainly odd for me—to find ourselves painted into the position of being against choice, competition and deregulation, which are now being advocated from the Liberal Democrat Benches. I do not normally associate them with that particular role. Instinctively I am a deregulator, and to be honest, many of the arguments that noble Lords have made resonate strongly with me. Clearly there is a huge vested interest at stake. Whether that is being improperly used in this case I do not know—but one can see that there will always be a strong voice for the status quo.
I should also pay tribute to the company for its work in Rwanda, which is clearly very important. Equally impressive, in many ways, is its breaking into the Japanese and American markets—no easy feat for a small private company. I take on board the words of the noble Lord, Lord Hunt, about how often we hear about companies finding it easier to break into overseas markets than into our own market. It is deeply frustrating, when we produce so many highly innovative products such as this one.
As for an independent review, perhaps we can come back to that question later. I rather like the thought, but although the role of the PSA was brought up in the context of the GDC, I am not sure what powers it has in such areas. That may be worth exploring. Unfortunately, however, I am going to disappoint the noble Lord, Lord Newby—but perhaps not wholly. We shall see when we get to the end. I shall put the other side of the argument, if I can—but in doing that I do not want to imply that the arguments we have heard are not powerful: they are. I know that my right honourable friend in the other House, Oliver Letwin, back when the Deregulation Bill was going through, would have instinctively been very positive towards the arguments that noble Lords are making.
As noble Lords are aware, in order to do what the noble Lord asks it would be necessary to amend the Opticians Act to remove requirements relating to the sale and supply of optical appliances. Clearly this is something we would do only after very careful consideration, and if we were confident that the proposal could stand parliamentary scrutiny. So if we were to take this forward at all, an independent review of some kind would be a requirement.
In the UK the sale of optical appliances is governed by the Opticians Act, which requires spectacles and contact lenses to be dispensed to a prescription issued by a registered optometrist or medical practitioner following a sight test. We are probably all aware of the exception that has been made. In response to the noble Lord, Lord Stoneham, I should say at this point that I will reread—or rather, read for the first time—the 1989 review, where similar arguments were put forward against the exception for reading glasses.
The Opticians Act does allow reading spectacles to be sold over the counter to adults with age-related sight loss. However, this exception has very limited criteria. The reading glasses must have the same power in both lenses, the power of the lenses must be in the range between 0 and 4 dioptres, and the glasses must be for reading purposes only. The General Optical Council is responsible for regulating the sale of glasses in the UK.
I am aware that Adlens has been in discussion with the GOC about its proposal that over the counter sale of its adjustable-focus glasses be allowed. As noble Lords know, in considering this issue the GOC sought the views of its standards committee, asking for its views on any benefits that adjustable-focus spectacles might bring, and any adverse effects that these products might have on the public’s health and safety. I am not aware of the extent to which it took into account the Charman report, which the noble Lord, Lord Hunt, mentioned. That is something that we should look into.
The standards committee raised a number of concerns, including concern about the safety of the product and the possibility that the product might not meet legal standards for driving.
Lord Hunt of Kings Heath
The point is that although the note we have says that the standards committee was provided with the independent report, it is not clear what it actually did with the report. It does not look as if the committee went through it in detail and considered the arguments—but that might just reflect the way in which the note was taken.
Lord Prior of Brampton
We have often been provided with reports, but that does not necessarily mean that we have read them and given them our full attention. I will ask that question.
I was going through the standards committee’s concerns. Another was that individuals may incorrectly self-adjust, causing a danger to the public when driving. Another was that the sale of these products may distract the public from having regular eye examinations. That is an issue that needs consideration. I appreciate that the noble Lord may not be convinced by the arguments put forward by the GOC’s standards committee, but we would be foolish not to take into consideration its professional view—the precautionary view that the noble Lord, Lord Hunt, mentioned. We have to give that due weight.
I understand that one of the original intentions behind the development of these glasses was to bring accessible vision correction to the developing world, particularly to areas where there was little or no affordable eye care. In the UK we are lucky enough to have no barriers to accessing sight tests and optical appliances which correct refractive errors. The NHS provides free sight tests to children, older people, those with or at risk of eye disease, and people on low incomes. In addition, help with the cost of glasses is available to children and people on low incomes.
It is already the case that self-adjustable glasses can be supplied by a registered medical practitioner or optometrist if they would benefit patients in particular circumstances. I do not think that we should downplay the important role of optometrists in carrying out sight tests. Optometrists are healthcare specialists trained to examine the eyes to detect defects of vision, signs of injury and ocular diseases, as well as problems with general health. Anyone who has had a sight test in recent years will know how much more is done these days than would have been done four or five years ago. Optometrists also offer valuable clinical advice, in addition to prescribing glasses and contact lenses.
One of the concerns raised by the standards committee was that members of the public might be discouraged from attending for regular sight tests. I appreciate that noble Lords do not agree with this argument, given that the availability of ready readers has not had such an impact. However, ready readers have a minimal prescription power and are for reading only.
Lord Stoneham of Droxford
I reiterate to the Minister why it is so important to read the report about reading glasses. Exactly the same arguments were used then—that they would undermine eye tests—yet exactly the opposite happened.
Lord Prior of Brampton
I have made a promise, and that will be among my other reading material. I do not know how long the review is; we shall see.
However, reading glasses are for a very specific, limited purpose, so might not lead people to think that a sight test is no longer necessary. Self-adjustable glasses, on the other hand, are for wider use, and could potentially lead people to think that their vision needs have been met. They may make do with those glasses for longer, and not consider the need for a sight test. In that way, the case might be slightly different from that of reading glasses.
I accept that there is reasonable concern about the potential impact on the take-up of sight tests if these glasses were to be made available over the counter. It is important to be clear that a sight test is not only about checking whether or not you need glasses. As I said earlier, it goes much further than that. A sight test can identify at an early stage diseases such as macular degeneration, glaucoma, diabetic retinopathy and cataracts. Good vision is also particularly important for safety on our roads, both for drivers and pedestrians. So I appreciate the concern raised by the GOC in respect of the safety of drivers using these self-adjustable glasses.
I draw a distinction between the current proposal—which, as I understand it, is for a range of magnification beyond that of ready readers—and magnification restricted to that of ready readers. I am not sure whether or not that makes sense. It makes sense if you read it slowly.
Even if the concerns I have outlined were overcome, it would be very difficult to justify a greater range for the adjustable, and arguably more risky, product than is allowed for ready readers. There is no appetite that I am aware of to extend the exemption applied to ready readers to stronger prescriptions, and similar objections would apply in that they would cease to be simply aids for the limited activity of reading.
However, I note that while the GOC standards committee did not endorse the idea of sale of adjustable glasses restricted to the ready readers range, it commented, as the noble Lord mentioned, that this might be acceptable. I do not know whether those proposing change have had further discussions with the GOC on this point but, if not, it would be sensible to do so before further consideration by the Government. I am not sure whether the noble Lord has had further discussions with the GOC. He might like to say so at the end. This does not mean that the GOC is convinced that this would be a sensible change or that the Government are minded to consult in the near future. I merely highlight that the GOC’s response was nuanced.
Changes to primary legislation are for government, although noble Lords will obviously appreciate that changes will only be made in the light of professional advice, and one of the sources of that advice will be the GOC. The GOC’s report was nuanced and is probably worth following up. I have an instinctive gut feeling of sympathy for the arguments made by the noble Lord but there are genuine objections from the GOC.