Opticians Act 1989

Lord Hunt of Kings Heath Excerpts

Monday 8th February 2016 Lords Chamber

[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.