Go back to article: Rather unspectacular: design choices in National Health Service glasses

Badge of poverty

The acknowledgment that frames were out of date had been raised in 1960 and a decade later this remained an issue of concern. The patient was in a very disadvantaged position in their role as a consumer, and in 1969 the Consumers Association took action on their behalf by reporting on health service provisions (The Times, 1969; Optician, 1969). The magazine of the Consumers Association, Which?, reported on a survey of health service spectacles claiming that they were outdated and criticising the lack of choice and the range of frames stocked by opticians. They stated that ‘the range of NHS frames is inadequate and out of date – not surprisingly opticians do not stock them all. Two-thirds of those buying spectacles pay several pounds extra on private frames’ (The Times, 1969; Which?, 1969). The report criticised opticians for promoting the more expensive frames to their patients; although it understood the reasons for this were that the NHS fees were not realistic enough to enable opticians to maintain their standard of living, the cost of which had ‘more than doubled’ since 1948. They suggested that ‘opticians might be less keen on private frames if NHS fees – which had only gone up by only five shillings 11d since 1948 – were more realistic’ (The Times, 1969). However, we can also see that opticians were giving patients the opportunity for a more styled frame by offering NHS hybrid styles.

Little action was taken in direct response to these complaints. However, the changing social conditions of the 1970s saw further concerns about the costs of the National Health Service and the implementation of the Welfare State. The 1970 the Conservative government extended the principle of means testing for benefit, and in this year the new budget introduced higher charges for health benefits. This led to an increased charge to the patient for optical services and costs for spectacle frames were now to include dispensing costs (The Times, 1970).

Figure 12

1971 Poster produced by the Labour Government informing of items that are free to the public on the NHS

Poster produced by Labour government Department of Health and Social Security – 1971

In 1971 a Labour government introduced leaflets and posters providing information to the public about the welfare benefits available to them; this was evidence of the Ministry beginning to demonstrate that the public should be given information directly from government rather than through the professional bodies.[54] These initial measures did not specifically describe the range of frames available, but informed applicants about entitlements. In 1972 there was a slight alteration to the range of frames available for children when ‘more attractive spectacle frames made from plastics will be introduced into the National Health Service free range for children’ (The Times, 1972). But there was no stylistic change in the adult range.[55]

The issue of appearance and fashion in frames, and the criticisms of the Consumers Association seven years previously, was openly discussed. Barbara Castle, Secretary of State for Social Services, addressed a conference of local optical committee representatives stating that the Department of Health may introduce better looking glasses on the National Health Service. They acknowledged that the limited range of NHS frames were unattractive and it ‘meant that people choose them because they could not afford the more attractive frames available privately’ (The Times, 1976).[56]

As she addressed the conference Mrs Castle explained that of the twelve frames in the NHS range most were designed to meet special clinical or minority needs. This resulted in one frame type, the plastic 524, being chosen by ninety per cent of people who were supplied with NHS frames. When the pattern was chosen for the range in 1948 ‘it wasn’t fashionable…but at least it was in fashion and not out of it’ (Optician, 1976). There had been minor variations on the appearance of the 524 but no major re-design. She acknowledged the significant changes in the optical industry over the thirty years since the range was introduced but that National Health Service frames had scarcely changed. The government now also recognised that spectacles were not merely clinical appliances but an integral part of the wearer’s appearance and personality. Although cost would always be a consideration, it was felt that ‘the therapeutic value of feeling one looks one’s best’ was also important in the state provision of optical aid. Mrs Castle said:

The nub of my point is that a good-looking pair of spectacles in which the wearer can feel self-confident is genuinely a need in a society like ours: it is a need which for many the NHS is not fulfilling. We must not force people to wear out-of-date frames like a badge of poverty across their faces. (Optician, 1976)

These comments triggered many newspaper articles on NHS frames. Good looking frames were presented as ‘morale boosters’ in contrast to the NHS range as an indicator of low social status. Mrs Castle was eager to work with the optical industry as a whole to solve the problem. Prompted by letters from members of her constituency she expressed that she was ‘particularly concerned about those people…who are too poor to be able to afford the more attractive frames which can be obtained privately’ (Optician, 1976).

Whilst the Department of Social Services initiated changes in the NHS range the issue of inflated prices of private frames was being investigated. Later in the same year the ophthalmic trade was criticised in a report by the Price Commission (Price Commission Report, 1976). Their view was that the price of private spectacles was higher than it needed to be and that there should be ‘more competition between opticians and less reticence about prices’. It was further suggested that ‘the National Health Service should offer a greater variety of frames and that the opticians should ensure that patients are in a position to make an effective choice between NHS and private spectacles’ (Price Commission Report, 1976). Opticians were accused of not fairly representing the range of frames available under the health service. The findings of this report also suggested that patients were still left somewhat in the dark as to their rights under the health service. In the first thirty years little advancement had been made over informing patients about the workings of the state’s optical service. The fact that there had been little change in health service frame styles over the years further compounded the fact that when an optician demonstrated NHS frames it did little more than ‘drive people towards the private frames’ (Price Commission Report, 1976).[57]

Measures were taken over the availability of frames in 1977. Following debate in Parliament about the lack of competition among opticians the government acknowledged there was a problem in the display of frames. No measures were taken to solve the root causes: the poor design and choice of frames, which made them undesirable due to their uniformity; and the low fees paid to opticians for their services. However, measures were taken that forced opticians to stock and display the full range of NHS frames:

Opticians will in future stock and display the full range of National Health Service spectacle frames, under measures announced yesterday by Mr Hattersley, Secretary of State for prices and consumer protection. He said the ophthalmic organisations had also agreed that prices should be shown where frames are displayed (The Times, 1977).

Giving information to patients was now seen as important. A leaflet that offered precise information about the schedule of frames was issued in 1978 (some eighteen years after a request had been made). NHS leaflet 6 was entitled Your Sight and the NHS. It described where NHS optical services were provided, how to get a sight test, and the entitlement to glasses.[58]

Figure 13

Black and white leaflet from November 1978 entitled Your Sight and the NHS

Your Sight and the NHS leaflet November 1978

The confusion over the rules concerning the display of the full range of scheduled frames under the National Health Service was clarified when the terms of service for opticians under the health service were amended in 1980; and following this a glazed case containing examples of frames available was produced. The government had also issued a leaflet containing illustrations of National Health Service frames and giving information on patients’ rights and what they would expect to pay. It was raised in parliament that it had taken the government 32 years to fully explain the public entitlements under the National Health Service; this had mainly been due to confusion over whose responsibility it was to inform the public of their rights to optical aid (The Times, 1980). The consumer was becoming a force in Thatcher’s Britain.

Figure 14

Colour photograph of a 1970s display case showing various styles of NHS spectacles

Example of a glazed case showing a range of NHS frames – Norville Optical c.1970s – with new pattern 924 added and handwritten label

Component DOI: http://dx.doi.org/10.15180/170703/010