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

The NHS range of spectacles

The range of spectacles provided by the NHS supplementary ophthalmic services was based on the existing NHI utility frames.[18] The frames available under both schemes were intended to fulfil a basic practical function: to hold lenses. The frames needed to be simple and cheap to produce, easy to glaze, and durable for the patient; the provision of styled frames and choice to the patient were not considerations. The government’s criteria for the range was that there should be a spectacle frame suitable for every medical requirement; frames were available for children and adults, and other frames were provided for special medical conditions. In a pair of simple spectacle frames there are many variable measurements: the width of the face; the distance between the pupils (PD-inter-pupillary distance); the bridge over the nose (DBL-distance between lenses); and the measurement of the side arms which rest on the ears and secure the frame to the face. For utility frames a degree of standardisation was therefore needed in order to enable large-scale production, and manufacturers produced a selection of sizes.[19]

At the inception of the health service the Ministry of Health formed a liaison committee to seek advice from the industry concerning the production capacity nationwide.[20] The range of frames was considered in terms of function and economy. Government notes stated their selection criteria:

…The types in the free range must however cover everything clinically necessary for any type of applicant and must be of good quality but not luxurious standard of appearance. The Minister’s aim is to concentrate on the minimum number of types in the free range in the hope of getting better prices for mass production.[21]

Although choice and styling were of importance to the patients these were not thought appropriate for the health service. Minutes from a meeting in May 1948 stated that ‘from a health point of view, any type of frame which would hold the lenses in position would be adequate. Other considerations were not valid in considering a health service’.[22]

Frames were available in three materials: nickel, gold-filled and cellulose acetate (plastic). The range of NHS frames was divided into groups, known as classes: one class of four frames were free; other classes of frame required a financial contribution as they were more expensive to produce. Metal frames were similar to those from the NHI glasses range; some of the metal frames were available with coloured plastic-covered rims. Plastic frames were available in a selection of colours. In 1948 there were 33 frames in the National Health Service range.

Although these figures suggest an element of choice, the frames were in effect only variations on a limited range of simple eye shapes with differences in the bridge, the position of the joints and the type of sides.[23] There were slight differences between frames, their materials or colour, and the combination of the design components that enabled the government to claim that there were such a large number of spectacle designs available. The frame styles, or patterns, under the NHS were given a reference number. The three-digit number referred to a specific frame shape and a particular material. If, for example, the pattern was intended for a child the code would be prefixed with the letter ‘C’, or if the style had ‘high joints’, where the arms were fixed to the front rim, the code would include the initials ‘H.J.’. Metal frames in the popular Windsor style, similar to those available under the NHI scheme, were produced in nickel and given the code 211 or 221 dependent on the style of bridge. There were four more style numbers for the children’s size of this frame type.[24] Other variations of the style produced in gold-filled metal required a financial contribution but produced nine more style numbers. There were also slight variations on the plastic frames with differences in the bridge – either ‘regular’, ‘pad’ or ‘keyhole’ – and the position of the joints, either centrally or high on the top of the frame.

When the service was introduced in 1948 frames from the old National Health Insurance range were used up then NHS patterns were produced. The information available for the design of NHS frames was very limited and provided only through comparison to the patterns previously available on the NHI schedule and by the simple description of frames in the statement of fees charges. This was explained to the profession through a document produced by the Joint Emergency Committee (Optical Profession), which was sent to ophthalmic opticians and which contained the information for individual opticians entering the scheme.[25]

There was no centralisation of production or distribution and due to the widespread demand for appliances large numbers of manufacturing firms, both large and small, were producing frames to conform to the NHS range. During 1950 manufacturers were invited to send samples of their NHS styles for Ministry approval and a system of frame stamping and authorisation for NHS patterns was introduced in July 1951. Once approved a certified trademark was issued to indicate the design was authorised by the government. The introduction of this frame stamping system raised some concerns in the trade as wholesalers did not wish to be left with unstamped unauthorised designs, and these fears of the NHS scheme interfering with the supply system were indicated in the trade press (Optician, 1950). However, any manufacturer, importer or supplier (and this initially included any ophthalmic or dispensing optician who manufactured his own frames by hand) was entitled to apply to the Ministry of Health for the use of authorised trademarks. This meant that where a dispensing optician used a manufacturer or wholesaler to supply appliances this enabled them to retain their trading relationship.

From July 1951, all frames supplied for the National Health Service needed to be stamped with the NH trademark and the identifying letters of the firm. Government instructions to the maker decreed that ‘Henceforth all patterns of such frames supplied by him for National Health purposes must be stamped by him with both the trade mark and the letters identifying his firm’ (Giles, 1953). Manufacturers were to send three frames of each pattern to the Ministry and a certificate would be granted if the design was approved and the firm was given permission to mark their frames. The Ministry attempted to regulate quality and pattern of frames within the range with the limiting factors being the cost of production and the appearance of the frame; conformity to the range was important and innovation and fashion were eliminated. Should there be any variation in quality or pattern, and complaints made about this, the frame in question would be compared to the three samples previously held by the Ministry.[26] The Ministry issued lists of authorised manufacturers, giving the name of the firm, their letters of identification, and the type of approved NHS styles that the company produced. The first list was published in the Optician journal on 29 December 1950, prior to the implementation of strict regulations concerning supply of approved and stamped frames to start on 1 July 1951.[27]

When frame producers sent samples to the government for approval, the Advisory Committee on Spectacle Frames, part of the Standing Ophthalmic Advisory Committee, would group the samples in three categories which were decided in accordance with the following criteria:[28]

New frames should in the first place be judged by the criteria laid down in the statement of Fees and Charges, including the description of the frames and the standards of the quality and workmanship. Any frame which complies with these criteria although it might differ somewhat from the original pattern should be regarded as a variation of the appropriate type already included in the Statement. Any frame which does not comply with these criteria should be regarded as a new type.[29]

Variations were strictly assessed primarily in terms of quality and cost of production. They were rejected if they did not conform to the schedule of prices as were those that ‘would be more expensive to dispense or which would increase the cost to the National Health Service in any way’.[30] Any frames that were considered to be too modern or stylised were also rejected: ‘Variations which seem designed to set a fashion which might increase the demand for spectacles under the National Health Service will also be ruled out.’[31] If a frame with a slight difference was admitted there was no obligation on prescription houses to stock the different variations of that pattern. The inclusion of completely new types would only be considered after wide consultation with the industry. These rules for classifying regulation frames relied very much on the committee’s opinion of what constituted frames that might ‘set a fashion’. Consequently, the frame patterns which attained certificates for production according to the ideas of the committee resulted in a very limited range of patterns; these were based on established designs that would soon become dated and old-fashioned.

The production methods for metal frames made them suitable for manufacture in large quantities; this also made them ideal for fitting the criteria of the health service. However, there were also possibilities in Britain’s manufacturing industry to produce cellulose acetate (plastic) frames. A major concern for the government was that, while the optical industry would be able to meet demand, ‘a wider choice would upset the present levels of demand and the demand for metal frames would cease’.[32] This comment is particularly pertinent as it shows evident concern over the popularity of plastic frames in this period. Plastic frames were included in the range, but it was felt by the liaison committee that if they were placed within the free class of spectacles that the uptake would be immense and demand for the remaining types might ‘virtually cease’.[33] The new material was associated with progress, and in a brown mottled colourway it imitated the more expensive material of tortoiseshell, and as such had an allure.[34] One of the most popular plastic frame patterns in the scheme was number 524. This was produced in a range of colours and could have slight variations of bridge pattern.[35] The trade advert for Merx (see Figure 7 below) shows the different options produced, with both an ‘open’ and ‘keyhole’ bridge available, and proudly proclaims its wide range of colours to include Pale Flesh, Brown Mottle, Demi Blonde, Crystal, Ice Blue and Black.

Figure 7

Trade advert for Merx Optical showing a popular NHS frame style – the 524HJ.  This example is from the pages of The Ophthalmic Optician 28 January 1961

Despite the popularity of the slightly more modern design of the 524 there was only a very limited array of contemporary design styles in the range. A representative of the Association of Wholesale and Manufacturing Opticians (Frank Wiseman, the chairman of manufacturers M Wiseman and Co. Ltd) had expressed his concern as early as September of 1950.[36] He wrote a personal letter stating that he was ‘seriously disturbed at the very narrow standardisation of spectacle frame patterns which has taken place as a result of the National Health Service’.[37] He was concerned about the effect this would have on the export industry, the development of the home market, and on the choice available to the public:

We see no reason why the public at home should not receive modern spectacles, always providing that they do come within the specification for quality and price as laid down by Ministerial regulations.[38]

The representatives from the Ministry of Health accepted his concerns for the export industry, and met together to discuss the issue, but no action was taken to update the appearance of regulation frames. Ministerial notes from 28 September 1950 stated:

[We] agree that this is undesirable and that it was never intended that the National Health Service should have the effect of putting the manufacturers of frames into a straight-waistcoat for ever and ever. We must, however, be careful not to admit a ‘fashion’ element which might easily increase demand unnecessarily.[39]

So, there was little scope for radical change, although there were no exact requirements on the visual appearance or shape of frames, and regulations were open to some interpretation. Durability and cost-effectiveness were key considerations of the government for production of the NHS glasses range; ideas of ‘good’ design aesthetics or fashion were of little importance thus the history of spectacle design is distinct from other types of industrial design in Britain during this period.[40]

From 1948 to 1950 the trade struggled to increase production and remove the backlog of people waiting for frames under the NHS scheme, so all assets were put into production of frames on a large scale. The circumstances were not right for considering innovation in frame design but the forthcoming Festival of Britain may have encouraged contributors to Optician to consider design and style. It is evident that the ophthalmic trade felt a sense of embarrassment at the lack of merit and innovation within their trade at that time, as this contributor to the Optician laments:

We wonder whether there will be any British spectacles thought eligible to be included [in the Festival of Britain]...so long as Whitehall retains a tight control of the types of appliances that comprise 80 per cent or more of the nation’s ‘consumption’ of spectacles, so long we fear must designers be inhibited and manufacturers deterred from tilling fresh ground. (Optician, 1950)

In 1950 the main trade journal made a heartfelt request to their readership that action should be taken:

Has not the time come when people in all sections of British ophthalmics should combine in a determined effort to infuse some variety, some freedom of design and colour, some novelty of line and embellishment into the spectacles that are put on the faces of the ametropes? (Optician, 1950)

The British optical trade’s contribution to the Festival of Britain in 1951 was an exhibition named ‘Britain’s Festival of Optics’. This exhibition was organised by the Association of Wholesale and Manufacturing Opticians as a large fair in order to cultivate international trade. The Chairman of the organising committee and editor of the Optician, W E Hardy, had a vision for the exhibition and used the pages of his publication to explain this to members of the trade: he hoped that the experience of it would be ‘both interesting, instructive, and stimulating at a time when a fresh inspiration is urgently and vitally needed by all those whose work is directed towards the betterment of human vision’ (Hardy, 1951). The article suggests that there was low morale among the manufacturing trade and that this might offer some stimulus to the industry as a whole: ‘…this 1951 trade exhibition therefore marks the beginning of the new, and what must be a hard and difficult stage, in our history’ (Hardy, 1951).

This assessment is understandably slanted to give a trade perspective and indicates the business concerns of an entire industry that was being restricted due to post-war conditions and the introduction of the ophthalmic services to the welfare system. These circumstances caused the optical practitioners to consider the status of their profession and the remuneration that they received from the government for their services. Whilst they acknowledged that the public undoubtedly benefitted, the professions who delivered the service felt that they did not.[41]

Component DOI: http://dx.doi.org/10.15180/170703/005