Is pribhléid dom bheith anseo chun an Bhille seo a chur os comhair an Tí.
The Bill I am bringing before the Seanad today seeks to modernise the Opticians Act 1956, as there have been no substantive amendments to that Act since its provisions came into force in 1959. During our deliberations, one of my Department officials remarked that this Bill has been awaited for 30 years. There is now a pressing need to bring the legislation up to date with the modern practise of optometry, while advancing the interests of the consumer and ensuring that effective precautions are taken to safeguard the health of the public. I hope it will, therefore, receive the full support of the House.
It is important to remind ourselves of the background to the regulation of the practice of optometry in Ireland. The primary purpose of the 1956 Act was to protect the public by a number of mechanisms. Those qualified to practise or those who, on the introduction of the Bill, were deemed to be experienced enough to practise now had to be registered. There was a commitment to fostering a continual improvement in the education and training of entrants to the professions. A set of rules was devised under the Act to control the activities of registered opticians and sanctions were put in place which would enable the Opticians Board to discipline those persons who breached the provisions of the Act, or the rules of the board as approved by the Minister for Health.
The development of legislation to regulate the practice of optometry was given impetus by the creation of the National Health Service in the United Kingdom in the late 1940s. When the NHS was established, central professional committees were set up simultaneously to assess the applications of those who wished to be approved as service providers under the new system. In the case of the profession of optometry, some of those who applied had no formal training or qualification. They were, therefore, deemed by the central profession committees to have inadequate competence to act either as ophthalmic opticians or dispensing opticians in the United Kingdom.
Consequently, an influx of persons who claimed to be ophthalmic opticians and who had been excluded from the National Health Service arrived in Ireland, where there were no barriers to their activities at that time. As evidence of these matters built up, the then Minister for Health and his officials accepted the need for legislation to ensure adequate standards of training and education for those entering the professions, and controls on their activities and behaviour. The Opticians Bill was subsequently introduced in July 1955 and was passed in 1956. Following the appointment of the first Opticians Board and approval by the Minister for Health of the rules made under the Act, the provisions came into force in 1959.
I now want to look in detail at the main provisions of the Bill. First, the title "optometrist" will be used in place of "ophthalmic optician". There is no issue of principle involved in this change of title and the purpose of this amendment is to give a legislative basis to the use of the more modern title of optometrist.
Sections 24, 25, 33 and 34 of the Principal Act will be amended to provide that being of good character and not having been declared bankrupt are requirements for the registration of optometrists and dispensing opticians trained both within and outside the European Union. In addition, having not been prohibited or suspended from practising because of a conviction for a criminal offence or serious misconduct in connection with the carrying out of professional duties will also be a requirement for registration for both professions.
Sections 24, 25, 33 and 34 are also being adjusted to provide for the registration of optometrists and dispensing opticians in different categories: those trained in the EU; and those trained outside the EU. These provisions will correlate with the terms of the EU directives on mutual recognition of professional education and training, which were transposed into Irish law by S.I. 1 of 1991 and S.I. 135 of 1996.
One of the main provisions of the Bill will be to deregulate the sale of ready-made reading glasses and to provide for their wider and cheaper distribution. Under the current legislation, only a registered medical practitioner or a registered optician may prescribe and/or dispense spectacles. In 1993, the Opticians Board adopted rules under which a registered optician could sell spectacles without prescription where "the spectacles are intended to correct, remedy or relieve the condition known as presbyopia." I hope my pronunciations are accurate; these terms show that health issues cover a very wide spectrum.
The Office of the Attorney General previously advised that legislation to deregulate the sale of ready-made reading glasses was urgently required to avoid a potential liability in damages should litigation by the European Commission be instigated, as was proposed, and prove successful. My Department was subsequently advised, through the Department of Enterprise, Trade and Employment, that the Commission had decided to close the case. It is assumed that the Commission took this decision on the basis of our proposal to deregulate. However, under the existing legislation, the potential for action to be taken by private citizens in the Irish courts remains. In fact, a case was heard by the High Court in December 2002 and my Department is currently awaiting judgment on it.
In regard to the Opticians (Amendment) Bill 2002, the specific details of how the sale of ready-made reading glasses will be deregulated is as follows. While section 49(1) of the Principal Act, which regulates the sale of spectacles, will remain unchanged, its provisions will no longer apply to the sale of ready-made reading spectacles by unregistered persons.
The Bill redefines spectacles to exclude ready-readers, afocal sunglasses and afocal goggles and defines ready-made reading glasses separately. The separation of ready-readers from the definition of spectacles in the Act, has the effect of excluding them from the provisions of section 49(1). I should point out that contact lenses with or without focal power are included in the definition of spectacles and their sale will remain regulated.
It was originally proposed that the sale of ready-made reading glasses should be subject to an age restriction and accompanied by the stipulation that clients must be advised that ready-readers are not a substitute for normal eye examinations. However, after consultation and detailed consideration, it was decided that the above proposals would not be included for the following reasons: it was realised that there would be practical difficulties with enforcement among sellers who are not registered with the Opticians Board; these stipulations are not enforced in other EU jurisdictions; imposing a labelling requirement would place an unfair burden on the industry; and, while worthy, these proposals are not medically necessary. The liberalisation of the sale of ready-made glasses already applies in the majority of member states of the European Union and should find favour with the general public.
Since 1993, the Opticians Board has expressed concern over the lack of disciplinary powers to deal with allegations of professional misconduct or unfitness to practise against registered opticians. The existing legislation provides two categories of fines, reflecting the fact that certain offences under the Act are more serious than others. The amounts payable in the two categories are derisory by modern standards. For first offences, fines are £20 and £10 and, for second and subsequent offences, they are £100 and £50, respectively. It is proposed to provide for fines to range between €500 and €3,000, respectively. This will enable the board to apply reasonable discipline in an effort to ensure that those registered under the Act, as well as those commercial interests who may employ them, are obliged to behave in a manner which will contribute to the protection of the public by ensuring proper standards of practice and behaviour.
The amendments to section 48(1) concern the provision of treatment and the prescription and administration of drugs. Under section 48(1) of the Principal Act, optometrists are prohibited from treating diseases of the eye or prescribing or administering drugs. The existing section 48(1)(a) prohibits the treatment of any disease of the eye and this is interpreted to mean that optometrists are precluded from undertaking even very minor procedures which would be otherwise legitimately done by a lay person, such as, for example, removing dust from the eye.
Section 48(1)(b) of the existing legislation places an absolute prohibition on the prescription and administration of drugs by a registered optometrist who is not also a registered medical practitioner. However, in modern optometry practice it is not possible to conduct a proper examination of the eye without dilation of the pupil, which requires the use of mydriatic drugs. One effect of such drugs is to freeze the accommodation of the eye, that is, to reduce the ability of the eye to change focus. In practice, optometrists are interpreting the 1956 Act to the effect that the use of such drugs is lawful because it refers to the administration of drugs whose purpose is to paralyse the accommodation of the eye. Optometrists contend that paralysing the eye is not the purpose, but the effect, of their professional activities.
It is now proposed to remove the absolute prohibition on the prescription and administration of drugs in order to allow optometrists to carry out their professional function, while stopping short of facilitating their medical treatment of an injury or disease of the eye. However, in order to limit the use of drugs by optometrists, the following additional changes are being made in conjunction with the deletions of paragraphs (a) and (b) of section 48(1). Article 14 of the Medicinal Products (Prescription and Control of Supply) Regulations 1996 will be amended, simultaneously as the Bill is enacted, to ensure that opticians will have limited access to just three diagnostic drugs. Under the amended regulations, optometrists will be unable to carry out therapeutic treatment as they will not be permitted access to therapeutic drugs. Control of the use of certain medicines by opticians would be put clearly within the remit of the Minister for Health and Children, and would safeguard against the use of potentially dangerous drugs in future. In addition, the regulations will stipulate that optometrists may use these drugs in the course of their professional practice only.
Furthermore, in the revised section 48(1)(c) there will be a continued prohibition on diagnosing diseases. It is also proposed to introduce an amendment in this subsection which will state that if an optometrist suspects the presence of a condition or a disease which requires medical attention, he or she will be obliged to inform the patient of this and recommend that the patient consult a registered medical practitioner. The new requirement for the referral of patients to medical practitioners where injury or disease is suspected will be indicative of best practice.
The question of striking a balance has not been easy to resolve and there have been extensive consultations with the Opticians Board and the College of Ophthalmologists. At a recent meeting with the college, in which the president outlined the difficulties which many ophthalmologists have with the use of the word "treatment" in section 12(b)(4) of the Bill, I gave an undertaking to have my Department re-examine this area. Having examined the subsection in question and having consulted with the Office of the Chief Parliamentary Counsel to the Government, I will be proposing an amendment on Committee Stage to delete the words “or treatment of the eye” from section 12(b)(4).
The decision to proceed with the provisions allowing optometrists to use certain drugs in the course of their professional practice was influenced in part by the fact that the UK General Optical Council permits the use of drugs by optometrists for diagnostic purposes, and is proposing to extend their provisions to allow optometrists to use drugs for therapeutic purposes also. The UK College of Ophthalmologists has accepted the General Optical Council's decision on diagnostic drugs.
I have recognised from the start that unanimity on the issue of the use of drugs by optometrists would be very difficult to achieve. There are those who would wish to see a more restrictive approach and others who would wish to see a more liberal approach. However, I would hope that the Department's previous concessions and the proposed amendment, which I have just outlined, will enable a level of compromise, if not consensus, to be reached. Indeed, those representing optometrists were very clear in their correspondence that they were not talking about treatment, that they themselves were stopping short of treatment also. Therefore I feel I have got the balance correct in terms of how we have configured the Bill.
I am pleased to introduce this short Bill to the Seanad. I commend it to the House and I look forward to the ensuing debate and any helpful suggestions which may arise from that.
