MAJORITY REPORT.

taken to give effect to it. If the insurance practitioner advises a
further medical examination of the patient’s eyes the proper
course is for the latter to consult a medical practitioner with
special experience of ophthalmic work, who would diagnose the defect
 and provide such treatment as might be required. This would
in the great majority of cases take the form of the testing of sight
and prescription of the necessary glasses. It was claimed by witnesses
 representing various bodies of opticians that this work was
within the competence of a qualified optician ; and we are prepared
to admit that where no doubt can exist that the defect is merely
an error of refraction the task of prescribing the requisite glasses
should not be beyond the skill of an optician who has undergone
the course of training and passed the examination required by
certain of the opticians’ organisations which gave evidence
before us.

90. In this connexion, however, two difficulties arise. In the
first place, in contrast with the position in medical practice and
dentistry, there is not in this country any State registration of
opticians and it is open to anyone to test sight and supply spectacles,
 however, unfit he may be to undertake the work.
Secondly, in a proportion of cases, which may be no higher
than 5 per cent., eye trouble may be due to some cause
other than a mere error of refraction and may be a symptom
of serious disease, and it is essentially a task for the
qualified medical practitioner to differentiate between cases
of this kind and cases of mere refractive error. It
was admitted, even by medical witnesses who appeared
before us to support the case of the opticians, that, other things
being equal, it would be preferable, for the purpose of testing
eyesight, to have recourse to a properly qualified eye-specialist
rather than to the most highly qualified optician (Joint Council of
Qualified Opticians, (). 17,660). It is true that there has hitherto
been a shortage of medical practitioners specially qualified in
ophthalmic work and this, no doubt, has contributed to the result
that the testing of eye-sight has very largely fallen into the hands
of opticians. We are informed, however, that the British Medical
Association has compiled a list of approximately 600 doctors in all
parts of the country who possess special ophthalmic experience
and who are willing to undertake this work for insured persons at
a moderate fee. It isnot within our province to consider the arguments
 for or against the prohibition of the testing of eye-sight
by persons other than medical practitioners. But as to the provision
 to be made for insured persons as part of the Health
Insurance Scheme, we consider that a satisfactory solution
could be found in connexion with a proposal which we make in
Chapter X directed to the provision of a specialist ‘medical
service as part of medical benefit. Such a specialist service
would include ophthalmic specialists whose services would be
at the disposal of insured persons requiring them, and the