NHS spectacles

The National Health range of glasses was an historical phenomenon peculiar to the United Kingdom between 1948 and 1985. Almost universally loathed at home because of the social stigma attached to state-subsidised medical appliances, they were admired abroad, but were 'popular' only in the literal sense that overwhelming numbers of people chose to wear them. This is proof, if ever it were needed, that price rather than fashion was the main factor influencing British consumer choice in the third quarter of the twentieth century. The high quality of NHS spectacles has meant, however, that many frames have survived to the present day and they have now taken on a new identity... as desirable retro-chic eyewear.

The NHS is a unique state healthcare system offering treatment to all, free at the point of delivery. It continues to enjoy a remarkable and unusual cross-party political support such that, despite its enormous cost, its critics only ever speak in terms of reform and never abolition. Legislation to form the NHS was introduced by the post-war Labour government in 1946 although the intellectual impetus was largely down to the Liberal economist W. H. Beveridge (1879-1963) whose wartime commission and resulting report on Social Insurance and Allied Services (The Beveridge Report), issued in 1942, identified the need to wage war on such nebulous concepts as want and disease as well as military enemies. Although the National Health Service Act is often associated with the firebrand Health Secretary Aneurin 'Nye' Bevan (1897-1960), the scheme enjoyed considerable Conservative support including from Churchill himself who had pioneered social welfare reform half a century earlier and was responsible for coining the phrase 'From Cradle to Grave'. This support on a welfare issue came in stark contrast to the Conservative position on the rest of the Labour government's programme of industrial nationalisation. Initially, the greatest opposition to the NHS came from the doctors themselves (regardless of political affiliation), driven it seems by vested self-interest. In time, however, a passion for the NHS became one of the most frequently cited motivating factors causing people to opt for medical careers.

Ophthalmic Services, however, always sat awkwardly within the NHS scheme because there were essentially two different processes going on - the provision of eye examinations (sight tests) and then the supply of medical appliances (most commonly spectacles). Many opticians had hitherto based their business model on the latter process, indeed dispensing practices did nothing else. Now the emphasis was to be on the promotion of good eye health as part of a wider and regular all-over health assessment. The consequences for the profession were immense. One really positive outcome was the final victory over that part of the medical profession which had always opposed the right of ophthalmic opticians to conduct eye examinations. There simply weren't enough ophthalmologists in the country to meet the increased demand now that there was to be universal and free entitlement. Opposition to the opticians meant that the services they were permitted to deliver were described as 'Supplementary' and there seems little doubt that the doctors hoped these supplementary services would eventually be abolished once demand had levelled off. Another direct outcome related to this, although it took a further ten years, was the legislation to regulate the optical professions (The Opticians Act, 1958) which the ophthalmic opticians had been demanding since the turn of the century. This raised the status of opticians by protecting their title and ensuring the need for them to be professionally qualified.

So far so good. The period 1948-1951 was a golden age for the ophthalmic opticians. New patients were presenting themselves from all directions and the cost could be claimed from the State by filling in a few forms. Many people who had never had an eye examination before, or at least not for a very long time, emerged from the woodwork. Some demanded their free spectacles even when the result of the sight test proved that they didn't need them! Displays of ‘Standard Spectacles’ like those produced by M. Wiseman & Co. Ltd in 1949 were hung on practice walls to publicise the availability of free and state-subsidised frames for all. There were ten free styles of frame and seven which could be chosen for payment of an additional fee. Two types of plastic frame were added to the free list but demand was not expected to be great for these and the versatility of plastic materials was not exploited; the plastic NHS glasses were nearly all black or brown in colour. The available range was quickly cut back, in order to meet demand more easily, much of it from people who had never owned spectacles before.

An initial rush, of sorts, had been predicted. The scheme was costed at £2 million for the first nine months and £3.5 million for the year. These figures proved woefully inadequate. The actual cost for these periods was £11 million and £15 million respectively. By 1950 the cost had risen to nearly £22 million a year. In Scotland four times as many people as predicted came forward to use the supplementary services. In England and Wales 5 million sight-tests were performed each year and 7.5 million pairs of spectacles were dispensed.

By the end of the 1940s there could be an 18-month waiting list before you received your finished spectacles. The problem with this was that your prescription might have changed in the intervening period. The result was that many free spectacles were useless by the time they were received and were discarded. Many families have an anecdote about the glasses pushed into a drawer which stayed there for years.

Kenneth Giles FSMC from Littlehampton recalled this period in From the Master and Wardens in July 1997:

My appointments increased immediately. I remember an old lady who booked an appointment in April that year [1948] for July! In due course, the appointment book became full for months in advance and, gradually, the supply of uncut lenses began to dwindle....eventually the workshop shelves were piled high with some fifty or more jobs awaiting just one lens. And when you got it, what anxiety! If you broke it or flaked it, you had no spare to take its place. I particularly recall a patient having ordered a rimless spectacle on Christmas Eve [Ed. Note this would have been a non-NHS frame but private customers suffered too as a result of the shortages], 1948. The job was completed exactly one year later - Christmas Eve, 1949! To his eternal credit, the patient had never once enquired as to how much longer he would have to wait.

Things, however, eventually evened out and the reign of the 524 and 423 began to crumble with the introduction of modestly designed private frames. We were still swamped with appointments, however. Indeed there was little or no time to do clerical work during the day. ordering, records and the completion of NHS pricing forms were things you took home to work on after hours.

Nye Bevan himself accepted a need for some restraint. He overcame his initial reluctance and approved a measure whereby free plastic frames were discontinued. Patients opting for plastic frames now received just a 5 shilling subsidy.

Free (metal) spectacles for all were amongst the first things to be cut from the NHS scheme, by Labour’s Hugh Gaitskell in 1951 on grounds of cost. Health service cuts are therefore nothing new. Henceforth free spectacles were restricted to certain qualifying groups. The NHS spectacles were subsidised for everyone else in terms of discounted lenses but the frames had to be bought at full cost, albeit that their mass-produced nature meant that they were still significantly cheaper than the bulk of private frames. Patients now had to pay £1 per pair. The cost of administering the supplementary ophthalmic scheme fell to a much more manageable £8.5 million in 1951/52 though this was still far higher than the planners had originally envisaged.

Selection was by a three digit numbering system that identified the different types of rim, bridge and side. The most common pair and the pair generally recognised as embodying the 'standard' pair of NHS glasses was the 524. The NHS frames also had their own terminology, for example the drop-end side was often referred to as a hockey end on account of its resemblence to the head of a hockey stick. The positioning of the joints was also commonly stated on a dispensing prescription. 'HJ' means high joints and 'CJ' means centre joints. There were various manufacturers, some producing solely for the NHS, though it is often claimed that they could have sold the lot to the USA, at a premium price, if the government had not prevented them. This is because, although subject to social stigma at home, NHS spectacles were noted elsewhere for their quality of materials and workmanship. You can often recognise a vintage NHS pair because of the four-letter codes begining with a conjoined NH stamped on the inside frame, usually on the upper rim or beside the nose pad. The museum has lists of these codes and may be able to identify the manufacturer for you, e.g. NHUK was the code for Wiseman.

The shape of the lenses necessary for some patients did not suit the NHS pattern of frame and in such cases it had always been possible for the NHS lenses to be fitted to a private frame instead. In 1964 the Ministry of Health approved the first 'Regulation 12' frame (the 'Candida' by Birch). The inner rim contour of Regulation 12 frames conformed to the NHS lens shape but the outer rims could be of a much more fashionable shape. Our experience at the museum is that a lot of people claim to remember their NHS glasses when they were not NHS glasses at all, but private Regulation 12 (also called 'Hybrid') frames, glazed with NHS lenses.

There were separate NHS glasses for children. At first these were just miniature versions of the adult glasses but with an emphasis on the curl sides that meant they stayed on whilst running about in the playground. Many young girls were encouraged to choose the transparent pink frame. Insiders called the colour 'flesh'because it was meant to be less visible although this good intent was never genuinely realised. A special tie-on side was available for very young children.

Stung by claims that the range was too conservative and did not move with the times the 924 ladies frame was introduced in June 1983 in a failed attempt to make the NHS range more glamorous. It was the first completely new NHS spectacle for 35 years and the first designed specifically for women. It came in three two-tone colours: lilac, pink and brown. They were available from opticians after 1 July 1983 at a price of £3.30 but were a commercial failure.

Production of a dedicated NHS range was discontinued in 1985. After that date eligible patients were given vouchers instead.

NHS Act OO Sign

Notice of qualified status to provide the services of an ophthalmic optician on a local basis.

NHS display of frames 1949

Display of approved NHS frames by Wiseman, 1949

NHS medical card poster 1953

Patients would need an NHS number on their medical card when applying for glasses. This poster from 1953 reminds them. It was part of the increased bureaucracy introduced of necessity to prevent a free-for-all situation.

NHS 422

NHS 422 frame

 NHS spectacle frames available in late 1970s

Poster issued by the Kensington & Chelsea & Westminster Family Practitioner Committee, illustrating and describing ten NHS spectacle frames: Adult 422, 423, 422 HJ, 423 HJ, 524, 525, 614, 615, 721, 722, 814, 824, and children's C223, C227, C253, C525, C127. Includes summary of available side types and acetate frame colours. Late 1970s?

NHS flesh child frame

NHS child's flesh-coloured acetate frame

NHS leaflet G11 1985

Form G.11 detailing revised rules on eligibility for NHS frames, April 1985

 NHS waste leaflet 2004

Governments of all political persuasions now need to hold the NHS purse strings very tightly. This leaflet issued by the Scottish Executive in 2004 aimed to combat the waste of NHS money spent on people who wrongly claimed help towards the cost of glasses.