Striving for influence

Bob Hughes is using his impressive skills of persuasion to tell me how optometry can seize the opportunities the 'modernised' health service has offered.
'We are already ahead of the game in terms of "patient choice",' he says. 'Our professionals are in the high street, with all the costs paid for by the private sector.
'My job is to galvanise the membership to gain the influence the profession needs.'
The former minister and MP has long been one of the more visible leaders of optics, and his new appointment at the AOP looks certain to make him more visible still.
I first interviewed him in the mid 1990s when he had just joined the profession as general secretary at FODO. Being both new to optometry we discussed how we were perplexed at a profession which seemed to have a plethora of representative bodies - when all agreed it was a singularity of voice which would best serve the profession.
Soon he set about reshaping FODO to be a more responsive federation to its membership's needs. To this end Hughes shared as much information as he thought would benefit FODO members with the optical press and the profession at large.
In addition, he and his colleagues in the multiples acted to stem the then growing manpower problem in the profession by establishing the optometry course at Anglia Polytechnic University.
Later on, attending the AOP's annual National Optometric Conference, I witnessed his controversial address on the need for more corporate representation within LOCs to improve their negotiating skills. Though this idea was denounced by a series of members speaking from the floor, in the long-run it has been adopted. Obviously Hughes is a man who can stand his ground in an argument.
So when meeting him again, I wondered whether now - as chief executive designate for the AOP - he would have changed his mind on the number of optical bodies dilemma I raised so long ago. He doesn't blink.
'I am still of that opinion,' he says. 'There should be two organisations - an educational college and one representative body. It's as simple as that.'

PUNCHING OUR WEIGHT
At a time when the health service is rapidly changing, with a wholescale review of the GOS on the cards, Hughes is anxious that optometry is united and can fight its corner effectively.
However, he's frustrated that when it comes to headline-grabbing issues - such as the Department of Health's most recent successes in cataract care - the role of optometrists can be overlooked.
Indeed, it is the others who seem to carry a more weighty punch, he feels. 'When other health professionals, dentists or the doctors, decide to put their foot down, the Department backs away.
'We've never really done that, until very recently. The issue where we did get very "heavy" with them - and contacts within the Department have told me we were right to do so - was regarding the ophthalmic lists issue early last year.' He tells me that if the civil servants had gone ahead with the draft legislation then a number of optical concerns would not have been able to continue in business [unless companies were on the GOC's bodies corporate, or owned by an optometrist, effectively they would not have been able register to carry out GOS]. Behind the scenes a deal was reached in which the DoH's lawyers' 'idiosyncratic interpretation' of the law was not revealed, but the Department backed down.
'But generally, we can't punch that weight,' he says, 'which frustrates me because I know that optometrists, and to an extent, dispensing opticians have so much to offer,' he says.
His own efforts to turn this state of affairs around as the AOP's boss will be to attempt to communicate optometry's successes in specialist magazines - the Health Service Journal for one, the weekly aimed at PCT managers - and other medical journals. 'One of the big questions [for the AOP] is how can we be more influential,' he says. 'I think we can. It's one of the strategies I've had in mind for ages - at FODO we never really had the resources to carry this out - and I feel that many optometry stories ought to appear in other medical journals.
'Our presence in negotiating issues should be appearing in HSJ. There are an awful lot of stories which end up in the nationals which start in specialist magazines. We just need to broadcast our achievements more widely.'

IMPROVING NEGOTIATIONS
However, it will be the grassroots membership that Hughes will pay most attention to as he starts his new job. He wants to look at the services the Association offers owner optometrists, and those for employed optometrists, and how benefits can be maximised for both parties; he wants to see how he can attract the 1,800 UK optometrists who are not AOP members; and he hints at the possibility that the Association could be given official trade union status so that it can represent members in internal disciplinary hearings within companies.
An important brief Hughes has set himself is to improve the negotiating skills of the LOCs and with it their relationship with PCTs.
Some LOCs are 'excellent', though it appears it will be the others that will stand to benefit the most from Hughes' input.
And in a 'modernised' NHS, where optometry services will be influenced by individual PCTs, it is vital he says that local negotiators are well rehearsed when speaking up for the profession's benefit.
'I am looking at a much more comprehensive strategy for LOCs to be able to punch their weight,' he confirms.
'They will all be negotiating far more in the future. It's unavoidable. The way the health service is being determined indicates that things will be organised and negotiated locally.'
He says that local representatives for optics can be improved, provided they stick to a formula, what he calls a 'negotiating tool box'.
'If you want to influence those you're dealing with it comes down to a number of truths about these things. If you go in and try to influence the first time you meet someone - the clinical director or the PCT's chief executive - and you try to convince them to do something, you're much less likely to succeed unless you have done the spade work for the year beforehand.
'So meeting with people, nominating people to those committees which may not seem 100 per cent relevant to optometry, having meetings, inviting those you wish to communicate with to your meetings, having dinners where you socialise with them are all valuable things for an LOC to do. What we need to make sure is whoever is leading the LOC has got the wherewithal to be able to negotiate.'
He recounts the story of one 'really nice young optometrist', a chairman of an LOC, who lacked the experience required to negotiate. 'This person had agreed to be chairman but had no skills to negotiate with people and didn't know how to influence the PCT.
'Fortunately FODO was able to send someone along to negotiate alongside the chairman and basically to hammer the table and say the PCT couldn't just walk all over the profession and pay a fiver for a number of matters related to cataract work.'

A REALIST'S APPROACH
Given the right circumstances, Hughes feels even the hiatus on the NHS sight test fees is not insurmountable. A realist, he believes the Government will not shift in the short term, but that changes taking place in the NHS, and more specifically to the Welsh and Scottish professions will eventually make the Department alter its 'ridiculous view' and improve payments.
So can the profession eventually benefit from an extended eye health check, with the possibility of the additional fees that entails? Hughes takes comfort from last year's Threlfall High Court case when the judge recognised that the optometrist's patient 'didn't need a sight test but a basket of procedures'.
The possibility of such schemes as Wales' PEARS arriving in England will have to wait until the GOS review, Hughes concedes, though whatever changes are made he is determined to protect the valuable areas which are already part of the profession's landscape.
Thinking of the GOS, he feels the Health Service is well off with the profession's contribution as it stands, going back to his 'professionals-in-the-high-street' argument. 'There are different ways eye care in the community can be achieved, but this is the best one.'
He says that patient choice needs to be protected. 'It is good for the public and, in the finality, good for the profession that people can take their custom where they want, and businesses have to compete and cope with that.'
Hughes takes up his role in March - when the AOP has a high profile area at Optrafair with its ACE lectures - and is clearly looking forward to his new challenge.
As we leave I hand him what I offer as a kind of good luck card from optician's cavernous photo library - a 1997 shot of Hughes on the phone taking one of his first calls for FODO. Though it is intriguing to imagine what the profession will look like when Hughes eventually leaves his new role, his sights are firmly set on the here and now.