The start of a new year should bring with it optimism and hope for good things to come in the next few months. Back in my December column of 2019, I suggested that as the year of 2020 unfolded we would have a major opportunity to design and develop our own destiny as a profession. Of course, we all know that opportunity was, to a great extent, thwarted by the Covid-19 pandemic. Looking back much further to 16 years ago, I was writing about the same thing and how we needed to rapidly change the NHS GOS regulations if we were to flourish as a profession. Covid-19 did not exist 16 years ago and so the lack of progress we have made during that time cannot be blamed on it.
The end of 2022 saw a flurry of activity around funding for NHS optical services in the light of the current cost-of-living crisis. A poll carried out in October 2022 showed some horrific outcomes for the future of eye health in this country. Of the 1,000 people surveyed, 36% were wearing prescriptions that were out of date, 19% were wearing broken glasses and 31% were wearing family members’ or friends’ glasses because they could not afford to buy new spectacles. They needed the money to buy food for their children. Glasses are just way too expensive and therefore cannot be prioritised. Horrific though these findings are, there cannot be a single person in the optical professions who is surprised by them. We have known for years and from several earlier studies that people stay away from having their eyes tested because of how much the product costs. Further reports show that even if people do come for an eye test they choose not to change their spectacles because they can’t afford new ones.
We all know, and have known for decades, that one of the main reasons for the high costs of the products we sell is the gross under-funding of the clinical side of our work. This unsatisfactory situation has existed for years, and we have been complicit in allowing this situation to exist. Year-on-year-on-year, we have been happy to continue this cross-subsidy and have backed down in the face of government intransigence to pay us properly. Every year, we have moaned about the situation but done nothing. We have accepted meekly that this is the price we pay for holding an NHS contract. Now, we have a very serious problem because the situation has become so dire that we can see for ourselves that people will literally go blind because they fail to attend sight tests. Many eye diseases will go undetected. We already know that as much as 50% of glaucoma is currently undiagnosed, a figure we have been aware of for years.
A press release from the Association of Optometrists tells us that, in order to address this current problem, they have called for a 12.5% increase to the NHS voucher value in England. Will this resolve the crisis? As is pointed out in the press release, were this increase to happen it would equate to just £5 per voucher for most, ‘so patients in financial hardship and in most need can access proper eye care’. I must admit, I had to read the last bit twice. The plain truth is that there needs to be an urgent end to the cross-subsidy and no tinkering with NHS voucher values will address that.
Only by ending the cross-subsidy will we see what needs to happen; the overall cost of spectacles needs to fall radically. By the government paying an economically viable rate for the sight test, and also us charging a realistic private fee, thereby not forcing people to pay higher prices for spectacles, we may just be able to avert the looming eye healthcare crisis.
This coming year sees an opportunity for the professions within eye healthcare to launch a radical new approach to this and future governments. We must set about ending this cross-subsidy. We know it happens and the government knows it happens. It is wrong, cynical, and not in the patient’s best interests, but also now actively a cause for people to fall victim to preventable serious eye disease. This year must be radical for all of us. If not, then the message at the start of 2024 may well be even more dire than this one has been. The warnings are there for us all to see in the research that has been done. This year, we cannot and must not ignore those warning.