Our new government is going to save the NHS – again! Okay, so that is where the sarcasm and cynicism will end, hopefully. We all have our own views of the state of the NHS and, no doubt, we have our own views on how we have been treated historically by previous governments.
Today, I would like to approach this latest shuffling of the deck with an element of realism. However, it is not going to be easy. The noises we have heard to date about future provision of eye care services may sound optimistic to some but maybe it is an opportune time, at the start of this process, for a bit of a reality check.
There is no doubt the big hitters will make their voices heard loud and clear. That is already obvious. Most of the healthcare professions have very active trade unions: the British Medical Association for doctors, the Royal College of Nursing for nurses, the Chartered Society of Physiotherapy for physiotherapists, the Pharmacists’ Defence Association for pharmacists, to name just a few.
These trade unions have already made their positions and views about the future of the NHS very clear in national media and social media. Our trade union, as far as I know, has said nothing.
At least I can’t find anywhere it has said anything. What trade union? I hear you say. Well, our union is Prospect – Ophthalmic Branch. Of course, we have much better-known bodies, such as the Association of Optometrists, who have done exceedingly well in raising the profile of optometry, and for that they are to be congratulated.
But I did say, at the outset, what was really needed early on in this process is a reality check. Just what do you, as a front-facing optometrist, want for the future of your profession?
Recently, when talking to a group of optometrists about what they see their role as in 10 years – 10 years because that is the length of time the government has placed on this latest NHS review. I started by asking what they do as optometrists – the response was similar to one I would have expected a decade ago.
Most saw their role as performing refraction, looking for and ‘diagnosing’ eye diseases, treating dry eyes and myopia and referring to a doctor when necessary. This is somewhat depressing given the massive strides that have been made by many to achieve higher qualifications to allow them to treat and monitor certain conditions among a host of other new abilities.
Given that so many seem to have a very limited view of their potential scope of practice, I wondered whether they had considered what they might be capable of doing in years to come. This was a little more optimistic, but I was struck by just how ‘eye-based’ their view seemed to be.
When I introduced the concept of general health monitoring and systemic disease case finding and management as part of their everyday function, most just looked blank and came up with the line that they were not taught this at university. They seemed to have no concept of broadening their healthcare base to take in the wider determinants of health.
With a government wedded to the concept of wellness and disease prevention rather than cure, surely this should be at the core of our thinking. As optometrists, we are probably the best placed of the clinician entourage to intervene with patients at risk of many potentially fatal diseases.
As design would have it, many people who consider themselves to be very healthy will visit an optometrist at some stage in their forties as they begin to have near vision problems. The optometrist may well be the first medical-based person they have seen in decades. We, and our staff in our practices, are the ones who should be carrying out those standard health checks the government says it wants to see done.
I accept this doesn’t require a cover test or a motility test or a need to see letters clearly, but is that really all we should be doing as we go forward? Optometry is uniquely placed to see otherwise healthy individuals. We are trained to work across many areas of general health, such as hypertension, diabetes, arteriosclerosis, smoking cessation as well as areas like lifelong metabolic monitoring. No one else is as well placed as us. But somehow, we just do not seem to want to routinely take this on board.
As the NHS debate develops, we need to have a debate about what our true capabilities are, where we fit in the overall picture of disease prevention and our ability to prolong a healthy lifestyle. Probably more importantly, we need to decide whether we all actually want to get involved in such a major reform.
Once we know where we as optometrists want to be in five or 10 years, and not just where our professional body leaders think we want to be, we can join the table and truly make our voice heard as one loud voice.
