Will the abolition of NHS England herald a new age for optometric NHS services, or will we continue to see the same old problems recurring? Much as I would like to think we may be witnessing the dawn of a new era, I fear this is a false hope.
In large part, the problems for patients on a day-to-day basis have little to do with the manifest incompetencies we have known about for so long in NHS England.
Rather they lie at a more local level with integrated care boards and the total inability of service commissioners to see the benefits that optometry has to offer to their populations.
I say this on the back of the news from Hampshire that, far from commissioning new novel services for the benefit of local patients, its intention is to decommission existing cataract and enhanced triage contracts on March 31, 2025.
This sort of measure can only be viewed as a serious retrograde step in providing sight-saving care to a local community in the face of existing eye care services struggling to cope. The fact that these sorts of services are highly valued by patients and have been shown to run exceedingly well seems to be ignored by this merry band of people.
There can be little doubt that these health commissioners may have played a central part in some of their local population, to put it bluntly, going blind. Is this what health service commissioners are meant to do?
I do not profess to understand how such a crass decision has come about, but I sincerely hope they are held to account over the coming months and years and that those people who will inevitably go blind as a result of these actions take the appropriate restitutional action. Why, however, do commissioners do these things?
Just recently, I have personally experienced two incidences that show the ridiculous way that eye care services are structured. The first concerns my mother-in-law. Now, my mother-in-law defies all mother-in-law jokes known to us. She is just the best you could ever wish for and, as such, in my opinion, deserves the best when it comes to any of her needs.
She had two very good cataract operations but complained of subsequent clouding of her vision a few months later. As suspected, this was due to secondary capsular thickening. As we all know, sorting this out is a simple procedure that quite a number of optometrists are now capable of carrying out.
A quick trawl through the internet confirms that many of the private clinics will carry out this procedure on the same day as the patient attends as it is so straightforward. However, my mother-in-law was seen in an NHS clinic.
The first visit, some weeks after the initial referral, had her seen by a consultant who told her that her vision was blurred because she had secondary capsular thickening and they needed to make her an appointment to have this seen to.
A week or so later, the appointment arrived by post for the procedure to take place a few weeks later. The whole process was slow, long-winded and unnecessary. This could all have been done in one visit. Why is this sort of wasteful process not being called out?
The second event concerned a patient aged 94. He reported that he had developed sudden onset torsional diplopia and was told to ring the local triage service. He was diagnosed by them as having wet age-related macular degeneration (AMD) and was referred for injections.
On the day, he was told he did not have wet AMD but needed to be seen in the adult motility clinic for investigation of the diplopia. This could not happen on that same day as it was a different clinic and so he would be sent an appointment in due course.
Given that this sort of symptom can be associated with a neurovascular incident such as a transient ischaemic attack, one would have thought that some sort of urgency would be associated with the case. However, a week later, he had still heard nothing.
These incidents are just two examples of shoddy commissioning of eye care services. Some of this commissioning is, at best, totally unacceptable and, at worst, potentially life threatening.
I have heard it argued that it is necessary to be thorough and practice due diligence to protect patients. However, in so many cases this line of thinking may actually harm, or even kill, patients. How can that possibly be ‘protecting patients’?
With the demise of NHS England, we have an opportunity to change age-old inefficient and dangerous practices. Commissioners need to wake up and do their jobs properly. They need to commission the modern safe services that optometry can, and so often does, very successfully provide.
That way, we can begin to address the current problems within the eye care sector. We must hold these local commissioners to account for the sake of our patients.
