Ahead of this week’s Budget, MP Dominic Raab made a controversial statement that would affect both the older generation and high street optics.
‘From wider pensions reform to abolishing free bus passes and eye tests for the wealthy, the ground needs to be prepared for a more balanced approach that both reduces the burden on the taxpayer, and makes government spending fairer,’ he suggested.
The idea was floated along with other potential cost-saving reforms for the Chancellor, including for child benefit, public sector pay and holiday allowance and TV licences for the over 75s. Raab referenced reports showing the scope to overhaul ‘grey welfare’ where there were £31bn of savings to be made, he said.
His reference to free eye tests in the statement ‘With courage, Hammond could save billions’ resulted in a flurry of reactions within the optical profession.
Jonathan Lawson, CEO of Vision Express
Dominic Raab’s statement calling on the Chancellor to ‘end free eye tests for OAPs to save billions’ is both irresponsible and unqualified. Research highlights that 37% of people are put off having an eye test due to cost concern, despite more than 30 million people in the UK qualifying for free NHS eye tests.
Almost two million people are living with sight loss and forecasters predict a further half a million could lose their sight by 2020. Alarmingly, over 50% of sight loss is preventable, yet many people are not having their regular check-ups every two years.
As we age, we are more susceptible to age-related sight problems and eye health conditions so ensuring those entitled to their free eye test, have one, will not only help prevent potentially sight-threatening conditions, but ultimately reduce strain on the NHS.
A simple eye test can detect increased risk of stroke, high cholesterol and diabetes, as well as AMD, glaucoma, eye cancers and cataracts. If left untreated, these conditions could lead to major health concerns, blindness and even death.
The long-term cost of the over 65s not undergoing eye tests is in my view far greater than the short-term savings Dominic Raab is suggesting.
Jo Mullin, director of policy and strategy at the College of Optometrists
It is essential that the elderly continue to have access to free NHS sight tests. Senior citizens are more prone to eye disorders such as cataracts, AMD and glaucoma and early detection ensures that sight loss is not an inevitable consequence of ageing. Unnecessary sight loss can result in people experiencing mobility problems, social isolation, a higher risk of falls and subsequent hospitalisation, and, as the social care cost of supporting those with visual impairment is significant, it makes economic sense to prevent unnecessary sight loss. Sight tests are also very important for older people to be able to retain their independence through driving, and for the good of road and wider public safety, it is imperative this group be encouraged to have regular sight tests.
Prevention as well as treatment is key – not only in ensuring quality of life but in safeguarding precious resources. For example, the College’s Falls report found that undetected and untreated visual impairment plays a significant role in the high incidence of falls among older people and, across the UK, falls are the most common cause of hospitalisation for people aged over 65, and of accidental death in those aged over 75.
Rather than saving money, any decision to restrict sight tests could result in a significant increase in social care costs. Comments such as those made by Dominic Raab send the wrong message to the elderly by suggesting that eye tests are not worth investing in for the government and the NHS.
Vivian Bush, optometrist at Hull-based Bush the Opticians
The elderly are an at-risk group for a range of sight threatening conditions which can be prevented, arrested or managed.
However, the NHS sight test is far from an ideal model for eye care. The fee simply does not allow for the level of clinical depth required. This can lead to overburdening of the secondary care sector and a significant cost to the NHS. It has already been shown that properly funded optometry-led, community-based care can work efficiently to look after patients promptly and economically.
Yes, some patients would pay, because although they resent such costs when they have paid taxes all their lives, they will regard their sight as a priority. Others will not, because they do not have the money. After all, means testing will always leave some people disadvantaged and they may be very deserving.
The NHS eye test fee is pitiful but we are stuck with it. One would have to be very brave in most practices to refuse to provide NHS sight testing, and it constitutes part of the typical business model.
Peter Warren, chairman of the AIO
I find it strange that Mr Raab would pick out eye tests from the wide range of NHS services that are universally made available free to citizens of this country as something to abolish for ‘the wealthy’.
If it is his view that we should move to a ‘user pays’ model for access to health services for wealthy people, why does he not extend his thinking to hip and knee replacements, or dentistry or any other NHS discipline for that matter.
Perhaps what Mr Raab is demonstrating is the ignorance prevalent among our politicians, which sadly includes the Ministry of Health, about the importance of eye examinations not only in reducing sight loss and blindness, but also as a way of contributing more widely to general good health.
If politicians focused more on how to reduce the £11bn annual cost to the economy of sight loss and blindness, they may come to an entirely different conclusion about proper NHS resourcing of in depth eye examinations for everyone – regardless of their wealth.
Peter Black, dispensing optician and advisor to the board of ABDO
When we are talking about the over 60s, the work of community opticians is a vital, and good value, primary health care service not simply a welfare benefit. Sight-threatening eye conditions rise exponentially in the population over 60, and some diseases, such as glaucoma, exhibit no symptoms until sight has been permanently lost. Preventable and treatable conditions, if not diagnosed through the opportunistic case finding service afforded by regular NHS tests, can result in the premature loss of a driving licence, loss of independence and increasing dependence on others, including the welfare system.
The entire GOS budget is around £500m, around £8 for every man, woman and child in the UK. Means testing would allow all those that get free glasses to continue to do so since vouchers are only issued to those without the means to pay themselves. In my experience the savings made would be outweighed by the costs of means-testing and the cost of increased sight loss as people put off getting their important eye health examination. The cost of sight loss is put at tens of billions of pounds, so perhaps Mr Raab should book a sight test, as he is certainly showing signs of myopia.
His local optometrist will probably tell him that the real way to save money is to end the unfair postcode lottery in eye health commissioning that so frustrates voters. Stop the pointless negotiation of thousands of contracts with CCGs across England. Instead learn from Wales and Scotland, roll up all services within one new nationwide contract, and watch our sector deliver incredible value for money and incredible patient care.