Moneo: Thankless tasks
It is rare that I return to a previous column I have written and continue to comment, but I feel I cannot let recent events go by without engagement. I ended my March column of this year by suggesting that if the NHS was serious about engaging properly with optometry to deliver new eye care services, it should deliver a realistic sight test fee increase to indicate its willingness to engage. However, the announcement that this year would see only a paltry 2% increase signals that there is no serious intention there. Worse still, in his speech on March 8 to the Royal College of Physicians, Health and Social Care Secretary Sajid Javid laid out his views for healthcare reform. There were some grand statements including why the NHS should focus on illness and disease prevention.
These are things that, to him, seem like grand ideas but, are already well established parts of our work. The lowest moment of his speech came when he stated ‘every part of the NHS has to play its role’ and then went on to say ‘...as we look at every part of the NHS, naturally we must look to primary care where the bulk of prevention already happens. Primary care and all of our GPs, pharmacists and dentists must be at the heart of this new agenda on prevention.’
This is perhaps the biggest snub of our profession that any Health Secretary has chosen to do since the inception of the NHS. This was an important speech. It will have been written and rewritten many times. It will have been scrutinised for major and minor errors or omissions. Why then has he chosen to ignore the contribution optometry makes to primary care? This omission will have been deliberate; there can be no other reason. He is either not aware that optometry exists, and if that is the case his position as Health Secretary needs to be seriously questioned, or he has chosen deliberately to ignore our contributions. Either reason is disgraceful.
When Covid hit and hospital outpatient departments effectively closed, optometry stepped forward and filled the gap that opened. Thousands of optometrists put themselves on the front line with all the inherent risks of infection in order to protect and save the sight of those who would normally have sought hospital care. What thanks did we get from Sajid Javid? None. What we have got is the biggest snub that he could have delivered accompanied by an insulting pay offer for the coming year that will solve nothing when it comes to keeping practices viable.
How long are we going to keep accepting this situation? From his speech it is patently clear that he is never going to recognise this profession and what we bring to the table, despite us already delivering on an agenda that he trumpets as his great new vision. Our professional bodies are so keen to sign us up to Optometry First when it is clear the NHS and the Health Secretary have adopted a stance of optometry last (if at all). The Association of Optometrists tells us that NHS England and NHS Improvement National Eye Care Recovery and Transformation Programme has published guidance recommending that commissioners should better use of expertise in primary eye care. Well, they would wouldn’t they?
We should avoid having absolutely anything to do with this right now as they have provided no formal recognition of appropriate core funding. It is clear from the stance that the Health Secretary chose to take in his speech that the chances of realistic funding for any new programme is just pie in the sky. However, as usual we will be expected to deliver this service for pretty much nothing, and what we do get offered will rarely be paid on time. Before putting out statements welcoming these new initiatives our professional bodies should be making it blatantly clear that we will not permit any involvement without firm commitments on realistic funding. If we sign up to this new world without those commitments, we will live to regret the decision for years to come. These professional bodies are the same ones that tell us our standing within the NHS is greater than it ever has been, so great that we don’t even warrant recognition of our role within the NHS from the Health Secretary himself.
Never has it been more important to make our views known – both to our professional bodies and to the NHS – than now. We must not agree to any new services until our role is formally recognised and an apology by the Health Secretary for his snub of our profession is forthcoming. We must not pander to the whims of our professional bodies. We have an opportunity to be recognised properly for the first time by the NHS and if we do not take it then I suggest that this could be one of the biggest mistakes made in the history of optometry.