“At least policymakers are now convinced that optometry is going to be part of the solution”

No – building profile is only beneficial if it translates into impact, which in our case means putting optometry closer to the centre of healthcare provision. Sure, we have been successful in garnering a great deal more media coverage – our media mentions doubled in 2022, and more than doubled again last year. And we are getting a lot more political traction too: having not met a Minister for the first 18 months of my tenure as CEO, the last year has seen us having face-to-face encounters with no fewer than seven Ministers. But what does that add up to?

On one level, it could be argued, not very much. Perhaps the best example of contact failing to translate into influence is in this year’s general ophthalmic services (GOS) negotiations in England, where, yet again, optometry has been fobbed off with a low – no, make that insultingly low – annual uplift. Compare that to the pay increases for nurses and the offers made to junior doctors, and it is clear that, for all the warm Ministerial words about how optometry matters, we in England are still a long way short of exercising the political muscle of some of our healthcare peers (the position in the other parts of the UK may be slightly better, but this point remains true for them too).

It is clear that, for all the warm Ministerial words about how optometry matters, we in England are still a long way short of exercising the political muscle of some of our healthcare peers

I am not making excuses for the Government: the GOS fee uplift is an outrage and the logic behind it indefensible – measuring success in straight financial terms at this point in the political cycle is only going to produce one result. For various reasons, I have spent a fair bit of time recently in meetings with the Department of Health and Social Care (DHSC) and Treasury officials, and can vouch first-hand for the fact that, no matter how hard they plead, the NHS is not going to be given any big bailouts by government. “If you want more money for something, find it from within the budget we have already given you” is the message.

At a time when secondary care still has an effective hold on NHS thinking - it is not for nothing that The King’s Fund recently identified the failure to give parity of esteem to primary care as the biggest healthcare failing of the past 30 years – optometry is always going to be some way down the spending priority list.

The optometry solution

While our increased profile has not led directly to a better GOS settlement, there are signs that politicians and policymakers are taking notice of us in a way that they weren’t doing a few years ago. A year ago, the first round of our media campaign on hospital eye care waiting lists led directly to the then Health Minister, Neil O’Brien, asking the sector to develop a standard service specification for minor and urgent eye care for commissioners. And just last week, an AOP-led report on the patient backlog featured across the ITV news network and sparked another overture by ministers to discuss more ideas about how the sector could help. At the same time, we have had similar reach-outs from a Labour party preparing to be in power within a year.

None of this is concrete: in the chaos of an overloaded health system and with tension between DHSC and NHS England (NHSE) about how to tackle treatment backlogs, we cannot be sure that any of these ideas will bear fruit. But at least policymakers are now convinced that optometry is going to be part of the solution.

Whatever the strategic intent of the policymakers in Whitehall, much of the day-to-day power is wielded by local entities, particularly Integrated Care Boards (ICBs). Given the stranglehold that secondary care has on ICBs, getting attention – and funding – for primary care is not easy. Moreover, even where primary care does exert influence, the power of the GP sector is difficult to combat. It is not merely at the national level that optometry struggles; the local is also problematic. While the national settlements in Scotland and Wales have their problems too, they at least have only one set of decision-makers to deal with.

As a result, we increasingly find ourselves fighting unnecessary local fires lit by ICBs who do not understand the role of optometry in healthcare. For example, there is the ICB that has suddenly decided to decommission a successful CUES service in an area of huge need without having conducted any impact assessment or having any plans as to how the patients will now be managed. That is the challenge that is emerging.

As we edge towards the election, now is the time to build that influence... We are beginning to win the strategic battles at the centre; we now need to win the tactical ones locally”

Over the past year or two, the AOP has developed a well-oiled machine for influencing at national level. We are also building our capacity to support the sector in exerting influence in the other nations in the UK. But reaching into the local is much more difficult for us. On a national level, we can be effective. Locally, we don’t have the structures to do that.

Responding to the ICB challenge is not something that the AOP alone can do. These are local issues and, at the risk of sounding like Tubbs and Edward from the League of Gentlemen, they need local people to tackle them. This is where local optical committees are such an essential part of the optometry landscape. Influencing is not something just for the likes of me to do; it is everyone’s task.

As we edge towards the general election, now is the time to build that influence: an MP (or candidate) practice visit; a letter to the local paper or directly to the ICB; postings on key local social media – all make a real difference. We are beginning to win the strategic battles at the centre; we now need to win the tactical ones locally.