Northern Ireland GOS data confirms drop in vulnerable patients receiving sight tests

New data shows that the number of benefit recipients accessing free eye care in Northern Ireland has plummeted following the removal of automatic access in 2017.

The latest General Ophthalmic Services (GOS) statistics for Northern Ireland confirm anecdotal reports that the requirement to fill out the HC1 form in order to access eye care has been a significant deterrent to the uptake of sight tests by people on benefits.

Between 2017–2018 and 2023–2024, the number of people on legacy benefits who accessed free sight tests dropped by 32,676.

After accounting for an increase in the number of people who applied for help with healthcare costs, there remains a shortfall of 23,910 patients.

Optometry Northern Ireland chair, Jill Campbell, shared her concern that there will be a proportion of patients not accessing care who have undiagnosed pathology.

“It’s worrying and unacceptable that we are still not providing access to care for our most vulnerable patients,” she said.

The situation has arisen because legislation that was passed in the other three nations of the UK to enable automatic entitlement on Universal Credit was stymied by the collapse of Stormont. Despite the resumption of Stormont in February this year, legislation has not yet been passed that would reinstate automatic access to free eye care and dental care for Universal Credit recipients.

“We need to see the Government act now to implement policy change to enable equitable access to care,” Campbell emphasised.

“No patient should be in a position where they have avoidable sight loss,” she said.

The latest GOS data also illustrates a 16% decrease in the number of patients accessing vouchers for help towards the cost of glasses and contact lenses between 2016–2017 and 2023–2024.

It’s worrying and unacceptable that we are still not providing access to care for our most vulnerable patients

Laura Cummings, PR and communications manager with RNIB in Northern Ireland, highlighted that the healthcare inequality resulting from the move to Universal Credit in Northern Ireland has been a major campaigning focus for RNIB in recent years.

“The removal of the automatic right for claimants to avail of free eye tests, unlike [for] claimants in Great Britain, is unfair and leaves NI claimants at a distinct disadvantage compared to those in England, Scotland, and Wales,” she emphasised.

Cummings shared that half of sight loss is avoidable.

“The current situation puts people in NI at a significant disadvantage, and at greater risk of missing the early signs of a problem with their sight, and other health issues that an eye test can pick up on,” she said.

RNIB is working with NI optometry colleagues, the Stormont All Party Group on Visual Impairment and the Department of Health. The group have brought the issue to the attention of Health Minister for Northern Ireland, Mike Nesbitt.

“We await his response. At RNIB, we’re determined to eliminate this disparity created by the migration to Universal Credit. We will work tirelessly to rectify this situation on behalf of those affected. It is simply intolerable that a move to Universal Credit means that citizens here Northern Ireland are left at a health disadvantage, compared to those living in England, Scotland and Wales,” Cummings emphasised.

Optometrist, Sam Baird, who owns practices in Lisburn, Dromore, Belfast, Glengormley and Dundonald, shared that his staff have patients come into the practice every other day who are unaware of the need to fill in a form to access care.

“There is a workaround, but the workaround isn’t working,” he said.

“The figures show that fewer sight tests and vouchers are being taken up,” Baird shared.

He highlighted that as an optometrist he sees the value that people get out of vision correction – and the disadvantage they experience when this care is not accessible.

“Many people cannot function without their glasses. They cannot work, they cannot drive,” he said.

“You see people suffering in a way that their contemporaries in England, Scotland and Wales are not suffering,” Baird emphasised.

He urged the Government to take action on the issue as a priority.

“The fact that that bureaucratic oversight has not been corrected is beyond explanation,” he said.

Dispensing optician and past chair of Optometry Northern Ireland, William Stockdale, highlighted that the requirement to fill out an HC1 form causes delays, adds cost and “is a deterrent to many.”“There are some people with special needs who are not in a position to complete this reasonably complicated form and so cannot access eye care,” he highlighted.

“The question everyone has is: ‘why has this not been sorted out?’ Is the Minister for Health Mike Nesbitt aware of the situation, and if he is what is his timeframe for restoring parity?” Stockdale emphasised.

The fact that this problem simply doesn’t exist in the rest of the UK is insult to injury

Past OT coverage has outlined how the Department of Communities spent £28,092 printing the HC1 form in 2023, with the average annual printing cost doubling after the removal of automatic access to free eye tests and dental care for Universal Credit recipients in 2017.

OT has also revealed that a patient on Universal Credit was among 24 cases taken to court as part of efforts to recover eye care and dental costs by the Business Services Organisation.

A spokesperson for the Department of Health acknowledged that the requirement to complete an HC1 form to access free sight tests and dental treatment “has obvious implications for some of our most vulnerable people.”

“It is clear that there is an urgent need to update our legislation to reinstate automatic passporting to those who are eligible,” the spokesperson said.

The spokesperson highlighted that preparatory work is being undertaken in advance of updating the Travelling Expenses and Remission of Charges Regulations (Northern Ireland) 2004.

“The focus of this work is to reinstate automatic passporting for those eligible to receive free sight tests and free Health Service dental treatment,” they shared.

The Department of Health is currently in talks with other Northern Ireland departments and colleagues in Great Britain to gather information around setting the income threshold for Universal Credit becoming an automated passport benefit.

“A short public consultation will be conducted in the coming months on proposed changes to our legislation in relation to Universal Credit, with the associated legislative process commencing in due course thereafter,” the Department of Health spokesperson concluded.

Clinical and policy director at the AOP, Dr Peter Hampson, said: “It’s unfathomable that this continues to be an issue that is not addressed. It’s a very worrying situation when vulnerable people, those that are already experiencing hardship, are excluded from accessing NHS healthcare. Vital healthcare that in a practical sense enables them to continue working, driving, caring for loved ones but in the long term, the impact is potentially catastrophic with sight threatening pathology simply not picked up for some until it is too late,” he said

“The fact that this problem simply doesn’t exist in the rest of the UK is insult to injury with some of the most vulnerable people in Northern Ireland facing a huge health disparity that is both unjust and avoidable. Now with process underway to enable automatic entitlement, we hope to see the Department of Health taking swift action to resolve this as quickly as possible – something we have not seen to date,” Hampson emphasised.