“The only way to achieve real reform in healthcare is to shift the balance from hospital to the community”

The other day, I came across a scientific article seeking to explain why time seems to speed up as you get older. The answer, it appears, is that our perception of time is subjective and linked to the extent to which we are having to process new information.

The more processing a person has to do, the slower time seems to go. As children, the paper shared, we have lots of new experiences and therefore do lots of processing. But, as we age, we are less exposed to new situations and information, and our perception of time passing is less defined.

Paradoxically, however, when you are highly absorbed in a task you process less information than when you are less focused on a single task, so time appears to pass more slowly when your mind is free to wander. So, it turns out that Dunbar in Catch 22 was onto something, and the more bored you are, the slower time appears to go (and as Dunbar argued, the longer your life therefore appears to be).

Fortunately for those of us involved in health policy, the next year is likely to bring a host of new developments and expose us to a heap of new information – although to balance that, opportunities for being ‘bored’ are also likely to be rarer.

While the initial consultation for the Government’s June 10-Year Health Plan has now closed, the coming months will see a programme of face-to-face events designed to explore different areas of potential improvement to how the NHS works. Whatever plan is produced is likely to be subject to further refinement and detailed development in the following months (and years) after publication.

Fortunately for those of us involved in health policy, the next year is likely to bring a host of new developments and expose us to a heap of new information

At the same time, we (the AOP) will be ramping up our own policy and research output to help inform decision-making. For example, we are currently completing some further internal modelling work on the cost-benefit of providing eye care via High Street optometry compared to via hospital-led services. This will supplement the fantastic (and immensely influential) economic modelling report that we co-commissioned PA Consulting to produce last year – work that demonstrated the benefits to be had by diverting more clinical eye care from hospital into the community.

It is not just the research findings that will be vital. Part of what will be played out over the next year or more is the political battle between a secondary care-dominated NHS England and officials in the Department of Health and Social Care who recognise that the only way to achieve real reform in healthcare is to do what Darzi suggested: shift the balance from hospital to the community. But what will be at stake here is very real. Darzi was unequivocal in demanding that it was not just work which needed to move – it's money too. The historical (and growing) underspend on community provision needs to be reversed, and the priority set for new spending that shifts from propping up (and expanding) the hospital estate – and doctors’ pay – to building capacity in community health providers.

Read more

AOP publishes response to Government’s 10-Year Health Plan consultation

The association has submitted its full response to the consultation, outlining a growing need to transform eye care for patients in England

What has been accepted by the NHS as correct in principle will be very difficult to achieve in practice. And in eye care, it will be particularly controversial. It is becoming increasingly clear that the vision for what an increase in community eye care means in the minds of some key ophthalmologists is an eye care system where all decisions rest in the hands of ophthalmologists themselves, and any community-based clinical care is provided by staff working in eye care hubs set up and overseen by hospitals.

The role of High Street optometry in this model is likely to be strictly limited to the initial identification of clinical problems and – perhaps – the provision of limited clinical interventions, but only where access to an eye care hub is difficult and always under the – virtual – supervision of an ophthalmologist. In short, rather than Darzi leading to a rebalancing of eye care towards primary care optometry, that plan would see a wholesale takeover of primary care optometry by secondary care ophthalmology.

To be clear, such a vision is still only something that is merely muttered about in some senior NHS rooms and has certainly not been adopted as official healthcare policy. However, it – or something like it – could come to pass. Our role over the next year or more is not merely to resist such notions, but to develop and vigorously champion our own vision of post-Darzi eye care.

Our role over the next year or more then is not merely to resist such notions, but to develop and vigorously champion our own vision of post-Darzi eye care

I have been a policy influencer for many decades now and in many different sectors, and if there is one thing I have learned about effective lobbying it is this: lobbying against other people’s plans is easy and can produce short-term wins. But merely resisting change is ultimately doomed to failure. If you want to lobby, you have to have something to lobby for – some better, more compelling vision of the future which you can use to surface the flaws of the policy you are criticising.

There is work to be done over the next months and years. Difficult – yes. Demanding – absolutely. But necessary. The next year will undoubtedly be an interesting one. And a year filled with the sort of activity which, in a very real sense, makes you feel alive.

At the end of 2024, OT asked eye health experts about the major events to watch out for in eye and healthcare policy in 2025. Read more.