Adam Sampson: “There is a time when you have to stand your ground”

In a far less salubrious place, just down the hill from Winchester station, lies the last known site of the bones of another King. A man with a far stronger claim both to the title ‘King of England’ and the sobriquet ‘the Great’, King Cnut ruled the whole of England from c.1016 to 1035.

In contrast to Alfred, Cnut, or Canute as he was also known, suffered from two enduring PR disadvantages: first, being an immigrant, originating from Denmark; and second, his historical reputation was overshadowed by the misleading story that he attempted to demonstrate his royal omnipotence by commanding the tide to halt.

In truth, the story of Canute and the tide was originally told not to emphasise his arrogance, but his humility. His purpose in going to the beach was not to show his courtiers how powerful he was, but to teach them the limits of power. No ruler – no one at all – can hold back the tide of history. You can fight against forces you can overcome. If you can’t overcome them, you have to recognise that and concentrate on trying to forge an accommodation with them.

This is a lesson that we in optometry could do well to heed. There is no question that we are facing multiple pressures at the moment. We have a government in flux, with Ministers promising healthcare transformation, but providing neither the funding nor detailed leadership to deliver it. We have commercial pressures, with the economy uncertain and customer (and patient) behaviour volatile. And we have technological transformation, with the pace of IT integration and artificial intelligence rollout increasing exponentially.

There is no question that we are facing multiple pressures at the moment

The question is: which changes should we embrace, which should we fight off, and which should we negotiate with? It is not always easy to decide.

Take IT connectivity, for example. Last month, the Government announced its planned roll-out of a national Electronic Referral Service (ERS), enabling optometrists in the community to refer patients into NHS hospital eye services.

On the one hand, improved IT connectivity in eye care is something for which we have all been campaigning for years. On the other, the design of the new service seems to be focused on the needs of secondary care, and there is no money to pay practices for the administrative and time burden using this service will create. Nevertheless, in various parts of England, Integrated Care Boards are already pressurising practices to sign up.

How should we react? Canute-like refusal to engage would be futile: not only is connectivity something which the sector has long sought but the tide of technological advancement is irresistible.

The AOP is working together with all the other sector bodies to push back, and demand both involvement in the detailed design of the new service and proper discussions about how the cost burden will be met

However, merely rolling over and implementing ERS in eye care, with its flaws and its cost burden, would be equally foolish. That’s why the AOP is working together with all the other sector bodies to push back, and demand both involvement in the detailed design of the new service and proper discussions about how the cost burden will be met.

Unlike our colleagues in other professions, in optometry we do not have a track-record of being difficult to work with. It is fair to say that the response on the part of officials to our refusal to merely accept the ERS rollout has not been entirely welcoming. But being effective is not the same as being a push-over. Canute’s predecessor on the English throne was a man called Aethelred, better known as Aethelred the Unready, whose policy towards the previous King and his fellow Viking raiders was one of continuous appeasement, paying huge sums of money to bribe them to leave him in peace. That worked for a while. But eventually, there comes a time when you have to stand your ground.