“The S in NHS stands for 'service'”

Perhaps she had been softer before, but she absolutely hated being old. “I can’t taste my food now,” she used to say. “I can’t hear properly. I can’t bend to garden. No man will look at me. What is there left to enjoy?”

But she could still read. As a former journalist, her life revolved around the written word. If she had to choose one sense to retain, it would have been her eyesight. And although she had to have her cataracts removed, her sight never left her.

However, she was one of the lucky ones. As this edition of OT discusses, older people are increasingly likely to suffer sight issues: cataracts, glaucoma or entire vision loss.  Not only do these conditions rob them of some of their most valued pleasures, they expose them to a vastly increased risk from slips and trips. 

Furthermore, as the AOP’s recent work on vision and driving has emphasised, it also means that they themselves pose a vastly increased risk to other people when they get behind the wheel of a car – a brutal truth brought home to me personally via my involvement as an expert witness at a coroner’s inquest on the deaths of three individuals killed by drivers who had, it seems, been warned that they should not be on the road. Just after this edition comes out, I will be in Preston at one hearing, doubtless alongside the relatives of the deceased. No matter that we have been pushing for change on this issue for years, that is not an experience I am looking forward to.

For my grandmother, who provided her care before or after her cataract surgery would have been a matter of sublime unconcern. But where that care was provided would have mattered considerably

Given the ageing profile of the UK population, policy makers need to be planning a response to the growing issue of elderly eye care. In Scotland and Wales, there are signs that this is happening, and officials in Northern Ireland are also considering what needs to be done.

In England, however, the eternal internal battles of the NHS are making any progress difficult to discern. On the one hand, you have Ministers welcoming the recent report by PA Consulting for the AOP showing that cataract and glaucoma services delivered by High Street optometry brings big benefits. On the other, you have a push from ophthalmology in England to have such support only delivered under its supervision – in other words, either in a hospital setting or in one of the new network of hubs that hospitals are increasingly moving to develop in an effort to circumvent the recommendation of the Darzi report that money should be moved from hospitals to community providers.  

For my grandmother, who provided her care before or after her cataract surgery would have been a matter of sublime unconcern. But where that care was provided would have mattered considerably. I remember being there a year or so before she died when the village doctor had the temerity to refer her for a second opinion to a hospital 15 miles away. Her response was blistering: “Why the hell can’t you deal with me?  If you think at my age I’m going to be catching two buses simply to talk to another doctor, you’ve got another thing coming.”  

In a world where High Street optometry has all the skills and equipment to provide most of what elderly people need from their eye care, why are we still requiring people with poor mobility, limited resources and questionable eyesight to travel long distances to be seen by the NHS?

Explaining to her that the village opticians wasn’t allowed to check her eyes to confirm that all was still ok after her surgery would not have gone down well either. And, in my part of rural Kent, it would have involved a lot more than just two buses to get her to an ophthalmology department.

As I say, she was irascible. But she also spoke the truth. In a world where High Street optometry has all the skills and equipment to provide most of what elderly people need from their eye care, why are we still requiring people with poor mobility, limited resources and questionable eyesight to travel long distances to be seen by the NHS?  The S in NHS stands for “service.”  In the case of older people’s eye care, my grandmother would have said, we are expecting the patients to service the system rather than the system to service the patients. Only if she had said it, there would have been a few swearwords in there too…