Adam Sampson: “A solution without a problem is no solution at all”

If you’re lucky, you’ll solve one or two of these challenges quickly enough to begin building a reputation as an effective leader. But the reality is that many of the issues you inherit have persisted not because they were ignored, but because they are difficult to solve. And, of course, the problems you’ve created yourself are rarely the ones you’ll want to shout from the rooftops.

Given this, it is understandable that some leaders lean into the old mantra that is sometimes attributed to Margaret Thatcher: “Don’t bring me problems; bring me solutions.” As usual with these things, the citation has been long debunked. Politicians, we are told, are always looking for good ideas that can be quickly implemented as evidence that the Government is making a difference in people’s lives.

One criticism I hear of Keir Starmer in his role as Prime Minister is that he refused to engage with difficult problems, preferring instead the lure of easy solutions neatly packaged up for media release.

In that context, the sorts of case examples contained in this edition of OT should be catnip to ministers in the new Burnham team looking for ways of moving healthcare from overcrowded, expensive hospital settings into the community. Making more considered use of optometrists’ skills in glaucoma detection and management, for example, is but one such policy that should go down well.

No matter how compelling your solution, no one in power is ever going to be interested in it unless it helps them solve a problem they understand and are worried about

For more than a year, the AOP has been making the case to politicians in Westminster and beyond for the rollout of a comprehensive package of community eye care services across England and Northern Ireland respectively. Building on the success of Scotland and Wales, this would include minor eye conditions services, community urgent care services, cataract care, glaucoma management and optical coherence tomography scans, enabling more patients to access timely care closer to home while making better use of optometrists' expertise. And there are encouraging signs that the message is landing and that politicians from all parties are becoming increasingly aware of the potential of using eye care as proof of the principles set out in the 10-Year Health Plan.

So why hasn’t it happened already? Some of that is down to money. Although the longer-term financial advantages of moving eye care from hospitals into the community are well-established, the savings that would be realised would take some time to come through, and additional funding is required for the inevitable period of double-running. There are, in part too, other interests at play – most notably pressure from secondary care that has a strong grip on NHS policy-making.

But there is a harder truth here too. No matter how compelling your solution, no one in power is ever going to be interested in it unless it helps them solve a problem they understand and are worried about. As I said at the start, part of the experience of power – at whatever level – is that your inbox is full of problems. That is what obsesses you; that is what keeps you awake at night. You have no time for, or interest in, people offering you solutions to things you don’t know or care about. A solution without a problem is no solution at all.

In optometry, as the recent Mintel report made clear, the underlying strength of the sector continues unthreatened

For optometry, that creates a real problem. Ministers know all too well the crisis in dentistry, and the British Medical Association is doing a very good job in evidencing the continuing travails of the GP sector. Community pharmacy too is showing signs of strain, with profits declining and pharmacies shutting. However, in optometry, as the recent Mintel report made clear, the underlying strength of the sector continues unthreatened. Yes, for small optometry practices the economics of the sector are increasingly tricky. But overall, there is no optometry crisis.

What we can point to, though, is the continuing pressure on eye care in other parts of the NHS. For some time, we have been raising the fact that ophthalmology waiting lists are proving stubbornly high. By the time this piece appears, we will have published some new research on the pressures on A&E departments to deal with patients with eye care problems who could and should have been dealt with in community optometry. And we are also working with the Royal College of General Practitioners to evidence the pressure on GPs from people with eye problems.

The success stories in this edition matter because they show that a better model of care is already within reach. However, for ministers to listen, optometry also needs to share stories of where the current system has failed patients. We need the evidence of what works, and the evidence of what happens when optometry-led services are not available. One gives ministers a solution; the other gives them a reason to act now.