16 August 2023
Achieving change is a grindingly slow process. First, you have to convince people that there is a problem which needs solving; then that the problem is capable of a deliverable solution; next that it is worth committing the time or money to getting it sorted, and finally, you have to sit on top of the implementation to ensure that what is done will achieve the result you are aiming at. While the first of these steps is the easy bit (and elicits both gratifying levels of attention and a huge sense of moral righteousness), unless you do the other, harder steps of shaping the actual change you want to make, all your campaigning is preciously close to mere self-indulgence.
Although most of the time, you never actually get to the end of the process, when you do make a positive change, you really want to shout it from the rooftops. Yet sometimes that is not easy to do.
Take the fact that patients wanting a General Ophthalmic Services (GOS) sight test had to be able to provide an address to access the scheme. That requirement has, up to now, presented those without a stable home with an insuperable barrier to eye care services. Its withdrawal has been seen as an essential first step to increasing access for a uniquely excluded and disadvantaged group. And, given my background leading organisations such as Shelter, removing it was one of my personal priorities.
When I was working in homelessness, many people reported to me that their primary problem was not the rules but the attitude of those providing services
It was with real delight that I read a recent letter from a senior NHS official telling us that the NHS would be willing to accept the practice address, or a family or temporary address, as sufficient to satisfy them of eligibility. While this is not quite the removal of the requirement that we had been seeking, it provides an elegant way of enabling homeless people access to GOS services. It is a win worth celebrating.
What makes that tricky, though, is the fact that the letter stated that this did not constitute a change at all. Far from being a concession to the pressure that the AOP (and others) had been putting on them, using a proxy address was something which, the letter said, could always have been done. If we have been denying services to homeless people, it seems, the fault was ours.
Still, we have achieved what we set out to do. Lack of an address is no longer a barrier to access to GOS services. But, let’s be honest with ourselves, NHS policy is not the only obstacle to people accessing services. When I was working in homelessness, many people reported to me that their primary problem was not the rules but the attitude of those providing services. Optometrists – understandably enough – are keen to prioritise patients who have the capacity to earn them more than just a GOS sight test and voucher fee: homeless people are just one of a number of patients who struggle to get appointments with some providers.
If we are going to make progress, we have not merely to make demands of others, but challenge ourselves about what we need to do differently
There is a broader conversation to be had about how we can ensure that we make eye care services available to more people in our society. In this case, we don’t need to labour the problem part: pretty much everyone agrees on the objective. But constructing a solution is not easy: for all the talk about making eye care easier to access, the reform proposals in Wales, for example, risk doing the very opposite for poorer people, those with low vision, and people requiring domiciliary care. And if we are going to make progress, we have not merely to make demands of others, but challenge ourselves about what we need to do differently.
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