“Everyone knows the rules of the game”

At times like this, when we are nearing, not merely an election, but one that – if the polls are right – will see a seismic shift in the political landscape, things get very interesting. On the plus side, access suddenly becomes much easier as ministers, more focused on the necessity of getting re-elected than on the act of governing, seek routes to engage with the very organisations they have spent the previous few years desperately keeping at arm’s length. On the minus side, those meetings become less and less useful as the election date approaches, with little chance of any actual follow-up action being taken. We have been seeing that pattern play out in optometry over the past few months. 

“In the past six months, I or other AOP team members have had half a dozen ministerial encounters – and not just junior ministers, but time with both the Health Secretary and the Chancellor.

For my first year or so at the AOP, there was little or no contact with any of the ministerial team. The following year, we managed to get in front of ministers on three occasions. Yet in the past six months, I or other AOP team members have had half a dozen ministerial encounters – and not just junior ministers, but time with both the Health Secretary and the Chancellor. Using access as a metric, we have had a very good few months. 

But while it is nice to be able to report that you have met such and such, that is not the metric that matters. It is action that matters, not access. In the final months of an administration, Ministerial power ebbs quickly. While they can, they will increasingly wish to be seen doing and announcing new, popular initiatives. But unless those promises can be delivered on quickly, they are more likely to be soundbites than realities. And with officials increasingly aware that their political masters may not be long in post, even decisions that have been taken are increasingly at risk of being kicked into the long grass. 

For example, the extended services eye care pathway, specifically requested by the (then) minister last year, has, despite the official endorsement of the Clinical Council (whose members include both Colleges and the NHS clinical director), now been pulled back into a further NHSE endorsement process that will delay its formal adoption by months, raising questions about whether it will be quietly shelved entirely as ministerial authority wanes. 

At the same time as access to ministers becomes easier, access to the potential ministers-in-waiting (again, if the polls are to be believed) becomes more difficult. One of my overwhelming memories of last October’s party conferences was the comparison between how current ministers moved around the conference set-up compared with their Labour counterparts: the former wandering – often unaccompanied – at a leisurely pace through the crowds; the latter being rushed from fringe to fringe, protected from the likes of me by a phalanx of advisers.  We may have got to the current Health Secretary in the past few weeks, but we have yet to get through to her shadow. 

It is not just access that changes. It is also what you talk about when you do get access. The short-term, tactical asks (extended services, email connectivity, extended prescribing powers) go back into your pocket. Replacing them are the longer-term, visionary ideas, the sort of changes that will take years rather than months to implement and which, you hope, help to shape the overall approach of the new administration. Full IT integration and data sharing, modernised regulation including a move from individual to business regulation, moving resources from a bloated, creaking secondary care system into a properly joined-up, confident primary care system; a full review of the clinical commissioning model for eye care services in England, learning from what has worked (and not worked) in Scotland – these are the sorts of conversations we need to be having.   

And having them we are. Let’s just hope that the people we are talking to are actually the ones who will be in place to implement them over the next five years…