“There is a gross inequality”
Around 70,000 people on benefits are set to lose automatic entitlement to free eye care and dental care in Northern Ireland
08 November 2023
A legal technicality has meant that people receiving Universal Credit in Northern Ireland are no longer automatically eligible for General Ophthalmic Services (GOS) sight tests and vouchers.
The Belfast Telegraph estimates that there are already 150,000 people in Northern Ireland who have already lost automatic entitlement after being transferred from a host of legacy benefits on to Universal Credit.
In October, all GOS contractors received an email from ophthalmic services highlighting that a further 70,000 existing benefit recipients were being moved on to Universal Credit – and would need to fill out an HC1 form to receive eye care.
“The challenge for practice staff, and for patients who previously were on benefits that gave automatic access to GOS, is recognised. Work is ongoing to try to resolve this difficult situation,” the email highlighted.
The situation has arisen because legislation that was passed in the other three nations of the UK to enable automatic entitlement on Universal Credit was stymied by the collapse of Stormont.
As a result, thousands of people in Northern Ireland have had to navigate a 22-page document in order to receive help with a range of healthcare costs since 2017.
Food shop or sight test?
Lauren*, 33, of Belfast, made an online appointment for a sight test in October after noticing changes to her vision.
Lauren, who is a single mother, has a health condition that prevents her from working and is currently receiving Universal Credit.
“It was only when I got to the appointment that I found out that I am not automatically entitled to the free eye test,” she said.
“The girl was really lovely. She explained to me that she thought it was terribly unfair too,” Lauren shared.
She had the option of either paying £29 for the sight test or cancelling the appointment.
“While that may not seem like a lot of money to some people, it wasn’t something that I could fit into my budget,” Lauren said.
“That is either doing my food shop for myself and my daughter, or getting an eye test,” she said.
When OT spoke with Lauren, she was in the process of filling out the 22-page HC1 form.
“It is quite long and it doesn’t seem straightforward at all. There are so many different parts to it,” she said.
By the numbers
70,000Universal Credit recipients in Northern Ireland have lost automatic eye care entitlement as of October
150,000have lost entitlement since 2017
22pages in the ‘workaround’ HC1 form
Optometrist, Sam Baird, has worked as an optometrist in Northern Ireland for four decades. He owns Sam Baird Opticians in Lisburn, Dromore, Belfast, Glengormley and Dundonald.
Baird estimates that the loss of automatic entitlement to free eye care affects up to 30% of patients in some of his practices.
“These are people who come back regularly and faithfully. Daily we have someone who turns up and cancels their appointment,” he said.
Some patients with broken spectacles will ask Baird to perform a temporary repair as they cannot afford to pay privately and cannot function without their spectacles.
Baird, who has two sons working as optometrists in Scotland and Wales, shared that conversations with his family have highlighted the lack of parity across the UK.
“There is a gross inequality. Their patients get automatic help with eye care whereas our patients don’t,” he said.
Optometrist and chair of Optometry Northern Ireland, Jill Campbell, shared that many people on Universal Credit are unaware that they need to fill out an HC1 form.
“One of the worst things is that people come in expecting to get their eye test and new glasses. When you explain that they are no longer automatically entitled and need to complete the HC1 form, they can often be unnecessarily embarrassed,” she said.
Campbell worries that this negative experience will stop people from seeking eye care in the future – and also prevent them from seeking care for their children.
“So much of eye disease is asymptomatic. There will be a cohort of patients in Northern Ireland who will absolutely be in a much worse position by the time they are diagnosed,” she said.
The people of Northern Ireland are being treated as second class citizens
Campbell shared that the current processing time for an HC1 form is around four to six weeks.
“With 70,000 households moving on to Universal Credit, that processing time is absolutely going to increase. It is a long time for someone not to have glasses – they may not be able to drive their car or help the children with their homework,” she said.
Campbell highlighted that being faced with a patient who needs eye care but cannot afford it can pose a professional dilemma for optometrists working in Northern Ireland.
She added that there is a large amount of goodwill that goes on in practices.
“We are all professionals who went into the profession because we care about patients,” she said.
“I think there probably are practitioners who make the decision to provide free eye care because it is just the right thing to do. But no practice should have to do that,” Campbell shared.
A legislative blind spot
Dispensing optician and past chair of Optometry Northern Ireland, William Stockdale, expressed his frustration that the situation has arisen by accident rather than intention.
“If the Government sat back and said, ‘We don’t believe there is a need. We have analysed this and we don’t think eye care is important.’ Then at least you would think it has been through a process. We have arrived where we are by mistake,” he emphasised.
Like Campbell, he is concerned about the long-term ramifications of creating barriers to accessing eye care.
“We are training a generation of people to think that eye care doesn’t matter,” he told OT.
An employee of Stockdale’s domiciliary business recently drove 65 miles to visit a man with a learning disability who lives independently. His business has provided regular eye care to this patient over the years.
“We then realised that he wasn’t entitled to an eye examination,” Stockdale shared.
The sight test was performed anyway, revealing a change in prescription.
However, the patient was not entitled to help with the cost of new spectacles until he had completed an HC1 form.
“For a person with a learning disability, they are potentially less able to complete the form and send it in,” Stockdale highlighted.
We are training a generation of people to think that eye care doesn’t matter
He noted that some people have waited up for three months for their HC1 form to be processed – and are not entitled to eye care during this time.
“For anyone who needs a pair of spectacles, you are impaired if you don’t have them. If you have a learning disability, that impairment is magnified because you are already dealing with other factors that make life challenging,” Stockdale emphasised.
“It has so many knock-on effects and it is fundamentally just not right,” he said.
Stockdale highlighted that people who are financially disadvantaged are already less likely to access eye care.
“We are effectively compounding health inequalities. If they wanted to take the boat to Liverpool, they could walk in and have a sight test. It’s madness,” he emphasised.
The situation has also created challenges for practice staff – who spend time helping people to navigate the complexities of the HC1 form or dealing with the frustration of patients who were previously entitled to free eye care.
“There are times when people come in and they are abusive to staff. They think it is the person behind the reception desk who is responsible for this. I have heard that so many times – that people are venting their anger on the messenger,” Stockdale shared.
An issue of parity
Andy Allen, who represents East Belfast for the Ulster Unionist Party, shared that people regularly come to his constituency office for help filling out the HC1 form.
“People are potentially being turned away from the essential care and treatment that they need. We don’t know how many people are turned away with a form and don’t complete it,” he said.
Allen has written to the head of the civil service in Northern Ireland highlighting the issue as a legislative gap in terms of parity with Great Britain.
“At the moment because we don’t have an assembly to address the legislation, there is a strong focus on the civil service and seeing if they can do it under their current decision-making powers. If they can’t, then there has to be an onus on the Secretary of State to step in and address this fundamental issue,” he emphasised.
We don’t know how many people are turned away with a form and don’t complete it
Allen, who lost his sight from an improvised explosive device in Afghanistan, shared that his experience has taught him the value of preserving sight wherever possible.
“If I reflect back to before being injured, it is like anything in life – we often take things for granted,” he said.
“It was only when I woke up in a hospital bed, completely blinded, that I came to realise the crucial importance of vision. We should be doing all we can to make sure that barriers to treatment should be removed,” Allen emphasised.
The AOP view
AOP chief executive, Adam Sampson, described the lack of automatic eye care entitlement for Universal Credit recipients as a “diabolical situation.”
“The people of Northern Ireland are being treated as second class citizens. We call on the Department of Health to act immediately to enable automatic entitlement on Universal Credit – which simply matches the approach in England, Wales and Scotland,” he said.
Sampson highlighted that the current circumstances could result in people failing to make eye care appointments for themselves and their children, resulting in delayed diagnosis and treatment for eye conditions.
Avoidable sight loss
Royal National Institute of Blind People (RNIB) Northern Ireland policy and campaigns manager, Paula Beattie, highlighted that 50% of sight loss is avoidable.
“This inequality puts people in Northern Ireland at a significant disadvantage and at greater risk of missing the early signs of a problem with their sight,” she said.
“It could also prevent many from being able to take simple, yet vital, corrective measures, such as glasses or contact lenses,” Beattie shared.
She observed that the lack of automatic entitlement to free eye care on Universal Credit could potentially exacerbate already long waiting lists in Northern Ireland.
“RNIB is calling for the legislative change necessary to remove this deeply unfair and potentially damaging disparity in Northern Ireland,” she said.
*Surname supplied but OT has agreed not to publish
The Department of Health responds
“We will work with stakeholders to see if the process for the interim solution – the form HC1 – can be improved. We also accept that a longer-term solution is required. As set out in the Department’s 2017 public consultation, this will require a decision on which income threshold to apply to Universal Credit recipients for help with health care costs eligibility.
“It was not possible to make the required changes to the legislation at that time (2017) due to the absence of the Northern Ireland Assembly. Regrettably progress was paused again when the Department’s resources were diverted to respond to COVID-19. The Department remains committed to bringing forward a longer-term solution.”