How can we ensure access to safe and effective eye care for everyone?
Our annual public perceptions survey continues to show that those with vulnerability markers (i.e. on a low income, with a disability, or going through a difficult life event) are significantly less likely to go for a sight test every two years and are generally less satisfied when they do go.
Our lived experience research gives us new insights into why people with vulnerabilities can struggle to access eye care services – and what can potentially be improved to support them.
Barriers in accessing services can result in poorer health outcomes, including avoidable sight loss, for some of the most vulnerable people in society. It can also exacerbate the pressure put on secondary care if diagnoses are delayed due to patients not accessing services at an early stage in primary care.
One key barrier is the perception of eye health. Generally, research participants viewed eye health as a low priority and had a lack of awareness about the frequency and benefits of regular testing. Moreover, there was a lack of knowledge that testing could also help identify wider issues such as high blood pressure or diabetes. A deterioration in vision was seen as the main driver to get tested, but many had a high tolerance for self-managing any changes.
I didn’t realise that you should go every two years. It doesn’t tell you that on any adverts, does it?
Cost was another significant barrier. We heard that those with vulnerabilities felt uncomfortable visiting an optical business because of pressure to buy and a lack of transparency around pricing. There was also a lack of awareness around any financial help that might be available to them for example NHS vouchers.
I used to feel a bit pressured about buying glasses because, well, we'd just be thinking, are these girls on commission?
Previous negative experiences, that those with vulnerabilities were more likely to have, was another barrier to them returning. Some felt being in a retail environment was off putting or intimidating because of a feeling that it was ‘too open’ and of ‘being watched’ which differed from other more traditional healthcare environments such as GP practices or hospitals. Those with hidden vulnerabilities such as mental health conditions particularly felt a lack of support because their vulnerability wasn’t easily identifiable.
…It can be scary…because obviously you don't know what to expect when you get there. Do you see the same person? This one does that test. Then there's the someone else does that. And then there's the puffing things in your eyes.
We hope that this research will help provide fresh insights into effective interventions for policy makers in reducing barriers to accessing eye care services. Although the issue is multifaceted, many of the solutions identified by research participants can be easily implemented. For example, businesses could do more to promote the benefits of regular tests, ask patients about additional needs during the booking process, and offer more tailored appointments to those with vulnerabilities.
As a sector it is important that we listen to the individual stories highlighted in our research about why those more vulnerable patients find it difficult to access eye care services. Reducing health inequalities and improving health outcomes is a key priority in the Government’s new 10-year health plan, and as a sector we should ensure that we are also aligned to this aim.
We have committed, in our new corporate strategy, to create fairer and more inclusive eye care services, and we must ensure that the workforce effectively and compassionately welcomes and supports patients with different kinds of vulnerabilities. We have strengthened our standards to reflect this and are consulting on supporting guidance. However, as a sector we should challenge our thinking about whether there is more we can do to promote the health, safety and wellbeing of the public so that everyone can have access to safe and effective eye care.
