In the UK today people are still losing their sightunnecessarily. The abolition ofuniversal free eye tests and the failure of successive governments to investsufficiently in eye care and eye health promotion are largely to blame.Disadvantaged groups such as people of African Caribbean, Indian, Pakistani andBangladeshi origin, older people who cannot get out of the house, people withlearning difficulties face particular barriers to accessing eye care.
The NHS sight test plays a key role in preventing eyedisease. Between April 1999 (when freeeye tests for people over 60 were re-introduced) and April 2000 10 million eyetests were carried out on the NHS 3 million more than the previous year. Over that period half a million people (5per cent) were referred to the eye hospital because signs of eye disease hadbeen detected. Many more will have beenspared accidents in the home because vision problems were picked up. Yet many high risk groups people over 40 andpeople from African Caribbean communities are not eligible for a free sighttest and evidence suggests charging is a powerful disincentive. Confusion over who is eligible for help withthe sight test fee and who is not is also a problem. RNIB calls for therestoration of universal free sight tests as an essential public healthmeasure.
The most urgent threat to eye health lies in Customs andExcise's decision to levy full VAT on the dispensing of glasses and contactlenses from 1 June. This would result in an additional charge of 10 on a pairof spectacles - a hike which we believe will deter many of those at risk ofeyesight problems or eye disease from having an eye test. The Government hasjust declared a moratorium on this issue until a test case can come totribunal. RNIB is totally opposed toany measure which would increase the cost of eye care to the consumer. We also want to see an increase in the valueof vouchers for spectacles and contact lenses for people on low incomes.
But that will not be enough on its own. There is inadequate regulation of sighttests and professional standards are being undermined by underinvestment.
The optometrists union, with the tacit approval of theDepartment of Health, advises its members that they can charge patients extrafees for tests for specific eye diseases which have always been regarded asstandard parts of the NHS test. Thiscould lead to deregulation of the eye test which would compromise standards andlead to more people losing their sight from treatable eye diseases. RNIB calls for national standards for eyetests and auditing of optometric practice to ensure that national standards areadhered to by all professionals, together with a stronger role for the GeneralOptical Council in monitoring these standards.
The old Patient's Charter stated that everyone shouldbe able to expect a thorough eye examination.This provision has been dropped in its successor publication "YourGuide to the NHS" which makes no mention of the importance of regular eyetests for eye health and prevention. RNIB calls for the new Guide to be revisedto protect patients' rights to good eye care.
Recent RNIB research found that the provision of domiciliaryeye care visits - essential for many older people who are not independentlymobile - does not meet the known need.The availability, accessibility and quality of these services are constantlyjeopardised by insufficient funding, lack of regulation, non-existent publicityand inadequate training of practitioners. Again this means sight problems goundetected and older people lose out on vital support as a result. RNIBcalls for a full review of domiciliary eye test services based on users' needsand adequate Government funding for thedomiciliary eye test and the equipment required to provide this.
In addition, while 30% of people with learning difficultieshave sight problems only a minority have regular sight tests. Sometimes peoplehave not had their eyes tested owing to the ignorance or prejudice of staff orcarers OR because it is difficult to find an optometrist who will test thesight of someone with learning difficulties.Equal access to eye care would enable people with learning difficultiesto have more independence and live fuller lives. It would also be a better useof resources, preventing recourse to more expensive care services.RNIB calls for adequate funding for eyetests for adults with learning difficulties. Examinations may take longer than for ordinary patients,putting financial pressures on optometrists and creating a disincentive totreat adults with learning difficulties. This problem might be addressedthrough a supplementary fee for optometrists or proposing that Primary CareGroups/Trusts offer community based optometry, employing their own optometrist.
April 2001.