“We need to take every opportunity to engage people into healthcare”

For the past 18 months, Specsavers has been working with a focus group of people with lived experience of homelessness to better understand the barriers they face when accessing eye health services.

With stigma and potential embarrassment cited as key reasons to avoid accessing eye care, alongside practicalities such as not having clarity on cost, the group has been able to advise Specsavers on how it can best adapt its services to include all patients – including those who might be initially reluctant to walk through the practice door.

With pilot out-of-hours clinics now rolled out to 44 Specsavers practices, OT travelled to Bristol to meet the group and its facilitator, Expert Focus director Stan Burridge, alongside Specsavers’ Philippa Simkiss.

How do we ensure that practical training and communication adaptations to benefit those experiencing homelessness are rolled out to the optometry profession as widely as possible?

Stan Burridge (SB):We need to be realistic in how much this is actually going to cost the system. With all the goodwill in the world, if we create a model and then saddle a cost to it, that is constantly dipping into people’s bottom line, we’re going to find some resistance. We need to be very honest, and we need to get people engaging with what’s already there.

The work that we’re doing is about creating avenues to access services. There are some changes that need to happen, which we need to challenge the government on. But primarily, our aim should be to make sure we achieve the same level of quality eye care for homeless and disadvantaged groups as is available to the rest of the population.

We also have to be reasonable with that group of people, and help them to understand what the NHS voucher is, the value of it, and what they can get for their money, or for the NHS money, without having to worry about topping it up. We need to be much clearer about the messages on that.

Philippa Simkiss (PS):There are some important basics that are relevant for everybody. With articles in Optometry Today, for example, it’s not difficult to share some key messages, to upskill everybody to a certain level.

To go beyond that, to do training modules and so on, maybe takes a little bit more commitment. But we have started to explore ways of doing that. We have talked about 100% Optical, we’ve talked about online training that everybody could access, and colleagues have contributed to that.

Referral into the hospital eye service is something that you’re planning on working on in the future. Could you say a bit about the need for change in that area specifically?

SB:I think it’s covering similar ground, in relation to accessibility. There are two routes to secondary care in any service, whether it’s acute secondary care services for hospital or secondary care for eye care.

One is through an unplanned admission, normally through an ambulance service or an emergency admission, and one is through a planned route. Often, planned routes are the best route to take – when things are planned, they are more structured, and people are on a journey through the process. If we create a model which makes access to the first stage of primary care, in this case the eye test, accessible, then we’re able to address the issue of secondary care.

Our vision is patients being referred on by something that is warm and fuzzy, and makes them feel good. For homeless and disadvantaged groups, healthcare systems can often be harsh and prickly, and very inflexible. We need to take every opportunity to engage people into healthcare.

The bottom line is, if you’re improving people’s access to health, you’ll improve their health outcomes. Whether that’s that they get their eyes tested and find they don't need glasses, or they do need glasses, or they need secondary eye care, it’s a journey that they will go on and they will be supported throughout. Everyone else gets that, and it is available, but often the challenge is to get people to believe that they can access it, and to give them enough information to understand that it isn't going to penalise them financially. It’s not going to push them into a corner.

The education that Specsavers is doing is a start. We can make that much more robust in some areas. With that information going out, Specsavers colleagues are less fearful of the challenge of working with people who aren’t in the best position. That’s the key for us. We need to create something that people will go to, because they know they’re going to be treated well and they know everything is going to be completely open for them, and that they’ll be able to ask questions.

Everybody goes in with high expectations. There are examples in dentistry – people go in with a chipped tooth and think, ‘I’m going to get an implant.’ But there is a difference between what you can get and what you do get. People get what is available. The same is true for optical care. The explanation about what it is for, and what it does, needs to be much, much clearer.

We’re getting to that point. The lived experience group is acting as a catalyst for change. They are having those conversations. They are creating a greater awareness of the complexities that people face, and they’re using language that breaks down that barrier as well, so it becomes much more understanding. They are the key element to what we’re doing.

Specsavers colleagues are less fearful of the challenge of working with people who aren’t in the best position. That’s the key for us

In the focus group’s launch video, you noted the importance of the people who are impacted being the ones who make the decisions. Could you speak about the risks if they aren’t included? 

SB:The risk of not doing it is that nothing changes. If you feel excluded by something, whether that’s because of your own impression about how you feel, or because there’s deliberate discrimination, you’re not liable to want to engage in it. If you begin to bring people who have had those experiences into the conversation, they can then point these things out.

PS:Change can be superficial as well. Relatively recently, NHS England wrote to every optometry practice to remind opticians that people don’t need to have a fixed address to be able to get the eye care that they need.

But actually, it’s not just about the fixed address. It’s about the benefits that people are claiming. It’s really quite complicated, and unless you’re talking to people and understanding their barriers, you become side-tracked by messages and don’t tackle the root causes. Understanding deeper issues by talking to people who are experiencing and having lived experience – that’s what brings an understanding of the root causes that need to be tackled.

There were lots of comms around that letter from NHS England, and there is a danger now that the Department of Health and Social Care think that the issue is solved. When we take issues to them, they may think it’s all sorted. But this is how we know it’s not.

SB:The challenge really comes from making a change at the top. We’ve got a series of wants that Specsavers have built up, along with Vision Care for Homeless People and ourselves. We are supporting all of those changes.

It’s about demands that, in the end, will save money. There’s the whole ‘cut to spend’ policy. There are lots of examples where money has been taken from certain areas, only to find that actually, when you’ve cut that area, you’re now spending more on it. Invariably, if people are disengaging from healthcare systems, their healthcare costs more, because when they turn up to access healthcare, they’re much sicker and they require much more treatment. In this particular instance, what might just have been a need for glasses, might mean that now you’re looking at something a lot more sinister. You’re also missing the opportunity to identify the illnesses that can be picked up from an eye test, that have now progressed beyond the point of just medication, to reveal something which will cost more.

There is a friends and family test across the NHS: would you recommend this service to your friends or your family? Would you give this to your child? Would you give this to your brother, or sister, or mother? If you wouldn’t, don’t give it to anyone else. Don’t expect one element of society to accept a lesser form of the healthcare system. Expect everybody to have the same.

You can go right back to Julian Tudor Hart on the inverse care law: how care, really, is aimed at those who have money. It’s not aimed at those who don’t. That’s where we are. 

Don’t expect one element of society to accept a lesser form of the healthcare system. Expect everybody to have the same

 

<Question> You’re hoping that the views of the focus group will be put to Parliament. Could you both speak about what impact you hope that has?

PS:We want to get General Ophthalmic Services regulations changed to improve access to care for people experiencing homelessness. It’s hard work, and it feels like an uphill struggle sometimes, to cut through the decision-making processes and understand actually who can make that change – who are the individuals and the bodies that we need to speak to to make that happen?

One of the things that we need to do is get our industry as a whole sharing that same message, at the same time. We’re planning to have an event to bring everybody together to share the key messages and agree on a common language that we can coalesce behind, so we can take the same message together. It would be much stronger than just Specsavers or just the groups that we’re working with, because it would be an industry-wide call for change. That’s what we need to do.

SB:It’s the start of that whole message that needs to get into government. The next stage is supporting this group to actually deliver that message themselves, but do it in a way which is very on point, and very formal, and structured. Nobody listens to the shouting idiot in the corner. Slowly, as a group, we have become much, much more than that.

Listening to them today, you heard some of their insights and their knowledge, and the way they’ve worked as a team. They tease information out of each other, and they get points out of each other. Harnessing that energy in that room and ensuring that that energy is taking on the messages from the sector – I think that will make a change.

OT spoke to Stan Burridge and Philippa Simkiss in June 2024, ahead of the UK general election and subsequent change in government administration.