16th December 2022
11 minute read
Categorised under:
Eye Health

The cost-of-living crisis and its impact on eye health

This winter, many of us will be feeling the effects of the cost-of-living crisis. With energy, food, fuel and mortgage costs on the rise, it comes as no surprise that in September 2022, 87% of UK households reported that their cost of living had gone up from the previous month[1] – and that was before the energy price hikes in October.

As a result, more than a third of people (35%) have resorted to cutting back their spending on food and other essentials, according to the Office for National Statistics[2].

With eye tests costing at least £20 and Optometry Today reporting that the average Brit will buy 26 pairs of glasses in their lifetime at a typical cost of £120 per pair (rising to £158 for those living in London)[3], it’s clear to see that – for people forced to choose between heating and eating – visiting their optician might not be at the top of their priority list.

Financial support is available to those on a low income, with the NHS offering free eye tests and no-frills glasses vouchers to people who meet their eligibility criteria, but people might find themselves having to top up the difference if the glasses they want exceed the value of their voucher.

Meanwhile, for those aged 19-59 who aren’t in receipt of benefits or at risk of glaucoma, glasses may become an expense they have to save up for months to afford, with research from Shelter and YouGov showing that more than a third of Brits are just one pay cheque away from homelessness[4], and research from Yorkshire Building Society suggesting that many people don’t have savings to spare[5].

The NHS recommends having a routine eye test once every two years, but if people start putting this off because they can’t spare the extra expense, it could have a devastating impact on the nation’s eye health, which has already suffered in the wake of the pandemic. In ‘The State of the UK’s Eye Health’ (2021), Specsavers reported a 23% decline in the number of people booking eye tests, and a 28% decline in the number of people being referred to ophthalmology services. As a result of this, nearly 3,000 people lost their vision due to delayed diagnosis and treatment.[6]

Conditions like glaucoma, diabetic retinopathy, wet AMD and cataracts – which many people aren’t aware they have until they visit their optician because they’re often symptomless in their early stages – are going undetected for longer. If left untreated, they can cause irreversible sight loss, so early intervention is essential.

The expense of eye care isn’t the only issue people are facing – accessing ophthalmic services is becoming increasingly difficult too. In their latest report, Specsavers note that 633,000 people were waiting for NHS ophthalmology appointments in May 2022, and only 64% of ophthalmology patients were seen within the NHS’ recommended 18-week timeframe.[7] This means that even people who do visit their opticians are often left waiting for follow-up appointments with their local hospital if any issues are identified during their eye exam.

The NHS “postcode lottery” has been the subject of intense political debate for years, with people who live in deprived areas often falling foul of longer waiting lists and poorer outcomes as a result of delayed treatment. This can also be compounded by variations in referral criteria, with some NHS trusts having stricter requirements than others.

In 2018, SpaMedica’s Medical Director, Dr Alex Silvester, analysed the records of 24,978 patients based in the North of England who underwent cataract surgery, and concluded that patients living in the most deprived areas (as determined by the 2015 Indices of Multiple Deprivation) presented with more severe cataracts and a poorer standard of vision than patients who lived in more affluent areas, meaning their visual outcomes after surgery were often worse than their wealthier counterparts’.[8]

Four years later, and the story is much the same. The National Ophthalmology Database Audit, published by the Royal College of Ophthalmologists in May 2022, revealed that: “Patients from more deprived post codes are presenting for cataract surgery with worse Visual Acuity (VA) overall. From the most deprived decile, 10.9% of patients have a LogMAR of <0.30 and 24.5% have a LogMAR of ≥1.00, which compares to 17.8% and 13.4% respectively in the least deprived decile.”[9]

As well as experiencing poorer outcomes overall, cataracts that have been left to develop over a sustained period of time are often harder to remove, which means patients are more likely to experience complications during surgery.

So, what is SpaMedica doing to address the inequalities in the system and stop them from widening even further?

1) Offering a free transport service to patients

Millions of people are at serious risk of being cut off from work and healthcare because of the rising costs of owning and running a car, or because they live in an isolated area with limited access to public transport. Even those who do have access to public transport are affected by cancelled services, delayed journeys, or system-wide strikes, which can lead to people missing vital healthcare appointments through no fault of their own.

SpaMedica was one of the first independent eye health providers to launch a free transport service for patients, so people who don’t have access to – or can’t afford – transport can get to and from their appointments. Our transport service has always been popular with patients – mainly those whose friends or relatives aren’t available to take them to their appointments – but since the rise in fuel costs, there’s been an increase in demand. Of course, by offering this service for free, we’re absorbing the fuel costs that would usually be paid by patients, so we do have to take some steps to ensure the service is as efficient and cost-effective as possible. We use minibuses so we can pick up and drop off several patients who live in close proximity to each other at the same time. This sometimes means patients spend a little longer at the hospital while they’re waiting for everyone’s appointments to finish, but most patients are happy to do that if it means saving money on train, bus or taxi fares, which can be cost-prohibitive for people who are struggling to make ends meet.

2) Helping to reduce waiting times by creating additional capacity 

Based on current estimates, the average waiting time for cataract surgery is nine months, although data from 12 NHS hospitals across London and Bedfordshire showed that, for some hospitals, it can be as long as 94 weeks.[10] For patients who can no longer go about their day-to-day tasks – whether that’s reading, driving, housework, or watching television – it’s not uncommon for cataracts to affect their mental health and wellbeing, as well as making them more prone to slips, trips and falls. For patients who are still in employment, cataracts can also make it difficult for them to carry out their jobs, posing a potential risk to their livelihoods.

The pandemic has put a considerable strain on the NHS – the same would be true of any service experiencing this kind of relentless and unprecedented demand –  and with 314,790 people currently waiting for cataract surgery[11], it wouldn’t be possible for any national provider to single-handedly treat such a large volume of patients, in spite of their herculean efforts. That’s why it’s important for independent providers to work in partnership with the NHS to help alleviate pressure on local services.

SpaMedica has opened 43 hospitals across the country to meet rising demand, and we base ourselves in areas where we’re needed the most to ensure that all NHS patients – regardless of their income or location – can access the services they need as quickly as possible. A significant proportion of our hospitals are based in areas that rank highly in the indices of multiple deprivation, including Bradford, Hull, Oldham, Manchester, Leeds, Liverpool, Bolton, Peterborough, Wolverhampton and Birmingham.[12]

We’ve also extended and developed our medical retina services so patients can benefit from additional screening services and access age-related macular degeneration clinics closer to home, as well as taking on more complex patients so they can be seen by specialist consultants sooner.

If a patient is referred to us by their optician directly, our target referral to treatment time is just four weeks, but we’re also taking on a number of inter-provider transfer (IPT) patients who were initially referred to hospitals with long waiting lists, so they can be seen more quickly too.

Of course, we have to ensure that taking on more patients doesn’t put additional strain on our services or affect the high quality of patient care we always strive to provide, and that means constantly evaluating our resources, facilities and staffing.

3) Educating patients 

As a healthcare provider, we don’t just want to advertise our services to prospective patients, we want to educate people from all walks of life about the importance of eye care – whether that’s having regular eye tests, making sure they visit their optician if they notice any changes to their vision, reducing their screen time, or eating a diet that helps to keep their eyes healthy. We want people to know as much as possible about common eye conditions – from symptoms and diagnosis, to treatment, prognosis and aftercare. While most of our marketing takes place online, we appreciate that some patients in deprived areas – or elderly people struggling to get to grips with technology – don’t always have regular and reliable access to the internet, so we do leaflet drops and ensure our patient information booklets are freely available to opticians throughout the country too.

We also work hard to dispel any myths people have about independent healthcare providers. Patients – especially patients in deprived areas – are more likely to believe that private providers only treat private patients, and that the services we offer come at a premium cost. A lot of our advertising and marketing strategies are focused on highlighting that we treat NHS patients, free of charge, with no catch or hidden costs!

We’re also committed to educating patients about their right to choose their treatment provider because – until they’re given the option – most patients aren’t aware that they’re able to go somewhere other than their local hospital for treatment. Some patients can also have reservations about whether private consultants have the same qualifications and experience as NHS surgeons, particularly if they’ve never heard of a provider before, so we put their minds at rest about that, too.  

4) Standardising our services 

We want our patients’ experiences to be consistently excellent, regardless of where they live – so we make sure all our hospitals are following the same systems and processes, implementing the same policies, and striving for the same standards. Having a tried and tested business model, where all of our staff receive comprehensive training on their respective roles and responsibilities, means we can ensure we’re delivering the very best care to patients across the country. Whether you’re in Wokingham (one of the most affluent areas in the country) or Bradford (one of the most deprived), when you visit a SpaMedica hospital, you’ll receive the same standard of service, and that’s evidenced in patients’ experiences, outcomes and feedback.

We know from the number of referrals we receive from patients living in deprived areas that these strategies are working, and we’re committed to doing everything we can to continue making our services accessible to everyone.

[1] Source: https://www.statista.com/statistics/1300280/great-britain-cost-of-living-increase/
[2] Source: What actions are people taking because of the rising cost of living? – Office for National Statistics

[3] Source: Brits underestimating cost of eye care (aop.org.uk)

[4] Source: Over a third of UK households are one paycheck from financial ruin… :: Drewberry (drewberryinsurance.co.uk)

[5] Source: UK Savings Crisis – Nearly one in five UK adults have less than £100 in savings | YBS

[6] Source: https://www.specsavers.co.uk/eye-health/state-of-the-uks-eye-health-2021

[7] Source: https://www.specsavers.co.uk/reports/state-of-the-uks-eye-health-2022

[8] Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32921-0/fulltext

[9] Source: https://www.nodaudit.org.uk/resources/publications-annual-report

[10] Source: https://practiceplusgroup.com/news/how-long-is-the-waiting-time-for-cataract-surgery/

[11] Nepogodiev D, Acharya R, Chaudhry D, et al. ‘Forecasting waiting lists for elective procedures and surgery in England: a modelling study’ medRxiv. 2022:2022.06.20.22276651

[12] Source: https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019

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