Equality of Service in the Supply of Children’s Glasses

We submitted an e-petition to the Department of Health in 2014 to try and change an aspect of the NHS regulations regarding children’s glasses. The reason we did this is because at the time there was an inequality in the regulations depending on how children access the NHS system.

We eventually managed to get the regulation changed in 2016 after 2 years of campaigning. We will keep this page here to explain what was done.

The inequality exists because the current Hospital Eye Service has evolved and modernised but the regulation hasn’t quite caught up with those changes yet. We hope that by bringing this to the attention of the Department of Health we can help modernise the system and be able to provide the best care possible to all our patients, regardless of how they access the NHS system.

We have the support of the following charities:

dhg logo   seeability logo

 

 

 

DS Association logo

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(This page explains our e-petition in a bit more detail.)

Online Petition

The e-petition can be accessed here

We believe that the NHS regulations surrounding the supply of glasses for children should be amended so that all children receive the same level of care regardless of how they access the system.

There are two ways in which children can obtain glasses through the NHS system; either from a voucher issued through the Hospital Eye Service (HES voucher) or from a voucher issued by an Optician (termed General Ophthalmic Services or GOS.)

There is currently an inequality surrounding the issue of a “special facial characteristics” voucher. This is for children for whom a basic spectacle frame will not fit correctly and a more expensive, specially-made frame is clinically required. There is financial help available for these patients within the Hospital Eye Service but not from General Ophthalmic Service.

This has created the situation in which patients with exactly the same clinical need will receive a different level of service depending on how they access the NHS service. It also varies throughout the UK depending where the patient lives, how individual authorities interpret the regulations, and how referrals to local hospital departments are organised.

To rectify the situation the GOS regulations need to be changed to include the provision for a “special facial characteristics” voucher.

Real life examples of situations in which such a voucher may be issued include:

  • Down’s Syndrome

The characteristic facial features of a small, flat nose means that standard glasses tend to slide down constantly. Almost all frames for children with Down’s syndrome require changes of nose pad, and side length shortening, which takes time and equipment. Specialist frames can mean a better fit, fewer repairs and better quality of vision.

  • Microtia

This is a condition in which child may have malformed or missing ears. Traditional spectacles often do not fit correctly and ideally need to be customised or altered to obtain a satisfactory fit.

 

Background

In the UK, the National Health Service pays for a child under 16 to get a pair of glasses. This is to ensure that children’s eyesight develops normally regardless of their circumstances. It does not discriminate by need, by prescription, or by financial circumstance; but it does currently discriminate by how that child accesses the service.

There are two ways in which children can obtain glasses through the NHS system; either from a voucher issued through the Hospital Eye Service (HES voucher) or from a voucher issued by a high street optician (termed General Ophthalmic Services or GOS.) The funding streams are different but essentially from the patient’s point of view they are still obtaining an NHS voucher towards a pair of glasses.

These vouchers are meant to cover the cost of a basic pair of glasses so that children do not need to pay for glasses, or any repairs to those glasses.

For some children a basic spectacle frame will not fit correctly and a more expensive, specially-made frame is required. There are two recognised situations in which this happens within the NHS regulations:

  1. A “small frame supplement” designed for babies or toddlers needing glasses.
  2. A “special facial characteristics” voucher for cases in which a frame needs to be specially made because of the facial characteristics of the patient.

In the instance of small frame supplement this can be ordered through the GOS or the HES service because there is a provision in the regulations for both. This means that there is an equality of service for very young patients and they can access free glasses from either service. It also means that they can obtain free repairs for those glasses because again there is provision for those repairs in both the HES and GOS regulations.

In the instance of special facial characteristics, this voucher is only available through the HES service. There is no provision for this voucher within GOS service. This means there is an inequality of service and a GOS patient will not get the same level of service, or financial contribution towards glasses as a HES patient. To receive the same specialist frame they would be expected to pay towards to that specialist frame.

In the past it was common for Hospital Eye Services to make and repair glasses themselves but today this is not always the case. It is now common for a pair of glasses initially issued as a HES voucher to be repaired through a GOS “repair” voucher. This has raised further issues regarding the repair of specialist glasses because under the current regulations the patient would have to wait to be issued with an HES “repair” voucher before proceeding with the repair. This means a delay before glasses can be repaired, over-complicates an already complicated system and again emphasises the inequality between HES and GOS services.

HES repair vouchers are within the regulations but are not commonly used; their use varies between different areas of the country and therefore in some areas patients would be asked to contribute to repairs whilst other areas might get those same repairs funded through the NHS.

It is possible to refer patients into the Hospital Eye Service from the General Ophthalmic Service but it is not a useful use of this service to refer simply refer to obtain a specialist voucher. This would cause strain on an already busy service, would cost approximately 6 times more to the UK tax payer than the equivalent GOS service and may not be a practical solution for most patients if they do not live close to a hospital with an eye department.

To ensure an equality of service for all patients accessing the NHS service the regulations regarding HES and GOS vouchers should be the same; or at least there should be some way of being able to apply for the same level of funding through the GOS. There are a few ways of ensuring equality without having to completely change the regulations but at the time of writing we have been unable to make our points strongly enough to those within the system that have the authority to change things.

The fact remains that there is an inequality within the NHS system. It only exists because no-one has thought to change it. A “special facial characteristics” voucher is a clinically necessary use of NHS funds and will not cost the NHS a great deal of money.

Please add your support to our e-petition, click here…

It will ensure that patients receive the most appropriate spectacle frame for their individual need.

Please feel free to email info@simonberry.co.uk with any questions, or suggested corrections to this document.

Thanks, Simon

If you, or the person you care for has a disability and would like further information on our specialist frames and services, please click here.