General Ophthalmic Services, Activity Statistics. England,

General Ophthalmic Services, Activity Statistics England, 2014-15 Published 16 July 2015

Some figures relating to NHS vouchers for repairs and replacements were corrected in April 2016. These figures have been updated in this report and the accompanying annexes, and have been highlighted in yellow. We are the trusted national provider of high-quality information, data and IT systems for health and social care. www.hscic.gov.uk enquiries@hscic.gov.uk @hscic This publication may be of interest to members of the public and other stakeholders to make local and national comparisons and gain a picture of General Ophthalmic services in England. Author: Responsible statistician: Primary Care Team Health and Social Care Information Centre Gemma Ramsay, Section Head Version: V1.0 Date of publication: 16 July 2015 2 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Contents Executive summary 5 Key findings 5 Introduction 6 Use and usage of these data 6 Feedback 6 Data quality 2014-15 7 NHS sight test data 7 Background 7 Results 7 Other data 8 NHS sight tests 9 Domiciliary sight tests 17 Private sight tests and private domiciliary sight tests with partial help 18 NHS optical vouchers 19 NHS vouchers for repair or replacement 24 Annexes 27 Technical notes regarding sample based data 28 Other publications 28 Copyright 2015 Health and Social Care Information Centre. All rights reserved. 3

This is a National Statistics publication The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics. Designation can be broadly interpreted to mean that the statistics: meet identified user needs; are well explained and readily accessible; are produced according to sound methods; and are managed impartially and objectively in the public interest. Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed. Find out more about the Code of Practice for Official Statistics at www.statisticsauthority.gov.uk/assessment/code-of-practice 4 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Executive summary This yearly report, General Ophthalmic Services, Activity Statistics: England, 2014-15, includes information on NHS sight tests, NHS optical vouchers, NHS vouchers for repair or replacement and workforce. The objective of General Ophthalmic Services (GOS) is, through community opticians practices, to provide preventative and corrective eye care for children, people aged 60 and over, adults on low incomes and those suffering from, or pre-disposed to, eye diseases. All data are final and represent financial years, April to March. This report presents a summary of information about GOS activity in England for the year 2014-15 and a time series from 2005-06. A time series back to 2002-03 is available in Annex A. Most data included in our publication are collected through the Central Ophthalmic Payments System; some eligibility data are submitted through our OMNIBUS system. For more detailed information on data collection, please refer to our Beginners Guide. The report presents information at a national level; further breakdowns of data are available in the Annexes. Key findings NHS sight tests fell by approximately 23,000, which represents a 0.2 per cent decrease; the first decrease seen in the lifetime of this publication going back to 2002-03. There were about 23,700 sight tests per 100,000 population. The number of NHS optical vouchers decreased by 1.4 per cent (approx. 66,600) from 2013-14 to 2014-15, with approximately 8,600 processed per 100,000 population. The maximum potential expenditure from NHS optical vouchers is approximately 200 million 1. There were approximately 527,193 vouchers for repairs and replacements reimbursed during 2014-15. Until 2013-14, sight tests steadily increased from 10.4 million in 2005-06; with the most pronounced rises in 2007-08 and 2009-10. The rate of increase has varied over the years, and the reasons behind these fluctuations are unknown. The latest annual statistics for 2014-15 saw the first decrease in the numbers of sight tests when compared with the numbers in the previous year. Patients aged 60 and over have remained the dominant eligibility category in terms of the share in the number of tests carried out. NHS optical vouchers have risen by a quarter since 2005-06. The period between 2007-08 and 2009-10 saw the most rapid growth. However, as with sight tests, this year has seen the first decrease since our publication records began. NHS vouchers for repair or replacement have had an overall rise of almost 30 per cent since 2005-06, although with more fluctuation than either sight tests or vouchers. Vouchers for repair or replacement peaked at 527,193 in 2014-15. 1 Estimates are calculated using the maximum redeemable value for each voucher type set out in: http://www.nhsbsa.nhs.uk/documents/healthcosts/hc12_april_2014.pdf Estimates are maximum potential as vouchers may not have been redeemed to their maximum value and/or may have been issued during the previous year and redeemed at April 2014 s price levels. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 5

Introduction This report presents a summary of NHS Ophthalmic activity, which includes NHS sight tests, NHS optical vouchers and NHS vouchers for repair or replacement. The data reflects activity in England, as well as a time series from 2004-05. All tables and charts provided in this report are available in Excel format in Annex A. An additional two years of data (2002-03 and 2003-04) are provided in the time series. Detailed tables at Area Team level for the information contained in this report and some national level historical years are provided in Annex B. Annex C contains flat files of unformatted data for 2014-15 at Area Team and Region level. This is suitable for analysis by local and regional analysts. Users should be aware of the Data Quality Statement which accompanies this report and is available at: www.hscic.gov.uk/pubs/gosactivity1415 For more information on this publication and the ophthalmic data published by the Health and Social Care Information Centre (HSCIC), we recommend our Beginners Guide to Eye Care Publications available at: www.hscic.gov.uk/pubs/gosactivity1415 Use and usage of these data This publication informs the Department of Health (DH) and NHS England Area Teams, allowing for the monitoring of the provision of ophthalmic services and planning. The data provide a published reference on the provision of eye care services, such as volume of sight tests and of domiciliary sight tests. Patient eligibility breakdowns provide information about service access by different patient groups. These help inform NHS planning, allowing local commissioners to compare patterns of service provision and assess whether particular eligible groups are accessing services. For example, if the number of sight tests for people aged 60 and over decreases at a time when numbers of people in that age group are increasing, policy teams and commissioners may judge that, in the interest of public health, there should be increased promotion of the availability of these services. The HSCIC also engages with representative bodies such as the Royal National Institute of Blind People, exploring ways in which the current data available can be improved or made more useful for researchers and other users. While we receive little direct engagement from other users of these data, they will be useful for public health observatories, patient representative groups, academics, charities and other members of the public with an interest in the uptake and provision of eye care services across England. Feedback We welcome all feedback on any aspect of this report, as well as any suggestions for future reports. Your comments can be submitted by email to: enquiries@hscic.gov.uk 6 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Data quality 2014-15 NHS sight test data In all area teams, the number of sight tests recorded on the Exeter Payments System will be accurate. It is possible that any data fields which do not form part of the payments methodology or are not under regulation, for example patient eligibility, suffer from underreporting or data quality issues. Over recent years we have increased the use of Exeter to extract eligibility data to reduce the burden for organisations. In the spring of 2014, we carried out an investigation into the quality of this data with the aim of reducing the burden further. In spring 2015 we sent Area Teams a summary of their sight test eligibility data, held on Exeter, for the first six months of the year (April 2014 September 2014). They were asked to confirm whether the data was representative of their Area Team population. Background Some providers, e.g. Specsavers, have a computer system that links to the Exeter system. This means we receive their eligibility data automatically through Exeter. As these providers are predominantly based in high street town centres, they are not necessarily representative of the population as a whole. In order to ensure the data on Exeter are representative, and to improve the quality, Area Teams supplement these figures by manually entering forms they receive for providers into the Exeter system. Some providers have stated that this is most forms they receive; others submit a manual data entry for every 20 th or 50 th form. Others do not enter any data manually but collate a sample of forms throughout the year (typically around 2%) and send the overall bulk figures through to us when we request it via an online collection system, Omnibus. Results Twelve of the twenty five Area Teams confirmed that their data were representative and thirteen did not. We therefore only asked for a manual sample from those thirteen. One of those provided a sample that appeared much reduced when compared to the average range of returns (0.1 per cent sample). It was decided that, for this area team the sample of eligibility data stored on Exeter was large enough to justify the use of the Exeter data. Two further Area Teams were unable to supply a sample based on 12 months worth of data. We agreed that they could base their sample on 6 months and gross this up to make a 12 month sample before they submitted it to us. There are still ongoing concerns regarding patient eligibility for sight tests, particularly when the data are based on small sample sizes. Therefore this data will continue to be monitored for future publications. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 7

Other data West Yorkshire Area Team did not provide patient eligibility or voucher type breakdowns for NHS optical vouchers, although the total numbers of vouchers were available. For this Area Team, no breakdowns are available, only totals. Data quality has improved since 2011-12, when a range of issues impacted on eligibility breakdowns, and also on national level totals for optical vouchers and vouchers for repair and replacement. However, these issues should be considered, especially when comparing data acquired since 2012-13 with data from 2011-12. 8 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

NHS sight tests This section presents information on NHS sight tests and excludes private tests given to patients who are not eligible for an NHS test. Patients with an HC3 2 certificate, as part of the low income scheme, are entitled to partial funding towards a private sight test. Figures relating to HC3 certificates are presented later in the Private Sight Tests and Private Domiciliary Sight Tests with Partial Help section of this report. For more information on the eligibility criteria for an NHS sight test, see our Beginners Guide. Optometrists comprise an increasing proportion of the ophthalmic workforce 3, and this is reflected in the proportions of sight tests carried out by Optometrists and Ophthalmic Medical Practitioners (OMPs). Optometrists undertake more sight tests per practitioner than OMPs (table 1.5), which is likely to be a reflection of the more specialist nature of OMPs, compared with Optometrists. Optometrists are qualified to test eyesight and to prescribe and dispense spectacles. Their training enables them to recognise abnormalities and diseases of the eye; they are registered with the General Ophthalmic Council (GOC). OMPs are qualified doctors specialising in eyes and eye care. In addition to their medical skills, they are qualified to test eyesight and prescribe spectacles; OMPs are registered with the General Medical Council (GMC). On 31 December 2014, there were 11,560 Optometrists (97.7 per cent) and 267 OMPs (2.3 per cent) in England. In the year ending 31 March 2015: 12.8 million sight tests were provided to patients in England during 2014-15, a decrease of 22,945 (0.2 per cent) from 2013-14. This is inconsistent with recent year-on-year increases in the number of sight tests. There were 23,697 sight tests per 100,000 population. After a steady growth in the aged 60 and over category since its introduction in 1999, peaking in 2011-12 at 45.0 per cent, the proportion of sight tests in this age group have fallen for the third consecutive year; 5.5 million were delivered in 2014-15, a 43.2 per cent share of all sight tests. Since 2005-06, sight tests per 100,000 population for those aged 60 and over has, for the most part, increased progressively until 2011-12, suggesting that growth in this category is attributable, in part, to a greater uptake by these patients. However, since peaking in 2011-12 at 46,569 per 100,000, there has been an overall steady decline in this and it now stands at 44,981 per 100,000. The number of children aged 0-15 receiving an NHS sight test has increased by 7.5 per cent to 2.7 million since 2013-14. This corresponds to 26,764 4 sight tests per 100,000. Optometrists continue to conduct the vast majority of NHS sight tests, with a 99.9 per cent share of NHS sight tests (12,749,584) at a rate of 1,103 per Optometrist. The remaining 0.1 per cent (14,901) were carried out by OMPs. As a demand led service, with largely only sample-based data for patient eligibility, it is difficult to establish specific drivers for the fluctuations in the rate of increase in sight tests and changes in share of activity among the eligibility groups. The number of practitioners per 100,000 population has increased over the last ten years by 13.7 per cent from 8,639 in 2005-06 to 11,827, which suggests greater provision of services. Eligibility categories such as Diabetics/Glaucoma sufferers have received an increasing proportion of sight tests, suggesting an increasing demand from these patients or an increase in diagnosis. 2 HC3 certificates provide income related help to people who are not exempt from charges, but who may be entitled to partial help if they have a low income. 3 General Ophthalmic Services, Workforce Statistics England and Wales, 31 December 2014: http://www.hscic.gov.uk/pubs/genophworkfstatsdec14 4 This number is subject to revision when new mid-year population estimates are released. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 9

Table 1.1 Number of NHS sight tests, in England, during the specified financial years April - Sept Oct - March April - March Year-on-year change Year-on-year percentage change 2005-06 5,191,490 5,163,191 10,354,682 205,704 2.0 2006-07 5,321,953 5,162,969 10,484,922 130,240 1.3 2007-08 5,523,000 5,525,000 11,048,000 562,968 5.4 2008-09 5,641,406 5,637,068 11,278,474 230,584 2.1 2009-10 6,052,100 5,759,551 11,811,651 533,177 4.7 2010-11 6,132,035 5,806,494 11,938,529 126,878 1.1 2011-12 6,039,974 6,265,753 12,305,727 367,198 3.1 2012-13 6,231,831 6,107,422 12,339,253 33,526 0.3 2013-14 6,445,283 6,342,147 12,787,430 448,177 3.6 2014-15 6,413,065 6,351,420 12,764,485-22,945-0.2 Figure 1.1: Number of NHS sight tests, in England, during specified financial years 10 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Sight test eligibility data, presented in table 1.2, are sample based. In 2014-15, one of the Area Teams (Essex) was able to provide a complete set of data. For 12 Area Teams, data stored on the Exeter Payments System were used; the proportion of eligibility data available was used as the sample base. For the remaining 13 Area Teams, data on Exeter were not representative or we did not receive a response, and the HSCIC undertook a manual 2 per cent collection of eligibility data. Further details about the collections process are included in our Data Quality Statement on page 7 of this document and our Beginners Guide. See Annex B for a list of sample sizes returned by each Area Team. Table 1.2: Percentage of NHS sight tests by patient eligibility and number, in England, during the specified financial years Per cent Number 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2014-15 Aged 60 and over 43.0 43.1 44.0 44.5 44.0 44.4 45.0 44.4 43.6 43.2 5,507,932 Children 0-15 20.9 20.2 20.8 20.5 20.8 20.5 20.0 19.0 19.9 21.4 2,732,370 Students 16-18 4.5 4.7 4.6 4.6 4.5 4.5 4.2 4.4 4.1 4.3 548,379 Adults receiving income support 1 10.5 11.2 10.1 9.8 9.2 9.1 8.5 9.0 8.1 7.8 995,884 Adults receiving tax credits 5.2 5.4 6.0 6.0 5.8 5.8 5.6 5.5 5.5 5.8 746,124 Adults receiving JSA 2 2.1 2.3 2.0 2.1 2.7 2.6 2.5 2.6 2.7 2.1 265,421 Low income certificate holders (HC2) 1.4 1.3 1.2 1.1 0.9 0.8 0.7 0.8 0.8 0.8 100,364 Adults receiving UC 3................ 0.0 0.0 11 Registered blind/partially sighted 0.2 0.3 0.2 0.2 0.2 0.1 0.2 0.1 0.1 0.1 8,476 Diabetics/Glaucoma sufferers 6.2 5.7 5.4 5.4 6.0 6.1 6.9 7.4 8.0 7.3 934,786 Need complex lenses 0.7 0.8 0.7 0.7 0.5 0.6 0.6 0.7 0.5 0.6 72,027 Close relatives 40 & over of Glaucoma sufferers 5.2 5.1 5.0 5.2 5.5 5.4 5.8 6.0 6.7 6.7 852,150 Prisoner on Leave 5...... 0.0 0.0 0.0 0.0 0.0 0.0 0.0 562 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 12,764,485 Notes: 1. Income Support includes patients receiving Pension Credit Guarantee Credit (PCGC) and also Income-related Employment and Support Allowance (ESA), which was introduced in October 2008. 2. Job Seekers Allowance. 3. Universal Credit is a benefit that has started to replace 6 existing benefits. It started to be introduced from April 2013. See www.gov.uk/universal-credit for more information. 4. Patients may qualify for an NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The count by eligibility is therefore approximate. 5... Not applicable. 6. See our Beginners Guide to NHS Eye Care Publications for information on eligibility categories. 7. The numbers relating to eligibility data for previous years can be found in Annex B. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 11

Table 1.3: NHS sight tests per 100,000 population, in England, during the specified financial years Number of NHS Sight Tests per 100,000 Population Children 0-15 Adults 60+ All Sight Tests. 2005-06 22,336 41,835 20,518 2006-07 21,856 41,905 20,654 2007-08 23,816 43,925 21,618 2008-09 23,934 44,270 21,915 2009-10 25,350 44,985 22,798 2010-11 25,084 45,164 22,856 2011-12 24,515 46,569 23,171 2012-13 23,200 45,410 23,067 2013-14 3 24,900 45,545 23,739 2014-15 4 26,764 44,981 23,697 Notes: 1. Patients may qualify for an NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The counts for these age groups may therefore be underestimates. 2. Figures are calculated from the Office for National Statistics' (ONS) mid-year population estimates of the first year shown, ie. figures for 2006-07 use the ONS mid-2006 population estimates. 3. Since the previous publication, ONS has released population estimates for mid-2013. Information for 2013-14 has been recalculated using these new estimates and will therefore differ from figures previously published. 4. 2014-15 figures use the ONS' mid-2013 population estimates as these are the latest available. 2014-15 figures will therefore be subject to recalculation in future reports once 2014 mid-year population estimates are available. 5. The recall period for NHS sight tests varies according to patient eligibility. Not all groups are entitled to an NHS sight test every 12 months. Further details are contained in our Beginners Guide to NHS Eye Care Publications. 6. The information presented here is based on the number of NHS sight tests and is not necessarily a count of individuals. Individuals may qualify for an NHS sight test at shorter recall periods and therefore be counted more than once in the figures depending on their clinical need. 12 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Rates shown in thematic maps are based on the locations in which the activity occurred, rather than patient residence. Figure 1.2: NHS sight tests per 100,000 population by Area Team, in England, 2014-15 Contains Ordnance Survey data Crown copyright and database right (2015) Figure 1.3: NHS sight tests of children age 0-15 per 100,000 of 0-15 population by Area Team, in England, 2014-15 Contains Ordnance Survey data Crown copyright and database right (2015) Copyright 2015 Health and Social Care Information Centre. All rights reserved. 13

Figure 1.4: NHS sight tests of adults age 60+ per 100,000 of 60+ population by Area Team, in England, 2014-15 Contains Ordnance Survey data Crown copyright and database right (2015) Figure 1.5: NHS sight tests per 100,000 population, during the specified financial years 14 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Table 1.4: Number and percentage of NHS Sight tests by practitioners in England, during the specified financial years Number Per cent Optometrists OMPs Total Optometrists OMPs Total 2005-06 10,075,000 280,000 10,355,000 97.3 2.7 100.0 2006-07 10,297,000 188,000 10,485,000 98.2 1.8 100.0 2007-08 10,878,669 169,221 11,047,890 98.5 1.5 100.0 2008-09 11,181,039 97,435 11,278,474 99.1 0.9 100.0 2009-10 11,767,625 44,026 11,811,651 99.6 0.4 100.0 2010-11 11,905,963 32,566 11,938,529 99.7 0.3 100.0 2011-12 12,277,754 27,973 12,305,727 99.8 0.2 100.0 2012-13 12,316,310 22,943 12,339,253 99.8 0.2 100.0 2013-14 12,765,781 21,649 12,787,430 99.8 0.2 100.0 2014-15 12,749,584 14,901 12,764,485 99.9 0.1 100.0 Workforce data are sourced from the General Ophthalmic Services, Workforce Statistics, England and Wales - 31 December 2014 publication, which can be found at: http://www.hscic.gov.uk/pubs/genophworkfstatsdec14 Figure 1.6: Ophthalmic Practitioners per 100,000 population, by Area Team, in England, as at 31 December 2014 Contains Ordnance Survey data Crown copyright and database right (2015) Copyright 2015 Health and Social Care Information Centre. All rights reserved. 15

Figures in Table 1.5 exclude private sight tests. Time series figures are calculated using workforce numbers for the respective years and have been affected by changes in the average working hours. Workforce numbers have been affected during the period by various changes in regulations, as detailed in the footnotes. Table 1.5: Number of NHS sight tests conducted per practitioner, in England, during the specified financial years Number of Practitioners on 31st December All. Optometrists OMPs Practitioners Number of Sight Tests per Practitioner All. Optometrists OMPs Practitioners 2005-06 1 8,193 446 8,639 1,230 628 1,199 2006-07 8,563 383 8,946 1,202 491 1,172 2007-08 2 9,238 394 9,632 1,178 429 1,147 2008-09 9,199 341 9,540 1,215 286 1,182 2009-10 9,679 344 10,023 1,216 128 1,178 2010-11 10,079 330 10,409 1,181 99 1,147 2011-12 10,482 324 10,806 1,171 86 1,139 2012-13 10,832 306 11,137 1,137 75 1,108 2013-14 11,164 293 11,457 1,143 74 1,116 2014-15 11,560 267 11,827 1,103 56 1,079 Notes: 1. Revised GOS regulations commenced in England on 1 April 2005, which introduced the Supplementary Lists in addition to the existing Ophthalmic Lists. 2. New regulations were introduced in England on 1 August 2008 replacing the Supplementary Lists and Ophthalmic Lists with a contractual regime for providers, and Performers Lists for clinicians. The new regulations mean that data at a local level are no longer comparable with data collected under the old regulations, due to a change in the basis of the information. With the introduction of the Performers Lists, NHS England Area Teams were asked to validate their data. This validation may have had an effect on workforce figures reported for 2008 at both a national and local level. 3. The figures presented are affected by the extent to which the GOS guidelines relating to maintaining lists have been followed. NHS England Area Teams may remove a practitioner who has not provided GOS in the past six months from its lists. The procedure for removing inactive practitioners is through an agreement between the PCT(2003-2012)/AT(2013) and optician. 4. Figures are calculated on the basis of headcounts for workforce numbers. 5. Figures presented are rounded. Calculations have been carried out using unrounded figures, which are available in the annexes. 16 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Domiciliary sight tests In 2014-15, the majority of NHS sight tests were conducted at ophthalmic medical practitioners premises; however, 3.3 per cent were conducted away from ophthalmic premises. These are known as domiciliary sight tests. In these instances, the ophthalmic practitioner visits the patient at their home, a residential care home or at a day care centre. For more information on domiciliary sight tests, see our Beginners Guide. Over the last 12 years, the number of domiciliary sight tests has risen by 63.9 per cent (162,742). Whilst tests reimbursed at the higher rate 5 have increased by a substantial 102.9 per cent, those at the lower reimbursement rate 6 have increased by 23.9 per cent over the same period. All patients who are eligible for an NHS sight test can qualify for a domiciliary sight test, if they are unable to attend a high street practice unaccompanied. However, no data are collected on the eligibility of users of domiciliary services. Without these data we can only speculate on the drivers for increasing use of services. It is possible that an ageing population, with increasing numbers of elderly patients seeking access to sight tests in their own homes accounts for some of this growth, but there are no data to directly support this. The increasing share of higher rate tests may support this idea. Table 1.6: Number and percentage of domiciliary sight tests by type, in England, during the specified financial years Dom. Lower Rate Number Dom. Higher Rate Dom. Total. Dom. Lower Rate Dom. Higher Rate Per cent Dom. Total. Dom Total as a percentage of Total Sight Tests 2005-06 135,221 158,673 293,894 46.0 54.0 100.0 2.84 2006-07 139,651 170,100 309,751 45.1 54.9 100.0 2.95 2007-08 142,761 186,604 329,365 43.3 56.7 100.0 2.98 2008-09 147,893 198,591 346,484 42.7 57.3 100.0 3.07 2009-10 154,817 218,898 373,715 41.4 58.6 100.0 3.16 2010-11 157,085 222,782 379,867 41.4 58.6 100.0 3.18 2011-12 161,802 234,398 396,200 40.8 59.2 100.0 3.22 2012-13 154,926 252,069 406,995 38.1 61.9 100.0 3.30 2013-14 163,107 265,002 428,109 38.1 61.9 100.0 3.35 2014-15 156,092 261,445 417,537 37.4 62.6 100.0 3.27 Notes: 1. Totals may not equal the sum of component parts due to rounding. Calculations have been carried out using unrounded figures, which are available in the annexes. 5 Domiciliary visits made either to a single patient at the address or where the patient is first of second to be seen are reimbursed at the higher rate. 6 Sight tests carried out on a domiciliary visit to a third or subsequent patient, at the same address, are reimbursed at the lower rate. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 17

Private sight tests and private domiciliary sight tests with partial help Patient with HC3 certificates as part of the low-income scheme are entitled to varying degrees of financial help with private sight tests. Over the last 10 years, there has been a 76.0 per cent decrease in the number of patients receiving partial help with private sight tests, with 1,285 patients receiving help in 2014-15. Table 1.7: Number of private sight tests and private domiciliary sight tests where partial help was given, in England, during the specified financial years Private Sight Tests Of which: Private Domiciliary Sight Tests 2005-06 5,355 90 2006-07 4,471 72 2007-08 3,783 209 2008-09 3,349 202 2009-10 3,191 226 2010-11 2,698 218 2011-12 2,526 178 2012-13 2,169 120 2013-14 1,703 112 2014-15 1,285 103 18 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

NHS optical vouchers The NHS optical voucher scheme was introduced in July 1986. Under the scheme, patients who had previously been eligible to have NHS spectacles were given NHS optical vouchers to put towards buying their own choice of spectacles, or having new lenses fitted to their existing frames. From April 1988, NHS optical vouchers could also be put towards the cost of contact lenses. Patients may receive a voucher for more than one pair of spectacles. Eligibility for vouchers is largely based on income, and therefore differs slightly to the eligibility criteria for sight tests; those aged 60 and over and those suffering from, or predisposed to, glaucoma/diabetes are not eligible. The type of voucher issued is dependent of the strength of the lenses needed. There are currently 8 voucher values (A-H), ranging from 38.30 (voucher A) to 211.30 (voucher H). More information on voucher eligibility and voucher type is available in our Beginners Guide. In the year ending 31 March 2015: There were 4.6 million vouchers processed in 2014-15, a slight fall of 1.4 per cent (66,564) from 2013-14 The maximum potential expenditure 7 on NHS optical vouchers was estimated to be 199.6 million; a 0.37 per cent increase on the 2013-14 value of 198.9 million. As with sight tests, use of optical vouchers is a demand led service and increases in activity reflect greater uptake of the service. The eligibility criteria for vouchers is largely based on income, and since 2005-06 there has been an increasing share of vouchers claimed by adults receiving tax credits and adults receiving job seekers allowance. We do not know the reasons for these increases, though they could include increased awareness of services and/or increased numbers of patients qualifying for services. Data from the Office of National Statistics indicates a rise in the number of JSA claimants since 2008 8. 7 Estimates are calculated using the maximum redeemable value for each voucher type as set out in http://www.nhsbsa.nhs.uk/documents/healthcosts/hc12_april_2014.pdf 8 http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=claimant+count http://www.ons.gov.uk/ons/rel/lms/labour-marketstatistics/index.html Copyright 2015 Health and Social Care Information Centre. All rights reserved. 19

NHS Optical Vouchers (Thousands) General Ophthalmic Services, Activity Statistics: England, 2014-15 Table 2.1: Number of NHS optical vouchers processed, in England, during the specified financial years April-Sept Oct-March April-March Year-on-year change Year-on-year percentage change 2005-06 1,860,000 1,819,000 3,678,000 54,000 1.5 2006-07 1,923,000 1,841,000 3,765,000 87,000 2.3 2007-08 1,983,389 1,967,518 3,950,907 185,907 5.0 2008-09 2,079,232 2,059,073 4,138,305 187,398 4.7 2009-10 2,260,239 2,159,779 4,420,018 281,713 6.8 2010-11 2,314,782 2,166,170 4,480,952 60,934 1.4 2011-12 2 2,200,306 2,359,033 4,559,339 78,387 1.7 2012-13 2,305,486 2,273,752 4,579,238 19,899 0.4 2013-14 2,368,165 2,311,361 4,679,526 100,288 2.2 2014-15 2,343,324 2,269,638 4,612,962-66,564-1.4 Notes: 1. Figures presented are rounded. Calculations have been carried out using unrounded figures, which are available in the annexes. 2. Figures are revised from those originally published, which were under-reported. Figure 2.1: Number of NHS optical vouchers processed, in England, during the specified financial years 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 Year Notes: 1. 2011-12 figures are revised from those originally published, which were under-reported. 20 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Table 2.2: Percentage of NHS optical voucher processed by patient eligibility and number, in England, during the specified financial years Per cent Number 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 7 2012-13 2013-14 2014-15 2014-15 Children 0-15 27.1 26.9 27.1 27.0 25.5 25.3 24.8 25.3 26.2 27.6 1,271,412 Students 16-18 6.6 6.9 6.9 6.9 6.6 6.4 6.3 6.4 6.5 6.7 307,941 Adults receiving IS 1 44.2 44.2 44.3 43.9 43.4 43.6 40.1 39.1 38.6 38.1 1,756,234 Adults receiving Tax Credits 12.7 13.0 13.5 13.9 14.4 14.9 14.2 14.2 14.7 15.0 690,892 Adults receiving JSA 2 3.9 4.3 3.9 4.3 6.3 6.3 6.2 6.5 6.1 4.8 223,568 HC2 full remission 3.6 3.1 2.8 2.6 2.5 2.4 2.1 2.2 2.0 2.0 92,542 Adults receiving UC 3................ 0.0 0.0 390 Complex appliance payment only 0.9 0.9 0.9 0.9 0.8 0.8 0.7 0.7 0.7 0.8 35,231 Prisoner on Leave 4...... 0.0 0.0 0.0 0.0 0.0 0.0 0.0 202 Total full vouchers 99.1 99.2 99.4 99.5 99.5 99.5 94.5 94.3 95.0 94.9 4,378,413 HC3 partial payment of voucher 0.9 0.8 0.6 0.5 0.5 0.5 0.4 0.4 0.4 0.4 16,769 HC3 complex appliance payment 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4 Total all vouchers 5,6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 4,612,962 Notes: 1. Adults receiving Income Support and/or Pension Credit Guarantee Credit (PCGC) and also Income-related Employment and Support Allowance (ESA), which was introduced in October 2008. 2. Adults receiving Job Seekers Allowance. 3. Universal Credit is a benefit that has started to replace 6 existing benefits. It started to be introduced from April 2013. See www.gov.uk/universal-credit for more information. 4... Not applicable. Prisoner on Leave was introduced in October 2008. 5. Totals may not equal the sum of component parts due to rounding. 6. From 2013-14 the total of all vouchers is higher than sum of eligibilities as eligibility data were not available for all organisations, while total data were available 7. 2011-12 figures are based on those originally published, not the revised figures shown in table 2.1. This is because revised breakdowns by voucher type and eligibility are not available. Table 2.3: NHS optical voucher processed per 100,000 population, in England, during the specified financial year Number of Optical Vouchers Number of Optical Vouchers per 100,000 Population Children 0-15 All. Vouchers Children 0-15 All. Vouchers 2005-06 996,535 3,678,000 10,264 7,289 2006-07 1,011,619 3,765,000 10,461 7,416 2007-08 1,069,393 3,950,907 11,077 7,731 2008-09 1,116,307 4,138,305 11,548 8,041 2009-10 1,126,040 4,420,018 11,603 8,531 2010-11 1,114,869 4,480,952 11,415 8,438 2011-12 3 1,110,177 4,559,339 11,068 8,426 2012-13 1,156,481 4,579,238 11,416 8,560 2013-14 1,224,724 4,679,526 11,996 8,687 2014-15 4 1,271,412 4,612,962 12,454 8,564 Notes: 1. Patients may qualify for an NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The counts for these age groups may therefore be underestimates. 2. Figures are calculated from the Office for National Statistics' (ONS) mid-year population estimates of the first year shown, ie. figures for 2006-07 use the ONS mid-2006 population estimate. Since the previous publication, ONS has released estimates for 2012. Information for 2012-13 has been recalculated using these new estimates and will therefore differ from previously published. 3. 2011-12 figures are based on those originally published, not the revised figures shown in table 2.1. This is because revised breakdowns by voucher type and eligibility are not available. 4. 2014-15 figures use the ONS' mid-2013 population estimates as these are the latest available. 2014-15 figures will therefore be subject to recalculation in future reports once 2014 mid-year population estimates are available. 5. The information presented here is based on the numbers of NHS vouchers and is not necessarily a count of individuals. Individuals may receive more than one NHS voucher in a 12 month period and may therefore be counted in the figures more than once. Our Beginners Guide to NHS Eye Care Publications contains further details. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 21

Figure 2.2: NHS optical voucher items processed per 100,000 population by Area Team, in England, 2014-15 Contains Ordnance Survey data Crown copyright and database right (2015) 22 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Table 2.4: Number and estimated potential maximum expenditure of NHS optical vouchers, by voucher type, in England, during 2014-15 Voucher type 1 Maximum. Estimated potential. Vouchers Redeemed Redeemable maximum expenditure 2,3 Value,. Number Per cent Pounds Per cent A 3,237,799 70.2 38.30 124,007,687 62.1 B 458,931 9.9 58.10 26,663,912 13.4 C 25,261 0.5 85.10 2,149,695 1.1 D 14,451 0.3 192.20 2,777,549 1.4 E 526,966 11.4 66.10 34,832,442 17.4 F 91,871 2.0 84.00 7,717,169 3.9 G 2,448 0.1 109.00 266,832 0.1 H 2,223 0.0 211.30 469,708 0.2 CAP 4 Single 25,064 0.5 14.40 360,916 0.2 CAP 4 Bifocal 10,171 0.2 36.60 372,274 0.2 Total 5 4,612,962 100.0 199,618,184 100.0 Notes: 1. Vouchers are issued to eligible patients to use towards buying their choice of spectacles (or having new lenses fitted to existing frames) or to purchase contact lenses. Each voucher type has a different value depending on the strength and type of lenses prescribed by the practitioner. 2. Potential maximum expenditure is based on the maximum redeemable value for each optical voucher which are available at: http://www.nhsbsa.nhs.uk/documents/healthcosts/hc12_april_2014.pdf 3. Expenditure is presented as 'estimated potential maximum' as that all vouchers may not have been redeemed to their maximum value and/or may have been issued during the previous year and therefore redeemed at that year s price levels. 4. CAP = Complex Appliance Payment. 5. Expenditure on prisms, tints and small frame supplements are excluded from the expenditure total as they incur a supplementary charge which varies with lens type. 6. Totals may not equal sum of components due to rounding. Calculations have been carried out using unrounded figures, which are available in the annexes. 7. For 2013-14 total vouchers is higher than sum of types as voucher type data were not available for all area teams, while total data were available. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 23

NHS vouchers for repair or replacement Some figures relating to NHS vouchers for repairs and replacements were corrected in April 2016. These figures have been updated in this report and the accompanying annexes, and have been highlighted in yellow. Repair or replacement vouchers are available to children under 16 and adults who are eligible for NHS optical vouchers. For details regarding eligibility for repairs or replacements, see our Beginners Guide. In the year ending 31 March 2015: The number of NHS vouchers reimbursed for repair or replacement was 527,193, a rise of 31,909 (6.4 per cent) from 2013-14. After declining in 2009-10 and the subsequent year, vouchers for repair and replacement had been steadily rising. Table 3.1: Number of NHS vouchers for repair of replacement, in England, during the specified financial years April-Sept Oct-March April - March Year-on-year change Year-on-year percentage change 2005-06 201,782 205,220 407,002 4,564 1.1 2006-07 210,427 216,446 426,873 19,871 4.9 2007-08 229,992 232,438 462,430 35,557 8.3 2008-09 234,784 232,475 467,259 4,829 1.0 2009-10 226,527 216,902 443,429-23,830-5.1 2010-11 219,957 211,992 431,949-11,480-2.6 2011-12 1 207,981 227,821 435,802 3,853 0.9 2012-13 223,652 233,754 457,406 21,604 5.0 2013-14 239,030 256,254 495,284 37,878 8.3 2014-15 261,946 265,247 527,193 31,909 6.4 Source: Health and Social Care Information Centre Notes: 1. Figures are revised from those originally published, which were under-reported. 24 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

NHS Vouchers General Ophthalmic Services, Activity Statistics: England, 2014-15 Figure 3.1: Number of NHS vouchers for repair or replacement, in England, during the specified financial years 600,000 500,000 400,000 300,000 200,000 100,000 0 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 Year Table 3.2: Number of NHS vouchers for frame repair or replacement, in England, during 2014-15 Number. of Frames Of which SFS 1. Front 18,280 71 Side 52,302 235 Whole 352,983 5,364 Total 423,565 5,670 Source: Health and Social Care Information Centre Notes: 1. Small Frame Supplement; these figures are included in Copyright 2015 Health and Social Care Information Centre. All rights reserved. 25

Figure 3.2: NHS repairs and replacements per 100,000 population by Area Team, in England, 2014-15 26 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Annexes Annex A: Report tables and charts (excel workbook) All table and charts presented in the reports are available in excel format. Annex A also contains some additional tables and charts that are not included in this report. Annex B: Summary and national level time series (excel workbook) National level time series are available for NHS sight tests and NHS optical vouchers. Data are also presented at Area Team and Region level. Regional Table number Title Financial Years Breakdown / National Only A1 NHS sight tests, by patient eligibility 1996-97 - 2014-15 National A2 Proportion of NHS sight tests, by patient eligibility 1996-97 - 2014-15 National A3 NHS sight tests,by patient eligibility 2014-15 Area Team & Region A4 Proportion of NHS sight tests, by patient eligibility 2014-15 Area Team & Region B1 NHS optical vouchers, by patient eligibility 1996-97 - 2014-15 National B2 Proportion of NHS optical vouchers processed, by patients eligibility 1996-97 - 2014-15 National B3 NHS optical vouchers processed, by patient eligibility 2014-15 Area Team & Region B4 Proportion of NHS optical vouchers processed, by patient eligibility 2014-15 Area Team & Region B5 NHS optical vouchers, by voucher type 2014-15 Area Team & Region B6 Potential maximum expenditure NHS optical voucher items, by voucher type 2014-15 Area Team & Region C1 NHS vouchers for repair or replacement, by patient eligibility 2014-15 Area Team & Region C2 Proportion of NHS vouchers for repair or replacement, by patient eligibility 2014-15 Area Team & Region C3 NHS vouchers for repair or replacement, by one lens, both lenses and frames 2014-15 Area Team & Region Annex C: CSV file Unformatted dataset presenting NHS sight tests, NHS optical vouchers and NHS vouchers for repair or replacement, in csv format at Area Team and Region level. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 27

Technical notes regarding sample based data Users should consider the sample based nature of some data in the GOS activity dataset when interpreting changes over time and applying the data to further analysis. Sight test patient eligibility data are sample based for all Area Teams and are derived from different sources. The data for the majority of Area Teams are sourced from the Open Exeter Payments System, for other Area Teams a manually collected, 2 per cent sample of sight test data based on GOS1 forms is submitted through the Omnibus system. We use Exeter data where Area Teams are able to satisfy us that the data provide a representative sample of activity. Where either the sample source or Area Teams (previously PCTs) processing arrangements have changed over time, anomalies can occur in the data, particularly when comparing to other years. We have undertaken some impact analyses on sight test patient eligibility data, using different volumes of data from Exeter. General Ophthalmic Services Activity Statistics England, Analysis of sight test patient eligibility data 2009-10, published in July 2012, is available on the HSCIC website 9. Following this analysis, we do not believe that the changes to sight test eligibility data sources is detrimental to the dataset or how it can be used, providing users understand that all sample based data are inherently less robust than complete data collections, and that this can result in fluctuations in activity at a local level over time. Other publications A full list of Health and Social Care Information Centre (HSCIC) reports produced on eye care can be found at: www.hscic.gov.uk/primary-care Our Beginners Guide to NHS Eye Care Publications contains a further list of related publications and data sources: www.hscic.gov.uk/pubs/gosactivity1415 Scotland http://www.isdscotland.org/health-topics/eye-care/ Note that different regulations are in place in Scotland, with all patients entitled to an NHS eye examination which replaced the NHS Sight Test in April 2006 Wales http://wales.gov.uk/topics/statistics/theme/health/primary-care/ophthalmic/?lang=en Data for England are broadly comparable to data for Wales. Collection arrangements may differ between England and Wales; this may impact sample based data. Northern Ireland http://www.dhsspsni.gov.uk/index/stats_research.htm Ophthalmic data is not currently published, but there is some health and social care data available. 9 http://www.hscic.gov.uk/catalogue/pub10038 28 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Published by the Health and Social Care Information Centre Part of the Government Statistical Service Responsible Statistician Gemma Ramsay, Section Head ISBN 978-1-78386-435-5 This publication may be requested in large print or other formats. For further information www.hscic.gov.uk 0300 303 5678 enquiries@hscic.gov.uk Copyright 2015 Health and Social Care Information Centre. All rights reserved. This work remains the sole and exclusive property of the Health and Social Care Information Centre and may only be reproduced where there is explicit reference to the ownership of the Health and Social Care Information Centre. This work may be re-used by NHS and government organisations without permission. Copyright 2015 Health and Social Care Information Centre. All rights reserved. 29