HES vouchers.

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Dek
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HES vouchers.

Postby Dek » Wed 16 Jan 2019 10:10 am

Are there any optoms or anyone that can explain entitlement to Hospital Eye Service vouchers? To give you briefly my background. I am now 66 and suffered from KC since my mid 40’s. Within that period I was occasionally given a voucher by the hospital Ophthalmologist to help towards the cost of RGP’s. Not fully understanding what they meant at the time invariably they were not used. Fast forward to later life and I have had INTACS implanted and bilateral cataract extraction one eye being implanted with a toric lens. This has required at least annual visits to see my hospital Ophthalmologist and during the operation phases, more frequently. During this time I did not receive any HES vouchers. In 2015 I was discharged into the care of a local optometrist who was president of the BOA and had considerable experience in the fitting of scleral lenses. Since then I have not paid for my consultations, investigations or lenses from him. He explained that the cost was covered by the hospital voucher scheme. That changed last year when due to local hospital cuts I now have to pay fully. When I questioned my hospital about this it was explained that it was because I was no longer a hospital patient (but I haven’t been for the last 3 years). I do feel cheated by this because after having at least annual reviews at the hospital for more than 10 years it was an easy decision to discharge me to the care of my optometrist who had equal expertise and equipment to monitor and treat me. This seemed a win win situation as it prevented expensive hospital appointments. Optoms can you explain HES vouchers and why I was entitled and now not? Patients, what are your experiences? Is this a national trend? Thanks all.

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Lia Williams
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Re: HES vouchers.

Postby Lia Williams » Wed 16 Jan 2019 8:31 pm

Hi Dek,

Details of the NHS vouchers can be found here:

https://www.nhs.uk/using-the-nhs/help-w ... nd-lenses/

Voucher J is the contact lens voucher. Confusingly this is the price charged to the patient per contact lens and not the value of the voucher towards the cost of contact lenses.

I get my contact lenses from a hospital and I am charged this price (£57) per lens. This is also the charge for replacement lenses. Some specialist KC lenses are designed to be replaced every six months and one would be charged for the six monthly replacements.

If the hospital discovers that someone's KC can be corrected with ordinary contact lenses (ie not a specialist fit) then they are discharged from the hospital system back to the High Street.

Lia

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Anne Klepacz
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Re: HES vouchers.

Postby Anne Klepacz » Thu 17 Jan 2019 10:42 am

Just to add a bit more background - where a hospital doesn't have its own contact lens department, then they usually have a contract with a high st optom with KC experience to supply contact lenses for the KC patients who have a clinical need for lenses. Hospital Eye Service (HES) vouchers are issued so that the patient pays £57 per lens. From what you say, your optician wasn't charging you anything, which is very unusual, or have I misunderstood?
A month or so ago, I was contacted by a KC Group member who had been paying the subsidised rate for his lenses at his local optician's and had now been told the hospital was no longer funding contact lenses. So it looks as though yours may not be an isolated case. I don't know how the funding works these days - presumably it's the local clinical commissioning group (CCG) who actually foot the bill, so any cuts are due to them reducing their budgets? I'll try to find out more.

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Ali Akay
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Re: HES vouchers.

Postby Ali Akay » Thu 17 Jan 2019 7:42 pm

Hi Dek
I'll try to shed some light into this. There are two slightly different issues here:

1. Regarding charges for lenses under HES, hospitals have been allowed to make a "statutory charge" for contact lenses for decades. Hence, unless you were exempt from NHS charges (eg receiving income support, ESA, JSA, guaranteed pension credit, etc), the practitioner who supplied you with lenses since 2015 should have asked you to pay the statutory charge prevailing at the time. As mentioned by others, this is currently £57 per lens. If you were not exempt, and he hasn't asked you to make a contribution towards the cost, he would have claimed more from the relevant Hospital than he needed to, as he should have deducted your contribution from his invoices. It is possible than there was a local arrangement and the Hospital was happy to cover the full cost. It is also possible that they weren't aware that they needed to ask you to make a contribution!

2. The second issue is regarding you being asked to pay the full private cost. If the hospital in question have their in-house contact lens clinic, they could reasonably expect you to attend the hospital clinic. This would reduce the cost, and also enable them to claim a "tariff" from the local CCG for your appointments. If you're seen in a practice contracted to the hospital, it'd be difficult for the hospital to recoup any of the cost from CCG. As Anne said, some hospitals without an in-house contact lens clinic would have an arrangement with a practice they know and trust and refer patients to. I think you need to find out if the hospital in question have a contact lens clinic you could be referred to.

It is also possible that this is one big mistake! With all hospitals being under pressure to cut costs, they're looking into all avenues they could do this, and, contact lens provision is often seen as an area to make cost cuttings! Have you discussed your concerns with the practitioner who's been looking after you since 2015? There may be a new manager at the hospital who has been asked to look into ways of cutting costs! They are right, in the sense that, if you have been discharged from the hospital, then they dont see why they should pay for your care! However, it was their decision to discharge you, hence they could easily reinstate you!


The bottom line is that, you suffer from a condition that entitles you to have lenses through HES by paying the relevant stautory charge (unless you are exempt). My advice is to speak to the chap who's been looking after you, and see if he can guide you, as he would be more familiar with the local arrangements. If you dont get any luck, you can ask your GP to refer you to the nearest hospital with a contact lens clinic.

Dek
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Re: HES vouchers.

Postby Dek » Fri 18 Jan 2019 8:31 pm

Thanks all for your replies. Ali thank you for your detailed explanation.
I did try to investigate my entitlement to optical services and lenses but am not really any the wiser. As I understand it HES vouchers give a financial contribution to glasses and contact lenses if various conditions are met. I haven’t been given such a voucher for a considerable number of years even for my visits to the hospital based optician who really was only able to offer conventional hard CL’s which were not effective. At the time of my discharge in 2015 my Ophthalmologist referred me to a local optometrist who had considerable experience in the fitting of scleral lenses and a plethora of sophisticated equipment one of which was able to measure in microns the gap between the lens and cornea ensuring a comfortable fit. At that time I’d had cataracts treated in both eyes. In the left I had a toric lens implanted which gave excellent 6/6 vision. My right eye was more severely affected by keratoconus and the plan was to implant an aspheric lens (which I had done locally) then piggy back a toric lens in a second operation at RVH. Surprisingly to me I achieved quite good vision with the scleral lens (6/7.6) and am put off having the second piggy back one. My Ophthalmologist’s decision to refer me to the local optometrist that she did was well placed. I’m sure she felt confident she could discharge me as he could perform the same investigations, and more, that were being performed at the clinic. I did write to the hospital to question the decision but was told as I was no longer a hospital patient I wasn’t entitled to HES vouchers. But it seems I wasn’t getting these but a higher level of service where I paid nothing! The hospital did admit it did not keep records of which patients were receiving vouchers so when they made the decision to withdraw them they contacted the opticians. This suggests a certain degree of mis-management.
So basically it seems that I should not have been in receipt of anything when I was discharged from hospital care unless there was some contract between the CCG and hospital which allowed this. It would make sense as in my case it prevented a second operation on the nhs and I no longer took up valuable clinic time. Win win for both of us. I’m confused at the moment and don’t know if I should feel grateful for the free treatment I’ve had (and I am) or angry that it’s been withdrawn and I’ve been forced into an optical care plan costing £30 per month not covering the cost of lenses. Also I don’t want to open a can of worms by digging deeper which may have repercussions on the optometrist.
Sorry the post has been so long.

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Ali Akay
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Re: HES vouchers.

Postby Ali Akay » Sat 19 Jan 2019 9:43 am

Hi Dek
it's a tricky situation, and I sympathise with you. I am afraid it's all down to finances. I came across a very similar scenario a few years ago. We run clinics at 4 hospitals, and also have a small number of patients we see at our practice under "HES umbrella", similar to what you've been doing. A few years ago, one hospital had a change of management and they started refusing to settle our invoices on the grounds that the patients hadn't been seen at the hospital for a long time, they were no longer under their care, hence they did not need to pay for their treatment! The consultant referred you to the local practitioner as he obviously knew him and believed you would be looked after better than their in-house clinic. However, consultants often don't get involved, and aren't really interested in the financial aspect of things! They just want the best for the patient. My guess is that there's either a new manager at the hospital, or they've been ordered to look at all ways of cutting costs, and have decided to stop paying for the treatment of patients not seen at the hospital, and you can't really blame them. As I mentioned before, they most probably wouldn't have been receiving any contribution from CCG towards your treatment, and it'd have come off their general budget. Scleral lenses aren't cheap, and, especially as you weren't asked to make any contribution towards the cost, each lens would have cost the hospital hundreds of pounds. I guess the other option you have is to speak to your GP and ask to be referred to the nearest hospital with scleral lens fitting service. You may need to do a bit of research, perhaps have a chat with the chap who's been looking after you, explain that, although you've been very pleased with the service he provided, the cost is prohibitive, and ask his advice on where you could be referred to. Good luck

Dek
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Re: HES vouchers.

Postby Dek » Mon 21 Jan 2019 12:19 am

Thanks Ali, I think you’ve hit the nail on the head. My local hospital is no different from many others and exploring different areas in which to make cuts. Finally it seems they’ve got round to the Ophthalmology Department and you’re correct that Consultants don’t want to get involved in financial squabbles especially when the Chief Executive is a fellow Consultant. I thought my discharge from hospital to the local optometrist who was able to fit me with a scleral lens thus preventing another operation on the nhs was a good example of integrated care and probably resulted in a net cost saving. Now the funding has been withdrawn I see it differently, that I’ve been subcontracted out to the private sector which is not uncommon now in the nhs eg cataracts. From personal experience over the years, I have been through the hands of many optometrists with varying success which is understandable with a condition as complex as keratoconus. Now having found one who was able to fit a scleral lens with good results and more comfortable than I could ever have imagined I am reluctant to get back on the merry go round. I guess I’m just going to have to “suck it up” and pay up. On the question of paying for future lenses I’m still a bit confused if the nhs voucher towards their cost for someone with a complex eye condition is determined and paid for by the local hospital or paid by the nhs in the same way as a prescription for over 60’s and therefore the patient has a right to it. I obviously accept I have no right to the level of service that was previously being paid for but any contribution to the cost of future lenses would be helpful.Thanks again for your views and advice which have been most helpful.

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Ali Akay
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Re: HES vouchers.

Postby Ali Akay » Thu 24 Jan 2019 9:45 pm

Hi Dek
The issue is that NHS Voucher scheme for glasses on the High Street is very different from HES voucher scheme for contact lenses! The former is called GOS (General Ophthalmic Services) which provides help towards the cost of glasses ONLY to people in certain categories- children and adults receiving various benefits only. Over 60s get free eye test, but they only get help towards glasses if receiving Income Support, guaranteed Pension Credit, etc. If you're receiving such a benefit, then your optician could issue you with a GOS voucher which you can use towards the cost of either glasses, or contact lenses. The value of the voucher depends on the prescription, and with KC patients often needing very powerful lenses, the voucher would normally cover a big part of the cost, if not all. However, this is of no benefit to you unless you're receiving one of the benefits I mentioned (the actual list is more extensive, but essentially still based on benefits). You may be able to get a small amount of help toward the cost if your prescription is within the definition of Complex Lenses (over +/-10D), but this isn't worth getting excited about!


HES (Hospital Eye Service) contact lens voucher, on the other hand, is available to anyone needing contact lenses for a clinical need, and it is patient's contribution towards the cost, rather than "grant" towards the cost. Hence, you'd only need to pay £57 per lens, regardless of the actual cost of the contact lens. Patients in the income-based exemption categories I mentioned above, or children, don't pay any charges at all for contact lenses supplied under HES. The problem is, HES vouchers can only be issued by hospitals.


I hope this clarifies the matter. Best wishes.

Dek
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Re: HES vouchers.

Postby Dek » Fri 25 Jan 2019 7:28 pm

Hi Ali
Thanks again for your detailed explanation. I am not on any benefits and do not qualify for a GOS voucher. I think my hopes lay with an HES voucher which I had hoped was a statutory NHS entitlement once a complex eye condition treatable by a specialist scleral lens had been met. This belief was reinforced by receiving free treatment and lenses from my optometrist for 3 years following my discharge from the hospital Ophthalmology Department. However, it seems that possibly a local contract may have been the explanation for this although I do not know for certain. I will question my optometrist at my next visit. It seems that although only hospitals can issue HES vouchers they can refuse them once you’ve been discharged, notwithstanding the fact the eye condition has not changed and only improved by a specialist contact lens. This is at odds with patients who are investigated at hospitals, discharged then still qualify for free prescriptions eg diabetes, hypothyroidism. As I said previously I guess I’m just going to have to suck it up and pay up knowing when the lens needs replacing it’s going to be expensive! Many thanks indeed for explaining the complexities of the voucher system. It’s really appreciated.
Kind regards
Dek


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