In Opticians they have a mixed NHS and Private system -like Dentistry but the cost of glasses effectively funds the low eye test NHS cost to the government so it's still easy to get NHS care.
The people who get NHS tests who fail to arrive for appointments are by the vast majority kids (dependent on parents bringing them) and those of working age and in work or not in receipt of an NHS test entitlement under the low income category.
The over 60s who also get NHS care are the most reliable to turn up and are by far the biggest category and more frequent users of free NHS eye tests and then referral on to the hospital.
Funding via private paying eye tests only (opting out of NHS) is happening increasingly at some independent opticians (like dentists) as the hassle of administering the NHS claim for the eye test paid to the opticians company by the government is difficult and time consuming. If this continues there will effectively be a two tier system with easy access for those paying and a selected number of NHS providers such as Specsavers.
Like dentists this a part of the NHS also under private control and also isn't a model for success as the glasses cost is the reason NHS eye care exists. If everyone bought their glasses online say then the private companies wouldn't fund an effective loss leader of an NHS eye test.
There is an issue that the fewer users of the service are the ones paying the fee so this isn't enough to make a difference and it doesn't affect people not turning up for their appointments .
The vast majority do turn up for secondary care hospital appointments- but if they don't because hospital eye care is so busy missing an appointment means you are discharged from hospital care and have to be re referred by your GP or optician.
This model shows that paying for a certain proportion of the working population for NHS care doesn't make the hospitals less busy and those who don't turn up less frequent as the reason for not attending is more complex and as others say the model with exempt the vast majority of the service users anyway.
It would be a drop in the ocean.
I do agree we are an ageing population and the NHS increasing provides treatment that wasn't available years ago.
For instance there's an ageing eye condition called wet macula degeneration where the bi monthly injections would cost £1,000 a time and some people have had 30+ (plus the cost of the appointment).
This treatment wasn't available 20 years ago and those developed the condition lost all their central vision in the affected eye and if both eyes their sight. Macula degeneration is an ageing eye disease (as are a lot of the eye diseases )so hospital eye departments have to have more funding and this department of the hospital as it's one of the busiest.
The NHS care is amazing and we should be wary of any charge introduction.
I would agree with cross party talks on what is funded .
The NHS over 60 free test was brought in because the social care cost is more from people developing advanced eye disease and potentially going blind than funding for primary care for the most at risk category (including diabetics and those with a family history of glaucoma are also funded for NHS sight tests).
Social care is the issue. I've encountered this with my parents. No one wants to face they need to look at then fund by giving up their property for the cost of care/nursing homes and this makes the process of discharge from hospital slower.
There's suddenly the prospect of looking at homes at short notice and family helping make a decision. Often the elderly person is understandably reluctant to go into care initially making return hospital admissions more likely.
I think we should be looking more at social care models for the elderly in other countries and as individuals thinking about what health we will be in and preparing for a change that inevitably will happen.
Why don't we build more bungalows and have models for keeping elderly people from needing in patient hospital care from falls?
Perhaps the old 'cottage hospitals' to come back into existence with less doctors but a higher ratio of nurses for those who can't go to a care home yet, but aren't well enough to go home but also don't need a main hospital bed. This relies on a great nursing team which we should absolutely fund appropriately (the younger ones have student loans and it is not well paid for the responsibility and stress of lack of staff).
A dedicated GP who can deal with multiple chronic conditions more personally. The issue with accessing GP care is in some part that there are increasing elderly service users taking up multiple appointments- could this be reduced by any known person dealing with their care. We'd certainly need to recognise we need to fund and value our GPs.
Sorry for the length - I appear to have written a dissertation 