Richard Knight: Reflections on a Decade of Policy Evolution
30 August 2023
Richard joined LOCSU as Head of Policy from a role in the financial services sector ten years ago, and it is safe to say he has seen some considerable changes during his time here. In fact, change has been the defining feature of his tenure.
In April 2013, just before Richard started his role, the Health and Social Care Act was implemented. “When I joined LOCSU, both it and the wider healthcare sector were in a state of flux,” he recalls. “The Health and Social Care Act had prompted the creation of CCGs, meaning there was a huge amount of competitive tendering in place due to the focus on best value. Suddenly the primary eyecare companies that had been set up years before needed to step up. A large part of my early work involved helping to get those companies into a position that they could take part in the tendering processes and be credible organisations delivering on behalf of the sector.”
This was just the start of a decade where frequently changing policy required LOCSU to adopt an agile approach if LOCs and primary eyecare companies were to reach their potential. It quickly became clear that the reforms of the Health and Social Care Act were not working in the way intended. “There were too many CCGs and too much focus on competition, resulting in inefficiencies and duplicated effort. By 2014 NHS England had published its five-year forward view, which began to roll back some of the changes. There was a desire to set up commissioning groups with larger footprints, and although this didn’t really work at that time, the direction of travel towards more integrated and preventative care was established. This was reinforced through the 2019 Long Term Plan and the Health and Care Act 2022, which sees providers and commissioners undertaking collaborative decision making on integrated care boards straddling health and social care. This was a major policy change and once more LOCs and primary eyecare companies were required to adapt.”
LOCs and primary eyecare companies have come a long way in ten years, and the future will require continued evolution, says Richard. “Now it’s a case of actively engaging with these new bodies on a local and regional level to understand what they can do and how LOCs can provide support to help develop local services for local people to improve access and care outcomes. LOCs are capable of facilitating all kinds of comprehensive services that meet the priority outcomes for integrated care. The primary eye care sector is relatively small scale in the scheme of things but has scope to bring large results if actively engaged, the perennial challenge is getting a hearing.”
Looking back over his time at LOCSU, Richard is most proud of the way primary eyecare companies have developed to become instrumental in facilitating service delivery through local contractors with multiple pathways commissioned throughout the country. “There’s been huge development,” he notes, “and there’s a strong roadmap in place, in Optometry First, to ensure that the sector can reach its full potential.”
Reflecting on a decade in the role brings Richard a sense of satisfaction: “It has been great to watch the evolution of LOCs. The industry is full of good, hardworking, and innovative people with a shared sense of mission, and it has been an honour to do what I can to support it. I feel I’m leaving LOCSU in a better place than when I joined, and that’s something to be proud of.”