A plan for equitable eye care was promised years ago. Why are we waiting?

Hannah Telfer, chief executive of Vision Care, tells a story about a man she encountered at a recent Crisis at Christmas clinic. He was trying to choose a drink, squinting, holding bottles at arm’s length, bringing them close to his face. ‘What’s this? Sorry, I can’t see what the drink is.’ He’d lost his glasses. Or they’d been broken. Either way, he’d been navigating the world in a blur for months.

Despite technically being entitled to free NHS care, he’d hit the same barriers that lock thousands of people experiencing homelessness out of the system every year. Even when eligibility isn’t the issue, the system doesn’t usually cover replacements for lost or broken glasses. Many high street opticians would have asked him to pay for a new pair. He had no means to do so. Under the General Ophthalmic Services (GOS) contract – the framework that governs NHS eye care – eligibility is tightly defined, relying on benefit status, age and narrow exemptions that don’t reflect the realities of homelessness.

Vision Care, a charity set up to ensure people experiencing homelessness can access eye care, found that a third of those they saw last year were in exactly this position – ineligible for NHS eye care at the precise moment they desperately needed it.

This shouldn’t be happening. Not because charities like Vision Care, working in partnership with Specsavers, haven’t stepped in to provide pop-up eye care clinics in community centres across the UK – they have, and they’re doing extraordinary work. It shouldn’t be happening because seven years ago, Theresa May’s government agreed to fix this exact problem.

‘Back in 2018 they agreed to make the changes needed,’ explains Telfer. ‘But then Brexit happened. And the legal support that was required from a government point of view was diverted away.’

The solution was agreed. The policy was ready. And it fell through the cracks.

These are issues that wouldn’t be expensive to fix. It would take less than 1% of the overall NHS eye care budget to close these gaps. ‘It probably equates to a rounding error realistically,’ Telfer says. A rounding error. That’s what stands between people experiencing homelessness and the ability to see properly. That’s what we’ve been arguing about while overall homelessness in England rose to an estimated 382,618 people, including more than 175,000 children, in 2025.¹

Research by Vision Care shows that 14% of people experiencing homelessness have at least one eye health condition, compared to just 1.4% of the general population.² That’s 10 times the rate. Conditions such as glaucoma, cataracts and age-related macular degeneration can be serious and eventually cause vision loss if left untreated. And yet people are locked out of care by bureaucratic barriers that were supposed to have been removed seven years ago.

The really maddening element here is that it’s not even about creating a new system. It’s about letting people use a service they’re already entitled to.

Specsavers’ role here is not as a stand-in for the NHS, but as proof that accessibility failures are impacting people’s lives. By partnering with Vision Care, Big Issue and Crisis to deliver eye tests directly in shelters, hostels and even Big Issue offices, Specsavers have shown that the barriers keeping people out of NHS eye care are just administrative. The care already exists. The expertise already exists. What’s missing is a system willing to meet people where they are.

Vision Care and Specsavers are jointly calling for three fixes. First: make homelessness an eligibility criterion for free NHS eye tests and glasses, so that people don’t fall through gaps in the system.

Second: let mobile opticians deliver NHS eye care at homeless shelters without bureaucratic hoops. Currently, NHS rules say you need three weeks’ advance notice and, absurdly, a list of named patients before you can bring eye care to a shelter – which is impossible when people are in crisis, moving between hostels, or sleeping rough.

Third: provide free replacement glasses when they’re lost, stolen or broken due to homelessness. Currently anyone with lost glasses must wait up to two years for their next NHS test before they’re eligible for replacements, forcing people to navigate their lives with serious eyesight issues, including rough sleepers for whom vision problems can be especially dangerous.

The government keeps saying it cares. Lord Darzi’s independent investigation into the NHS, published in September 2024, described homelessness as a ‘health catastrophe’ and highlighted how difficult health services are to access for people experiencing homelessness. The government says that its upcoming 10-year health plan will prioritise these inequalities.

And yet when questions are asked in parliament, the healthcare minister gives what Telfer politely calls ‘a non-answer’. Just words. No action.

Meanwhile, private companies and charities are plugging a gap that the NHS won’t – or can’t – fill. Since 2022, Specsavers have offered free eye care to all Big Issue vendors and thanks to their ongoing partnership with Vision Care, have helped over 6,000 people experiencing homelessness access free eye care and glasses. This shouldn’t require corporate partnerships, though. This is basic healthcare. It should be there when people need it.

This isn’t even about finding extra money or ambitious reforms. It’s about keeping a promise made in 2018. It’s about spending less than 1% more on eye care. It’s about removing bureaucratic barriers that actively prevent people from accessing services they’re already entitled to.

‘We want to make as much noise as possible,’ Telfer says. ‘We want MPs to be fed up of hearing from us.’

To find out more, visit specsavers.co.uk/about/charitable-partnerships/homelessness or vision-care.co.uk/.