Agenda item

Cllr Eileen Keller, Chair, Health and Adult Social Services Select Committee (HASSC), presented the Scrutiny Review on Local Eye Care Services to the Board and highlighted the following reasons why the Select Committee had decided to take a closer look at eye health in LBBD:

·  There was concern that sight loss could have very serious emotional, social and financial impacts on people’s lives.

·  It was believed that the fear of having to pay a high cost for glasses was putting some local people off of going for an eye test regularly, and possibly missing out on early treatment for any eye conditions they were developing

The results of the Scrutiny Review, attached as Appendix 1 to the report, had indicated that there were many positive areas of practice, for example:

·  Eye care services in the Borough compare well with national benchmarks

·  There was a good supply of opticians spread across the Borough

·  Diagnosis and treatment was available at Queen’s Hospital and Morefields in Upney Lane.

·  Rehabilitation, support and information was offered by the Council

·  There were a number of relevant local and national voluntary groups active in the Borough.

Cllr Keller advised that there were, however, areas for improvement and it was on those areas the HASSC had based their six recommendations on, which were:

·  Two of the recommendations related to the eye-care pathway, because HASCC felt the current pathway was over-complicated and there was scope for local opticians to refer people directly to other eye services, rather than send them to their GP for referral.

·  HASSC had heard from national organisations about the benefits of having access to an Eye Care Liaison Officer locally and were recommending that the CCG consider commissioning this role.

·  HASSC would like the CCG to consider whether cost-effective improvements could be made to low vision services, as in other parts of London those services were closer to where people lived and provided more tailored support.

·  HASSC had recommended that the Council undertake a local communications campaign emphasising the importance of going for an eye test every two years.  This was because statistics showed that during 2014/15 only one in five people in LBBD went for an eye test, which was lower than in Redbridge and Havering.

·  Although NHS glasses and eye tests for children were free, there was no way of ensuring that all children had an eye test as it was dependent upon parents taking their child to a local optician.  HASSC recommended that the Board considered and introduced a scheme to encourage parents to take their children for an eye test before they start school, possibly using some of the health check systems already in place.  Cllr Keller mentioned that in the past an optician, dentist and nurse would make school visits to see every child and perhaps something could be arranged along those lines.

Jignasa Joshi, Chair, North East London Local Optical Committee (LOC), advised that the LOC had supported the recommendations from the HASSC. However, the Service Specifications for Community Ophthalmology were often confused with primary care services; accordingly, the Clinical Council for Eye Health Commissioning had recently produced a Community Ophthalmology Framework, which explained the areas of responsibility and procedures that should be followed.  Jignasa felt that the guidance may have been overlooked by the CCG, as many of the services which the CCG were tendering for currently should now be Primary Eye Care.  B&D CCG, who were working closely with Redbridge CCG in relation to an ongoing Community Ophthalmology Service procurement, appeared not to have noted the guidance issued by the Clinical Council For Eye Health Commissioning.  Jignasa added that the Clinical Council consisted of representatives from the Royal College of GPs and the Royal College of Ophthalmologists, RNIB and Faculty of Public Health and many other organisations.  The LOC would like to engage with the CCG in regards to this issue.  Jignasa was asked to provide the information to Sharon Morrow.

The Board commended the report, which was evidence based, clearly written and succinct. 

Melody Williams advised that the school health process did include universal screening of basic eye and hearing, with onward referral if necessary.  The CCG indicated that it was possible that, as a result of earlier service reviews and changes, some of the suggestions in the recommendations may already be underway, however, Sharon Morrow, Chief Operating Officer, Barking and Dagenham CCG, agreed to take the recommendations to the relevant CCG committee(s). 

Matthew Cole, Director of Public Health, LBBD, agreed to take on responsibility for Recommendation (v) in the Board report. 

Anne Bristow suggested that Recommendation (vi) in the Board report would be led by the Council, due to its contact with parents when a child starts school: as that contact would offer an ideal opportunity to undertake prompts about eye and dental checks and immunisation.  The Children and Maternity Sub-Group would lead on this issue and report back to the Board in due course. 

The Board supported the recommendations made by the Health and Adult Services Select Committee (HASSC) in its Scrutiny Review report on Local Eye Care Services 2014/15.

Accordingly the Board:

(i)  Agreed to oversee a review by the Barking and Dagenham Clinical Commissioning Group (CCG) of the local eye care pathway, given that:

·  The current arrangements seemed complex and difficult for patients to understand;

·  It was not clear that everyone who should have a sight test was getting one; and

·  It was not clear to the HASSC that the pathway currently fully promoted choice and control by service users;

(ii)  Agreed to oversee a review by the CCG, which would consider the clinical benefits of community optometrists (high street opticians) being able to refer patients directly to hospital eye clinics and other services, rather than having to do this via GPs;

(iii)  Asked the CCG to consider the benefits of commissioning an ‘Eye Care Liaison Officer’ for local residents, to ensure that people with newly acquired sight loss were provided with support at the point of diagnosis and were signposted to appropriate services;

(iv)  Asked the CCG to consider whether cost-effective improvements could be made to local low vision services, given that the HASSC found that in other parts of London these services were delivered closer to where people lived and provide tailored support to ensure that visually impaired people were able to make ongoing, beneficial use of magnifiers and other equipment provided to them;

(v)  Agreed to oversee a local communication campaign, to be undertaken by the Council’s Public Health Team, which would emphasise the importance of having regular eye tests, whilst also delivering other important eye care messages as part of the future programme of public health campaigns;

(vi)  Considered what options could be used to ‘make every contact’ count and introduced a scheme or schemes to encourage and possibly incentivise parents to arrange an eye test for their child prior to starting school; and

(vii)   Noted that the appropriate Partners and Sub-Groups of the Health and Wellbeing Board would progress the work emanating from the recommendations and would report back to the Board and HASSC, as appropriate, in due course.