“Going the final mile”: The community eye health approach

Andy Cassels-Brown Consultant in Community Eye Health Leeds Teaching Hospitals Trust and Leeds Primary Care Trust

Chapter 2 lead correction treatment and the eyecare journey

• Passion is fuelled by late presentation of both preventable sight loss and visual impairment disability • On Tuesday in my clinic at st james’s very moving consultation with a 39 yr old mother of 2 attended with her mother diagnosed severe albinism as a child not registered, never had LVA appointment, not working both angry and in tears

The UK Vision Strategy

• Whilst not perfect, we have a very good health and social care infrastructure for those in the system and DOH targets and the UKVS will improve it • With the UKVS we have the opportunity to prioritise those not accessing or able to access the system ie go the final mile

Who is not accessing the system?

• Access/Uptake of free NHS optometry sight test is poor in some sections of community (40% in ethnic minority groups) • Uptake of CVI registration system has reduced ? why • Uptake/access to low vision and social support services is sub optimal

High risk groups

• Elderly • Young • Ethnic minorities • Poor mobility • Low socio-economic status • Multiple disability • Dementia • Institutionalised

Barriers to accessing services

• A B C D • AWARENESS of sight loss, silent disease, available services and how to access them • BAD SERVICE not user centred, waiting, poor communication, lost to FUp + support • COST to get there, glasses, carers cost • DISTANCE remote rural, no local optometric service in certain low socio-economic areas, poor mobility, lack of domiciliary uptake

How will we tackle this?

• Holistic Public Health/Community eye health approach • UKVS national/local advocacy health and social care guidance and commissioning • Needs assessment- we need a national epidemiology unit to provide local evidence based numbers and barriers • Develop Control Strategies

Control strategies

• Local eyecare networks/groups/fora • Lobby commissioners and PCT public health and primary care directors eyecare low vision very good QALY interventions to prevent stopping of work, driving, falling, independent living • Target High risk groups: – Health promotion – Community Directed vision testing – Community Based Integrated primary/secondary/social care services

NHS Optometric sight testing

• Regular sight testing for high risk groups is essential • Annual sight test for all may reinforce importance but will soak up NHS resources • No guarantee of any impact on high risk groups and may reinforce cost of specs barrier • Prof Hugh Taylor says perhaps only required every 5 years • Need to increase awareness of domiciliary visits + consider NHS Optometrist outreach from HES • Consider Moral responsibility for over 70 year old drivers have compulsory yearly sight test

Vision 2020 Leeds Community Eye Health programme priorities

• Develop Information Prescription for Low Vision pathway • Develop ECLO/VILO posts linking HES and community • Leeds Save your sight campaign leaflet • Health promotion, Test yourself, Test others • Train Sightsavers

Training Sightsavers

• Home wardens • Neighbourhood Network volunteers • Community Health Educators NVQ • 7 Healthy living community centres • Library, GP Health centres QOF • 3000 Community Care nurses, pharmacists, falls prevention teams, intermediate care rapid response teams

Summary

• UKVS needs to bring about a Sea change of community awareness and culture to – value vision and the need to look after it with routine sight testing – Understand how to access all the services to minimise disability from visual impairment – Will only happen if we can pull together and bring the DOH and commissioners along with us – Please post your top 5 priorities for chapter 2 to consider