«December 2006 Review of Community Eyecare Services in Scotland FINAL REPORT December 2006 Scottish Executive, Edinburgh 2006 © Crown copyright 2006 ...»
Services in Scotland
Services in Scotland
Scottish Executive, Edinburgh 2006
© Crown copyright 2006
St Andrew’s House
Produced for the Scottish Executive by Astron B49354 12/06
Published by the Scottish Executive, December, 2006
Further copies are available from Blackwell’s Bookshop 53 South Bridge Edinburgh EH1 1YS The text pages of this document are printed on recycled paper and are 100% recyclable Contents Page Foreword by the Deputy Minister for Health and Community Care 1 Executive summary and key recommendations 2 Introduction to the review 4
• Purpose of the review 4
• Background 5
• Format of the report 6
• Context of the community eyecare review 6 Work done in the course of the review 9
• The changing role of the community optometrist 9
• Centre for Change and Innovation (CCI) Patient pathways 10
• Certification and registration 10
• Services for visually-impaired children 11
• Locality-based interagency work 12
• Setting national standards 13 Conclusion, recommendations and an agenda for change 16 Key recommendations of the community eyecare review 18 The agenda for change 21 List of annexes
• Annex A Membership of review and working groups 24
• Annex B Glossary 28 (Annexes A and B are attached to the report, all other annexes are available at www.scotland.gov.uk/eyecarereview) iii
List of website links in the report:
• Summary of the responses to the public consultation Annex D
• Workforce planning issues Annex E
• Report of the working group on children’s services Annex F
• Summary of a study of interagency work in three localities Annex G
• A community optometry model for the future Annex H
• Report of the working group on certification and registration Annex I
• Report of the working group on standards Annex J
• Shared and delegated care schemes Annex K
• Epidemiology of common eye disease Access to the report Copies of this report are available in Braille, in large print and on tape.
Electronic copies are also available on request. The report has been produced in summary form, with references to more detailed material in annexes and on the Scottish Executive website www.scotland.gov.uk/ eyecarereview. If readers have difficulty accessing the website, the information can be provided in alternative formats by contacting Mike Cairns on 0131 244 3572.
Terminology There are many ways to describe sight problems. The formal certification and registration system uses two categories: “blind” and “partially sighted”.
When the system was changed in England recently, “blind” was replaced by “seriously sight impaired” and “partially sighted” changed to “sight impaired”. This report recommends that similar changes be made in Scotland, as part of the review of certification and registration. It is difficult to reach a consensus on terminology. Some people find the word “blind” unacceptable, others prefer its simplicity. In this report neither the old or the new registration terms will be used. More general terms, like “visually impaired”, “people who have a serious sight problem” and “sight loss” will be used to describe a spectrum from complete absence of vision to a partial impairment that affects the individual’s ability to function.
iv Foreword by Lewis Macdonald MSP, Deputy Minister for Health and Community Care I am very pleased to introduce the report of the Review of Community Eyecare Services in Scotland. The review was commissioned in March
2004. The review group was asked to consider the full range of community services available to visually impaired people in Scotland, and to make recommendations for modernising the system to ensure that it meets individual needs.
A great deal of work has gone into the review and I would like to take this opportunity to thank all of the contributors. One of the key messages of the review is that visually impaired individuals receive a better service if the helping organisations work closely together. This message is at the heart of the government’s approach to improving health and social care for everyone. The principle of partnership working is evident both in the way in which the review has been conducted and in the conclusions that have been reached. There have been contributions from a wide range of service users, from professionals and from voluntary organisations.
Some changes are already underway. In particular, the new eye examination, introduced on 1 April this year, is opening up opportunities for optometrists to work more closely with the hospital eye service and to become more involved in local eyecare networks. The review has set out examples of good practice, both for adults and for children, that can be applied across Scotland.
The response to the public consultation has demonstrated both an appetite for change and a broad consensus on the way forward. The focus on building local services designed to meet local needs is consistent with the future direction of health and social care in Scotland. The review sets out an agenda for action to improve the quality of life for all visually impaired people in Scotland. It is a pleasure to welcome such a positive and timely document.
Lewis MacdonaldDeputy Minister for Health and Community Care
EXECUTIVE SUMMARY AND KEY
RECOMMENDATIONSThe review of community eyecare services in Scotland brings together a series of initiatives, all of which are intended to improve the quality and consistency of support offered to visually impaired people. Loss of sight can create a wide range of problems for the individual and no single agency or profession can deal with all of them. Within the wider context of current government policy on reforming health and social work, the review brings together all of the agencies involved in providing services to visually impaired adults and children. The aim is to create a local, integrated network of support which is readily available to individuals who are either born with serious sight problems or who lose their sight later in life.
Different approaches have been taken to the various aspects of the review.
Some changes have already been made, like the new arrangements for optometry that were introduced in April 2006. Other areas of activity have been the subject of detailed scrutiny by interagency working groups, which have made proposals for change. The review has set out to be open and inclusive in its approach, involving both service users and service providers.
The response to the public consultation shows that there is a broad consensus, both about the need to modernise community eyecare services and the general direction of change.
The review has produced some detailed recommendations. The emphasis is on organising services around the patient by integrating support at a local level. This principle is applied to services for adults and for children, but the report makes a strong case for recognising the particular needs of visually impaired children and organising support that is tailored to individual needs.
There are examples of good practice which can be used as a guide. The report recommends changes to the certification and registration system, which is the formal link between health and social work. It is important that services are designed to include those who have additional disabilities or impairments. The report sets out some common standards, based on good practice, which should guide the planning and delivery of services. Finally, the report lists the practical steps that need to be taken to achieve lasting changes to the quality and consistency of support for all visually impaired people in Scotland.
Introduction to the review
INTRODUCTION TO THE REVIEWPurpose of the review In March 2004 the Deputy Minister for Health and Community Care announced a review of eyecare services in Scotland. A group was established to review arrangements for the provision of eyecare services in the community in Scotland, and to provide recommendations on good practice for effective models of care. The aim is to encourage the development of integrated eyecare services to ensure patients receive a good quality and efficient service, in a convenient setting without undue wait.
The review has been timely in bringing together some outstanding tasks, like the review of certification and registration, with some exciting new developments in eyecare, like the expanding role of the community optometrist in Scotland. The original remit of the review group was expanded to include an examination of particular needs of visually impaired children. The study of interagency work in three localities builds on earlier work (“Sensing Progress” Scottish Office 1998) and on several communitybased co-management schemes like the Glasgow Integrated Eyecare Service (GIES), the Lothian Optometry Cataract Initiative (LOCI) and the Grampian Glaucoma scheme. (Details are given in annex J at www.scotland.gov.uk/eyecarereview). In parallel, the Centre for Change and Innovation (CCI) has developed patient pathways for a range of eye conditions.
The strength of the review is that it deals with all of these important issues in a coordinated way, within the policy framework set by “Delivering for Health” and “Changing Lives” (Scottish Executive 2005 and 2006). At a more detailed level, there are links between the review of community eyecare services and other work in progress within the Executive, like the Rehabilitation Framework and the Equipment and Adaptations Advisory group. The recommendations of the review provide the basis for a strategy that includes all eyecare professionals and carers. The aim is to make optimal use of professional expertise in a setting that is acceptable to visually impaired people.
Background Traditionally, within the NHS, the first point of contact for most patients with an eye condition is their General Practitioner. This has limited the level of care being provided for many people as GPs often do not have the necessary equipment, expertise or experience to adequately diagnose and manage more complex eye conditions. Hospital eye departments have been used to manage the latter with the diagnosis and management of ophthalmic conditions being undertaken by ophthalmologists. Demands on the hospital eye service and an acknowledgement that some patients currently attending hospital eye departments could be dealt with in the community has led to a need to review how eyecare services are designed and provided. The recent changes to General Ophthalmic Services offers GPs and others the opportunity to make greater use of optometrists, and so free up both GP appointments and reduce pressure on the hospital eye service.
Crucial to this is the need for cost-effective care, avoiding the unnecessary duplication of tasks. It is acknowledged that better use could be made of a number of professionals (optometrists, orthoptists and ophthalmic nurses as well as rehabilitation and social workers) to deliver care in settings more appropriate and convenient to the patient. Given their numbers, and geographical spread, optometrists are a key group of clinicians in the primary care sector. Although they have been underused in the past, there is a growing number of informal co-management schemes with local GPs and NHS Boards across the country. Such schemes have demonstrated the need for a level two optometric service (as described in annex G at www.scotland.gov.uk/eyecarereview). Optometrists have been granted supplementary prescribing rights, with independent prescribing rights to follow. This will enhance their capability to manage anterior segment disease and chronic eye diseases such as glaucoma, in the community and in hospital settings.
The current review of community eyecare services is not the first attempt to modernise the way in which visually impaired people are supported in Scotland. In 1998, the report “Sensing Progress” (Scottish Office 1998) was published. That report covered similar ground to the current review. The only recommendation from “Sensing Progress” that was fully implemented was the establishment of a working group to examine the certification and registration of blind and partially sighted people in Scotland. The working group reported in 2002 and the Scottish Executive Health Department commissioned further work on the subject. The conclusions of the earlier working groups have been taken into account in the current review of community eyecare services. The review has also benefited from the opportunity to observe the changes made to the certification and registration system in England in 2004.
In addition to the review of eyecare services, the Executive has also been working towards improvements in the broader context of sensory impairment. A Sensory Impairment Action Plan is being prepared covering visual impairment, hearing impairment and dual sensory loss. The plan examines issues that are common to individuals across the spectrum of sensory impairment.
The lack of progress on the recommendations from the two earlier reports has been a source of frustration for many visually impaired people in Scotland. It had been widely believed that visual impairment services were in need of reform when the work began on “Sensing Progress”. Despite earlier disappointments there has been a great deal of commitment to the work of the current review and there are high expectations that the review of community eyecare services will lead to positive change.
Format of the report The report gives a brief description of a series of linked initiatives that have taken place in the past two years, all of which contribute to the recommendations for change. A more detailed account can be found at www.scotland.gov.uk/eyecarereview. There has been widespread consultation on all of the work that has been done. A summary of the responses to the consultation can be found at www.scotland.gov.uk /eyecarereview.