NHS England have made a commitment in the NHS Long Term Plan to commission an in-school visual assessment for all children in special schools in England. This will allow visual assessment, refraction and dispensing of spectacles (where appropriate).
The Special Schools Eye Care Programme team are keen to hear from ophthalmologists with existing Special Schools child eye care schemes in place in their area. This will allow the project to begin to map out what level of support different areas will need to implement a service, or enhance existing services. Hospital eye services could begin to identify children who would be suitable for discharge to a special school eye care team and alert parents to the upcoming change in service delivery.
What is a Special Schools Eye Care Programme?
The Clinical Council for Eye Health Commissioning stated the need for comprehensive and targeted programme of eye care for all children in Special Schools. Children with special needs are 28 times more likely to have visual problems than other children, yet only 7% will ever have had a community eye test, or be able to access community services. Over the past five years, work has been undertaken by NHS England, College of Optometry, RCOphth, BIOS and other stakeholders to develop a framework to address this.
The aim is not to replace existing services but offer a common framework, funding stream and service quality benchmark across England. It is anticipated the first teams will begin within the current financial year.
How will patients/carers/parents benefit?
Existing Special School Eye Care Teams (SSECT) across the UK have demonstrated benefits in many areas:
- Identifying previously undiagnosed visual impairment in children who cannot access regular optometry assessments
- Providing direct communication of outcomes to teachers, enabling them to offer appropriate educational opportunities
- Providing easy read reports for parents, carers, teachers and other health care professionals.
- Signposting resources and strategies for parents and teachers of children with visual impairment
- Parents consistently favour in-school assessment over hospital eye clinics, finding it more convenient and improving their child’s ability to complete a visual assessment
- Improving uptake of spectacle wear and providing teachers with strategies to improve spectacle adaptation, offering in school dispensing and repairs.
- Building confidence and capability in children to enable them to engage with annual optometric assessments as they get older, reducing undiagnosed visual loss in adults with learning disabilities.
- The service can be delivered by a range of eye care professionals with appropriate skills and competency. It is anticipated that most areas will use an optometrist led service with some elements delivered by orthoptists and dispensing opticians.
Who will deliver the service?
NHS England are aware that many schemes are in existence already and have visited some. The intention is not to “knock-down” existing programmes, but to highlight areas which may require additional support or funding (for example to enable dispensing/repair of spectacles in-school) to ensure comparable services across England. BIOS have been involved from the outset and it is anticipated that a multi-disciplinary approach will be needed. Hospital eye departments might choose to bid for this work, especially where a hospital-led service already exists. This model offers several advantages, particularly around communication, referral management and information exchange. In other areas a university or a community optometry practice may choose to bid for the work.
How will it be funded?
The intention is that NHS England will commission and fund SSECT centrally through the General Ophthalmic Services (GOS) framework, using Integrated Care Systems to incorporate the skills of various eye health professionals to deliver different aspects of care. The service will sit independent of CCG and there should be no impact on hospital paediatric eye clinic funding or contracts.
How will ophthalmologists need to be involved?
An ophthalmologist will be required to offer input at several stages:
- Set up – An ophthalmologist would usually form part of the Special School Eye Care Board, in particular to develop a set of referral criteria for the SSECT to use when assessing children in school. An expert panel has produced a set of criteria for guidance, but local decisions can be made to adapt these.
- Information sharing – In order to establish if a child’s visual condition has changed, information will be sought by the SSECT from parents and the health care team, in particular to minimise duplication of services. It is anticipated that information contained within a clinic letter would suffice in most cases. Over time as children transition into the SSECT service, these demands will reduce. The reports generated by the SSECT will reduce the need for education and health care teams to contact ophthalmologists to ask for reports.
- Ongoing advice – It is anticipated that while a service is in development, advice might be sought to refine the referral criteria or to clarify a clinical pathway.
- Referral management – Part of the role of the SSECT will be to offer a community alternative to hospital based visual assessments for children who have stable conditions but are unable to access high street optometry services. Identifying these children within current clinic populations and providing referral information to the SSECT would fall within the role of the paediatric ophthalmologist or delegated to an appropriate colleague.
How will it affect paediatric eye clinic demand?
The impact will depend on the current special needs workload within the hospital eye service. The SSECT offers a route to discharge stable patients and reduce DNA (children with special needs are more likely to DNA.) Once established, SSECT referral rates into hospital eye services are between 3-5% (around 10-25/year for most areas.) Typically this would be a single visit to confirm diagnosis, and then referred back out to SSECT for monitoring. In one area, once established, a SSECT reduced demand for follow up appointments by 150/year.
How will referral criteria be set?
A set of referral criteria have been developed from a panel of experts who have been offering special school visual assessments for several years: these can be used as a starting point for discussions by each Special School Eye Care Board to create locally agreed referral criteria.
What will be the clinical governance arrangements?
The Special School Eye Care Team will be led by a clinical lead who will be responsible for quality assurance, audit, information governance, staff training and competency and school liaison. It is anticipated in many cases that this will be an optometrist, but any clinician with the appropriate skill set could undertaken this role. A set of Quality Assurance criteria are set out in the service delivery document which services are expected to report on annually.
What do I need to do now?
The project team are keen to hear from ophthalmologists who may already be implementing similar work, or those who would like support to do so. If you would like to know more about this new service, or how you can participate, please get in touch with [email protected] or [email protected]. Information events are being planned for later in the year: please contact [email protected] if you would like to be kept aware of these.