As April looms health commissioners across the country are preparing with apprehension for the changes that the CCGs will bring. Much is unknown but change is inevitable and the only constant is the reality of extreme budget pressure.
With every challenge comes an opportunity and it is possible to find solutions for local people that are cost effective and save money in the long-term. An example is eye care services for people with learning disability.
It is well known that learning disabled people find it harder to access the health care services that they need. Unfortunately, they are also more likely to experience poor health and the consequent vicious circle of this deteriorating, when they fail to receive preventative services.
Recent research by RNIB and Sense found that people with a learning disability were 10 times more likely to experience sight loss than the general population but the problems associated with this were often misinterpreted and they consequently often failed to access an eye examination and follow-up services. This, in turn, results in loss of independence, social isolation, depression, falls and challenging behaviours. These all cost the state large amounts of money in treatment and support services.
Things don’t need to be like this and as chair of the Barking and Dagenham Vision Strategy Group I wanted to do something to help. We partnered up with the Local Optical Committee to better understand the problem and to develop a pathway. This led to Barking and Dagenham NHS awarding an enhanced contract to four local optometry practices to deliver a specialist service for people with a learning disability.
Delivering eye tests is often difficult for this user-group for a number of reasons, so the process starts with a home visit to put the patient at ease and start to prepare them for the test. The patient may also visit the optometrist to become familiar with the setting before the test is undertaken. 45 minutes is allowed for the test, which is more than twice as long as a standard examination. The idea is to build the patient’s confidence, help them relax, facilitate good communication and thereby get a better result.
In addition all of the optometrists delivering the enhanced service have received special training and use special techniques and visual materials appropriate to the client group.
The Barking and Dagenham enhanced optometry service for people with a learning disability is a genuine example of an initiative prompted by what service users and carers told us – that it was very difficult to get a local optician to give them a sight test.
The service now forms part of our wider Bridge to Vision Project, which aims to eliminate avoidable sight loss among local learning disabled residents and to ensure that blind and partially sighted people maximising their independence and wellbeing by accessing available eye care services.
The enhanced optometry service is the gateway to this pathway and we know that it has already identified treatable and correctable eye care conditions that would otherwise have been missed.
In setting up these new initiatives, we were supported by the Local Optical Support Committee (LOCSU) who are developing numerous similar eye-care pathways around the country. Like the enhanced service in Barking and Dagenham, most of them drive efficiency, better outcomes for patients, reduce demand on eye-care units in hospitals, reduce patient waiting times – in hospitals and at GP surgeries and, of course, save money.
We are convinced that the enhanced optometry contract in Barking and Dagenham will prevent the need for more costly treatment and support services along the line by increasing independence and preventing avoidable sight loss – with associated savings to the acute sector. These types of preventative savings, however, are notoriously difficult to quantify – the so-called ‘fairy gold’ savings that never appear on a balance sheet.
Bill Brittain is group manager for intensive support at Barking and Dagenham Council