REPORT ON THE VISION 2020 UK CONFERENCE, 19th JUNE 2008
Nick Astbury
85 people attended an excellent conference that focussed on implementation of the UK Vision Strategy and related topics with some light entertainment after lunch.
Welcome and Introduction by Stephen Remington, Chairman of VISION 2020 UK
Stephen reiterated the achievements of VISION 2020 UK which has uniquely brought together so many across the eye care sector and helped break down barriers between organisations by having a common purpose to address the unmet needs of visually impaired people. He stressed the impartial and objective nature of VISION 2020 UK and urged members to “ask not what VISION 2020 UK can do for them; but ask what they can do for VISION 2020 UK (after JFK, 1961). Involvement is not about surrendering power but contributing to a united voice.
Keynote Speech by Ben Dyson, Director of Primary Care, Department of Health: ‘Our NHS, our Future’: Promoting Health and Reducing Health Inequalities
Ben Dyson confirmed that the UK Vision Strategy (UKVS) resonated strongly with government work on primary care, key points of which will be released in 2 weeks time. The NHS ‘next stage review’ has looked at all aspects of primary community care and all the staff who work in the community. The work has built on ‘Our health, our care, our say’ and the GOS review. However he also said that there is a feeling that the NHS has ‘lost its way and purpose’ and this needs to be remedied.
Lord Darzi has a ten year vision for the NHS to make it an environment in which better care can be delivered and better outcomes achieved. The three main themes are:
- Health inequalities and health promotion
- An NHS which is personal and responsive
- Quality in primary community care
Primary Care Trusts (PCTs) must be developed as commissioners and integrated working achieved across professions.He mentioned polyclinics as there is a will for community services and clinicians to be brought together under one roof.
- Health inequalities and health promotion
A ‘wellness service’ is also articulated in the UKVS. Prevention is better than cure, but how to achieve it?
- embed in the millions of NHS patient ‘contacts’ better health promotion and public health messages
- Predict and prevent – ie identify ‘at risk’ groups and give them access to services. Improvements in general health (cardiovascular) will also benefit eyesight
- Shared responsibilities: government, hospitals, primary care, schools etc all play a part. Health inequalities (HIs) are not just a socio-economic issue. They exist in every community and setting.
- Personal responsive integrated care
Treat people as individuals. Visual impairment impacts on quality of life. Listen to the views of patients.
- Quality in primary community care
Understand peoples’ whole needs by combining pathways (eg stroke, depression, obstructive airways, heart, diabetes etc) with eye health.
How will this be developed?
- Role of PCTs. “World class commissioning” means a defined set of competencies with public feedback. In order for the local NHS to achieve the best outcomes, tools must be provided and appropriate professional skills employed
- Local clinicians. Practice-based commissioning has not really worked in getting professionals together and has encouraged GPs to make it work for themselves. GPs need to work with local authorities, other health professionals and charities
- Identify barriers and if necessary ‘throw away the rule book’. If a group of clinicians can think of better ways of working (such as shared leadership or budgets), pilots of flexible ways of working should be encouraged.
Ben Dyson sounded committed and interested in visual health but the above points are often generic and we know that government does not consider eyes and vision a priority. We shall see in two weeks whether eye health features in the Darzi report. NJA
Parul Desai, Consultant in Ophthalmology and Public Health, MoorfieldsEyeHospital. Improving the Eye Health of the People of the UK. The Public Health Agenda in Relation to Vision.
This is about raising awareness amongst the public and professionals. How can it be achieved objectively and quantifiably? Public Health outcomes in the NHS often focus on mortality (stroke, diabetes, smoking, cardiovascular) but the overall goal to improve health will impact on vision, ie NHS policy is also relevant for visual impairment.
Raising awareness for those attending the conference.
There is a danger of professionals working within their own spheres of professional competence and expertise (silos). Patient care can become ‘compartmentalised’ and health inequalities (social, cultural and economic) can be induced by ‘silo-specific’ care.
Two examples:
- The National Service Framework (NSF) for Older People (2001) involved the concept of ‘patient centred care’ and the ‘Single Assessment Process’ (SAP) which had the purpose of providing a framework to avoid duplication, shared across health and social care agencies - but none were tailored for the visually impaired. The only mention of vision in the NSF was ‘do more cataracts!’ A huge missed opportunity, through lack of involvement.
- Stroke. 100,000 people/year in England are affected, 2½% of whom have a severe visual impairment due to cerebrovascular disease. 20% have uncorrected refractive error and visual field defects often go undiagnosed. The recent Scottish SIGN guidelines for stroke did not include vision! Vision missed out again.
Raising awareness amongst the public
Changes in lifestyle have a dramatic effect on eye health. Face to face consultations that occur throughout the NHS, social care and charities provide millions of opportunities for passing on health messages eg smoking cessation programmes. Information on eye health must be made available to eye health professionals as well:
Information on eye health - the National Library for Health (
The Eyes and Vision Specialist Library coordinates with diabetes, disabilities, stroke, later lives etc. Information is also accessible for the visually impaired.
The National Programme for IT(NPfIT)
Involves upgrading IT for the NHS’s 1.3m employees and 53m patients. One feature will be ‘health space’ in which people can access their own test results, manage their appointments etc and a forum through which communication can be undertaken. The National Clinical lead is John Sparrow. The plan is to use the NPfIT to monitor and evaluate health service activities as information is gathered. Good quality clinical data, accurately entered, will inform future health planning and policy. The CVI is potentially available electronically. We need to make better use of it as it is the only mechanism for establishing the extent of visual impairment in the UK.
Group Discussion – What needs to be done by individual organisations and bodies to take these issues within the Strategy forward? Focusing particularly on similarities and differences between issues for children, adults of working age and older people.
See summary at end
Andy Cassels-Brown, Consultant Ophthalmologist, VISION 2020 Leeds.Eliminating Avoidable Sight Loss and Delivering Excellent Support for People with Sight Loss. “Integrating Health and Social Care: From Hospital to Community”
What is the Royal College of Ophthalmologists doing?
Activities include: providing advice at a national level/advocacy/teaching, training and accreditation/health promotion/research/four recent symposia involving VISION 2020 UK/articles in RCOphth bulletin/technical support via the primary care group that has now been subsumed into VISION 2020 UK/active ocular public health group chaired by Nick Astbury/distribution to all ophthalmologists of ‘Low Vision – an essential guide for ophthalmologists by Anne Sinclair and Barbara Ryan, supported and published by the Guide Dogs for the Blind Association/new curriculum incorporating public health/work-based assessments that include communication skills/Seminars in community eye health – next on Sep 4th
What is happening locally?
VISION 2020 Leeds initiative for community eye care and new module and certificate in public eye health based in Leeds.
What individuals can expect?
People’s Vision Charter – to be circulated later
Debbie Keogh. The role of the Eye Clinic and information Officer (ECLIO)
Debbie works at St James, Leeds and supports two community eye clinics.
An A5 booklet is used to record the treatment/care pathway. A pilot showed that people want:
- Information on their particular eye condition
- Someone to talk to
- A directory of services
- Helpline
- Different formats
The work of an ECLIO involves:
Explaining the treatment, care, support process and that support is not dependent upon registration/support for people struggling with reduced vision/ensuring that nurses testing vision also ask about coping/support for families/early ie timely support/identifying those people at risk/advice or referral for advice on jobs, mortgages etc/freephone help/ensuring that the patient is ‘in charge’/maintaining confidentiality/liaising with wards/taking referrals from the voluntary sector or other departments eg stroke or self-referrals/referring out to social care, education, employment, welfare rights, pensions, DLA, travel,local organisations
Summary:
First point of contact
Information
Emotional support/listening
Safety – falls, depression etc
Care Plan
An exhausting but thoroughly worthwhile job, described with enthusiasm!
“Who Wants to be a Visionaire?” chaired by Stephen (Chris) Remington (Tarrant)
Contestants: Andy Cassels-Brown, John Harris, Mary Bairstow, Michael Wolffe
Prize (stress ball) won by A C-B with help from the audience and a friend.
Lesley-Anne Alexander, Chief Executive, RNIB & Chair, UK Vision Strategy Advisory Group
Inclusion, Participation and Independence for People with Sight Loss
Recap of rationale for UKVS – ‘UK failing its citizens’
Account of the RNIB strategy 2009-2014:
- Preventing avoidable sight loss and ensuring timely treatment
- Hands on emotional and practical support for independent living including education and employment
- Helping to create an inclusive society eg accessible transport and travel
Through: Direct service/political campaigning/influencing/working with other organisations
Alison Hood, Guide Dogs “Let us Focus on Quality of Life” -
Social policy requires ‘joined-up’ partnership between services and organizations. Exclusion
may be brought about by an individual’s emotional state and loss of confidence leading to
social isolation. Predictors of depression include renal disease, cardiovascular disease and
visual impairment. Emotional well-being is the key. This must be addressed at the right time
which is often when someone is registered blind. The Guide Dog’s middle step initiative fills
this gap and aids transition from sight loss to independence. Functionality indices help with the
determination of need for the future.
And finally: some‘good practice’ discussion points:
- Imaginative use of existing resources eg use the 1m/year DWP visits for visual assessment or enable DLA/AA payments for purchasing LVAs
- Improve communication to: service users, between professionals, with policy makers
- Minimum outcome rights for children
- Base care on need ie treat the person not the condition
- Improve links between hospital departments (cardiovascular/stroke/eyes)
- Good practice involves joined-up working: eye-care forums, integrated health and social care
- Declare WAR: Working together/Awareness/Real action!
Nick Astbury June 19th 2008