Towards a National Eye Care Plan

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Towards a National Eye Care Plan

• Bob Ricketts
• Acting Head of Access Policy and Capacity
• 28th November 2003

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Towards a National Eye Care Plan

• Context
• Potential Key Components
• Challenges
• What Next?

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Towards a National Eye Care Plan

• Origins
• Successful modernisation within ophthalmology
  (action on cataracts)
• Debates with the Royal College re capacity and
  productivity (summer 2002)
• Potential to eliminate cataracts waits v. need to
  develop other eye care services
• Eye Care Services Steering Group (December 2002)

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Towards a National Eye Care Plan

• Eye Care Services Steering Group
• Purpose To develop plan for modernising NHS
  Eye Care Services
• Maintain and develop integrated, patient centred
  services
• Improve access, choice and quality
• Consistent with Vision 2002 Programme
  (eliminating avoidable blindness by 2020)

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Towards a National Eye Care Plan

• Why a National Eye Care Plan?
• Demographic changes
• Foundation of previous successful modernisation
• Evidence of potential for improvement
• Increase choice and responsiveness (embed user
  views)
• Needs a balanced approach
• Elective Non-Elective Pressure ?
• ProvisionCommissioning

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Towards a National Eye Care Plan

• Demographic Context
• Ageing population - by 2020, 23 increase in
  65-74 group, 25 in 75 group
• Visual impairment predominantly affects older
  people
• Projected incidence of visual impairment rise 35
  by 2020

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Towards a National Eye Care Plan

• Major Conditions
• (1) Cataract
• 50,000 patients waiting over 3 months for
  cataract treatment
• By age 75, 25 of people will have developed a
  cataract
• (2) Glaucoma
• Common potentially blinding disorder requiring
  life long care
• 5 of over 75s

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Towards a National Eye Care Plan

• Major Conditions
• (3) Low Vision
• Estimated 650,000 people in England with low
  vision
• (4) ARMD
• Most common cause of irremediable serious visual
  loss in over 65s
• Accounts for 14 of new partial sight and blind
  registrations for the working population

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Towards a National Eye Care Plan

• Strategic Objectives
• Elimination of avoidable blindness (vision 2020)
• Improve access to care and provide it closer to
  patients
• Increase choice and responsiveness
• Develop effective partnerships between primary,
  secondary care, voluntary agencies, social
  services, patients and carers
• Make the best use of the available skills and
  resources
• Build the evidence base of what works
• Spread good practice

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Towards a National Eye Care Plan

• Emerging themes
• Develop integrated networks of eye care services
• Optimise access and practise through adoption of
  agreed national care pathways
• Provide more care in appropriate primary/
  community care settings
• Build patient perspectives and choices into
  service design

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Towards a National Eye Care Plan

• Emerging Themes
• Cut waiting times in all services
• Make better use of skills in primary care
• Increase role of professional groups working in
  primary care
• Build commissioning capacity and competence

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Towards a National Eye Care Plan

• Emerging Challenges
• Funding
• Payment and Incentive Systems
• Workforce
• Supply
• Skills
• Regulatory and Statutory Frameworks
• IT Infrastructure

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Towards a National Eye Care Plan
Proposed Cataract Pathway
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Towards a National Eye Care Plan
Proposed Glaucoma Pathway
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Towards a National Eye Care Plan

• (1) Evidence based pathways for
• Cataract (3 month max wait a pre-requisite)
• Low vision
• Age related macular degeneration
• Glaucoma (needs piloting)
• (Care Pathway for diabetic retinopathy via
  diabetes NSF)
• (Proposed development of Care Pathway for the
• management of Anterior Eye Disease)

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Towards a National Eye Care Plan

• Pathways designed to
• Have fewer steps for users
• Make best use of available resources
• Make more effective use of professional resource
• Provide high standards of clinical care with
  good
• outcomes
• Main areas of change in pathways are at interface
  between primary and secondary care

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Towards a National Eye Care Plan

• Proposals
• (2) Invest
• 72m over 2003-2004 to cut waits for cataract
  treatment
• 6 months maximum by March 2004
• 3 months maximum by December 2004
• 4m to fund and evaluate innovative
  projects/pilots to improve services for patients
  with chronic eye conditions and low vision
• Publish commissioning guidance on eye care
  services.

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Towards a National Eye Care Plan

• (3) Extend Choice
• Choice at 6 months - major pilots in London and
  South for cataract treatments/ophthalmology
• Piloting choice at referral (linked to e-booking)
• Implementation of choice at referral in England
  by January 2005
• National consultation on Choice and
  Responsiveness (strong focus on long term
  conditions)
• Choice proving to be a powerful driver of quality
  and access improvements

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Towards a National Eye Care Plan
Choice and Waiting Times London Patient Choice
Project Choice at 6 months for cataract treatment
from October 2002 Orthopaedics and General
Surgery April 2003
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Towards a National Eye Care Plan

• Proposals
• (4) Remove Regulatory Barriers
• Change GOS regulations to allow optometrists and
  ophthalmic medical practitioners to refer
  directly to hospital eye services
• Prescribing
• (5) Grow and develop workforce
• Modelling workforce impact
• Engagement of Workforce Development
• Confederations

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Towards a National Eye Care Plan

• Next Steps
• Further work, especially on
• Workforce
• Regulations
• Anterior Eye Disease
• Choose pilot projects (chronic eye disease and
  low vision)
• Develop commissioning guidance
• Launch pathway (New Year)

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Towards a National Eye Care Plan

• Huge challenge but if we deliver it
• Major contribution to reducing avoidable sight
  loss
• More choice for patients
• More responsive and convenient services
• Better use of everyones skills
• Joined-up Eye Care