Low vision survey highlights need for review

Results from a Clinical Council for Eye Health Commissioning (CCEHC) survey have highlighted the need to review commissioning and provision of low vision (LV) services to deliver more accessible and integrated care for patients in England.

The CCEHC, which represents the major clinical professions (including ABDO) and sight loss charity organisations in the eyecare sector, conducted a survey on the commissioning and provision of LV assessment services in England for five weeks from 5 April 2021, to understand the impact of the pandemic on LV assessment services between April 2020 and March 2021.

The survey showed that, prior to the pandemic, there was variation in the use of service specifications, protocols and thresholds for LV assessment.

Since the pandemic, service provision has been challenging, with deployed clinical staff, patients and some practitioners shielding, and lower clinic numbers to maintain distancing. This has been associated with a significant fall in certifications of visual impairment during lockdown periods.

Based on the findings of the survey, full details of which can be found here, the CCEHC has made the following recommendations, and is calling for LV services to be included in system recovery and transformation planning:

1. Manage low vision assessment backlogs by:
– Risk assessment of patients waiting to prioritise those in greatest need
– Triage to interim support by another part of the system
– Aiming to clear backlogs within six months

2. Review existing low vision service provision (demand and capacity), protocols and pathways to:
– Scope potential for more integrated services
– Incorporate remote consultations for prioritisation and follow-up as appropriate, e.g. patient initiated follow-up, access to advice and guidance, review to check managing with existing aids/new requirements
– Ensure there is domiciliary provision for those that require it
– Ensure eye clinic liaison officers are core members of the LV service team and link across primary, community, hospital and social care
– Include provision of information on digital assistive aids (e.g. digital magnifiers) and signposting to IT courses for those who are visually challenged

3. Develop service specifications and quality standards for integrated LV care as part of a whole systems approach to:
– Ensure consistent access and availability of services
– Offer a choice (where possible or appropriate) making optimal use of primary, community, local authority and hospital services
– Provide processes for governance, audit, engagement, service improvement, and review of services provided
– Identify a dedicated (ring fenced) low vision budget that can be accessed system wide (primary, secondary and tertiary) to ensure a sustainable service

Parul Desai, CCEHC chair, commented: “Many providers have tried to ensure safe services and looked to innovative solutions. The learning from Covid-19 is already changing the way some low vision services are delivered. We encourage all commissioners and providers of eye health services to review their current low vision assessment service provision, particularly use of remote consultations for pre-assessment review and follow-up/monitoring; and their processes for ensuring equitable access to services meeting consistent standards of care.

“The development of more integrated low vision services has significant benefits for patients, practitioners and organisations across health and social care. The CCEHC will be considering further phases of work to monitor progress,” added Parul.

Debbie McGill, ABDO head of policy and public affairs, commented: “We were pleased to be involved in this piece of work and ask that NHS England considers the findings with a view to delivering a national low vision service in England, to provide our ageing population with the eyecare support they need, close to their homes. Dispensing opticians are well placed in optical practices to provide this care and advice.”

Images courtesy of Enhanced Vision.