“Going the final mile”: The community eye health approach Andy Cassels-Brown Consultant in Community Eye Health Leeds Teaching Hospitals Trust and Leeds Primary Care Trust

Chapter 2 lead correction treatment and the eyecare journey Passion is fuelled by late presentation of both preventable sight loss and visual impairment disability On Tuesday in my clinic at st james’s very moving consultation with a 39 yr old mother of 2 attended with her mother diagnosed severe albinism as a child not registered, never had LVA appointment, not working both angry and in tears

The UK Vision Strategy Whilst not perfect, we have a very good health and social care infrastructure for those in the system and DOH targets and the UKVS will improve it With the UKVS we have the opportunity to prioritise those not accessing or able to access the system ie go the final mile

Who is not accessing the system? Access/Uptake of free NHS optometry sight test is poor in some sections of community (40% in ethnic minority groups) Uptake of CVI registration system has reduced ? why Uptake/access to low vision and social support services is sub optimal

High risk groups Elderly Young Ethnic minorities Poor mobility Low socio-economic status Multiple disability Dementia Institutionalised

Barriers to accessing services A B C D AWARENESS of sight loss, silent disease, available services and how to access them BAD SERVICE not user centred, waiting, poor communication, lost to FUp + support COST to get there, glasses, carers cost DISTANCE remote rural, no local optometric service in certain low socio-economic areas, poor mobility, lack of domiciliary uptake

How will we tackle this? Holistic Public Health/Community eye health approach UKVS national/local advocacy health and social care guidance and commissioning Needs assessment- we need a national epidemiology unit to provide local evidence based numbers and barriers Develop Control Strategies

Control strategies Local eyecare networks/groups/fora Lobby commissioners and PCT public health and primary care directors eyecare low vision very good QALY interventions to prevent stopping of work, driving, falling, independent living Target High risk groups: –Health promotion –Community Directed vision testing –Community Based Integrated primary/secondary/social care services

NHS Optometric sight testing Regular sight testing for high risk groups is essential Annual sight test for all may reinforce importance but will soak up NHS resources No guarantee of any impact on high risk groups and may reinforce cost of specs barrier Prof Hugh Taylor says perhaps only required every 5 years Need to increase awareness of domiciliary visits + consider NHS Optometrist outreach from HES Consider Moral responsibility for over 70 year old drivers have compulsory yearly sight test

Vision 2020 Leeds Community Eye Health programme priorities Develop Information Prescription for Low Vision pathway Develop ECLO/VILO posts linking HES and community Leeds Save your sight campaign leaflet Health promotion, Test yourself, Test others Train Sightsavers

Training Sightsavers Home wardens Neighbourhood Network volunteers Community Health Educators NVQ 7 Healthy living community centres Library, GP Health centres QOF 3000 Community Care nurses, pharmacists, falls prevention teams, intermediate care rapid response teams

Summary UKVS needs to bring about a Sea change of community awareness and culture to –value vision and the need to look after it with routine sight testing –Understand how to access all the services to minimise disability from visual impairment –Will only happen if we can pull together and bring the DOH and commissioners along with us –Please post your top 5 priorities for chapter 2 to consider