1. Children’s Vision Pathway and School Pupil Eye Care Service Project
Dr Heather Payne, Senior Medical Officer for Children and Maternal and Child Health
Rebecca Bartlett, Clinical Lead Low Vision service Wales and School Pupil Eye Care Service project
Figure 3. Sisters who have accessed the SPECS pilot
Figure 3. Sisters who have accessed the SPECS pilot

2. Children’s Vision Screening 2013
National Screening Committee - Screening for visual impairment between 4 and 5 years of age should be offered
Screening of children’s vision had been taking place in schools for a number of years; however this was variable
Inequality for children across Wales
Formation of Children’s Vision Pathway
NSC document: Childhood vision screening is a well-established practice and pre-dates the formation of the UK NSC. In 2005, the Child Health Subgroup considered the issue in a context informed by concern about unnecessary screening before and after 4 – 5 years of age. The current policy reflects this.
More recently (2013) the concerns about unnecessary screening have been raised within the ophthalmology community, the need for the standardisation of screening has been raised in parliamentary questions and questions regarding the practical commissioning of screening have been raised at service level.
National Screening Committee - Screening for visual impairment between 4 and 5 years of age should be offered
Screening of children’s vision had been taking place in schools for a number of years; however, feedback from health boards and others showed that evidence of regular screening was patchy. There was a very real need to direct health boards to take a systematic, auditable approach to children’s vision screening across Wales
Inequality for children across Wales
Formation of Children’s Vision Pathway

3. Children’s Vision Pathway
Evidence based pathway (4-5 year olds)
Multiagency consultation
Advisory Group consensus
Auditable standards with onward referral criteria and national training package
Welsh Health circular All Health Boards carry out and report on vision screening on school entry
Prudent health care
Helps all children in Wales to reach their full educational and social potential
WHC (2015) 011 April 2015
Prudent health care and designed to reduce inequality that children were facing across Wales
From Autumn 2016 health boards were asked to report on progress with the Pathway to ensure a systematic, measurable approach is taken across Wales. Data has been gathered from the first year of service delivery via a suite of performance measures, put together by Welsh Government in collaboration with health professionals. The data illustrates excellent compliance with the Pathway, ensuring that children are tested at the appropriate age and referred onwards to primary or secondary care should they require subsequent eye tests or treatment. We now have a robust and auditable screening service that is fit for the future.
Ultimately, the Pathway we have introduced will help all children in Wales to reach their full educational and social potential.

4. Prudent Health Care The principles of prudent healthcare
Public and patients equal partners
Care for those with the greatest health need first
Do only what is needed
Reduce inappropriate variation

5. Who does the Children’s Vision Pathway miss?
Children with additional learning needs educated in special schools
Children with additional learning needs educated in mainstream school
These children are;
More likely to need glasses (over 50%)
More likely to have vision impairment which will impact on their education (20%)
Less likely to attend and optometric practice

6. School Pupil Eye Care Service (SPECS)
Funding from Welsh Government from April 2018-March 2019
The aim of the project is to develop all service infrastructure and delivery model which would be required for phased role out of the All Wales SPECS service from 1st April 2019.
The project is led by HDUHB
Clinical Leadership - provided by the existing clinical lead for the LVSW who holds an Honorary contract with HDUHB
Project manager - HDUHB
Welsh Government

7. SPECS aim PRUDENT HEALTH CARE
To provide eye care for children and young people with additional learning needs who are unable to access the current Children’s Vision Pathway within the educational setting
PRUDENT HEALTH CARE

8. Service delivery model
A non-profit making model
Hosted by a host health board on behalf of others in Wales
Practitioners (optoms and DO’s) employed by the host health board will;
deliver sight tests which fulfil General Optical Services (GOS) ‘sight test’ requirements for children and young people (CYP) within the school setting who meet the SPECS eligibility criteria
Spectacles will be dispensed if required, alternatively a prescription for a voucher can be issued for dispense at optometry practice
Paperless service, with host health board acting as administrators

9. Eligibility criteria
Children and young people who attend school and require an alternative route to the standard and current Children’s Vision Pathway, due to a physical disability, learning disability, behavioral considerations or wellbeing considerations, e.g., a large wheelchair that cannot access a standard family vehicle
Or,
For children and young people who do not meet the entry criteria, an application can be made to the clinical lead for approval for entry to the service on an individual case basis

10. Training and accreditation
A bespoke SPECS module will be developed. This will consist of;
Distance learning lectures
A mandatory practical training day
A mandatory day spent within the (Special) school environment
Additional practical training and support will be offered to suit individual practitioner needs
Ongoing training, reaccreditation and clinical support
There will be flexibility with regards to when in the year the course is delivered, how often and course content will be adjusted and updated as required
Service specific, Builds upon core competencies
Practitioner led with support for relevant practical experience provided
Practitioners will not be formally assessed but will have a list of competencies that they will need to sign off

11. Frequently asked questions
How many children will be eligible?

12. The numbers Total number of children 75% uptake Special school 5360
4022
Special units mainstream schools
3981
2989
Total numbers
9341
7011

13. Frequently asked questions
Is there are large enough workforce to meet the demand?

14. Frequently asked questions
What if children and young people already see an optometrist?

15. Frequently asked questions
How will children and young people transition?

16. Thank you