1. Successes of the Eye Health Care Delivery Plan for Wales
Fiona Jenkins
Chair Wales Eye Care Steering Board

2. POLICY AND STRATEGY Eye health care delivery plan 2013 to 2020
Merged the early recommendations with the later priorities: 19 key outcome areas

3. Outcome 1: More People have regular sight tests Outcome Evidence
Stats Bulletin
2013/14 – 758,572 General Ophthalmic Services (GOS) sight tests were carried out on the NHS, 7237 Total LVSW Assessments Carried out, 96,487 EHEW assessments carried out in Wales.
Total number: 862,296
2018/19 – 795,188 (GOS) sight tests were carried out on the NHS, 9183 Total LVSW Assessments Carried Out, 169,920 EHEW assessments Carried out in Wales.
Total number: 974,291
Increase of 111,995

4. Outcome 2:
Outcome
Evidence
More information on reducing the risk of developing eye disease, what people can do for themselves and what services to expect to be available
Communications Group Eye campaigns
Acute eye campaign
Choose Well Campaign – 2015
BME Campaign – 2015
Public Health Wales Campaigns during
AMD Campaign – 2017
Deprived areas campaign
Diabetes Campaign – 2016
Low Vision
Over 60’s
Smokers – 2014
GP One Website – 2015
Local health board initiatives.

5. Outcome 3: More people aware of the importance of eye health Outcome
Evidence
More people aware of the importance of eye health
National Survey for Wales
2014/15 –
72% of respondents had their eyes tested at least once every two years.
57% of people aged 25 to 44 had their eyes tested at least once every two years, compared with 91% of people aged 75 or over
2018/19 –73 % of respondents had their eyes tested at least once every two years.
59% of people aged 25 to 44 had their eyes tested at least once every two years, compared with 91 % of people aged 75 or over.

6. Outcome 4:
Outcome
Evidence
More optometry practices providing the full range of extended eye care services in the community
2013/14 – 187 Accredited LVSW Practices in Wales
295 Accredited EHEW Practices in Wales
2017/ Accredited LVSW Practices in Wales
348 Accredited EHEW practices in Wales

7. Outcome 5:
Outcome
Evidence
More people aware of the most appropriate point to access eye care if they have an eye problem that needs urgent attention
Sensory Health: Eye Care and Hearing Statistics
2015 –
All respondents were asked who they would contact in the first instance if they had any pain or redness in their eye. 60% said they would contact their GP and 34% their optician
2019 –
All respondents were asked who they would contact in the first instance if they had any pain or redness in their eye. 47 per cent said they would contact their GP and 40 per cent their optician.

8. Outcome 5: Outcome Evidence
More people aware of the most appropriate point to access eye care if they have an eye problem that needs urgent attention
General Optical Council Public Perceptions Survey
26 per cent of Welsh would first visit an optician if they woke up with an eye problem compared to just 18 per cent in England.

9. Outcome 6: Reduced Inequalities in access to optometry services
Evidence
Reduced Inequalities in access to optometry services
Eye Health Examination Wales annual report March 2018 produced an audit looking at access to services.
Overview:
Mean age of patients accessing EHEW services- 56.4
Mean travel time for patients accessing EHEW services minutes
Mean travel distance for patients accessing EHEW services- 5.2 miles

10. Outcome 6: Outcome Evidence
Reduced Inequalities in access to optometry services
Summary of results
Most patients in Wales travel short distances to access the EHEW service, with travel times averaging 10 minutes. Additionally, patients from different socio-economic and ethnic backgrounds also access the service in large numbers demonstrating that the service is well used by different patient demographics. Travel times and distances were not substantially different for different socio-economic and ethnic groups.
The EHEW service succeeds in its aim of service all populations in Wales with excellent equity of access.

11. Outcome 7:
Outcome
Evidence
More people at high risk of eye disease accessing eye care services in the community including people with diabetes, family history of glaucoma and people from ethnic minority groups
Diabetic eye screening Wales is the only life-long UK screening programme.
All people aged 12 and over with a diagnosis of diabetes, who are registered with a GP in Wales, are eligible for regular retinal screening with DESW.
2012/ ,551 patients registered and 111,110 patients screened.
2017/ ,240 patients registered and 114,309 patients screened.

12. Outcome 7:
Outcome
Evidence
More people at high risk of eye disease accessing eye care services in the community including people with diabetes, family history of glaucoma and people from ethnic minority groups
EHEW Collected Figures:
2014: 4383 members of BME groups accessed EHEW services
2017/18: 8093 members of BME groups accessed EHEW services

13. Outcome 7:
Outcome
Evidence
More people at high risk of eye disease accessing eye care services in the community including people with diabetes, family history of glaucoma and people from ethnic minority groups
Sensory Health: Eye Care and Hearing Statistics
: Close relatives aged 40 and over of glaucoma sufferers 38,708 GOS sight tests performed.
: Close relatives aged 40 and over of glaucoma sufferers 39,610 GOS sight tests performed.
EHEW Band 2 examinations for patients who are suspected of having eye disease receive additional examinations, including those suspected of having glaucoma.

14. Outcome 8: More People in residential care having regular sight tests.
Evidence
More People in residential care having regular sight tests.
Not a specific measure captured on this, but statistics are produced regarding the number of domiciliary GOS sight tests and now Low Vision domiciliary examinations which do provide some information.
: 24,139 GOS domiciliary sight tests. No information regarding Low Vision
2018/19: 27,663 GOS domiciliary sight tests provided and 2663 Low Vision domiciliary examinations.

15. Outcome 9:
Outcome
Evidence
More children in special schools having sight tests in school
School pupil eye care service (SPECS)
Pupils who attend school who are unable to access the current Children’s Vision,
9,358 pupils attended a special school or a special unit within a mainstream school across Wales
The commissioned SPECS project was signed off by HDUHB executive team and submitted to Welsh Government 1st May 2019.

16. Outcome 10:
Outcome
Evidence
More children having their vision screened upon school entry
School vision screening programmes in place with referral to optometrists for children who fail screening.

17. Outcome 11:
Outcome
Evidence
People are seen within the primary and community setting, where its clinically appropriate.
Linked to outcome 1 which showed the increase in the number of examinations being performed under EHEW and LVSW.
Increase referrals to EHEW services across Wales, ( 6/7 LHS show increased referrals)
Increased EHEW practices
Pathways in place to increase referrals further

18. Outcome 12:
Outcome
Evidence
People receive appropriate access to on-going care and management of their eye condition.
National programme being led by Wales Ophthalmic Planned Care Board.
Additional funding allocated to increase capacity
Outcome focussed measures in place
Electronic patient record being procured to enable greater efficiency/effectiveness of pathways

19. Outcome 12: Outcome Evidence
People receive appropriate access to on-going care and management of their eye condition.
Positive signs of transformation:
The number of glaucoma patients discharged for management in the community varies across health boards. Aneurin Bevan University Health Board is the lead health board who were actively using community facilities to deliver its glaucoma service. This had resulted in around 70% of their glaucoma patients being seen by a non-medic, which has significantly reduced capacity requirement in hospital sites.

20. Outcome 12: Outcome Evidence
People receive appropriate access to on-going care and management of their eye condition.
Positive signs of transformation:
A modelling exercise undertaken by the NPCP across this pathway, identified that around 3,500 non-complex glaucoma patients could be followed up in an Ophthalmic Diagnostic and Treatment Centre (ODTC) / community setting.
In 2016, 15,000 patients were managed in this way. There are now clear indications that progress is now being made at pace. In 2018 there were 22,000 patients being seen in an ODTC setting, which the expectation this will increase further in 2019.

21. Outcome 12: Outcome Evidence
People receive appropriate access to on-going care and management of their eye condition.
Positive signs of transformation:
The NPCP has agreed that 80% of post-operative follow-up for cataract element of patients’ care at 1 month are carried out in primary care. Aneurin Bevan, Abertawe Bro Morgannwg, Powys and Hywel Dda all report that 95% of non-complicated patients are now routinely being referred to Optometrists following surgery without a need for an additional hospital assessment. However, hospital based post-operative follow up is still being practiced in some health boards.

22. Outcome 12: Outcome Evidence
People receive appropriate access to on-going care and management of their eye condition.
Positive signs of transformation:
Hywel Dda University Health Board has taken the decision to review referrals for over 600 patients awaiting an OPD appointment on the pathway and move them directly to pre-operative assessment. Review of the success of this initiative will provide a significant evidence base for the wider adoption of this model within Wales.

23. Outcome 13:
Outcome
Evidence
Service users and carers are involved in the design of services and peoples views on service are sought regularly and acted on to ensure continuous improvement
RNIB and community health council provide input to all local eye care groups as the patients voice.
Local arrangements for gathering additional input

24. Outcome 14:
Outcome
Evidence
People are satisfied with the care they receive at their local optometry practice
One example:
In Aneurin Bevan UHB 1698 appointments were freed up in hospital eye care clinic in a 4 month period, as glaucoma patients had their follow up appointment by a community optometrist. Patient feedback
100% satisfaction from patients that saw the community optometrist
96% said it was easy to book an appointment
98% said the optometrist understood the condition
85% said that the practice was accessible

25. Outcome 14: Outcome Evidence
People are satisfied with the care they receive at their local optometry practice
GOC Public Perceptions Survey:
Patients’ satisfaction and confidence levels in opticians remains very high, with 96% of patients indicating that they were fairly or very satisfied with the optician who had carried out their eye test and 94% being satisfied with the overall experience of the opticians.
There continues to be a low level of complaints, with a very small percentage of the population (6%) having complained about an experience with an optician.

26. Outcome 15:
Outcome
Evidence
People are satisfied with the care they receive when they visit the hospital eye service
Yes, largely very happy with clinical care,… when they get there,
BUT
waiting time for first and follow up appointments remains the biggest concern

27. Outcome 16:
Outcome
Evidence
People are satisfied with the care they receive from social services
The only way we can get these facts is by asking people.
The Wales Vision Forum collected and continues to collect case studies.
We could also ask local groups about what they thought about the support they have received but this would take time.
What do you think?

28. Outcome 17:
Outcome
Evidence
People with sight impairment receive care and support which addresses all their needs – both physical and emotional
Once a person gets through the system and is seen by a Rehabilitation Officer that these needs are addressed.
Concern that some people can easily slip through the net because of lack of understanding of services available to them.
Would like to see a standardised assessment being used throughout Wales that captures a person’s needs and can be measured to see how successful rehabilitation intervention is.  
WCB will aim to address if our application under the Sustainable Social Services Third Sector grant ( ) is successful.   

29. Outcome 18:
Outcome
Evidence
Local eye care, Hospital eye care and support services are all joined up
This is probably the biggest success area.
ECLO
ROVI
Local eye care groups
National group
LHBs and Welsh Government aligned

30. Outcome 19:
Outcome
Evidence
People with sight impairment Are offered specialist training that enables them to live independently and get out and about
This is one of the core competencies of a rehabilitation officer. If people are aware of the service and they have identified this as an outcome. This should be being met.
Members of the Wales Vision Forum and Welsh Rehabilitation Officers Forum have published State of the Nation reports on Rehabilitation and Habilitation, with actions for improvements

31. Blinding diseases are treated by multi-disciplinary teams led by Ophthalmology
wAMD
treat & extend + virtual clinic oversight of MDTs
OH Chloroquine Screening Programmes
virtual clinic oversight of ‘mini-ODTC’
Minimally invasive glaucoma surgery
Selective laser trabeculoplasty
biggest change in new glaucoma patient management in a generation
Corneal cross linking  for keratoconus

32. Ophthalmology Wales: stuff to sort…
New ways of working
Outreach – not outsource – Ophthalmology in The Community
“How are we going to do all the virtual clinics?”
“Can we cope with all the electronic queries from Optometry?”
Delivering required numbers in cataract surgery
Avoidance of costly outsourcing
Hub & Spoke reconfigurations
North, South East, South West
Subspecialist care across All Wales via enhanced clinical networks
Sustainable Unscheduled Care, Training & Rotas
Consultant workforce
Recruitment & retention
Retirements

33. What Next? 14 Green: 2 Green/Amber; 2 to define
The plan should be completed by 2020
Planned Care Board will oversee the delivery of performance against national “targets”
Chief Optometric Advisor, will advise!