When OT met Sally
RNIB Group’s acting chief executive on the importance of building bridges in the eye care sector
It may have only been four months ago that Sally Harvey took on her latest role as acting chief executive at Royal National Institute of Blind People (RNIB), but with the family pictures on her desk and an abundance of healthy plants in her office, it is clear she is already settling in nicely.
Ms Harvey is not new to the charity, having been in a number of roles since joining the organisation in 2009.
Those have included managing RNIB’s services in Scotland, Wales and Northern Ireland. It was a role that she found “fascinating” she explained to OT, inspiring not only her interest in politics – “devolution actually worked really well for eye care, we are really close to the politicians” – but also the charity’s success at “connecting politicians to people.
“We get a lot done in the devolved nations,” she added.
Ms Harvey also has a solid grounding in the commercial arm of the charity, having been seconded for 18 months by the previous chief executive, Lesley-Anne Alexander, to lead the creation of what was to become RNIB Solutions – a part of the charity that works with businesses, handles its commercial activity, and runs its reading services.
“I have a breadth of experience,” she tells OT confidently, adding: “I am delighted and privileged to now be in RNIB CEO role.”
Back to beginning
Steering a charity that is just shy of it 150th birthday (to be marked in 2018) is no small challenge. Asking for Ms Harvey’s take on the ventures that lie ahead, she immediately points to a key change in perception.
“We are an organisation of blind and partially sighted people. We have moved away from being that philanthropic provider of services to people to one where the blind and partially sighted people are part of the charity – and driving the organisation. It is theirs, not ours. That is a big change.”
But there are similarities too with its first mission, she adds. “Braille, for example, was a new technology 150 years ago, and it is absolutely still important to us. We are very passionate that braille remains a key experience and opportunity, especially in schools for children born with sight loss.”
Technology, she notes, is moving all the time. “We need to keep at the forefront of new tech to help support blind and partially sighted people live independent lives. So some things don’t change – they just take a different form,” she emphasised.
Asked if RNIB has a particular focus in 2017, the acting CEO points to a number of overarching aims. Chief among them is that “people don’t know that RNIB exists, let alone all the other services that are out there,” she said, adding: “Through RNIB, we provide a gateway to other services, not just our own. It is hard to believe that people have not heard of RNIB – but people, as they get older in life, do not realise there is support.”
Ms Harvey also notes that there is a “fantastic opportunity” for blind and partially sighted people to support one another through the charity. “Our role at RNIB is to help people connect with one another. Sharing lived experience can be so valuable, as well as that professional knowledge and support born of good research and evidence that enables us to help shape the kinds of opportunities that are there for people,” she highlighted.
Getting the message heard
The question of sight loss prevention and the eye health message remains central to the organisation’s mission, Ms Harvey agrees.
“We know that there are two million people living with sight loss, and only a fraction of those people get the right support, or have access to treatment. We know that half of sight loss is preventable. It is a big statistic, and against that backdrop, it is an ongoing priority and a challenge that eye health is taken seriously in this country.”
One area where RNIB is clear in stepping back from is research into sight loss prevention. Why is that, OT asked.
Ms Harvey responds: “Prevention takes many forms. We don’t believe that our resources are best spent in that area, and that is against a backdrop of the other challenges that we have to balance.”
She added that “supporting people living with sight loss right now, in addition to prevention, means that we have to make our finite resources go a long way.”
"We don't believe that our resources are best spent in research, and that is against a backdrop of the other challenges that we have to balance"
In order to drive prevention, it “is absolutely important that we focus on the eye health message,” Ms Harvey shares with OT.
“This cannot be, and will never be, just RNIB – it would not work if it was. But we have a role to play. Early detection – people going and getting their eyes checked rather than waiting until they cannot see – would be a fantastic step.”
Ms Harvey points to the Royal College of Ophthalmology’s research, which shows that the number of people that are going blind because they did not receive timely treatment – whether that is for cataracts, or glaucoma – is on the rise. “The evidence is showing that appointments are being delayed and people are going blind needlessly,” she notes.
Lobbying political parties has an important role to play, and the acting CEO shares with OT that the charity has been working with politicians to raise the profile of cancelled appointments.
“We are hoping to work with them to put pressure on local NHS providers to make sure that appointments are kept, and that they are clinically appropriate. We feel very strongly about this,” she added. “Last summer RNIB’s research found there are significant differences in waiting times for NHS cataract treatment across England. For example, patients covered by one CCG in London waited a massive 467 days on average for cataract treatment. This compares with patients covered by Luton CCG waiting for just 15 days.”
The collaboration with Specsavers on an eye health report caught the attention of the wider eye care sector in 2016. What drove that initiative, OT asked, and are more projects in the pipeline?
Ms Harvey explained: “Our partnership with Specsavers is a very exciting for us, and our efforts here are particularly around that eye health message. For RNIB, the partnership enabled us to have our profile raised.
“But the important thing was the shared sense of clear purpose; that we both had an interest in developing the eye health messages and getting that out there. It was very exciting and we hope that the relationship will develop and flourish.”
However, the acting CEO is clear in reiterating that no such partnership is offered exclusively.
“This is an important message I’d like to give,” Ms Harvey told OT. “RNIB works with lots of different organisations across numerous sectors – we really cannot do it on our own, and it is not our place to do so.
“We are looking all the time for partnerships, big and small, because people live in local communities, and, in that sense, local partnerships can be the most effective. We have to be thinking about working in different ways in order to reach more people.”
Pieces of the puzzle
But what does RNIB’s acting CEO think about the role of optometrists in supporting patients in the delivery of good eye heath care?
For Ms Harvey, the role of optometrists is vital. “Their High Street presence, whatever that looks like, in every local community is an incredibly powerful opportunity in delivering the eye health message,” she confirms.
Aligned to this point, Ms Harvey notes that the right support at the point of diagnosis is critical for patients. “If someone does not get the right support, both practical and emotional, at that very early stage, then they go home not understanding their eye condition, what they need to do to treat it, and what is possible as the disease progresses.
“We know from blind and partially sighted people who have not had this support, and only found out about it later in life, that we have got to make sure that the right support is in place.”
As part of RNIB’s four core aims, the charity aims to be there for every patient when they are told that they are losing their sight.
“What we do know is that the NHS is incredibly hard-pushed – it is not practical, or indeed right, that ophthalmologists are having to spend time, even if they do have the knowledge, to support people with the ‘what’s next’?” Ms Harvey explained.
“We believe that RNIB has a role – and what we want to see is a sight-loss adviser – an eye clinic liaison officer (ECLO) in every hospital setting. That might be provided by us, that might be provided by partners – it is whatever is appropriate in that environment,” she added.
With much interest in the world of optometry surrounding the rollout of extended eye condition services, does RNIB see the approach as a means to ease the burden on the service, OT asks?
“It is a very exciting time. And of course tech plays an important part. If that enables early diagnosis to move further into optometry’s world, then that is a really positive opportunity to benefit everybody.”
Questioned by OT about the realities of protectionist thinking on the part of practitioners, be it ophthalmologists or optometrists, Ms Harvey offers a balanced view.
“I think territorial thinking can be dangerous if it leads people to stand still. If it is motivated by making sure that we understand and respect the professional disciplines, the skills and the training that have supported them, that is not a bad thing.
“But tech is moving so fast, and I would want all of us to be ahead of the curve, understanding the opportunities and helping to shape that.”
“We cannot deny the need for every pound of public money, and in our case, every pound of donor’s money, to be spent wisely. We have a responsibility and the opportunity to take that step back and see the difference we can make,” the acting CEO asserts.
Feeling the pressure
Coupled with a rise in the ageing population comes the realities of financial constraints on the public finances. Does the charity have concerns that the current financial pressures on the NHS could lead to cataract treatments, for example, being rationed by commissioners?
Ms Harvey’s response is clear, and it is an area she is able to confirm the charity is campaigning on currently.
“Our concerns are born out of the evidence that we have,” she tells OT. “RNIB often does freedom of information requests that enables us to track what is happening and we do know that treatments are being delayed and rationed.
“What we do know is that the NHS is incredibly hard-pushed – it is not practical, or indeed right, that ophthalmologists are having to spend time, even if they do have the knowledge, to support people with the ‘what’s next?’”
“It is something that we feel very strongly about – that patients are waiting months – and the impact is that people are living with sight loss. In some cases the damage caused is irreversible and sight could have been saved. And it is frightening.”
Ms Harvey added that RNIB is doing a number of things to get that message across. “That includes speaking to Jeremy Hunt, who has recognised the evidence we have put to him in terms of the delays, and he has asked that NICE bring forward its recommendations in terms of treatment. We are pleased that that step has been taken – it remains to be seen if that makes a difference.”
The canine connection
One other much-talked about relationship in the sight loss charity sector is between Guide Dogs and RNIB. What is the acting CEO’s take on the relationship?
“It is growing stronger all the time at all levels of the organisation,” Ms Harvey emphasises to OT.
“Actually, on the ground, we work really closely together, we campaign locally together, and we make sure that our services our joined up,” she added.
“We are looking at the moment to see if we can develop some more strategic relationships between us, and there are a couple of areas that we are really focusing on. For example, at the moment there are an estimated 40,000 children and young people (from birth to 25 years) living with sight loss.
“While that is a relatively low incidence for the population across the UK, the sector as a whole does not offer a cohesive service to children and families. It is one area we have identified that we could do better on,” Ms Harvey outlined.
Research is another area where collaboration is needed, Ms Harvey notes. “We are making sure that the charities are not duplicating work, and that we are identifying research that is carried out for maximum advantage, not just for ourselves and our goals and services, but the wider sector.”
“RNIB and Guide Dogs are the two biggest national players – the onus is on us to make sure that we are working well together,” she concludes with a wide smile.