“It’s so easy for any of us to end up in the same situation”

In 2015, NHS England Cheshire & Merseyside started a pilot providing eye care to homeless people in Chester, Liverpool and Birkenhead.

The pilot has since expanded to provide services to patients in St Helens, Warrington and Crewe.

Alongside the extension of geographic boundaries, additional services have been put in place to provide support to those in other hard to reach groups – including those with learning disabilities, asylum seekers and people in women’s shelters.

Before COVID-19 limited in-person care, around 50 patients were seen each month through the service. Local Eye Health Network chair and optometric adviser for NHS England and NHS Improvement North West, Rupesh Bagdai, talks with OT about the initiative.

Can you tell OT about how the pilot started?

We engaged with clinicians, patients and third sector organisations working with our homeless population. Our goal at that time was to understand if and how access to sight tests was limited within this population. Improving access to eye care was and remains a key priority for NHS England Cheshire & Merseyside, to reduce service variation and health inequalities while improving health outcomes and quality of life for our homeless patients. The pilot started in 2015 across Chester, Liverpool and Birkenhead and has since been rolled out across further locations across Cheshire & Merseyside.

How do you run an effective service?

Relationships and trust are key to a successful service. We have in place a recruitment process for interested providers. This led to the recruitment of three domiciliary providers who are funded through General Ophthalmic Services to provide the eye care service across Chester, Liverpool, Birkenhead, St Helens, Warrington and Crewe.

I was amazed when I came across one of our providers who was actually providing sight tests and spectacles to homeless patients at his own cost…. Our service has put in place a sustainable funding source for the clinician

One of the initial challenges our providers faced was building those relationships with their patients. It’s common for the provider to attend once or twice before patients are confident enough to let the clinician examine their eyes. After a few patients have experienced and recommend the service, demand increases. It’s vital that the same optometrist attends the same locations and builds those local relationships.

I also want to add that I was amazed when I came across one of our providers who was actually providing sight tests and spectacles to homeless patients at his own cost. I’m sure there are similar optometrists across the country who either provide voluntary services or would be keen to get involved and work with homeless people. Our service has put in place a sustainable funding source for the clinician.

What do you see as the main benefits of this service?

The benefits are wide-ranging. We have data and intelligence which enables us to improve other services for our homeless patients. There’s a significant proportion who require onward referral for sight threatening conditions. I recall one patient who was the victim of an assault. He had a detached retina and orbital fracture but had not attended accident and emergency or any other care. Our optometrist supported this individual to access the hospital care he needed.

More than anything it’s the gift of sight that we are able to give. We take this for granted in the developed world, as the majority of the population have access to eye care and corrective appliances. Homeless people are navigating a potentially dangerous environment. Some of the patients have very high prescriptions and, without glasses, they have levels of vision that meet sight impaired and severely sight impaired registrable thresholds. I often reflect upon our homeless population; it’s so easy for any of us to end up in the same situation.

How has the service been extended?

We are keen to improve services for our hard to reach groups and have recently expanded the service to include asylum seekers and people in women’s shelters. We worked closely with partner organisations to identify that the asylum seeker population required eye care support. We have identified nearby fixed site practices to provide eye care to these patients with access to interpreter services.

Some of these patients may be eligible for full help with health costs and have an HC2 form which entitles them to NHS-funded sight tests and prescriptions. Some do not so we have put in place local reporting to enable practices to be funded through GOS for patients within this group. I’d like to add that the practices involved have been really supportive.

The service for people in women’s shelters has recently gone live and is being delivered by two of the female optometrists who are currently delivering the homeless sight tests service. The domiciliary service model is similar to the model used across homeless shelters and is available to both women and children within shelters.

We continue to work closely with our local authority leads to identify and support hard to reach groups.