"We should make it our goal to ensure that no one loses their sight unnecessarily"

The Special Schools Eye Care Service (SSECS) was given particular focus during a debate in Parliament on the benefits of a national eye health strategy.

Marsha de Cordova, the MP for Battersea and co-chair of the All Party Parliamentary Group on Eye Health And Visual Impairment, was granted the debate on Wednesday 17 May.

Opening proceedings in Westminster Hall, de Cordova thanked organisations that have shared expertise to inform and support her proposed national eye health strategy, including the AOP, Specsavers, the Royal College of Ophthalmologists, SeeAbility, and the Royal National Institute of Blind People.

“There is an emergency in eye care in England,” de Cordova said, and “no question” that an eye health strategy should be introduced.

She went on to highlight the 630,000 people who were on ophthalmology waiting lists in England as of March 2023.

The estimated annual cost of sight loss is £37.7 billion, de Cordova said, with 250 people starting to lose their sight every day.

Responding to a question from Janet Daby, MP for Lewisham East, about the threat to the SSECS, de Cordova emphasised that provision should not be cut, and that it in fact capacity should be increased.

As it stands, the SSECS is due to come to an end on 1 August.

Consequently, there is a “very real prospect that there will be no service at all in special schools by September 2023,” Siobhain McDonagh, MP for Mitcham and Morden in south London, emphasised.

McDonagh called the SSECS “one solution to many of the problems in eye care” and noted that the SSECS came about after a report stating that children with special needs are 28 times more likely to have a sight problem than other children.

“Because children have complex needs, they can often not get a check-up,” in a High Street practice, McDonagh said, adding that 55% of children with special needs miss the optometry appointments that they have booked.

“By bringing eye care into special schools you are solving the problem of missed appointments, and you’re ensuring that thousands of children who would have had their eyesight disability ignored are able to get the healthcare they deserve,” she said: “That value cannot be overstated. If you are a child with special needs, you have enough on your plate.”

There has been “huge praise” from parents using the service, McDonagh said, adding that it is also a cost-effective way to improve health outcomes for this group.

McDonagh spoke about her constituent, Alison, whose daughter is now getting used to receiving eye care in the familiar environment of her school, greatly reducing her anxiety.

“Parents, schools and eye care providers are absolutely gutted,” about the potential halting of the service, she added, “but more than anything, they are confused about what will happen next.”

The evaluation of the service, promised in August 2022, has yet to be published, McDonagh said, adding that “it is still not yet clear what NHS England is going to do.”

She called for the evaluation to be published urgently, in order to provide certainty to parents.

She has “no doubt that it will provide evidence of the clinical need for this service,” she said, adding: “I am convinced that NHS England should continue the existing day school service after July 2023, and I hope that the minister can see why this makes absolute common sense.”

McDonagh concluded with a quote from Reshma Hirani, assistant head teacher at Kingsley Special Academy, in Kettering, which has used the SSECS.

“This service should be part of the NHS core offer so that it never stops,” McDonagh read. “My pupils have struggled to access eye care in the community and now they have, quite rightly, something that is going to transform their lives. Well done NHS England for thinking about schools like Kingsley and our children.”

Speaking later in the debate, Matthew Offord, MP for Hendon, emphasised that the “implications of problems at an early age are much longer term, and so you will find people without access to education and ultimately employment, and their quality of life would be much reduced if that [SSECS] is not implemented.”

The SSECS should be a “major component” of a national eye health strategy, Offord said.

Neil O’Brien, MP for Harborough and parliamentary under-secretary for primary care, acknowledged that the future of sight testing in special schools is a “very, very important concern” to members attending the debate.

A roundtable of experts has recently been convened to discuss the issue, he said, and he continues to “engage with NHS England on their proposals.”

“I hope it won’t be too long before I am able to update the house on this,” O’Brien added.

What a national eye health bill would mean

The merits of a national eye health bill were also discussed at length during the debate.

The proposed bill would include measures to improve eye health outcomes and patient experiences, remove the “postcode lottery” for care, reduce waiting times, increase the capacity and skills of the workforce, and make more effective use of data, research and innovation, de Cordova said.

“A strategy would ensure that, regardless of where someone lives, they would have access to good quality eye health care, through addressing eye health inequalities and ensuring that there is equity of access to eye care amongst different communities and people who are having sight problems but might not be accessing NHS sight tests,” she said.

She continued: “England is the only country in the UK without an eye health strategy. We know that these strategies can deliver positive outcomes, as has been the case in Scotland. In England, there are health strategies for other conditions. So, why not eyes? The benefits would transform lives, alleviate pressures on health services and reduce economic costs. So, we should make it our goal to ensure that no one loses their sight unnecessarily.”

Ensuring equity in eye health includes the homeless and those with learning disabilities, de Cordova added.

A national eye health strategy would focus on five key areas:

1. A pathway outlining support for those with loss of vision, focusing on the physical and emotional impact of being diagnosed with sight loss
2. Improvement of the relationship between primary and secondary care, “with an emphasis on Integrated Care Systems to ensure timely and accurate referrals,” including more investment in community optometry and changes to the way services are commissioned
3. Workforce expansion, as almost 80% of eye care units do not have enough consultants and a significant proportion of the current workforce is approaching retirement
4. Better utilisation of health intelligence and data, which is currently not being used to effectively “pinpoint location of need and places where opportunities for change can be found” as the UK has no national data that identifies those at risk of living with sight loss – meaning it is difficult to know if current expenditure is meeting need, as it is not based on evidence
5. Public awareness, including campaigns on the importance of good eye health and signposting on where to go with eye health issues.

Speaking in support of a national strategy, Dr Rupa Huq, MP for Ealing Central and Acton, emphasised that “people are in danger of going blind if they are not seen in time.”

Directly quoting her constituent, optometrist Joy Hynes, of Hynes Optometrists in Ealing, Huq also spoke about the importance of including myopia in a national strategy.

“I’d like to understand why the urgency for controlling our increasing numbers of myopic patients is not being taken seriously. The Government has no strategy for prevention of this myopic epidemic,” she read, adding: “it shouldn’t be the domain of the well-off. It should be available to every myopic child.”

The “jolt” of COVID-19 should be enough to connect the different factions of community and hospital optometry, Huq continued. “We can join up these different systems, and institute a national eye care strategy.”

Clearing the backlog is only part of the picture, Huq said, and there is a need for a systematic approach so that sight can be saved.

Karin Smyth, MP for Bristol South and shadow minister for health and social care, added that the workforce plan must “include a commitment to fund the workforce that we need to meet patient demand.”

She continued: “Sticking plasters are simply not enough. We need a government that will grasp the root causes of the staffing crisis within the NHS.”

Smyth added: “It is essential that everyone can access the right care, when and where they need it. Moving more care to the community will help support those suffering from sight loss, focusing on the provision of non-clinical community support, to compliment the work of community optometrists, ophthalmologists in hospitals, and rehab officers.”

Questions for the Government

Offord noted that he has previously asked the Department of Health (DoH) directly whether they have plans to put a national eye health strategy in place.

The DoH’s response emphasised the need for services to be organised and prioritised on a local basis rather than nationally, Offord said.

Offord then asked the DoH what specific assessment has been made of the potential economic benefits of additional funding in sight loss research, emphasising that this would be “a good fiscal policy.”

The answer, that “no specific assessment has been made,” means “we simply don’t know, and we aren’t going to get any answers by asking the Department,” Offord said.

“I would like to see greater provision for people, because the extent of sight loss and partially sightedness is a huge one,” he added.

De Cordova asked whether every Integrated Care Board could have a Minor Eye Conditions Service (MECS) in place, and whether these services could be consistent across the country, to which O’Brien said that MECS would be standardised.

De Cordova also pushed for an answer on when the Government will publish its long-awaited NHS workforce plan and whether it will focus on ophthalmology and eye care, as well as for clarification on whether investment in eye health will continue once the term of the current national clinical director for eye health, Louisa Wickham, ends.

O’Brien was not able to provide a clear timeline for the publication of the workforce plan, but said that it is expected “pretty soon.”

“We are working at pace on these issues,” he added.

De Cordova concluded by asking O’Brien for a meeting so that she could be updated on the work that is being done in this area.

“It is about action for us, and seeing those fundamental changes that need to be made,” she said.

She added: “I do hope, going forward, we can continue to champion the cause for eye health and the need for a national plan that will really tackle some of those challenges that people with sight loss are facing.”