NHS England announced its intention to extend in-school eye testing to pupils in all special schools (day and residential settings) in England from April 2024 onwards.
They have released an engagement document on which to base amendments to the Proof of Concept Model. As the BIOS Representative for this work, I continue to support ongoing and improved communications between this new service for all children with existing HES Orthoptic-led services. Should you wish to provide feedback on the engagement piece, please do so for your area. If you require any support with your response, I am happy to help.
Responses should be recorded in the response form or alternatively emailed directly to [email protected] no later than 5:00pm on Monday 16 October.
NHSE will be hosting a public webinar on Tuesday 3 October between 12:00 and 1:00pm – register here.
As this is a service commissioned through General Optometric Services (GOS), the personnel involved are Optometrists and Dispensing Opticians.
In response to the engagement document, we suggest the following:
- Proposal 1: Creation of eye care team – We feel that contractors could demonstrate sufficient competence if a competency framework is provided. The competency framework could then be met by any appropriate personnel with the skills and knowledge detailed in the framework. Another suggestion is that hospital eye services (HES) in the school area with or without an existing orthoptic-led special school service should be actively approached to bid for the service and network with paediatric optometrists who already provide this service to children in hospitals.
- Proposal 2: Provision of equipment – We appreciate that listing equipment can be burdensome to possible providers. We strongly suggest that equipment for the assessment of visual acuity should allow adequate assessment of children with a range of abilities, this should include tests that allow assessment of non-verbal children who may need vision checking by use of observation of eye movement. Examples are Keeler Acuity Card, and Cardiff Acuity Cards. We strongly suggest this because typical high street optometry practices do not acquire or use these tests, and they are the evidence-based way to assess visual acuity in non-verbal children. This could also align with the competency framework, where providers are required to have the equipment to meet competencies.
- Proposal 3: Professional Requirements – Optometrists who have already worked in the HES or Special School may not require more training, however, staff who have never worked in Special School will require training in the environment, completing eye health outcome reports, specifics of working with children with SEN. This will improve actions suggested in proposal 6 because the staff will understand the special school working environment, communication systems and language of other therapists and vision support teachers working in the school. We would also like more clarity on the responsibility for safeguarding, would this come under the school or the service?
- Proposal 4: Consent to testing – Opt-in may prevent duplication of care where the child is under the HES or a high street optometrist. Op-in may also be preferred because children will require instillation of dilating eye drops for their refraction (glasses test). We suggest that verbal consent, and over the telephone, text, or email consent can also be accepted in order to develop a high acceptance rate.
- Proposal 6: Engagement with school community – inclusion of HES, that HES are approached for the new GOS contract where no in-school service exists. That any new service is set up with careful merging of any existing service. This means that proposing a new service should always involve a communication to the local HES Ophthalmology department to find out what, if any, already exists.
- Proposal 7: Avoidance of potential over-treatment – At least 1/3 of UK Special Schools are served by an Orthoptic-led special school service (Allen LC, Dillon A, Bowen P. Eye Care for Children in Special Schools: An Audit of Provision. Br Ir Orthopt J. 2021 Feb 2;17(1):27-32. doi: 10.22599/bioj.166. PMID: 34278215; PMCID: PMC8269777). In the best interest of children attending the school, the primary care eye tests service should be amalgamated with the existing. This may require easy pathways of referral between each or that the HES should hold the contract for a service in that area so that communications between them are direct and secure.
- Proposal 9: Production of an eye health outcome report – fully supportive of eye health outcome reports, Orthoptists are familiar and experienced with complex communication requirements and outcome based language used for such reports. Orthoptists regularly contribute to Education and Health Care Plans (EHCP’s). Training of new personnel within the team will improve the effectiveness of these reports.
Please see my previous Parallel Vision article for the context of this work or contact me with any questions.
Best Wishes
Louise Allen, [email protected]