It is an exciting time in the development of the new and innovative NHS-funded Special School Eye Care Service (SSECS). With roll-out as part of its proof of concept phase truly in motion in north-west England, virtual training sessions were delivered recently by the SeeAbility Eye Care and Vision team, which included lectures and interactive case discussions. With participation from NHS England’s central and north-west regional teams along with the trainee clinicians, operational delivery and clinical management meshed together in vibrant interactive discussions. Planning for the delivery of SSECS clinics by these clinicians is under way as the newly recruited teams from the north-west look forward to shadowing SeeAbility Optometrists and Dispensing Opticians in service-established special schools in London ahead of these.
Success Story
As children with learning disabilities and/or autism are 28 times more likely to have eye or vision problems compared with children without a learning disability, the value and importance of a national programme of sight testing and spectacle dispensing in all special schools in England cannot be understated. In England, currently, it is estimated that 79% of children with severe learning disabilities and 81% of children with profound and multiple learning disabilities attend special schools; that is over 120,000 children.
Specialist public health optometrist Sonal Rughani
The role of eye care professionals in addressing the unmet eye health needs of these 120,000 children is invaluable. With our skills, and the dissemination of often simple observations of vision and its impact on mobility and behaviour, children with learning disabilities could have equitable access to eye care from refractive correction to surgery to enable them to play an active part in society and fully access education, employment and
leisure.
Support and investment from NHS England and NHS Improvement has been tremendous. Indeed, development of the SSECS can be celebrated as an exemplar programme of eye care underpinned by the generation of a robust evidence base over many years of eye examinations of children in special schools.
Richard Everitt, Senior Programme Lead, Optical Commissioning, for NHS England & NHS Improvement explains: ‘Having invested three years in the development of this service, it’s a genuinely thrilling time for everybody involved in the special school programme as we prepare to walk through the doors of the first tranche of schools to deliver this new NHS funded service. Credit must go to the large stakeholder group, which included representatives from all four professions who have informed this programme with passion and commitment, but none of this would have been possible without SeeAbility. The clinical data they have gathered over a five-year period enabled the case to be made, and the subject matter expertise of their clinicians has been fundamental to the development and implementation of the national programme’.
While the clinical skills required are underpinned by the core competencies of both optometrists and dispensing opticians, clinicians need to be comfortable and confident with ocular and visual assessment of children with learning disabilities. To support this transition, and in recognition of the limited experience both optometrists and dispensing opticians have working in an educational setting and with children with learning disabilities and/or autism, the SeeAbility and NHS teams have developed a bespoke training programme that all performers undertake before delivering the service. The north-west England team are the first to participate in this training based upon a clinical competency framework agreed across a number of stakeholders from the sector. This is, in turn, based upon the recommendations of the Framework for Special Schools Eye Care paper developed with all the professional bodies in 2016.
Highlights of the roles within schools, as well as conducting an eye examination and dispensing glasses include: relationship building with your local ophthalmologists and orthoptists as well as other healthcare and education professionals who benefit from understanding a child’s vision, including speech and language therapists, and occupational therapists, qualified teachers for the visually impaired (QTVIs) and paediatricians. For each child, a plain English plus optional easy-read report is provided for parents, carers, teachers and other health care professionals, to support the embedding of all adaptive strategies within both school and home and maximise a child’s vision, including support with glasses wear.
Career Opportunity
Involvement with SSECS provides an alternative career pathway for optometrists and dispensing opticians accustomed to working in community practice. The flexibility of the role is ideal as both a parent and clinician keen to be continually professionally stimulated around their children’s school hours. Report writing and collation of data for each clinic can be completed outside the clinical setting offering more flexibility.
The formulation of an evidence base robust enough to underpin the development of a national programme is no mean undertaking therefore completion of the dataset for each child is a pivotal part of the ongoing process.
Eye Health lead at SeeAbility, Lisa Donaldson, who has worked within special schools for 20 years explains: ‘Gathering of data from SeeAbility’s work in special schools since 2013 has allowed us to produce a solid evidence base of the high and yet unmet eye care needs of the special school population. This led to the long term plan commitment by NHS England to provide eye care in special schools in England. We need to build on that data set to further explore the eye care needs of this population, so that we can optimally support every child.’
On a personal level, I had worked with adults with learning disabilities at the RNIB Low Vision Centre. However, adapting these skills to children has been an extremely rewarding and insightful process. The special school setting is a game changer: support from the teachers and teaching assistants in conjunction with an opportunity to observe the children in their natural learning environment proves invaluable to positive engagement and successful clinical assessments. Every clinic is absorbing, challenging yet rewarding, and so diverse and varied. Working alongside the QTVIs, occupational therapists (OTs), physiotherapists and speech and language therapists, and the school nursing team, I realise just how valuable even the most basic observations of a child’s vision are to share among a multidisciplinary team. These findings often transform a child’s care, and in turn their lives. I wholeheartedly concur now with SeeAbility’s key message that ‘no one is too disabled to have an eye test’.
More than anything, the assessments require creative thinking to truly engage with a child, and that feels clinically fulfilling on a professional level and humane on a personal level. In such clinics, looking after children at increased risk of visual problems, primary eye care can be truly life changing.
Get Involved
Following a drive to recruit primary eye care professionals in the north-west of England, opportunities are now evolving in the London and North-East NHS areas. If you are interested, in applying your clinical skills in novel, innovative and engaging ways, get in touch with the NHS Special School Eye Care Service team at england.specialschooleyecareservice@nhs.net. The clinics in the SSECS are clinically engaging, thoroughly rewarding and fun.
- Sonal Rughani is a Specialist Public Health Optometrist and works with SeeAbility as well as acting as a specialist optometrist for the RNIB in London.