Emma White reports
At the third Westminster Eye Health Day on December 11, a coalition of national eye care charities and professional bodies launched its future of eye health report. The Laying the Foundations for the Future of Eye Health in England report set out a series of recommendations for the government as the building blocks for a national strategy in England.
The Eyes Have It (TEHI) partnership comprises six organisations including the Association of Optometrists (AOP), Fight for Sight, Macular Society, Royal National Institute of Blind People (RNIB), the Royal College of Ophthalmologists and Roche. Westminster Eye Health Day, organised by TEHI, aimed to engage MPs on eye health issues and drive policy change to improve outcomes for patients with deteriorating eye conditions.
Findings detailed in the report included more than 2.2 million people in the UK living living with conditions that cause sight loss, according to the RNIB. This figure was expected to rise to four million by 2050 and the cost to the UK economy was expected to reach £33.5 billion per year. More than 640,000 people were waiting to start specialist ophthalmology treatment in England in September 2023, making up over 8% of the NHS backlog, and 36% had been waiting over 18 weeks.
The report outlined how the elements of the eye care system are interconnected
Coordinated action
This year’s House of Commons event was hosted by Marsha de Cordova, MP for Battersea and chair of the all-party parliamentary group on eye health and visual impairment. ‘I welcome this foundation report which sets out the blueprint to deliver access to eye care for everyone, when and where they need it. Also, for what best practice should look like and the urgent need for the government to commit to my national eye health strategy for England,’ said De Cordova.
‘By taking coordinated action across each of the priority areas outlined in the report, I believe we can make the eye health system fit for purpose. I thank the members of The Eyes Have It for their tireless efforts and commitment to improving eye care.’
In November 2022, De Cordova put forward a motion calling for a Bill to require the secretary of state for health and social care to publish a national eye health strategy for England. NHS England consequently appointed Louisa Wickham in April 2023 as a national clinical director for eye care to oversee the recovery of eye care services and longer-term transformation. Wickham attended Westminster Eye Health Day in December, along with MPs and policymakers, including Will Quince MP, former minister of state for health and secondary care.
Carolyn Ruston, AOP policy director, said that the association was proud to be part of a forward-thinking and innovative partnership, carving out a better future for service delivery and achieving recognition for eye health issues.
‘I am delighted that MPs and policymakers were able to come together for the launch of the Laying the Foundations report. This vital roadmap sets out systemic proposals for a national plan for eye care,’ she said. ‘This includes a call for the necessary connectivity between primary and secondary eye care to improve the consistency of care that patients receive across the nation.’
Report recommendations
Rt Hon Lord Blunkett said in the report foreword that TEHI had been at the forefront of efforts to move sight loss up the parliamentary agenda over the past three years, but that ‘this progress is only the beginning’. ‘We must ensure we are consistently meeting the needs of people living with conditions that cause sight loss. That is why The Eyes Have It continues to call for a national plan for eye care,’ he said.
Key issues facing people affected by sight loss were highlighted in the report and 14 recommendations for policymakers were identified. Top of the list was the need to increase IT connectivity and digital clinical image interoperability within and between primary and secondary care providers.
As Dr Peter Hampson, AOP clinical and professional director, said: ‘The lack of IT connectivity between primary eye care and secondary care ophthalmology is a major barrier to addressing the backlog and reducing preventable sight conditions or sight loss. ‘Addressing this long overdue issue is key for improving patient outcomes. At the very minimum enabling all optometry practices and practitioners to have access to NHS mail would be a significant enabler to success.’
The second area of focus related to prevention, diagnosis and early intervention in an integrated system. Integrated care partnerships (ICP) should undertake an eye health needs assessment of the population to feed into public health plans and inform local commissioning and pathway development, it said.
Integrated care boards (ICBs) should also develop a consistent pathway of care that recognises the value of community optometry practices as diagnostic hubs and treatment centres, it added. ‘Integrated care systems provide a real opportunity to take coordinated action to improve the interface between eye care services to enable better care and early intervention, particularly for underserved or high-risk populations, reducing avoidable sight loss, led through primary eye care, said AOP chief executive Adam Sampson.
Attendees at the third Westminster Eye Health Day
Patient empowerment
Equity of access, support and patient empowerment throughout the patient pathway was another area of focus, calling on ICBs to commission eye care liaison officers and implement an eye care support pathway providing consistent patient information, communications and support. It also called on the National Institute for Health and Care Excellence to update guidance to recognise the need for psychological care to be provided as part of wider eye care.
‘It is vital that patients are both supported and empowered at all stages of their eye care journey,’ said Phil Ambler, England country director at the RNIB. ‘This means understanding what to expect at every stage, who they can turn to for advice and guidance, and that there is both physical and emotional support available at what can be an uncertain time in people’s lives.’
As part of efforts to boost the eye care workforce, the report urged the department of health and social care and NHS England to increase the number of ophthalmology specialty training places and fully resource trainers to deliver an expanded programme. Commissioners should also enable and upskill the wider eye care workforce to deliver more clinical care outside hospitals through universally commissioned, for example, optometry-led Mecs and Cues, it said.
‘Ophthalmology is the busiest outpatient specialty in the NHS. Despite this, most units do not have enough consultants to meet current patient need, let alone future demand as the population ages,’ said Professor Ben Burton, president of the Royal College of Ophthalmologists. ‘The next government must deliver on commitments and increase ophthalmology training places to ensure we have the workforce to meet patient demand,’ he added.
Technology and research
New technologies, including artificial intelligence, and treatment models were also recommended in the report to improve eye care services, along with increased investment into research for future treatments and the availability of treatments.
It urged NHS England to ensure the system has the necessary underlying infrastructure and processes in place to support the roll out of new technologies and treatment models across the country, including providing staff training and resources.
Finally, the report highlighted that research and innovation have the potential to transform eye care services through enabling a better understanding of sight loss and finding the next generation of diagnostics and innovative treatments. It called on the government to double funding for sight loss research, taking total public investment to at least £50 million per year by 2030 across the country.
It also called on the government to increase the provision of early career research studentships and fellowships in partnership with the National Institute for Health and Care Research and UK Research and Innovation.
As Fight for Sight director of research and innovation Dr Madina Kara said, eye research changes lives: ‘Increased investment in eye research across the UK is fundamental to improving our understanding of the causes of eye diseases and developing the diagnostics and treatments to enable improved outcomes for patients.
‘In addition, it is critical the UK attracts, trains and retains the next generation of discovery and clinical researchers to ensure the UK remains a world leader in eye research.’