Anticipated funding cuts to the Special Schools Eye Care Service risked thousands of children missing out on vital intervention, according to the Association of Optometrists (AOP). The AOP said up to 165,000 children with special educational needs (SEN) should be eligible for the service and it was shown to benefit development and wellbeing.
However, the AOP conservatively estimated the fee per child to be a real terms cut of 30%, from £116 in the proof of concept trial to £81. Adam Sampson, chief executive of the AOP (pictured right), said: ‘Much of the UK’s health service is in crisis but when we have a solution that fixes one very important element – reducing health inequalities for children – we must seize the opportunity.
‘A tremendous amount of work has already gone into setting up the service in many special schools in England – and children, parents and teachers can see the impact it is having. Cutting the fee by 30% is in effect an act of sabotage.
‘The government must reverse the cut and meet its commitment to support this life-changing eye care service for 165,000 children with special educational needs, or risk becoming the architect of the service’s collapse before it has even been built.’
A vital service
The government committed to rolling out the Special Schools Eye Care Service nationally in June last year with £10m investment as part of its NHS Long term Plan. Each child would receive an adapted sight test at least once a year in their own school by a team of professionals who were able to provide for their needs.
At the time, Neil O’Brien MP said: ‘I am pleased we will be able to support sight testing for all pupils in special schools, an environment where they feel more comfortable.
'We have worked closely with NHS England, stakeholders and charities to extend this important service and thousands of pupils will benefit as a result. It’s vital for all children to have access to NHS sight tests and I’m grateful to all those who helped make this possible.’
However, the AOP said the government had backtracked on the commitment in 2024, which would mean eye care professionals would struggle to find ways to offer the service. The professional body said plans were a devasting blow to children with SEN, their parents and teachers who relied on the service.
The AOP calculated the fee based on the £10m pledged in 2023, although it believed the actual figure to be closer to £12m with other funding announcements it was aware of.
It said the £81 figure was a conservative calculation and was based on 90% of the children in special schools accessing the service. However, the AOP believed the number of children was closer to 171,000, which meant the fee worked out to be around £78 per child.
Eliminating anxiety
An AOP survey carried out in 2023 found that 65% of UK optometrists believed that many SEN children were ‘experiencing a lower quality of life’ due to inadequate provision of NHS eye care services. A further 76% concluded that ‘trauma and worry’ was reduced for children and parents who have access to the specially designed service.
Professor Julie-Anne Little, optometrist, researcher on visual impairment and special needs, and past-chair at the AOP (pictured right), said: ‘Children with additional needs are 28 times more likely to have a serious sight condition but many simply find the experience of eye care in an unfamiliar setting too distressing.
‘By eliminating this anxiety, we can help children attending special schools access eye care and save sight. Importantly, this service brings it all together so children can have their vision and eye health checked along with having their spectacles fitted in familiar surroundings.’
The AOP said it has written to the Minister for Public Health, Start for Life and Primary Care, Dame Andrea Leadsom, to call for urgent action as part of its Sight for SEN campaign.
View from: Seeability
Lisa Donaldson, head of eye care and vision at SeeAbility (pictured below right)
'If the government and NHS England move forward on a lower fee, it would not be sustainable for the current service model. This model was independently evaluated and feedback from schools, parents and clinicians was extremely positive. That same level of care cannot be delivered for a fee of £81.
The proof of concept model is based upon the Framework for Special schools eye care, which was developed by all the eye care professional bodies. The success of the model is based upon continuity of care by a clinical team providing dispensing of and support with spectacles to ensure successful use, which is often such a problem for this patient group.
In addition, each child receives a plain English report explaining their visual abilities, needs and limitations – this has proved to have measurable educational and behavioural benefits, improving children’s quality of life.
It has allowed for discharge of many children for routine care from over-stretched hospital eye clinics thanks to good links being established and in some case contracts being awarded to hospital trusts to expand upon existing orthoptic services. SeeAbility have been providing to 25 schools at the current fee since April 2021. As a not for profit, this is just about sustainable with a fee of £116.
The service currently reaches an estimated 9% of the special school population. It has now been eight years since the Framework paper was published and over 90% of pupils are still waiting. The evidence that led to the proof of concept service being rolled out shows that over 40% of special students have never received eye care, yet 50% have a significant visual problem with up to 40% needing glasses, often to stronger prescriptions.
We need a timely roll out of a service that reaches as many as possible of the children that need it. If fees are unsustainable, there is a very real risk that the children who need it the most, who have missed out on eye care and glasses, will still miss out and will not get access to the service.
Furthermore, the proof of concept so far has shown potential to discharge 20% of these children under hospital eye clinics to be seen in an environment that’s more familiar to them. As these children often miss hospital appointments, being seen in their schools is not only more cost effective, but means fewer missed appointments and children getting the eye care they need sooner with less disruption to their education.
With so many question marks on how the service is actually going to be delivered and if it will be of the necessary quality, the whole potential of this service could be totally undermined.'