You may remember last month’s column discussing the challenges facing the NHS, in particular to provide excellent care at an affordable cost. To do this will require efficiency savings, however, the quick wins have already been taken and so there may not be significant savings left. Hence a great deal of reliance is being put on sustainability and transformation plans (STPs), to be the vehicle for real change over the next five years. The current 44 STPs in development across England, should not just be tinkering at the edges to make a few efficiency gains, but really changing how things are done. To use a sporting analogy of track cycling, this is not about shaving a few ounces of the weight off the bike, it should be about deciding whether a bike is the best means of transport.
The big question for our profession is whether eye health is being included in the discussions. If not, should it be and if so what would we have to offer? Reviewing those STPs that have been published online, all are different, but with many common themes such as inequality and keeping people independent. There is little detail, but where there is anything specific it concerns the high profile targets such as hospital bed numbers, cancer treatment and accident and emergency waiting times. It is no great surprise then that eye health does not feature almost at all, as I am aware that there has been criticism of the STPs being developed in isolation and away from input by patients or other interested groups. In which case I hope by now discussions are starting to look at detailed health pathways and what optometrists, dispensing opticians and optical practices can do to meet the aims and objectives of STPs.
All STPs talk about knowing the facts and figures applicable to the health of the population. This information exists as each area will already have an eye health needs assessment which will show key information. Perhaps the most relevant figure is on average an STP area will have around 160,000 ophthalmology outpatient appointments, and as this number is rising trusts will continue to struggle to meet targets for waiting times. Additional data will include; areas of deprivation where there will be unmet health needs, hard to reach ‘at risk’ groups, or variation in the take up of sight tests. The last is an important factor as it is arguably the most significant way to identify eye health issues and also meets STP aims to introduce early detection programmes so that more people are diagnosed early to enable better outcomes.
STPs talk about general health issues, prevention and enabling the population to keep themselves healthy through tackling issues such as obesity (clearly linked to diabetes), smoking and mental health problems. Already optical practices are involved in healthy living schemes where the staff will work with their patients as part of the community workforce. In one way or another all STPs talk about keeping people away from hospital, unless it is absolutely necessary, through new pathways and models of care, which means a hospital visit only happens if the patient cannot be treated in the community. Here optical practices are well placed to keep patients in the community as evidenced by Mecs and glaucoma monitoring schemes, giving effective and efficient planned care, with appropriate guidelines, pathways and audit. Community will be able to manage low risk long-term conditions.
STPs talk about the need to reduce variation and waste. Hallelujah, if this means at last we will have schemes that exist across CCG boundaries as national pathways for local implementation is something we have talked about for years. STPs also recognise the enablers have to be right. In our case we have a competent workforce, appropriate equipment and, ideally from an NHS view point, this is funded privately by each practice.
In summary we can show we are able to tick the boxes that are important within STPs and even better what we can do is already in existence somewhere in the country, waiting to be replicated. The final feature of all STPs is that there needs to be a financial saving, £500 million or thereabouts per STP. While eye health will not be the most significant cost area, this is a case where every little helps. I’m sure there will be health economists out there who can give the figures, with even the most simple of calculations suggesting that if half the hospital outpatient appointments were paid at half the secondary care tariff, this would save around £5 million per STP or over £200 million in England.
Lets hope those who are working on STPs look around, talk to the local eye health experts and listen, learn and act.