Peep into Policy, Politics, Parliament

Abstract

Equity and prevention of blindness with a disintegrated eye health serviceIn 1951, three years after the birth of the NHS, Nye Bevan resigned from the Labour Cabinet because Gaitskell's Government introduced prescription charges for dental care and spectacles. A decision not to provide false teeth and spectacles in order to save £13 million pounds was probably the reason why eyes and teeth are now extraordinarily and inappropriately lumped together in The Department of Health administrative structures, and continue to be half in and half out of the NHS.With the delegation of the primary eye care function to ophthalmic opticians (more recently termed optometrists) never formally taking place-beyond the expectation that they provide a prescription for the optical correction of refractive errors and refer anyone with an abnormality - the eye health service has become inefficient and disintegrated. Poor communication between optometry (primary care) and ophthalmology (secondary and tertiary care) is evident, with letters and operation notes from the eye clinic being sent to the GP but often not copied to the referring optometrist. Consequently there is no continuity for a management plan of patients who are discharged from the Hospital Eye Service (HES), which ultimately leads to unnecessary re-referrals and also potentially mismanagement.The location of many optometric practices also prevents access. The geographical distribution of optometric practices, results in a bias of services away from those in more socially deprived areas who have poorer access to health care in general.1 Moreover it is well understood that the prevalence of blindness is significantly higher in areas of high social deprivation.2 The perception of many that a visit to the optometrist will result in heavy expenditure also creates a further barrier to attendance. The opportunistic surveillance by optometrists for the major eye diseases such as glaucoma, cataract and diabetic eye disease is still how the majority of referrals to the HES originate.With a rapidly ageing population, further demand is placed on optometrists with the need for new treatments and higher standards for established interventions; all of which is creating unsustainable requirements for service delivery from the HES. This is exemplified in glaucoma.4 Glaucoma is the most common reason for referral to ophthalmology departments in the UK and 10% of UK blindness certifications identify glaucoma as the primary cause of sight loss.5 Lifetime ophthalmology followups are required if glaucoma is diagnosed and if appointments are sustained many of these patients will remain stable for years. It is increasingly argued that such patients could safely be reviewed by suitably accredited optometrists thereby freeing up clinic time to concentrate on the patients with advanced glaucoma. The argument is strengthened by the fact that in 2009, National Patient Safety Agency figures revealed that 44 patients lost part of their sight as a result of delayed followup appointments and a further 13 were rendered blind.6Currently 40% of referrals to ophthalmology for glaucoma are inappropriate and patients are often discharged at the first visit. …