Ginny Nash

Removing the blinkers

I am not certain that sightless, for me, wouldn’t be as bad as lifeless.” – NHS patient

If you’re wearing glasses, take them off. Now imagine attempting to do your regular, day-to-day routine without them. Disconcerting, isn’t it? Eyesight is one of the primary means by which we perceive and interpret the world around us. We use our sight in everyday communication, in our social, educational and professional pursuits. Sight allows us to maintain our own health, independence and mobility. It enables us to help others maintain theirs. So, rather than taking eyes for granted and looking at them in isolation, let’s pay attention to and acknowledge their importance for the whole person, let’s see beyond eyes and talk about sight.

An insight into the public’s health

There are almost two million people in the UK living with sight loss, and every 15 minutes someone in the UK loses their sight. Of those elderly living with sight loss, over one-third also live with depression. Of those of working age, 66 per cent are unemployed. These numbers are only going to get worse. 

As we move into older age we become increasingly susceptible to the main causes of sight loss. Given Britain’s ageing population, the number of people with sight loss in the UK is expected to double to 4 million by 2050. In addition to this, rising incidences of obesity and diabetes will compound the situation. 

every 15 minutes someone in the UK loses their sight

Inequalities in access to services and low social economic factors have also been shown to result in a higher propensity to suffer from loss of sight, and people with sight loss can often experience at least 25 per cent higher costs in everyday living. The shocking reality is that over 50 per cent of this sight loss can be avoided. 

It is critical that NHS eye services are sustainable for the future, so eye hospitals are going to have to see beyond the eyes as mere organs and turn their attention to treating the whole person. Providers need to focus on preventing sight loss and eye conditions by understanding the populations they serve and tackling the wider impacts.

Peripheral vision

Some are already doing exactly that, and looking across the sector and learning from these providers and systems will be an important tool to ensuring that everyone receives, and continues to receive, the timely, high-quality eye care they are entitled to. In November 2016 NHS Providers and VISION 2020 UK brought together providers of eye care services to share challenges, and progress and learning from efforts to address these challenges. A couple of highlights that emerged were:

Frimley Health NHS Foundation Trust’s mobile unit. A demand and capacity analysis undertaken at the trust showed current and predicted rising demand for age-related macular degeneration services as a result of the ageing local population. To ensure the trust had sufficient resources to meet this need, Frimley built a mobile unit. This mobile unit has successfully relieved the macular service capacity issues Frimley was experiencing, eliminating all evening and weekend clinics within the first six months, as well as achieved extremely high scores for patient satisfaction. 

NHS Grampian Eye Health Network’s data sharing. All practices within NHS Grampian – a large, rural area of 650,000 population – have access to NHS mail accounts. This facilitates a two-way conversation where photographs are shared on the network and consultants are part of an eye advice line where they can access and assess the photographs. Finally, consultants share the photographs with specialists if necessary. This reduces the number of patients coming into hospitals as GPs, for example, can manage the patients with consultant support. 

This shows how new and innovative approaches are already bringing success for providers.

The challenges facing ophthalmology services mirror the macro challenges facing health and social care across England

We must not underestimate though, the difficulties that providers are currently experiencing and that are acting as inhibitors to eye service change. The challenges facing ophthalmology services mirror the macro challenges facing health and social care across England: rising demand against funding pressures, limited workforce capacity and changing workforce competencies, the complications that arise as we move from an era of competition to one of collaboration, and insufficient data and barriers to data sharing. 

To read more about the NHS Providers and VISION 2020 UK roundtable for eye care providers, read Mercy Jeyasingham’s (chief executive, VISION 2020 UK) blog “When talking could be good for your sight”.