Barking & Dagenham / Havering: Low Vision Pilot
Aim of your project
To work with user and other groups to provide an integrated, multi-disciplinary centre-based Low Vision and Rehabilitation service for people with sight problems in Barking, Dagenham and Havering. The project would empower service users as partners and decision-makers in their own care and in the running of the service. Additionally there will be a significant improvement in rehabilitation waiting times, domiciliary visits and services for minority groups.
The service will adhere to the draft Baseline Standards for Low Vision (LV) as recommended by the National Eyecare Services Steering group.
What organisations will be involved in and supporting this application and why you believe they are crucial to your proposal
Sight Action, Macular Disease Society, RNIB, Barking & Dagenham PCT (B&DPCT), Havering PCT (HPCT), Barking and Dagenham Social Services (BDSS), Havering Social Services (HSS), Local Medical Committee (LMC), Local Optical Committee (LOC) and Barking, Havering and Redbridge Hospitals NHS Trust (BHRT). All working in partnership with service users via the Low Vision Consensus Group.
Plans for service development arose from the Low Vision Services Committee in response to the need to incorporate user groups and facilities with improved ways of working for the current hospital based LV service and the rehabilitation teams. The support of the organisations above ensures delivery of a high quality and sustainable service that will meet baseline standards 1,2 and 4.
Objectives of the project: why do you want to be a Pilot Scheme?
Excellent progress has been made in establishing a very committed network for low vision services. However, there are still enormous pressures in terms of long waiting times and capacity, especially for rehabilitation services. Being a pilot scheme would allow us to:
- Develop multi-agency integrated working between primary and secondary care including optometry, social services and user groups.
- Deliver timely high quality integrated services.
- Reduce waiting times, especially in rehabilitation.
- Increase choice and accessibility for the patient.
- Help meet NSF standards, for example older people and falls.
- Address unmet need, especially in minority groups and domiciliary visits (Baseline standard 3).
Whilst maintaining the existing single discipline service, the scheme would improve cost effectiveness, particularly through smarter ways of working and supply of optical equipment that really meets the user’s needs.
Where do you want to be in 2 years time – describe your vision for delivery of Chronic Eye Disease Services.
- An integrated low vision and rehabilitation service of excellence available to all residents with sight problems of Barking, Dagenham and Havering.
- Equal reach and accessibility to minority groups.
- Timely information and support, including supplementary support, such as, welfare rights advice (Baseline standard 10).
- Increased awareness, choice and accessibility of services.
- Single assessment process (Baseline standard 7).
- Integration of IT to increase efficiency.
- Sharing of knowledge amongst local professionals, increasing training and understanding between social, health and home care staff (Baseline 11).
- Cost effective through providing local services, better use of staff and releasing capacity in the secondary sector.
- Sharing of expertise at a national/regional level through networking and conference presentation (Baseline standard 13).
Scope and focus of the project: what aspects of Chronic Eye Care services do you want to develop; what new ideas do you want to test?
- Development of an innovative service, allowing flexible access and stream-lined referral between services and specialisations .
- Embracing current user consultation in the strengthening and development of service provision.
- Integration of the eye health check and functional visual assessment with rehabilitation services (Baseline standards 8 & 9).
- Extending the role of the traditional rehabilitation worker or similarly trained person into that of a Low Vision Therapist based within a one-stop centre.
- Developing specialist registration clinics for people with sight problems outside of the traditional secondary care setting.
- Integration of the single assessment process between health and social care (Baseline standard 7).
- Explore the impact of transferring chronic eye conditions, such as dry AMD, to the primary care setting.
- Testing the hub & spoke model application for low vision centres in the primary care setting.
How can being a pilot help you to achieve your vision?
The pilot will act as a catalyst enabling the low vision network’s vision of an integrated multi-disciplinary service to come to fruition. It will focus resources for the benefit of local people, and commit all parties to sustain and further develop the service.
a) Patients
- one stop holistic service for sight related problems,
- integrated low vision and service rehabilitation,
- greater choice and access with improved referral routes (Baseline 6),
- reduced waiting times, improved access for minority groups and domiciliary services,
- improved information and support,
- help prevent falls and promote independence,
- reduces social exclusion,
- reduced waiting times and improved domiciliary services,
b) Staff
- Joint training and expanded opportunities by working with a wider range of disciplines.
- Greater awareness of overall needs of people with sight problems.
- Greater motivation and satisfaction.
- Reduced demand in current hospital service, allowing better use of resources.
- Reduced GP workload with fewer referrals and less mental health support.
- Closer links between staff in all sectors facilitating flexible working.
c) Organisation/local health economy
- Increased capacity and choice in primary and secondary care.
- Reduction in inappropriate referrals and embracing of new registration system.
- Partnership and dialogue between all stakeholders.
- Supports the NSFs for Older People and Diabetes.
- Reduces falls and associated costs.
- Facilitates partnership working with voluntary organisations in service delivery as government directives.
- Enables effective use of joint working between the different stakeholder organisations.
Who are the key stakeholders and potential leaders in your scheme and why?
Service users are central to the scheme’s development and success. Sight Action and the Macular Disease Society have worked tirelessly for many years to achieve their vision of a service that will have such an innovative impact. These local groups will provide local knowledge, while RNIB will provide support and expertise that befits the largest voluntary organisation for people with sight problems.
Other key stakeholders are Barking and Dagenham and Havering PCTs and Social Services Directorates, the LOC, LMC and BHRT and RNIB. All the partners have demonstrated sustained commitment to the establishing of a new integrated low vision service.
Proposed project management arrangements
A Partnership Board would be established from the current Low Vision Service Committee. This board would consist of representatives from the key stakeholders and user groups. The service would employ a co-ordinator with RNIB’s Low Vision and Eye Health team being responsible for managerial training and support.
How will the success of the project be measured?
- To integrated service versus traditional service.
- Waiting times, especially for rehabilitation services.
- Adherence to Baseline Standards for Low Vision.
What are the challenges and barriers to the success of the project? How will these be overcome?
(a) There may be initial recruitment difficulties due the shortages within some of the disciplines. However, considering the nature of the pilot, developing integrated and multi-disciplinary services, and the national reputation of RNIB the posts are felt to be attractive.
(b) Initially there will be an expected surge in demand for low vision services, driven by the new service and additionally by the new BD8 process. The service co-ordinator, along with support from social services will prioritise and manage this demand. Systems will be put in place to ensure appropriate information and advice is given to anyone who experiences a delay in receiving the service.
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