Northumberland
Sight enhancement & equipment service
End of project conclusion and recommendations
1. Introduction
Northumberland Care Trust and its partners, local optometrists and third sector provider, aimed to develop a locally delivered, user-focused low vision service to the residents of Northumberland thereby reducing the need for patients to travel outside the county to the city hospital based in Newcastle upon Tyne.
2. Project aims (from Project Initiation Document - PID)
2.1 Provide community based service for people with sight impairment hereby reducing the need for people to travel outside the county to the city eye hospital
Model:
Multi-disciplinary clinics manned by optometrists and rehabilitation officers/rehabilitation assistants and held within high street optometry practices with fast-track referral to GP, hospital specialist services and sign-posting to other agencies, social and support groups, etc as appropriate.
Method:
- Expressions of interest sought from all practicing optometrists in Northumberland
- Selection process to identify 2 practices in each locality (West, North, Central and Blyth Valley) to be rolled out in 2 phases. This was implemented by using a self assessment tool and a scoring matrix.
- 8 optometrists receive 2-day RNIB accredited training (including potential Phase 2)
- 2 self-employed rehabilitation officers secured on a sessional basis
- Local voluntary sector organisation already contracted to Social Care branch of Care Trust to provide statutory registration function asked to provide rehabilitation assistant function to deliver individual care plans
2.2 Include a domiciliary service (where needed)
Participating optometrists were already approved GOS domiciliary providers. A domiciliary test should only be carried out for those patients who are truly housebound.
The preferred option is to enable the patient to access comprehensive sight testing and low vision assessment within the practice where specialist testing equipment is to be found. To this end, one practice has acquired a people carrier to ferry patients, including wheelchair users, to and from the practice.
Taxis have also been used, and paid for by the Care Trust, to enable patients to access the practices.
2.3 Provide equality of access for all
2.3.1 Access to optometry practices
A baseline assessment of the optometry practices with regard to accessibility and DDA compliance was conducted and informed the selection process.
2.3.2 Access to low vision service
In order to ensure equality, patients can access the service from a number of directions, including:
- Self referral
- Optometrists
- Social Services
- Hospital Eye Services
- Voluntary Sector
- GP
- Allied Health Professionals (OT, Specialist teams, etc)
2.4 Involve patients in the setting up and on-going evaluation of the service, making it a user-centred service based on the needs of the individual
Pre-project a professional optometric working party was set up in January 2002 to undertake gap analysis and look at training and standards, communication and user involvement.
Service users were invited to attend and the Low Vision Services Committee was formed with meetings held quarterly. In addition, the Care Trust has hosted 3 annual stakeholder events where service users and their carers can learn what services the Care Trust and other organisations can provide for individuals with vision impairment, access the latest innovations and have the opportunity to discuss topics that are meaningful to them. This involvement has been used to shape service provision. Some of the issues raised included education, access issues, employment opportunities, welfare rights and finance and communication.
Direct feedback to the project has been provided by the Low Vision Services Committee and post-appointment questionnaires completed by the expert patients who attended the pilot clinics.
2.5 Create an electronic management plan for each service user
Phase 1 development of the web-based electronic patient record was carried out by an external agency contracted to work within time-limited and budgetary constraints. The timing of this proved to be disastrous in terms of effecting the best possible outcomes because the project manager was not yet in post on a full-time basis and the other interested parties were either not Care Trust employees or only employed part-time making effective communication links almost impossible within the timeline.
The Care Trust in-house ICT team have now undertaken to carry out Phase 2 development work which will ensure a system that is fully fit-for-purpose, secure and compatible with other NHS networks.
In the interim a paper version has been developed for use by rehabilitation officers working in the field. The feedback from this will be used to aid the development of the electronic version and will be used as a contingency for back up in the event of a system failure.
3. Summary
For all the difficulties encountered throughout the duration of the project, the Care Trust is in a much stronger position now than before the project began.
A significant amount of useful data has been collected which was hitherto unknown and can be used to shape future service provision for patients with low vision. It now has access to a database of all the patients who have been referred to the service, have care plans completed, are waiting to be seen or have declined services at this time. The patient details are held within a system that has a mechanism for review. The data is readily adaptable to produce statistics to measure performance and demographics.
In addition, a strong network of contacts in both health and social care have been established and joint working in a multi-disciplinary team has been initiated. For some optometrists and rehabilitation workers this has been their first experience of multi-disciplinary working and they have highlighted the benefits in terms of communication and a seamless service for the patient.
Overall, the profile of eye health has been raised, the Care Trust has recognised its responsibilities to this client group and is supportive of future service development.
Carol Nelson
Project Manager
April 2007