VISION 2020 UK Ophthalmic Public Health Committee

VISION 2020 UK Ophthalmic Public Health Committee

Draft Minutes of Meeting, 13/09/17, 12:00 – 15:00 in the Lecture Theatre, Lower Ground Floor at The Royal College of Ophthalmologists, 18 Stephenson Way, London, NW1 2HD

Present:

PDParul Desai (Chair), The Royal College of Ophthalmologists

DSDarren Shickle, Faculty of Public Health(left 1435)

JPJanet Pooley, Optometry at NHS Education for Scotland – teleconf

JBJohn Buchan, The Royal College of Ophthalmologists – deputising for Richard Wormald

JRJugnoo Rahi, The Royal College of Ophthalmologists

MBrMatt Broom, VISION 2020 UK

ODOlivier Denève, The College of Optometrists

PBPeter Black, Optical Confederation –deputisingfor David Hewlett

RKRichard Knight, LOCSU

VGVeronica Greenwood, British and Irish Orthoptic Society (BIOS)

In Attendance:

TKTayyaba Kamal (Secretary), VISION 2020 UK

Apologies:

Catey Bunce, Certificate of Visual Impairment Committee

David Hewlett, Optical Confederation (Peter Black deputising)

David Parkins, The College of Optometrists

Helen Lee, RNIB

Raymond Curran, Integrated Care Health and Social Care Board, Northern Ireland

Richard Wormald, The Royal College of Ophthalmologists (John Buchan deputising)

1.Welcome, introductions and apologies for absence (PD)

• All were welcomed to the meeting, especially new member VGrepresenting BIOS, and introductions given.
• Apologies were received.

2.Declarations of interest (All)

• There were no new declarations of interest.

3.Notification of any other business (All)

• There were two notifications of any other business:
• 7.1 – CVI Committee report from MBr; and
• 7.2 – VISION 2020 UK / Vision UK from MBr.

4.Minutes of the last meeting, 9 May 2017 (PD)

• Page 1, PB represents the Optical Confederation not the Federation of (Ophthalmic and Dispensing) Opticians (FODO).
• The minutes were otherwise approved.

Actions:

4.1TK: Amend minutes and circulate to all.

5.Matters arising from the minutes(PD)

• Item 8.2 from 12 June 2017 – RW to provide a briefing paper at the next meeting on WHO’s report on the impact of improving vision. The report is likely to be launched at the end of 2018. Item now closed.
• Item 9.2 from 12 June 2017 – All to provide suggestions for indicators and their data source to PD and engage in email discussion on review of Portfolio content. This is due prior to the December 2017 meeting.
• Item 9.3 from 12 June 2017 – PD to draft reviewed Portfolio for December 2017 meeting. This is due December 2017.
• All other actions were either covered on the agenda or complete.

5.1Updated Terms of Reference (for information)(PD)

• The updated Terms of Reference were received for information.

6.Public health priorities for eye health (All)

• PD thanked JP, JR, DS and Raymond for their papers which were received (Attachments 6, 7,8,9 and10), and comments received from RK.
• As agreed at the last meeting the top 5 topics from the Beyond 2020 seminar (held 2015), would form the basis of identifying the public health priorities for eye health. No other topics had been put forward for discussion at this meeting.
• The objectives of the discussion were to:

1. identify the right public health questions for eye health for Vision UK. It would be for VisionUK to consider these for taking forwards through its various activities and committees.
2. ensure that these were public health questions and align these to a domain of public health practice:

1. health improvement;
2. health protection; or
3. healthcare public health, previously known as public health services.

• In doing so the following criteria would be considered:

1. Relevance to current health policy and the wider priorities of the NHS and its relevant governmental bodies across the UK.
2. Life course implications – factors influencing visual health in childhood and associations into adulthood e.g. social position, deprivation etc.(recent publication from JR et al, findings from 3 national cohorts )
3. Mechanisms to monitor impact of interventions (policy, service change or therapeutic etc.) on eye health.

6.1Beyond 2020 (2015) research questions(Attachment 5)

• MBr provided a summary of the methods employed by Beyond 2020 to identify the top five “priority” areas (Attachment Item 6.1) out of a total 17, and confirmed that these were still considered to be valid by VISION 2020 UK.
• It was noted that Question 9 – “What percentage of prevalent and incident sight loss is actually preventable?” – did not make it into the top five priorities, given that this is the basis for the proposed UK Eye Health Survey.
• The “next steps” (economic assessments and NIHR commissioned systematic reviews for these topics) are planned.
• The top five questions were considered and assigned a public health domain:

1)What is the relative cost effectiveness of different pathways into eye health services and what are the barriers within those pathways? [Public health category (c)]

2)What are the true direct and indirect costs of vision impairment and severe vision impairment? [Public health category (c)]

3)How do we improve early diagnosis for those at risk of sight loss? [Public health category (a)]

4)What should be the care package of health and social care support offered to people with impaired vision? [Not a public health topic. It is a clinical and service delivery issue.]

5)What is the most cost effective service configuration for: [Public health category (c)]:

a)patients presenting with new ocular symptoms or visual disturbance; and

b)opportunistic detection of people with asymptomatic conditions which are a threat to eyesight?

• The following were discussed :

(a)Questions (1), (2) and (5)

• These were all very similar, calling for cost-effectiveness assessments of various parts of the eye health and care systems; and were considered to be asking the same question. Whilst such assessments would contribute to the knowledge base on service delivery and organisation, they would take time to conduct and deliver. The immediate challenges ( and for the foreseeable future) are rising demand and need from an ageing population.

(b)Population Screeningwas understood to underpin Question 3.

• It was considered in terms of the following questions:

1. Are there are any conditions for which there is appropriate evidence that population screening should currently be undertaken but is not mandated/advocated at present? –

Glaucoma and age related macular degeneration were raised, but agreed did not currently meet the criteria.

1. To understand why and rectify where mandated/advocated screening programmes not being implemented as recommended -

• Discussion centred around Vision Screening in 4-5year olds, which is not a mandated screening programme and as such at risk of being omitted in favour of mandated activities e.g. within the Healthy Child Programme in England. It is not mandated because the evidence base at the last review did not justify it. Instead the “recommendation” category provided a place-holder status to the programme so that it would not be lost, as screening children at this age is an intuitively “reasonable” thing to do to detect any problems before their development/ education etc.is affected.
• However since then:

• The NSC has also developed service standards for the programme.
• Evidence is emerging on the impact of visual health in childhood on life course / life chances into adulthood.

• Given this it would be reasonable to call for a review of the evidence to support this becoming a mandated programme.

(c)Question 4

• Whilst this was not directly a public health domain, it was recognised that a range of standards, guidelines or frameworks for eye health and care services have been produced by national bodies and professional organisations across the UK. These standards should be implemented and monitored to ensure effective service provision.

(d)Question 5

• The perceived barriers to optometric care were considered. Changing these to being clinical services may improve uptake. Scotland (JP) has free sight tests;GPs and pharmacies direct anyone with eye issues to optometry practices; and a range of optometry based pathways have been in place for some time; but this has not necessarily improved the distribution of uptake of sight tests.
• Optometry services are well placed to offer brief public health interventions for eye health and general health, aligning the core public health messages.

(e)The following priorities were agreed:

1. Vision screening for 4-5 year olds – call for review of new evidence and together with published national service standards, to support it becoming a mandated NSC programme.
2. Implement national standards and guidelines for service delivery.
3. Align and incorporate benefits to eye health form broader public health strategies and interventions (determinants, life style, falls etc).

Actions:

6.1.1PD: Feedback these priorities to Keith Valentine, CEO of Vision UK.

6.2Portfolio of indicators for eye health and care

• This had been agreed (May 2017) as being one of the VisionUK priorities as a tool to monitor eye health. Its review is ongoing and shall be discussed in detail at the next meeting in December 2017.
• The following were discussed:

• Measures of quality assurance of optometric services, along similar lines to those adopted for hospital eye services, and could initially be process driven.These are being discussed in Scotland and could inform wider application across the devolved nations?
• The Clinical Council for Eye Health Commissioning Frameworks provide some metrics for non-GOS services within care pathways and these could be applied through service contracts.
• Optometric practices are currently “audited” regularly for infrastructure and estates, but not for clinical practice and service delivery.Any additional requirements would need to be discussed within the Optical Confederation (RK).

• Members were asked to contribute to the Portfolio review by considering the following:
• What additional categories of indicators should be included?
• What specific new indicators should be considered?
• Which indicators should be amended?
• Which should be “retired”?
• The underlying evidence base / policy for the indicators

Actions:

6.2.1.TK:Circulate current Portfolio with minutes to aid feedback review.

6.2.2RK:Provide information currently collected on optometric services.

6.2.3JP:Share scope of discussions on quality assurance of optometric practices, ongoing in Scotland.

6.2.4PD:Add Portfolio to feedback on priorities to Keith Valentine.

6.3Implications of NICE guidelines:

• PD summarised the key issues raised in the recent responses to the consultation of the draft Cataract, draft AMD and reviewed Glaucoma NICE guidelines.They shall be published from October 2017 to spring 2018, providing specifications for clinical practice and service delivery. Whilst not mandatory, their uptake and implementation would be consistent with the key priorities proposed above.

Actions:

6.3.1PD / TK: Add NICE guidelines discussion to agenda for December 2017 meeting.

7.AOB

7.1CVI Committee report (MBr / Catey Bunce)

• MBr had received a report from CB on behalf of the CVI Committee, and highlighted its key points-

• The new CVI Forms are being received by the Certifications Office.
• Confirmation that the CVI national database had been updated to accommodate the updated CVI Form as follows:

• NHS number;
• updated ICD codes list;
• new questions regarding dementia, learning disability, support with care and whether child known to the specialist visual impairment education service in part 3;
• added new CVI form version – “2017”;
• CVI Data Entry Guide updated accordingly.

Action:

7.1.1TK: Circulate report from CVI Committee with minutes.

7.2VISION 2020 UK / Vision UK (MBr)

• VISION 2020 UK held its final Board meeting and AGMon 12 September 2017.
• Vision UK will go live from 1 October with a hard launch in 2018.
• There will be continuity with work transferring to Vision UK.
• Any suggestions for the future of the OPHC should be passed to PD andMBr.

Action:

72.1All: Suggestions for the future of the OPHC to be sent to PD ()and MBr ().

8.Meetings

8.1Date and venue of the next meeting

• Wednesday 6 December, 12:00 – 15:00 at RCOphth, London(Note: date changed from 4 December)

8.22018 meetingtimes

• Meeting times for 2018 under review to facilitate transport arrangements.

Action:

8.2.1TK: Create doodle poll for 2018 meeting times of 11:00 – 14:00 and 12:00 – 15:00.

8.32018 Meeting Dates and Venues(Post note meeting: all times 11:30 – 14:00)

• 13 March 2018, Pocklington Hub – (near Euston station)
• 5 June 2018, The College of Optometrists, London
• 11 September 2018, The College of Optometrists, London
• 4 December 2018, Pocklington Hub – (near Euston station)

Summary of Actions Table

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