Improving Eye Health. Cardiff and Vale University Health Board

Transcription

1 Improving Eye Health Cardiff and Vale University Health Board Local Eye Care Plan

2 1. Introduction On the 18 th September 2013 the Welsh Government published Together for Health: Eye Health Care, Delivery Plan for Wales, It set out its vision and key themes which included: Raising awareness of eye health and the need for regular sight tests Early detection of eye health and sight problems Providing access to high quality, integrated services and support o Primary and community services o Specialist hospital services o Supporting people with sight/dual sensory impairment. Cardiff and Vale University Health Board are committed to improving the eye care of its population and this is supported by the significant investment in both staff and infrastructure over the last 3 years. However, it is recognised that there is a much larger agenda and that clinical and professional support, leadership and advice are required to review services to ensure that services provided are safe, cost effective and efficient. This document outlines the Health Board s vision and actions required. 2. Strategic Context Poor eye health is a growing issue, in Wales nearly 100,000 people are living with sight loss. It is predicted by 2020 that this will increase by 22% and will have doubled by There have been a number of key strategic drivers which influence the delivery of eye services which include: Focus on Ophthalmology. This provided pathways for Unscheduled Eye Care, AMD, Glaucoma and more recently Cataract. Setting the Direction. Strategic Delivery Programme for Community and Primary Care services Together for Health Together for Health: Eye Health Care Delivery Plan for Wales, National Institute for Health and Care Excellent (NICE) South Wales Plan (now Collaborative) for reorganisation of surgical services.

3 3. Local Population Race & Ethnicity A review of the literature in diseases due to race & ethnicity: summarised the relative risks of selected eye The black population has a greater risk of developing AMD compared to the white population in younger age groups, whereas the white population has a greater risk of developing AMD in the later years of life; the Asian population is at lower risk of AMD than the white population at all ages The Asian population has a greater risk of developing cataracts compared to the black population and white population. Black and Asian populations have a greater risk of developing diabetic eye disease compared to the white population The relative risk of glaucoma is much higher for the black population compared to the white population. The white population has the greater risk in developing refractive error compared to the black population. For other eye disease, no robust differences in relative risk as a result of ethnicity have been found. People in minority ethnic groups generally have a greater risk of eye disease and evidence in the review suggested they do not receive the same level of access to eye care services. The table below demonstrates that Cardiff has a significantly higher population than the Welsh average for people who say they are from a non-white background Area Population % of population who say they are from a nonwhite background Cardiff 354, % Vale 125, % Wales 3,007, Ethnicity by area and ethnic group The great majority of people (88%) aged 65 and older wear glasses and 90% of blind and partially sighted people are aged over 60 years old. Life expectancy in both Cardiff and the Vale are slightly above the Welsh average Males Females Wales Cardiff Vale Access Economics, The economic impact of partial sight and blindness in the UK adult population, 2009

4 Life expectancy Lifestyle choices are a contributory factor to poor eye health, particularly to the development of cataract and age-related macular degeneration. Three areas which have an impact are: Smoking Excessive alcohol consumption Diet and Nutrition Smoking It is widely recognised that smoking is a contributory factor to poor eye health, particularly to the development of cataract and age-related macular degeneration. % of adults over 16 who smoke in Wales Excessive alcohol consumption Evidence shows that excessive alcohol consumption over a long period increases the risk toxic amblyopia (reduced visual acuity and loss of central vision), in addition to its obvious short-term effects on vision (i.e. blurred and double vision, reduced contrast sensitivity and poor night vision). Excessive alcohol consumption in pregnancy can lead to foetal alcohol syndrome (FAS). This not only increases the risk of low birth weight and mental disability in newborn babies; it can also cause reduced visual acuity that cannot always be rectified by spectacles. % of alcohol consumption above guidelines Diet & Nutrition Poor eye health and the development of eye disease are strongly associated with a poor diet, particularly relating to insufficient consumption of fresh fruit and vegetables. Affordability and physical accessibility of foods have been identified as key barriers to eating a healthier diet, particularly in low-income families. Obesity is a risk factor for all four major causes of sight loss: AMD, diabetic retinopathy, glaucoma and cataracts. Other eye conditions, such as retinal vein occlusion, and hypertensive retinopathy, can also result from high blood pressure and raised levels of cholesterol due to obesity.

5 % consumption of fruit and vegetables meeting guidelines % of overweight or obese Welsh Health Survey 2013 Eye health is also closely associated with deprivation. People living in the most deprived communities in Wales have the worst eye health in Wales. 4. Local Delivery Plan The eye health care plan is structured around 3 key themes. Raising awareness Early detection Access, quality and integration 4.1 Raising awareness Working with Public Health Wales, DRSSW, Optometrists, Pharmacists, GPs and the third sector we will continue to: Encourage patients to live a healthy lifestyle focusing on the 3 areas which are known to impact on eye care (smoking, alcohol, poor diet) Further enhance links with the community and in particular optometrists by building on the already established Eye Health Pathway Group ensure the group is focused on the 3 key themes. 4.2 Early detection Giving patients access to services within a primary care setting is essential to supporting early detection. The health board is committed to providing Clear and easily followed pathways to ensure that where possible patients are managed within their own local community Providing support and educational material to enhance community optometrists and GPs in signposting patients to the most appropriate agency Continue to support children s vision screening

6 4.3 Access, quality and integration The health board recognises the benefits of moving eye health from a secondary care setting to primary care. The vision is for Primary care to have enhanced services to ensure that patients are managed where appropriate in a community setting. However a great deal of work has been commissioned over the last 3 years which has and will enhance the current services ensure patients have improve access to hospital based services. Service developments have included. Enhancing the cataract pathway, specialist nurses have been appointed to enhance the cataract services this has resulted in increased capacity ODTC Glaucoma Team ODTC Medical Retina Team Local Delivery Plan actions Development of ODTCs within optometry practices/ GP practices Improving IT links with optometry practices and allocating dedicated IT support to Ophthalmology in HES Undertake a needs assessment for priority ophthalmology services Increase referrals to smoking cessation and weight loss programmes Develop health promotion plans Improve on early diagnosis Explore the potential to commission services from optometry practices i.e., management of post operative cataracts Improve IT management of waiting lists and efficient management of Follow up in Hospital Eye Service. Centralise High Budget Specialist services in accordance with South Wales Collaborative Guidance. Improving Provision of High Quality and Consultant led Eye Emergency Services including specialist provision for eye trauma care and cancer services. Provision of Specialist Hub with integrated theatre Suite and achieve greater efficiency in theatre activity and training

7 5. Care and support for people living with sight loss or dual-sensory impairment 'Dual-sensory impairment' refers to people who have both sight loss and hearing loss and is increasing 2. Between 9% and 21% of adults over 70 have some level of dual sensory impairment: People can acquire these impairments at different stages; some people might be born deaf and blind, while others might be born with one impairment and develop a second impairment later. People also vary in how impaired each sense is; some might have more abilities in one sense than another. Everyone will have different strengths and weaknesses with their vision and hearing. Because there is so much variation, strategies for living with dual sensory impairment are different for different people. 3 Future Actions: The Health Board will work to ensure effective referrals to social services, the Low Vision Service Wales (LVSW) and third sector from the hospital eye services where the individual would benefit from an assessment by a rehabilitation officer and where appropriate a rehabilitation programme. The Health Board will work with stakeholders to promote LVSW and improve uptake The Health Board will work with eye health care pathway and audiology clinicians to develop two-way referral pathways. The Health Board will be compliant with the Accessibility Standards for Sensory Impaired People 6. Conclusion The Health board s five year plan for Eye Health is focusing on providing a high quality service which is efficient and effective ensuring care is delivered when possible in a local setting. It is important that promotion of eye health is a key message to everyone this will ensure that we have a sustainable plan to delivering an affordable and reactive service to the needs of our population. 2 Welsh Government, Together For Health: Eye Health Care Delivery Plan for Wales, , People first, accessed 09 April 2014