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Miss Rachel Pilling Consultant Ophthalmologist Bradford Teaching Hospitals NHS Trust

"Putting it into practice: the challenge of hospital eye care for people with learning disabilities". Miss Rachel Pilling Consultant Ophthalmologist Bradford Teaching Hospitals NHS Trust. Overview. Why do LD Eye services need commissioning? What happens when you visit eye clinic

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Miss Rachel Pilling Consultant Ophthalmologist Bradford Teaching Hospitals NHS Trust

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  1. "Putting it into practice: the challenge of hospital eye care for people with learning disabilities" Miss Rachel Pilling Consultant Ophthalmologist Bradford Teaching Hospitals NHS Trust

  2. Overview • Why do LD Eye services need commissioning? • What happens when you visit eye clinic • What adjustments can be made • What have been the barriers to adjustments • Bradford Learning Disability Eye Care Group

  3. Annual Health Checks • any concerns about patients eyes/vision • Has patient seen optician in last 2 years

  4. What usually happens at the eye clinic 2.00pm

  5. What usually happens Your appointment in Eye Clinic Mr Jones Thursday 31 March 2.00pm

  6. What usually happens • LETTER Your appointment in Eye Clinic Mr Jones Thursday 31 March 2.00pm

  7. Wish list

  8. Wish list • Every hospital should have a dedicated Learning Disability Consultant Ophthalmologist • Every hospital should have dedicated Adult Learning Disability Eye Clinics

  9. Wish list • Annual discussion with patient/carer about vision/ eye health

  10. Wish list • Annual discussion with patient/carer about vision/ eye health • Adequate Flagging of LD on referral • Adequate Flagging of LD nationally

  11. Wish list • Annual discussion with patient/carer about vision/ eye health • Adequate Flagging of LD on referral • Adequate Flagging of LD nationally • Administration flexibility • Empowered to discuss with clinic staff about special arrangements • Choose and Book provision?

  12. Arranging the Appointment

  13. Assessment of needs • Awareness from all staff that a patient may have special needs • Consideration of what adjustments might be made • May include assessment of patient in their own environment

  14. Arranging the Appointment • Sister in charge of eye clinic/nominated lead for LD • Administration staff aware that changes can be made • Adjustments to consider • Early appointment • Particular time of day • Kept waiting as little as possible • Visit to the department prior to appointment • Split visits – VA , no drops ?drops at home,

  15. Wish list • Annual discussion with patient/carer about vision/ eye health • Adequate Flagging of LD on referral • Adequate Flagging of LD nationally • Administration flexibility • Empowered to discuss with clinic staff about special arrangements • Consistent sharing of information • Health care information brought to all appts

  16. Patient background Booking an appointment

  17. Visual function • How might they have their vision checked? • Matching shapes • Orthoptic vision check • Functional visual assessment Booking an appointment

  18. Visual function • Why is there concern about vision? • What has changed? • What does the patient now find difficult? Booking an appointment

  19. Wish list • Annual discussion with patient/carer about vision/ eye health • Adequate Flagging of LD on referral • Adequate Flagging of LD nationally • Administration flexibility • Empowered to discuss with clinic staff about special arrangements • Consistent sharing of information • Health care information brought to all appts • Information fed back to all carers • Orthoptic provision for vision assessment • Including functional visual assessment

  20. Examining only what is necessary • Using different equipment • Allowing extra time • Completing examination over several visits Examination

  21. Wish list • Annual discussion with patient/carer about vision/ eye health • Adequate Flagging of LD on referral • Adequate Flagging of LD nationally • Administration flexibility • Empowered to discuss with clinic staff about special arrangements • Consistent sharing of information • Health care information brought to all appts • Orthoptic provision for vision assessment • Including functional visual assessment • Additional appointments/time • To allow familiarisation, complete examination and maximise cooperation

  22. Copy of the GP letter to be sent to patient • Utilise optometrist feedback form • Provide information leaflet/easyread • consider another appointment to come back and ask more questions Booking an appointment Communicatingoutcome

  23. CVI (certificate of visual impairment) • ECLO (eye clinic liaison officer) • ROVI (rehabilitation officers for the visually impaired) • Low Vision services Booking an appointment Community and social care links

  24. Overview • What happens when you visit eye clinic • What adjustments can be made • What have been the barriers to adjustments • Bradford Learning Disability Eye Care Group

  25. Barriers to improving eye care • The “ I don’t have” problem • The “ too difficult, too many, too much” problem • The “ been there, done that” problem

  26. I don’t have time

  27. I don’t have the skills or training I don’t have time

  28. I don’t have the skills or training I don’t have time I don’t have the information I need

  29. I don’t have the skills or training I don’t have time Use orthoptist/ OO Seeability training Undergraduate training Transferable skills Extra visit – carer/pt Pre appt prep – LD team Shorter appts better than long ones I don’t have the information I need Find someone who does Wider use of pt “flags” Consistent use of health pass

  30. Barriers to improving eye care • The “ I don’t have” problem • The “ been there, done that” problem • The “ too difficult, too many, too much” problem

  31. Barriers to improving eye care • The “ I don’t have” problem • The “ been there, done that” problem • The “ too difficult, too many, too much” problem

  32. It’s too difficult to get it right for everyone There are too many services which need to change It takes too much time and my managers won’t allow it

  33. It’s too difficult to get it right for everyone There are too many services which need to change Get it right one person at a time It takes too much time and my managers won’t allow it

  34. The Bradford Experience • Community LD team

  35. Community LD team Annual vision assessment Hospital Eye Service Screen C&B referrals

  36. Community LD team Community optometrist Hospital Eye Service

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