Miss Rachel Pilling Consultant Ophthalmologist Bradford Teaching Hospitals NHS Trust

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

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

10. What usually happens at the eye clinic 2.00pm

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

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

18. Wish list

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

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

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

22. 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?

23. Arranging the Appointment

24. 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

25. 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,

26. 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

27. Patient background Booking an appointment

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

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

30. 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

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

32. 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

33. 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

34. 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

35. 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

36. 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

37. I don’t have time

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

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

40. 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

41. 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

45. 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

46. 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

47. 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

48. The Bradford Experience • Community LD team

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

50. Community LD team Community optometrist Hospital Eye Service