18 August 2003
Ms Claire Phillips
Project Manager
Children’s National Service Framework
8 August 2003
Dear Ms Phillips
Getting the Right Start: National Service Framework for Children
The College is the professional and examining body for optometrists and is a public benefit body established by Royal Charter. In general terms we welcome the document as a positive step forward in the health and wellbeing of children. However, optometrists are one of the range of professionals involved in children’s health care and it is therefore disappointing that the document makes no reference to children’s eye care. Good vision is important for both a child’s education and social development, as well as for occupational reasons later in life. If a child has visual problems, the earlier these are identified the sooner that appropriate arrangements for refractive, educational or other support can be made. Annex A of the document states that all policies and services for children should be centred on the needs of the young person. Clearly young people need good eyesight and yet approximately one in five children have visual problems and more than two thirds of these are not receiving professional care. In our view it would be appropriate for the NSF to address this unmet need for healthcare services.
We are pleased to note recognition in the document of the need for improved access to child health screening for disadvantaged groups and areas. We would therefore ask that the NSF make specific recommendations to improve the visual screening of school children from these groups and areas.
Comments on specific sections of the document are as follows: -
P9 Life Chances for Children
We would suggest that good vision is part of giving children good life chances. During the first 45 years of life, amblyopia is responsible for loss of vision in more people than all other ocular disease and trauma combined, and in those aged under 20 years the incidence of amblyopia is ten times more frequent than all other diseases and trauma. Some occupations are barred to people with amblyopia, so correcting this as early as possible will help to give equality of opportunity. Educationally, poor vision is one more hurdle for the child to overcome.
P10 Improving the Patient Experience
We fully support the five key dimensions for a good patient experience and would suggest that these are all exemplified by optometric practice. Optometrists are easily accessible at convenient community locations and fulfil all of the five key dimensions.
P12 Workforce
We welcome the recommendations of the national capacity requirements, with the proviso that further training should be made available so that no worker has to make decisions beyond his/her competence. In this context optometrists have the specialised training and skills to take on work currently undertaken by doctors and are the obvious professionals to be involved in the transfer of eye care from the secondary to the primary sector, as envisaged in Shifting the Balance of Power.
It is stated that IM&T will facilitate greater patient choice, giving patients better information about options for their care. It is vital that all healthcare professionals are integrated into the IM&T strategy. This should include optometrists, who do not currently have access to the NHSNet.
P16 Para.2.2.13
We agree entirely that partnership between agencies should be promoted. Optometrists sometimes feel that they are at the fringes of ‘joined-up’ working, with little or no properly established information flow between themselves, other primary care providers and secondary care. This does not enhance patient care and links to the points made in the previous paragraph.
P17 Para.2.9
It is disappointing that there is no mention of visual problems. As with other health problems, the earlier any potential difficulties are identified, the more potential exists for overcoming those difficulties. Various healthcare professionals are involved in assessing children’s vision. These may be the school nurse (if there is one), health visitor, orthoptist (either in a community or secondary setting), optometrist and ophthalmologist. These professionals do not always share information with each other in the most effective way, which may lead to parents being given conflicting information or advice. This links to the point made in the previous paragraph.
P22 Para.2.35
Many teachers do recommend that children who are not progressing as well as would be expected should be referred to an optometrist for an eye examination. Commonly, significant refractive error or binocular vision problems are identified and treated (by spectacles or eye exercises). With the severe reduction in the school vision screening programme advocated by the latest edition of Health for All Children, the proposals in this paragraph are to be welcomed.
P24 Para.3.1
Mention is made of children’s need for immunisation, primary care and dentistry yet there is no mention of visual health or eye care.
P24 Para.3.3
Patients from poor social classes also have poorer visual health than those from other social classes. It is therefore particularly important that these children are encouraged to make use of the free NHS sight test for children under 16. Children do not have to be able to read to have their eyes examined (indeed it may be poor sight that is preventing them from progressing at school and thus hampering their ability to learn to read).
P28 Disabled Children and Long Term Conditions
We are particularly disappointed at the lack of recognition that some disabled children, such as those with cerebral palsy or Downs’ Syndrome, have a higher incidence of visual problems, such as myopia, astigmatism, squints and amblyopia. These children are amongst the most vulnerable in our society and it is vital that they have the best possible chance in life. All children with any disability should have regular eye examinations by an optometrist or ophthalmologist and appropriate follow-up.
Adults with diabetes are advised by their General Practitioner or Diabetologist to have an annual dilated fundus examination to screen for diabetic retinopathy, yet children with diabetes may miss this part of their care
P32 The Mental Health and Psychological Wellbeing of Children and Young People
Children with antisocial behaviour, ADHD and autism disorders have a higher proportion of significant refractive errors, particularly hypermetropia (long sight). These conditions can be easily missed in basic vision screening and this again highlights the need for proper eye care to give these children maximum support.
In addition to the above comments, we would like to suggest the following additional topics for inclusion in the NSF:
Complaints Procedure
There is no mention of the parent’s right to complain or the procedure for dealing with complaints. Recent cases of child death or severe damage to a child whilst in hospital have resulted in the hospital having to pay compensation and being reprimanded about their complaints procedures. There is concern that the complaints procedures are under-funded and under-resourced in terms of properly informed and trained personnel to deal with complaints. Parents need to understand from the outset what occurred and be helped to deal with their loss. Denial by a Hospital Trust of the responsibility for negligence by a member or members of their staff compounds the distress and often a court case is the only mechanism to enable the parent to find out what actually happened.
Non-Attendance
In all parts of the Health Service there are a significant number of patients who fail to attend new or follow-up appointments. A number of these will be children. Consideration should be given to the action that service providers should take to enable children to have an opportunity of assessment and treatment.
Screening
The NSF should perhaps encompass recommendations for children’s screening, i.e. the conditions, the timing of screening and ways of achieving universal coverage
I hope the foregoing is helpful but please do not hesitate to contact me if you have any queries or require any further information.
Yours sincerely
HELEN STANFORTH
Head of Professional Services