Disagree.
The College of Optometrists support a model that would allow more collaboration, integration and partnerships across traditional care boundaries, with organisations, groups and individuals coming together to collectively plan and deliver services and interventions in the best interest of patients.
However, while we agree that the new system should better meet the needs of local populations, it is not clear how the proposed new approach will allow a more consistent and joined-up approach to the planning, provision and commissioning of health and care services. The health and social care system in Northern Ireland already operates in an integrated system under statute. Therefore, we recommend encouraging a culture change by adding a duty to co-operate that would better allow trust and collaboration between stakeholders rather than another wholesale structural reorganisation, which may distract commissioners, managers and health professionals from achieving their core mission.
Having a legal duty to co-operate would ensure that all stakeholders engage constructively, actively and on an ongoing basis to maximise the effectiveness of healthcare plans. They should make every effort to secure the necessary cooperation and demonstrate how they have complied with this duty. As part of their consideration, stakeholders will need to bear in mind that the cooperation should produce effective and deliverable policies on strategic cross boundary matters.
Joint training and development sessions for all health and social care professionals would also help reinforce a culture of integration and collaboration. Despite the obvious synergies between the various professionals, current training systems offer few, if any, opportunities to interact with other related professions. Given the emphasis on multidisciplinary working and co-operation, this system can hinder joint working between health and social care staff. Joint training and education could enable the different professional groups to understand one another’s roles, responsibilities and ways of working, and encourage mutual respect.
Furthermore, we are concerned by the suggested closure of the HSC Board (HSCB), which currently has contracts with over 270 ophthalmic practices across the region to provide General Ophthalmic Services (GOS) for Health Service patients. These are services not provided by health and social care trusts. The HSCB plans and develops a range of special enhanced services that help manage increasing demands for eye care. Its closure and the delegation of commissioning functions at local level may lead to a more fragmented approach (i.e. a postcode lottery).
Optometrists are already working collaboratively in primary care, community, and hospital settings to provide care, helping commissioners maximise the scope for general ophthalmic services and enhanced eye care services for patients, and deliver eye healthcare capacity in accessible locations, rather than relying on overstretched hospital eye services. The new model should build on their competences and experience to improve the collaboration between primary care optometry and secondary care ophthalmology and ensure eye care services are designed around the real needs of patients, which will include growing eye healthcare capacity for an ageing population.
The General Ophthalmic Services (GOS) and special enhanced services are delivered by ophthalmic practices across Northern Ireland, which provides a standardised and equitable eye healthcare offer across the country. Our priority is to ensure that patients continue to receive a high quality and clinically robust service every time they visit an ophthalmic practice and we would welcome the reassurance that the commissioning of primary eye care services would remain national in the ICS model. This will ensure that equal access to, and benefit from, a standardised eye healthcare offer continues across the population.
Moving to local commissioning could create unwarranted variation in access to core eye care services and could reduce provision in some areas, damaging patient care. It is not clear how the delegation of functions to the level of ICS would be supported in practice. We are also concerned that a localised GOS budget could be spent before the end of a budget year, which could lead to a period of time each year where free eye tests are unavailable for some of the population most at risk of sight loss or vision problems.
Finally, the GOS system is driven by patients being able to access the eye care provider of their choice, in whichever convenient location they choose, guaranteeing access for all eligible patients and a standardised service, irrespective of where people live. These patients’ rights to choose should be protected.
We are also concerned by the suggested closure of programmes of work underway, in addition to the closure of the HSCB, as mentioned in paragraph 1.13. A Northern Ireland Eyecare Network (NIEN) was formally constituted in January 2021. It is not clear what would be the impact of the reform on this new Network. The Network is the successor to the Developing Eyecare Partnerships (DEP) Project, which was implemented in 2012 to improve how eye care services were commissioned and delivered in Northern Ireland. The NIEN is hosted by the Health and Social Care Board and aims at reducing “preventable sight loss by ensuring regionally integrated planning, commissioning, delivery, performance management, and funding of eye care in Northern Ireland.” It is our understanding that NIEN, and its precursor DEP, have already benefitted from a culture of integration and collaboration, where all stakeholders work effectively together to delivering agreed, shared, and prioritised outcomes. Any proposed new model of care should maintain these achievements and learn from them. We would also welcome the reassurance that this programme will continue at a national level, as the NIEN is well placed to continue to plan, co-ordinate, and deliver high quality, accessible eye care which aligns with the Programme for Government (PfG) outcomes, including reducing social isolation, inequalities, and improving life chances.