Review into funding for Special Schools Eye Care Service underway

A review into the future of the NHS England-funded Special Schools Eye Care Service (SSECS) is underway.

The South West Commissioning Support Unit has been commissioned to carry out an evaluation of the proof of concept (POC) service, which currently provides eye care to children in day and residential special schools in England.

NHS England informed providers in August that ‘the POC will cease on 31 March 2023, as will all existing contracts in place at that date.’

In Parliament on 18 October, Will Quince, Minister of State in the Department of Health and Social Care, stated that “there are 83 special schools with approximately 9324 children who have participated in the NHS England’s Special Schools Eye Care Service proof of concept programme.

“NHS England is currently evaluating the programme to inform the future of any special schools’ sight testing service model and will set out the further information in due course.”
 
Providers will be given notice that their contracts are ending in December, three months ahead of the scheduled end date.

The news has caused concern amongst those who deliver the service, with Lisa Donaldson, head of eye care and vision at SeeAbility, explaining: “Schools and providers have invested significant time and resource in establishing services on the understanding that they would be long-term.

“The data coming out of the service mirrors research findings that many special school children were missing out on eye care before the service – at least 40%, yet 35–40% need glasses and at least half have a problem with their eyes. Hospitals have been discharging children to the care of the service, again on the understanding that it was a long-term model.

“In Bradford, for example, an audit of discharges out of the HES paediatric ophthalmology clinic, presented at the British Congress of Optometry and Vision Science, shows 18% of the caseload of children have been discharged into the service. This is of course extremely concerning with regards to duty of care for these children.”

She added: “We are also concerned that the history of why this programme started and the evidence base for it may not be represented in the evaluation.”

SeeAbility currently holds a contract to provide services for 3000 children across 25 schools.

Since its commencement, around 45 amended GOS additional service contracts to provide the service have been issued across England. The service is currently funded by NHS England.

SeeAbility has released a series of blog posts, written by parents, headteachers and patients, that highlight the benefits of the service.

Optometrist Angela Henderson, who has been providing a SSECS in Newcastle since February this year, said: “We’ve invested quite a lot of time and money in getting the contract up and running and building relationships in the school. To think that that’s going to stop doesn’t feel right. We’ve started seeing children, and clinically where do they go if we drop out? It doesn’t look good for us professionally, and it doesn’t look very good for the NHS either.”

We’ve started seeing children, and clinically where do they go if we drop out?

She added: “We’ve got children who we were going to see again in six or 12 months. What happens to those children? They haven’t been accessing eye care services in the community previously, so they are unlikely to start doing that.”

Henderson pointed out that the presence of teaching assistants and support workers, in a familiar setting, allows for a level of teamwork that it would be impossible to achieve with a special needs child in a High Street practice.

“Having seen the kids, it isn’t appropriate for them to be seen under a GOS sight test in the practice setting,” she said. “It’s a very specialist service. It takes longer to do it justice and to get the best results, and it’s unreasonable to expect practitioners in everyday practice to do it. It’s unfair on the children if they’re unable to access services going forward.”

Stephanie Cairns has been delivering the service across two special schools, also in the north east, since March this year. She said: “We knew it was proof of concept, but it feels like it took so long to get it up and running, that we’re in the evaluation before the eye care teams have fully got their heads around how it is all going to work.”

Cairns is also worried about letting families down. “The school knew we were coming and sent out consent forms in October last year, and my uptake of parents was brilliant,” she said. “By the time I was there, in March, we had 80% consent. Because of that, I now feel obliged to try and see them all. We offered them something.”

Cairns added: “It’s such a different way of working, and it’s brilliant. The kids are lovely, and the school are really appreciative. We’ve had some really good benefits from it. We’ve got kids who refuse to go to the optometrist. They were literally screaming the place down; the parents couldn’t get anywhere near them. We’ve got situations where the whole appointment system at the hospital was too traumatic for the parents, let alone the children, to even get there and back.

“These children are high myopes and have high astigmatism, but it was really difficult to get them seen. We've managed to help with all of that, up to a point.”

Leaflets provided by NHS England to schools when the full service was rolled out in 2021 stated that “NHS England, who oversee the NHS, have committed to transforming eye care and vision for children and young people in special schools in England by delivering a free, eye examination on the school premises which will include the supply and fitting of two pairs of glasses for every child who needs them.”

The service provision began after work undertaken over several years highlighted a strong need for an eye care service in special schools.

44% of children attending special schools have no history of any previous eye care, and a 2017 study, published in the British Journal of Ophthalmology, found that 33% of children in special schools who were not already known to hospital services had a visual impairment.

In 2016, a paper entitled Framework for provision of eye care in special schools in England was developed by SeeAbility, alongside a number of sector bodies.

The paper stated that “the Clinical Council for Eye Health Commissioning has given its endorsement for a comprehensive and targeted programme of eye care for children and young people in special schools in England. For matters of equality this paper strongly recommends a nationally funded programme to achieve universal coverage across England.”

In 2018, a working group, set up by NHS England and featuring a number of professional bodies, produced a model service specification based upon the Framework model for pupils in all special schools, upon which the SSECS was based. Rollout of the SSECS began in April 2021.

The review now taking place is set to ‘determine future commissioning and funding model for the delivery of eyesight checks in residential special schools’ and ‘develop and evaluate options for delivery of sight tests to children in day special schools, subject to available resources,’ according to communication sent to providers in the summer, which has been seen by OT.

Providers have expressed their concerns that a continued service will focus only on residential special schools, which only a small percentage of children with special educational needs attend.

The Royal College of Ophthalmologists, which contributed to the 2016 paper, has also expressed its concern, stating that: “Following an evaluation of the current service, proposals have been put forward to focus on residential schools, which account for a very small percentage of all special schools in the UK, with no guarantee of funding for day schools. 

“The current SSECS is ensuring that children are being optimally managed in the community with the specialist care they need and which parents find much easier to access, alleviating anxiety during ongoing care of their children.

“A pause in the roll-out, and/or a scaled back roll-out offered only to residential schools, brings a risk of children being lost between services. There is a very real risk that children in a SSECS day facility will not have any ongoing care after March 2023.”

Henderson added: “The communication hasn’t been great. We need, clinically, to sort out something for these children. There’s a huge body of evidence now that children in day special schools do need some kind of eye care provision.”

Around 4000 children attend residential special schools in the UK, with 140,000 attending day special schools.

The Royal College of Ophthalmologists goes on to state that while it “supports the evaluation of a new service to identify areas for improvement, it is important to highlight the broader context in which the SSECS was created and the benefits it provides to the most vulnerable eye patients. In determining the future direction of the service, consideration must be given to the views of schools, parents and providers.”

The review has so far included a survey that schools have been asked to send out to parents, carers and students.
 
The AOP is researching alternative sources of funding that can be made to NHS England and the Department of Health and Social Care, should the need for alternative funding arise.

The AOP has also written to the review board in order to emphasise the importance of the SSECS.

The review is expected to be completed in the coming weeks, with January 2023 set as the point at which NHS England will “commence procurement and contract preparation as necessary to implement new model.”

NHS England has not responded to OT’s request for comment.