[To receive a short report on the Diabetic Eye Screening Procurement Programme in Birmingham, Solihull and the Black Country].
[Karen Davis, Interim Head of Public Health Commissioning NHS England and NHS Improvement will be in attendance].
The Interim Head of Public Health Commissioning NHS England and NHS Improvement presented a report on the Diabetic Eye Screening Programme in Birmingham, Solihull and the Black Country. The current programme contract expired on the 30 June 2021. They therefore needed to undertake a procurement exercise for the programme. It was possible that the way the services were currently provided could change. This was because the new provider could provide services in a different way or because the existing provider had a reduced amount of venues to use because of the Covid-19 restrictions. There were two types of venues where diabetic eye screening could be provided. One was GP practices or Health Centres and the other one was High Street opticians. Mobile vehicles were an alternative option for diabetic eye screening providers to use as long as they delivered the services in line with the national specification.
The Interim Head of Public Health Commissioning NHS England and NHS Improvement stated that as part of the patient engagement exercise they would use existing users’ feedback as part of the annual contract review from the existing provider. There had been other procurements locally within the Midlands and so they could use this feedback as well but recognising that the population would not be reflective of the Birmingham and Black Country area. They would be conducting some work with Diabetes UK, who had completed similar exercises to support patient engagement. In addition, following discussions with the Chair and Vice-Chair of the Panel earlier in the day, she had agreed to form a set of questions which they would like responses to from users of the service. They were particularly keen to receive responses from hard to reach groups.
The Chair asked if he could have some more information on the patient engagement exercise. The Interim Head of Public Health Commissioning NHS England and Improvement responded that they had some existing information from users of the service from the current provider. They had previously completed a procurement in the area of South Staffordshire and so they had all of this information on file. They were meeting Diabetes UK on the forthcoming Friday to discuss how they could help access the views of patients and users. They recognised that people from hard to reach and deprived communities did not traditionally come forward to give their views. They were happy to develop a set of questions which could illicit responses from patients in terms of priorities and issues they may have when accessing the service. Members of the Panel could then distribute these questions to their contacts. They were also open to suggestions on how they could obtain the views of patients in deprived Inner-City settings.
The Chair asked if there were any plans to introduce new digital solutions to improve the eye screening programme. The Interim Head of Public Health Commissioning NHS England and NHS Improvement responded that there were no plans currently that would impact on the current procurement. The Diabetic Eye Screening Programme was a nationally specified service in terms of how it was carried out and conducted. She was aware that there were some experimental assessments on the use of artificial intelligence (AI) to read some of the screens. When the results of these studies came to fruition, if it was decided to go ahead nationally, then it would be added into future service provision. She did however think this initiative was some years off being rolled out on a national scale.
The Chair asked the Consultant and Clinical Director for Diabetes at the Royal Wolverhampton NHS Trust what improvements he would like to see to the Diabetes Eye Screening Programme in an ideal world. He responded that clearly diabetes was the main problem and ultimately why a person attended eye screening appointments. The general health of a person would have an impact on eye health and it was important that this was recognised from the beginning of the process. Diabetes should be the central tenet of the process. An integrated approach would also ensure that patients also received all the information in relation to their health, which allowed them to make informed decisions regarding matters such as eye screening attendance. If they knew their eye health was connected to the rest of their health, it would hopefully engage the patient to make the right decisions and engage with the eye screening programme.
The Consultant and Clinical Director for Diabetes at the Royal Wolverhampton NHS Trust stated that collecting feedback continuously from patient groups, particularly patients that found it difficult to access services or had other challenges, he believed to be a good approach. He spoke in favour of NHS England and NHS Improvement and the current screening programme working with Diabetes UK. He thought if this could be done on a more regular basis there would be benefits, particularly in allowing the screening programme to be more flexible and meet service users’ needs.
The Vice-Chair asked the Consultant and Clinical Director for Diabetes at the Royal Wolverhampton NHS Trust, if he could explain how enhanced information sharing would help the eye screening programme. He responded that the Eye Screening Programme had started to share information with Primary Care. Having information fed back both ways, from Primary Care into the eye screening programme and from the eye screening programme into Primary Care was very valuable. This was because it meant the right patients were being called up for screening and the Primary Care Providers were receiving important information about their patients. He believed eye screening should be promoted by GPs and care providers amongst their patients across the Midlands. Enhanced data would allow for risk-based screening allowing resources to be better allocated with a targeted approach.
The Vice Chair asked the Consultant and Clinical Director for Diabetes at the Royal Wolverhampton NHS Trust how Covid-19 had impacted on the Eye Screening Programme to date. He responded that Covid-19 had been a huge challenge to all of healthcare. Eye screening had been significantly impacted particularly in the first wave of the Covid-19 pandemic. Once the first lockdown restrictions had been eased, the eye screening programme restarted and had been catching up with appointments since that time. Some patients had been reluctant to attend eye screening appointments due to the fear of becoming infected with Covid-19. They had tried to reassure patients about the infection prevention measures which had been put in place. The effects of people not attending appointments would become known in the next year to two years. Covid-19 had led to some positive steps, there had been more innovation, particularly in the areas of targeting people in different ways and making the service more impactful.
A Panel Member commented that she was pleased to be involved in the consultation for the Eye Screening Programme and that it was being discussed by the Health Scrutiny Panel. She highlighted the importance of being in contact with specific ethnic groups who may be more predisposed to diabetes.
A Panel Member remarked that he had a diabetes eye screening test in October of last year. He had been told that his next test would be in two years because his results did not cause concern rather than the usual year. He asked if this was a dangerous new course. The Consultant and Clinical Director for Diabetes at the Royal Wolverhampton NHS Trust responded that it was a good question to ask. Extensive research had shown that people’s eyes did not change every year and it may take several years for changes to occur. When changes did occur the rate of progression would vary depending on the person and the risk factors that the person carried, such as blood pressure, cholesterol levels and the control of their diabetes. Consequently, based on research it had been found that people who had been stable for a few years, the risk of progression in a year was very low and therefore interval screening was the best approach. If, however the person felt their eyes worsening they could have their eyes assessed earlier.
The Interim Head of Public Health Commissioning NHS England and NHS Improvement commented that they did not make the decisions about how regular someone had eye screening locally. It was a nationally prescribed service and so they had to follow the parameters set nationally.
A Member of the Panel asked what date the deadline was for feedback on the patient experience of the current Eye Screening Programme. The Interim Head of Public Health Commissioning NHS England and NHS Improvement responded that the procurement process had been paused whilst they completed due diligence and so ideally, they wanted responses back over the next 10-12 weeks. A temporary extension to the existing contract would allow a meaningful consultation.
A Panel Member commented that the elderly community could be sometimes hard to reach, particularly those classified as BAME. His suggestion was producing literature in Punjabi and Urdu which could be distributed to places of worship.
The Chair, on behalf of the Panel, thanked the Interim Head of Public Health Commissioning NHS England and NHS Improvement, and the Consultant and Clinical Director for Diabetes at the Royal Wolverhampton NHS Trust for their contributions to the meeting.
Resolved: That NHS England and NHS Improvement write to the Scrutiny Officer with a list of questions they would like help with answering, regarding patient engagement for the Diabetes Eye Screening Programme. The Scrutiny Officer can then arrange for onward circulation to Panel Members and also consult with our own Public Health Team.