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V isual I mpairment N etwork for C hildren and Y oung P eople. Dr Katherine Spowart Lead Clinician. Managed Clinical Network. What is an MCN and what does it do? Why do we need one? What VINCYP will aim to achieve and how?. What is an MCN?.

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V isual i mpairment n etwork for c hildren and y oung p eople

Visual ImpairmentNetwork forChildren andYoungPeople

Dr Katherine Spowart

Lead Clinician


Managed clinical network
Managed Clinical Network

  • What is an MCN and what does it do?

  • Why do we need one?

  • What VINCYP will aim to achieve and how?


What is an mcn
What is an MCN?

  • Concept from Acute Health Services Review 1997

  • Health driven and funded

  • National ( can be regional or local)

  • Set up to ‘get round’ Health Board and professional boundaries

  • Brings together interested professionals in specialist fields

  • Aim to improve quality of patient care

  • Use resources equitably and optimally

  • Doesn’t deliver services but provides structure, information and standards .


Mcn s in scotland
MCN’s in Scotland

  • 28 National MCNs

  • 14 Paediatric MCNs

    • Children with cancer

    • Paediatric epilepsy

    • Paediatric allergy

    • Children with exceptional health needs

    • Paediatric endocrinology

    • Paediatric Immunology and HIV

    • Children with cystic fibrosis

    • Congenital diaphragmatic hernia

    • Inherited metabolic disease

    • Paediatric rheumatology

    • Genital anomaly

    • Paediatric renal urology network

    • Gender identity

    • VINCYP


Principles of an mcn
Principles of an MCN

  • Produce benefits to patients via service improvement

  • Establish evidence base for care and develop standards from this

  • Develop protocols and share good practice through training and research

  • Audit impact of protocols, standards etc

  • Report annually on progress


Vi mcn why
VI MCN – WHY ?

  • Concern over inequity of service

  • Risks to current service

  • Workforce shortages

  • Training gaps

  • Need to improve outcomes

  • Pressure on all health, local authority and third sector services to improve and link better but with reduced workforce and funding.


Workforce
Workforce

  • Ophthalmology

    - 15 out of 88 posts in Scotland vacant

  • Paediatrics

    - 77% of community paediatricians >50yrs

  • Orthoptics

    - improved recently but still vacancies

  • VI Teachers

    - 40% not qualified ( statutory requirement )

  • Habilitation Specialists

    - some LAs have no service or provided by rehab workers with no child training


Vincyp progress
VINCYP - Progress

  • 2011 /12 - VI paediatricians approached various groups

  • September 2012 – first steering group

  • January 2013 - formal proposal submitted

  • April 2013 – recommended by HB Chief Executives Group for approval by Scottish Government

  • May 2013 – approved by Scottish Government to commence April 2014

  • 30th April 2014 - Conference


Steering group
Steering Group

SPROG - Paediatric Ophthalmologists

BIOS Scotland - Orthoptists

Optometry Scotland

VIPS - Paediatricians

SCOVI (LAs and 3rd sector)

SAVIE ( VI teachers organisation )

Education Scotland

RNIB

Hospital Optometrists, Fife Blind Society , University of Edinburgh


AIMS

To improve services and outcomes by :

  • Ensuring early identification of children

  • Ensuring appropriate assessment through production of clinical guidelines

  • Developing care pathways for use nationally

  • Improving early notification to other agencies

  • Improving data collection for audit and service planning

  • Providing information and training to allow improvement in services

  • Empowering children and parents to manage care better


Role

Leadership

Standards

Training

Information


Initial priorities
Initial Priorities

Refine definition

Ensure wide engagement and involvement

Identify what services are available and method of access

Develop system of robust data collection

Identify training needs


Definition
Definition

Best corrected VA , both eyes open 0.500 or worse

Visual field loss, both eyes open, which significantly affects function

Any eye movement disorder which significantly affects function

Any form of cognitive visual dysfunction due to disorders of the brain which can be demonstrated to significantly affect function

N18 print or larger required for comfort reading


Progress
Progress

Discussions with all professional groups and several parents groups

Commenced service mapping

Draft Standards and QIs

Agreed data system and developing fields

Information gathering on training needs

Input to Sensory Impairment Strategy

Agreement to host medical information sections of current VIScotland website


Mapping
MAPPING

  • Paediatricians Survey

Responses received from all Health Boards holding responsibility

Provided information on 29 local authority areas

missing information:

- South Ayrshire

- Orkney

- Shetland

Reflective of paediatricians knowledge of services


Local VI Services

Yes: 17 out of 29 local authority areas

No: East Ayrshire, North Ayrshire, Fife, Aberdeenshire, Aberdeen City, Moray, North Lanarkshire, South Lanarkshire

Don’t Know: Borders, Clackmannanshire, Stirling, Falkirk


Yes: 25 out of 29 local authority areas

No: East Ayrshire, North Ayrshire, Western Isles

Don’t know: Moray


Yes: 22 out of 29 local authority areas, variable content

No: Borders, South Lanarkshire

Don’t know: Fife, Clackmannanshire, Falkirk, Stirling, Moray


Yes: 19 out of 29 local authority areas

No: Borders, Falkirk, Aberdeen City, North Lanarkshire

Don’t know: Fife, Clackmannanshire, Stirling, Aberdeenshire, Moray, Western Isles


19 of 32 las had a database
19 of 32 LAs had a Database

Database held by?

education/ VI teachers

health/ specialist services

local authority/ social services

voluntary agencies

Is it reliable ?

Yes – 6

No -13

databases within same local authority do not correlate


Is there a functional vision clinic? 23 LAs

  • 22 had QTVI and Paediatrician

  • 19 also had orthoptist

    Services / professions available

    29 LAs had QTVI

    2 HB no paediatric ophthalmologist

    Most areas had some way of sourcing LVAs

    Mobility – 26 had some access but variable and fewer for independent living

    Early Intervention – 2 HBs only

    Emotional support – rare and variable


Standards
Standards

What is it reasonable to expect all services to provide ?

Help clinicians and managers know what they should be aiming for as a minimum

Help parents / YP to know what it is reasonable to expect


Proposed service standards
Proposed Service Standards

In each eye dept there is an ophthalmologist with an identified role for children/YP with VI

In each HB there is a paediatrician with identified role for children/YP with VI

Children are seen in a dedicated eye clinic

Children have a dedicated eye clinic waiting area


There is a clear pathway to access specialist assessments and investigations

Written information is given to parents/young people at the time of identification of VI

Letters should generally be copied to parents/young people

There is a process in place to measure patient satisfaction


Each LA has a service for children with VI to be supported by a QTVI

Each LA has a service for children with VI to be supported by a habilitation specialist

There is a service within each HB which provides early intervention and support on identification of VI


Quality indicators
Quality Indicators by a QTVI

Measures of the standard of services provided

Based on service standards and pathways

Allow comparison against a minimum standard, against other areas and measure progress over time


Proposed quality indicators
Proposed Quality Indicators by a QTVI

% of children seen in a dedicated childrens eye clinic

% of children seen at least once by a QTVI

% children seen at least once by a habilitation specialist

% of under 2’s and those with acute visual loss referred to early intervention service within 1 week

% of children referred to neurodisability team

% of children having a VI interagency plan /discussion within 8 months of identification


Pathways
PATHWAYS by a QTVI


VISION 2020 UK – Pathway for Children and Young People (0 to 25 years) with Vision Impairment, and their Families

Identification of potential vision impairment

Engagement with parent carer (and child / y p where possible)

Assessment of vision impairment and/or related conditions

Certification and Registration (where appropriate)

Statutory assessment (education, health and social care)

Service Provision – Health, Education, Social Care, Voluntary Sector

Regular review and updating of provision

Transition into Adult Pathway

Early intervention and key working

emotional support


Baseline vincyp pathway
Baseline VINCYP Pathway ? to 25 years) with Vision Impairment, and their Families

Optometrist

GP

Paediatric team

HOSPITAL EYE TEAM

Investigations

Early intervention service

Multiagency referral system

Specialist paediatric service

VI education service

Habilitation service

Emotional/ practical support

Multiagency review


DATA to 25 years) with Vision Impairment, and their Families

  • Clinical audit system

  • Supported national NHS Scotland system

  • Basic details fed in from SCI store

  • Limited flexibility

  • All children with VI to be entered

  • Initially 1 identified clinician per eye dept and 1 paediatrician per HB


CAS to 25 years) with Vision Impairment, and their Families

  • Referral source

  • Category of visual diagnosis

  • Specific visual diagnosis

  • Co-morbidities

  • Investigations

  • Vision testing results

  • Interventions and Referrals

  • Opt out system

  • Access to info by other agencies on opt in basis


Patient involvement
Patient Involvement to 25 years) with Vision Impairment, and their Families

  • Consultation – Glasgow, Fife, Inverness

  • Creation of patient involvement subgroup


Education and training
Education and Training to 25 years) with Vision Impairment, and their Families

Training needs identified via :

  • Mapping exercise

  • Professional groups

  • Parents feedback

  • Launch workshop


Outline plan
Outline Plan to 25 years) with Vision Impairment, and their Families

Stage 1

  • Map current services

    - what is provided in all areas of health , single service and jointly?

    - what other services provide?

    - what links are there between them?

  • Data

    - what to collect and how?

  • Audit

    - identify quality indicators to measure improvement against


Stage 2 to 25 years) with Vision Impairment, and their Families

  • Produce basic pathways of care from existing standards

  • Organise information and consultation event / events

    Stage 3

  • Develop standards , protocols etc

  • Develop information for parents/professionals

  • Provide training and education

  • Expand/ refine pathways


Next steps
Next Steps to 25 years) with Vision Impairment, and their Families

Identify all current services provided across HBs and LAs ( mapping group)

Finalise fields for datacollection then pilot in one HB ( data group)

Communication and Website development

Promote basic pathway from early identification of VI , regardless of diagnosis, to supportive services locally


Moving forward
Moving Forward to 25 years) with Vision Impairment, and their Families

  • Specific care pathways and guidelines

  • Bench- marking and measuring quality improvement

  • Training

  • Identify research required


Vincyp thoughts
VINCYP – Thoughts? to 25 years) with Vision Impairment, and their Families

  • Standards?

  • Quality Indicators?

  • Pathways?

  • Data?

  • Communication, engagement and consultation ?

  • Training ?

  • Priorities / Plan ?


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