Sight Tests in Special Schools

Tuesday 3rd November 2015 Westminster Hall

11:00

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I beg to move,

That this House has considered the provision of sight tests in special schools.

Every child has the right to a free NHS sight test. It is vital that all children have their sight assessed regularly and early on, as undetected problems can lead to deterioration or even permanent loss of vision. For a child with learning disabilities, it is an even more pressing issue. A relatively small number of students attend special schools, but they are the most in need when it comes to eye care. Those children also have a right to free eye tests, but often experience serious obstacles to getting the eye care they need. In fact, children with learning disabilities are 28 times more likely to have serious sight problems, and about half the children in special schools need glasses, but about 40% of children with learning disabilities have no history of sight tests. Many have to go to hospitals for specialist eye examinations, meaning more medical appointments and more time out of school. Those appointments are also more expensive than routine eye checks and, for those not under the care of a hospital, attending a high street optician can bring a whole new set of challenges.

In the very worst cases, children with learning difficulties who cannot access the eye care they need can eventually suffer from ultimately preventable sight loss. They are unable to make the most of their vision and are losing out, when a good pair of glasses could radically improve the quality of their lives. Therefore, I call on the Government, the NHS and the Department of Health to deliver eye examinations and dispense glasses to children in their special schools.

I draw the attention of hon. Members to the excellent work of the charity SeeAbility, which has worked extensively on this matter. The charity exists to support people with sight loss and multiple disabilities. Established in 1799 as the Royal School for the Blind, it now provides a range of services including residential care and supported living, and speech, language and rehabilitation services. Since 2005, it has run projects to address the health inequalities faced by adults and children with learning disabilities. Indeed, its “Children in Focus” campaign has attracted thousands of petition signatories and support from well-respected, professional bodies including the College of Optometrists, the Faculty of Public Health, and the National Association for Special Educational Needs. SeeAbility’s work is vital for so many reasons—most significantly because those children, who are most likely to suffer from the most serious sight problems, face the greatest challenge in accessing eye care.

Although the recommended guidelines for all children to be vision-screened at the school entry age of four to five need to be followed, the issue is significantly more pressing for children with special needs. When a child has a severe or profound disability, or multiple disabilities, they might not realise that they have a sight problem. They might not be able to tell a carer or a parent about it, or their sight problems might be overshadowed by other, more obvious needs. All of that means that parents, teachers, GPs and others might not realise that there is a problem.

SeeAbility has piloted an excellent project to offer sight tests for children in six special schools in London. It has used its own charitable funds and specially trained optometrists and orthoptists to visit those schools, including Perseid school in my constituency of Mitcham and Morden, to test sight and dispense glasses. Children, parents and teachers are all seeing the benefit of that work. Perseid school is a community special educational needs school that is rated as “outstanding” by Ofsted. It offers an exceptional, supportive atmosphere for children aged three to 19 who have severe and complex learning difficulties, including learners with an additional diagnosis of autism, or physical or sensory disabilities.

SeeAbility went to Perseid school with its proposal in May 2013, after consulting the eye clinic at Epsom and St Helier NHS Trust. One of the aims was to pilot the provision of eye examinations in the school for those who the clinic felt it was not necessary to see in hospital. It was after I visited the project at Perseid lower school in September 2015 that I felt compelled to table this debate. The visit was eye-opening in so many ways. I discovered just how much eye health and vision information a skilled optometrist can get from a child who may not be able to respond verbally, or to read. It was a real education to see the techniques that Marek, the SeeAbility optometrist I met, used to judge whether a child needs a pair of glasses or whether their vision is in more serious need of treatment. He was absolutely fantastic with the children.

I also met a super little girl, named Ellie, and her mum, Alyson. In so many ways Ellie is just like any other nine-year-old girl. She is active and sociable, loves music and chocolate, and her favourite colour is pink. Ellie was one of the first appointments of the day. She cannot speak and relies on her eyes to communicate by using eye gaze technology. Because of her condition, she has been attending hospital eye clinic appointments to ensure her sight is regularly checked. Her vision is her primary means of communication, but it is vulnerable to deterioration, making check-ups absolutely crucial.

Ellie gets very stressed having to go to the hospital for her sight checks. Taking time out of the school routine, and having the pressure to arrange it alongside her many other medical appointments is a logistical nightmare. She also uses a wheelchair and is now tube-fed, which add to the practical barriers she faces to access the eye care she needs. I heard from Ellie’s mum, Alyson, who said that SeeAbility’s work at the school has removed all that stress, and she has the comfort of knowing that Ellie is getting good eye care in school. Ellie can get her eyes tested, and glasses dispensed and fitted at school by SeeAbility, in a much more familiar, comfortable and convenient environment.

After I met Ellie, a little boy who is autistic came in for his eye test. He is nine years old and suffered sight loss in one eye in early childhood. Despite very little co-operation from the boy—who spent most of the time walking around the room—Marek, the specialist optometrist, was able to assess that his one good eye was focusing well and that he did not need glasses.

It is clear that it would be very difficult indeed for a standard community optometrist to assess the sight of children with special needs, such as the children I saw. Community optometrists rarely see a child with profound disabilities and may not command the necessary experience and skills, or have access to the specialist equipment that is so important. Furthermore, a child may become distressed in an unfamiliar dark room with lots of lights and menacing-looking equipment. In stark contrast, SeeAbility’s regular visits to Perseid school provide the children with the safe environment they need to have their eye sight assessed. The team can introduce themselves and become familiar with children in the weeks preceding an appointment and during regular visits. Furthermore, a child can have parts of their sight test on different days, if necessary, in the event that they need more time to become familiar with the process. It is even possible, if a child is very anxious, to complete tests in the classroom or in a sensory room, where they often feel more comfortable.

Testing vision in the schools is not only more familiar and reassuring to the children. It also reveals so much to the teaching staff and parents about how the children see, which can really maximise the potential of children with special educational needs. The project is now well embedded in Perseid school and the visits fit in well with the school’s day. The school’s fabulous headteacher, Tina Harvey, said:

“It has been fantastic to work with SeeAbility and we fully support this initiative. Our pupils can’t necessarily tell us what they can or can’t see in the classroom and now we have that information. And parents aren’t having to worry about how to get their child to yet another medical appointment outside of school.”

As the Minister’s portfolio includes eye care, I sincerely hope that he accepts SeeAbility’s recent invitation to visit one of the special schools that it is working in and to discuss the detail of its proposals, as I have done. I assure him that such a visit would be a greatly inspiring experience.

The work at Perseid school strengthens the case for national reform of eye care for children with learning disabilities. Having provided 600 eye tests, SeeAbility’s pilot, with the help of Cardiff University’s school of optometry and vision sciences, provides the most comprehensive study of eyesight in children at special schools in England. The sight of vulnerable children is being failed again and again. The early vision screening programme should be available to all young children when they first start school, but present provision is subject to a postcode lottery.

Furthermore, suggesting the use of hospital examinations as an alternative for children with learning difficulties is not good enough. Hospital appointments mean more medical appointments, more potentially distressing locations and more expense for the NHS. For instance, the average reference cost of a paediatric ophthalmic appointment is £115, and SeeAbility has found that 75% of children who have been discharged from a hospital eye clinic have had no follow-up sight tests in the community, leaving those children lost to the system. The compromise is unacceptable. If children go without sight tests, the tragedy is that they can suffer unnecessary sight loss and live their lives with poor vision just for want of a decent pair of glasses.

Hon. Members may be surprised that the appropriate checks are not already happening in schools. A few health bodies fund local NHS services similar to the one provided by SeeAbility, but the vast majority do not, which means that appropriate care for such children is limited. I am sure the Minister will agree that it is not acceptable for those children, who are so much more likely to have serious sight problems, to be reaching their teenage years having never had a sight test or the opportunity to see clearly. We need a more preventive and beneficial method, and we need to commission a new national programme of eye examinations and direct dispensing of glasses for children and young people in special schools.

The Minister may highlight that it is for NHS England to decide its priorities on eye care commissioning. To their credit, NHS England officials have been engaged in SeeAbility’s work. However, the Department of Health plays a crucial role in shaping legislation and establishing a payment regime for sight tests. The Department does the latter under the general ophthalmic services—GOS—contract, but the associated contract fee rates for sight testing are compounding the inequalities in eye care that I have described, which does not sit well with the fact that addressing the health inequalities of people with learning disabilities is a shared priority for both the Government and NHS England. Indeed, it sits well within the Health Secretary’s legal remit.

In August 2015, SeeAbility was awarded a GOS contract to run NHS sight tests in the special schools in which it works, but the contract provides only a £21.31 payment per sight test. That is the amount paid for a routine test in a high street optician, but SeeAbility estimates the actual cost of its tests to be some £85, which means that the charity is having to fundraise to keep this important project going. The GOS contract provides only a quarter of the actual cost of delivering eye examinations for children with learning disabilities.

As I have described, the sight tests provided by SeeAbility and others are specially adapted to the needs of children with learning disabilities and require specialist expertise and equipment. Furthermore, skilled orthoptists who can assess unusual and uncommon abnormalities of eye movement, and specialist dispensing opticians who are experienced in fitting glasses for children with special facial characteristics, are often needed. Can we truly accept such an inadequate fee that represents only a quarter of the overall cost of providing such adapted tests? The overall costs include the cost of what is often a longer, specially adapted test and any repeat visits to a child in a special school.

The current status quo ill-advisedly applies a one-size-fits-all approach to a complex issue. The needs of children with learning disabilities are varied and often unique, and such children need eye care provision that reflects that. We all know there are funding pressures on our health and social care systems, but the eyesight of children with learning difficulties is not a sacrifice that should be made.

In a few instances, there is already some recognition that those adjusted and specialist sight tests need proper funding. That extra, local support sometimes comes from local commissioners paying optometrists an additional £60 towards supporting someone with a learning disability to get a sight test. Although that is a good step forward, it occurs in only a handful of areas. Furthermore, the Department of Health has set enhanced fee rates for disabled adults to receive a sight test at home if they cannot leave the house unaccompanied. Clearly, some officials already recognise that specially adapted tests cost more. I sincerely hope that the Minister will acknowledge that his Department has set an NHS payment of £21.31 that does not cover the cost of those tests.

I hope the Minister will agree to open a consultation, as is happening in Wales, on how to cover the shortfall between GOS contract payments and the cost of providing such a specialist service. The provision of a reliable long-term alternative is essential. The relatively small number of children in special schools should mean that a fully funded NHS programme to address their needs is wholly realistic. Indeed, the quality of vision, and quality of life, of those 100,000 children should not be left to a postcode lottery in our 209 clinical commissioning groups.

Children with learning disabilities need a one-stop shop for the input of optometrists, orthoptists and dispensing opticians, as needed, with glasses provided on site, breakages repaired quickly and good links to hospital eye clinics if necessary. In turn, a fully comprehensive and tailored system would help to reduce NHS costs from unnecessary hospital visits. The programme should also be wholeheartedly supported by the Department for Education, which purports to help children with special needs to achieve their full potential. Let us be clear that the target will not be met if children are not provided with the best possible eye care.

SeeAbility and I eagerly await the Minister’s indication of support for a nationally funded programme of sight tests in special schools and a commitment to meet us to discuss those plans further. I urge all hon. Members to consider signing early-day motion 629, which supports the provision of such sight tests. The eyesight of children with special needs has been let down for too long. We look forward to this vital issue being treated with the seriousness it truly deserves.

11:17

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) not only for securing this debate but for the usual thorough and highly competent way in which she has presented her case, which was full of facts, information and understanding, and informed in particular by her visits. It will be slightly easier to respond to one or two of her requests than to others, but I will come to that in my remarks.

Before anything else, I acknowledge what everyone recognises, which is that, although all our senses are precious, sight is probably the one that we value most. Sight is the key way in which children learn about the world. Ultimately, as the hon. Lady said, undetected sight problems can lead to a reduced quality of life and unnecessary damage to the eyes, which we all wish to prevent. The risk is that the vision of children with learning disabilities can be overlooked and assumed to be just part of their overall condition and behaviour. There is no doubt about the background to the campaign she mentioned.

We all share the desire that all children should be able to access sight tests, especially that group of children for whom we know that visual impairment is much more possible. There are more than 100,000 pupils in special schools in England. New arrangements have been introduced for children and young people with special educational needs or disabilities to develop more integrated approaches to meeting need. There is rather more variability than the hon. Lady suggests, and that variability is necessary to cope with the different conditions we are talking about.

A new framework was introduced in September 2014 that will see commissioners and local authorities working together to agree arrangements for meeting the needs of children with special educational needs. That includes publishing a local offer of services and ensuring that health and education professionals undertake a co-ordinated assessment of a child or young person’s needs that will inform an education, health and care plan. The plan has to consider the aims and aspirations of the young person and focus on the outcomes that will have the biggest impact. It has to include the needs of a child or young person with a visual impairment. That approach has tremendous potential for stimulating much more joined-up approaches in local care settings; meeting children’s needs; and helping health commissioners and local authorities to understand jointly how population needs can be supported by more flexible delivery methods.

The hon. Lady spoke about a postcode lottery, which is the term commonly used when anything that is provided in one area is not provided in another. I am slightly hesitant about using that term, because it suggests that nothing can be done and implies that it is an accident of fate, when in fact it is not. The difference in provision in different areas often depends on the ability of the leadership and management in an area to recognise a problem and the local determination to make a change. We get change around the country when somebody takes a lead and does things differently, often because they have been stimulated by changes at a national level and have taken the opportunity to do something differently. I recognise that, at its worst, the term “postcode lottery” implies that people get less of a service in one place than another. However, we lever up standards by pointing to what is done best. If we did not allow for some variation, we would not be able to learn. I take the hon. Lady’s point, but SeeAbility’s work in London demonstrates what can be done and shows others the way forward.

[David Mowat (Warrington South) (Con)]

The Minister is right that the term “postcode lottery” can be pejorative. We need centres of excellence that can be spread out more widely. Warrington hospital is well-funded in that regard, and it considers itself a centre of excellence, at least in Cheshire. For that spreading out to happen more quickly, we need a national programme or some kind of national impetus, which is where the Minister might come in.

[Alistair Burt]

I am delighted to recognise the centre of excellence about which my hon. Friend speaks so powerfully. I will talk about the national side when I get to the conclusion of my remarks. I will illustrate how we are moving forward and what we are doing, which will address some of the concerns raised by the hon. Member for Mitcham and Morden and my hon. Friend.

Let me turn to the issue of children with learning disabilities and problems with vision. It is widely recognised that children with learning disabilities have a greater risk of a wide range of eye problems, including refractive errors that require correction with glasses, squints, cataracts and glaucoma. All children under 16 and those between 16 and 18 in full-time education, including children with learning disabilities, are entitled to free NHS-funded sight tests. Sight tests are an extremely valuable heath check of the eye that can pick up a need for glasses and early signs of eye conditions, many of which can be treated if they are found early enough.

As the hon. Lady said, NHS England is responsible for commissioning the NHS sight testing service. I will come on to the work that NHS England is doing with SeeAbility in a moment. The hon. Lady said that she is concerned that an optical practice is not necessarily the best environment for undertaking a sight test on a child with learning disabilities. I agree, which is why we want greater use to be made of different ways of providing sight tests for children with learning disabilities. The NHS can contract with providers for mobile, funded sight tests for children, which can take place at special schools. We appreciate that that provides a familiar environment for the test, as the hon. Lady said, which best serves the child. Any provider can apply for a contract with NHS England to provide those services, provided they meet the conditions for holding a general ophthalmic services contract. I will come on to the point about payments in a moment.

However, I am aware that, even with current provision, the concern remains that children with learning disabilities may find it more difficult than other children to access services. SeeAbility has been doing valuable work in that area to develop evidence and promote awareness of the specific needs of children with learning disabilities. I am pleased to accept the invitation to meet SeeAbility and visit one of the schools in which such work has been going on. It will not be my first visit. I visited it when it was the Royal School for the Blind when I was Minister with responsibility for disabled people 20 years ago, and it will be nice to renew the acquaintance.

I am also aware of SeeAbility’s “Children in Focus” campaign, which seeks a nationally commissioned service to provide sight tests and glasses for that important group of people in special schools. In addition, I understand that SeeAbility has recently been awarded a contract by NHS England to provide eye care services at a number of special schools in London.

Reducing health inequalities is a key part of the five-year forward view and NHS England’s 2015-16 business plan. In that context, I know that NHS England recognises a growing body of evidence that suggests that access to sight tests and glasses is an issue for some children and that regular eye tests and the wearing of appropriate glasses make a vital contribution to those children’s health, educational progress and general quality of life.

As the hon. Lady said, NHS England has been in dialogue with SeeAbility about sight test provision for those pupils, and it has met Dr David Geddes, the head of primary care commissioning. I welcome the engagement between the NHS and patient groups. As I said, SeeAbility has recently been awarded a contract by NHS England to provide eye care services at a number of special schools in London. NHS England is keen to see how that work is going, so that it can consider what can be built on it and see whether the model of care that is right for that cohort of parents can be rolled out elsewhere. Some good early work has been done, but it is early days. It is appropriate that NHS England carries out some longer term work with SeeAbility to assess how that contract is working and see what can be done. Although we would all like to see rapid progress, it is early in the contractual relationship, and NHS England needs to develop the evidence base further.

The hon. Lady rightly spoke about fees. SeeAbility has pointed to a structure that is considerably higher than the current fee of £21.31 per test. We all recognise that the current financial stresses in the NHS mean that a robust case has to be built before further funding is committed. NHS England is happy to work with SeeAbility to understand better what financial model best contributes to those patients’ needs. Its view is that SeeAbility has done some very good early work, but it is only two months into the contractual relationship. We therefore need to take a little longer to find out what is actually happening and what more can be done. NHS England expects to have concluded that work by next spring, and it will be in a position to consider the need for changing the current arrangements and possible service developments.

I hope that gives the hon. Lady a sense of where this is going. First, we all recognise the scale of the problem. Secondly, because there is now more variability in the NHS’s ability to meet this need, some things are being tried out to see how they work—particularly through the contract with SeeAbility. I am keen to see how it works in practice, which is why I am happy to accept the invitation to see some of the work it is doing in schools. I will work with NHS England on how it is assessing the work and on the next steps.

In closing, I reiterate that I recognise the importance of properly considering the needs of children with learning disabilities in service planning. If children are to be given the best chance in life, it is important that any vision problems that could affect or impair their development are identified and addressed. I am pleased that NHS England is closely looking at this issue and is already in discussion with SeeAbility. I look forward to hearing about the outcomes of NHS England’s work in this area and its proposed way forward.

The early day motion that the hon. Lady mentioned states that, as a start, it

“encourages the Government and the NHS to work together to create a comprehensive national programme and a properly-funded system to make sight tests available in all special schools in England”.

In the spirit of encouraging the Government and NHS England to work together to see what can be done, the hon. Lady can be sure that that is indeed happening.

I look forward to meeting SeeAbility and NHS England to pursue this matter further. I am sure the House will have a further opportunity to discuss it in the future. Once again, I thank the hon. Lady for securing the debate and conducting it in her normal thorough and effective manner.

Question put and agreed to.

11:29

Sitting suspended.