Special Schools Eye Care Service

Hannah Bardell Excerpts

Wednesday 30th March 2022 Westminster Hall

[Hannah Bardell (in the Chair)]

I will shortly call Siobhain McDonagh to move the motion. I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates. I call Siobhain McDonagh.

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

I beg to move,

That this House has considered NHS Special Schools Eye Care Service.

I am delighted to lead a debate on a hugely beneficial development for the children who are often the most overlooked and yet most in need of targeted healthcare. The NHS special school eye care service has long been in the offing, originating from the stark statistic that children with learning disabilities are 28 times more likely to have a sight problem than other children. Four out of five children with a severe learning disability attend a special school, and decades-worth of studies and reports have all identified a higher level of sight problems in children attending day special schools.

I was first alerted to the issue when I visited my local special school, Perseid in Morden, in 2015. The school has an exceptional record of innovation, with a fantastic headteacher. I was delighted to learn that the Minister also knows the school from her recent visit to see the service in action. In 2013, Perseid began to work with the charity, SeeAbility, to offer sight tests and dispense glasses in the school environment.

A user-friendly report on what the children could see was part of the scheme for parents and teachers. Parents like Alyson told me on the visit that her daughter, Ellie, was getting used to eye care in the familiar environment of school and not having to take time out for hospital eye clinic appointments. That provided one less thing for her to worry about as a parent and had greatly reduced Ellie’s anxiety.

I was so impressed that seven years ago I initiated a debate and the Minister at the time, Alistair Burt, readily gave his time to visit the project and see the benefits for himself. The Department of Health and Social Care then granted innovation funding for the SeeAbility project to expand in other day special schools and report on its findings. As well as finding a huge level of vision problems and a need for glasses in particular, it found that children were not accessing their right to an NHS sight test in the community. Only one in 10 children has ever had an NHS sight test, and over four in 10 have no history of eye care.

NHS England has a responsibility to ensure equitable access to sight tests and primary eyecare, but there was a clear picture of unmet need. Moreover, it was clear that where services were targeted, it was only down to motivated eyecare professionals filling a gap, usually through secondary care. The project found that almost half of the children had accessed or were under the care of a hospital eye clinic, but often for routine eye care such as a sight test.

Fast forward to 2018 and, to its huge credit, NHS England accepted that it lacked a strategic approach to targeting much needed NHS sight tests and to improving primary eye care for people with learning disabilities. It began working collaboratively with eye care professional bodies and learning disability charities, first on a proposal for an NHS special school eye care service with the potential to reach 130,000 children, but also on longer-term plans to improve community optical practice access, too—pathways for the children not at special schools and adults with learning disabilities. They exist in only a few areas of the country.

The new NHS special school eye care service model does not exist anywhere else in the country, because it provides a one-stop shop for multidisciplinary eye care through full NHS sight testing, glasses dispensing, and specialist lenses and testing kits, alongside the report on a child’s vision and liaison with hospital eye clinics and teaching staff. It is important to put on the record that clinical backing for the service has come from all of the eyecare professional bodies and colleges, and from Public Health England.

In 2019, I was pleased to attend an event at Perseid, with NHS England in attendance, to celebrate its commitment, which was signed off at a senior level earlier that year. The service has therefore been promoted as a long-term proposition. Although the pandemic knocked everyone off course, I understand funding proper began in April 2021. We are in the early days as the service is in its proof of concept phase, although it is important to put on the record that the pilot is not about the need for a service. That is beyond doubt. It is a phase that will help evaluate an appropriate fee and glasses dispensing service, and therefore the best way to operationalise nationally. The service is now up and running in 97 special schools, 91 of which are day schools, with a total pupil population of more than 12,000. Clinicians from Bradford to London, Cheshire to Durham, are also under contract to deliver the service.

Some of the new NHS teams have only just begun their work, but the early picture is of much unmet need, with many children not having had a sight test before and with a high need for glasses. So far, so good, but some ambiguity has crept in recently, which is the reason for calling today’s debate. Back in 2019, wording in “The NHS Long Term Plan” specified that dental, hearing and sight checks would be delivered in residential special schools, but that was in addition to a wider pledge in the same plan to improve access to eye care for children with learning disabilities. However, it now appears that NHS England is promoting the need to establish the service in residential special schools, and recruitment has stopped for new day special schools.

Anxieties are building about whether the long-term intention is to limit the service to a few thousand children in residential special schools only, despite all the important work done so far, and about what that ambiguity means for day special schools where there is now a new NHS service—for schools such as Perseid and children such as Ellie. There is talk of evaluation, but does that raise the prospect of a halt in day special school services, which have only just got off the ground, and for how long will we have to wait for evaluation?

As I have outlined, there is no doubt about the need for reform. That much is sure. I am sure that it cannot be the intention to send children who are now being seen by a service, some of whom have already been discharged to it by hospital eye clinics, back into hospital eye clinics, particularly as there is a separate NHS programme that is actively trying to reduce out-patient eye clinic use. I remind the House that one study found that 54% of children with disabilities do not attend their eye clinic appointments because of the difficulties they have—something that a special school service does not experience, as children who miss a visiting clinic one day can be seen quickly at the next and their place taken by another child who has been waiting to be seen.

Tens of thousands more children with severe learning disabilities attend day special schools than attend residential schools, and the residential school population is decreasing, with no residential special schools at all in some areas. How will a focus on residential special schools address the bigger picture of a huge cohort of children, young people and adults with learning disabilities missing out on the NHS eye care they need? Paring back a service to a much smaller number of schools—if that is the plan—misses the bigger picture of unaddressed health inequalities and leaves unreformed the NHS sight testing scheme for patients with a severe learning disability seen in optical practices or day special schools.

It has already been wonderful to read of the Minister’s recognition of the potential for the service and the work of Perseid School. I know that she already recognises the folly of sending children with learning disabilities into out-patient eye clinics for sight tests, as they are some of the busiest places, with the longest waits for appointments. Only yesterday we saw the publication of the Government’s ambitions for the special educational needs system. If anything, this is a programme of work that delivers outcomes for SEND children on so many levels. Let us get the Department for Education on board, too. It already recognises the need for glasses in mainstream schools through its “Glasses in Classes” initiative.

I conclude with a quote from a new school, Kingsley special school, which has just started with the service. Reshma Hirani, assistant head, says:

“This service should be part of the NHS core offer so that it never stops. My pupils have struggled to access eye care in the community and now they have, quite rightly, something that is going to transform their lives. Well done NHS England for thinking about schools like Kingsley and our children. As a Qualified Teacher of Children and Young People with Vision Impairment I can now put in the support that children need, with the confidence that I have all the right information to hand. It really is the gift of sight.”

I finish by asking the Minister to reassure me today that the Department of Health and Social Care and NHS England will publicly reaffirm the commitment to the special school eye care service and push on with the job of establishing it. Ongoing evaluation can still happen to understand how to fully operationalise, while ensuring that children get the service. These children deserve an equal right to sight.