Ophthalmic nurses play a key role in delivering care to people with sight conditions. But more often than not, they aren't consulted when national agenda-setting conversations take place. Editor, Hannah Adams spoke about the reasons why they are excluded at board level at last week's RCN Ophthalmic Nursing Conference 2016.
Back in July 2015, my predecessor and the previous editor of NB Online, Funmi Majekodumni, wrote a blog about the launch of what she called a “super group”. No, I don’t mean ABBA, but the England Vision Strategy.
It was announced that the England Vision Strategy, the regional division of the UK Vision Strategy, would bring together the leading eye health and sight loss organisations to work together to deliver a six-part plan for England. That all sounds wonderful, doesn’t it? Except what wasn’t so wonderful was that the executive board of the super group, lacked representation from ophthalmic nurses and other key professions including rehab workers, orthoptists and ECLOs.
Since then, ophthalmic nurse representation has been included on the board in the form of Juliat Burns, department manager at Warrington Hospital, but unfortunately not for the other professions.
When I read the blog, I had hoped this omission was an innocent oversight, an embarrassing one granted, but still just an error. The lack of ophthalmic nurse representation did ruffle some feathers, but I thought to myself, why does it need to take feathers to be ruffled before its natural to seek a nurse’s opinion when setting national agendas that’ll affect the whole population?
Last month, RNIB published a report called State of the Nation that said sight loss is costing the UK economy £28bn – this is an increase of over six billion pounds since it was last reported on in 2008.
Back in March, the President of the Royal College of Ophthalmologists, Carrie MacEwen, explained that hospital attendances had increased year on year in the UK. And of the 100m plus outpatient appointments made in England during 2013-14, nearly 10 per cent were for eye care.
MacEwen attributed the rise in eye clinic appointments to patients with chronic eye diseases, such as macular degeneration and glaucoma and the abilities we now have, thanks to the incredible advancements made in modern medicine. But as the baby boomer generation continues to live longer, pressure on eye clinics will only further increase as there’ll be more eyes to be treated.
Published within the same RNIB report, it was recorded more than two million people in the UK are living with sight loss that has a significant impact on their daily lives – increasing to 2.7 million by 2030. This includes people who are waiting for cataract operations and people living with partial sight or blindness. What is shocking is that nearly half of all cases of sight loss in the UK could have been prevented had they seen the right people at the right time.
To be able to meet this sizeable issue head on, surely the sector needs to club together and gather the most experienced and knowledgeable professionals both in primary and secondary settings to formulate a solution going forward? A super group that brings together not only GPs and optometrists, but also ophthalmic nurses, ECLOs, rehab workers, orthoptists and all the other professionals who care for people with sight loss? Surely, each profession will be able to bring a valuable, unique addition to the debate.
For patients with a sight condition, one of the key professionals they will encounter during their eye health journey will be the ophthalmic nurse in their local hospital’s eye clinic.
Ophthalmic nurses are in a unique position: they have the specialist knowledge to not only promote and maintain ocular health, but also to act as consultants by providing ophthalmic nursing expertise to other health care professionals. As well as this, nurses are able to highlight the reality of delivering services that CCGs commission. Mary Shaw, Senior Lecturer at the University of Manchester School of Nursing, Midwifery and Social Work and Forum Chair, told me that a draft NICE report suggested that patients weren’t to be given ocular injections until they had gone blind in one eye. She remarked, “you wouldn’t expect a diabetic to lose a foot to gangrene before they were treated for their diabetes”. The draft was quickly changed thanks to Mary’s work through the RCN Ophthalmic nurse network.
And importantly, to bring this back to the patient, ophthalmic nurses are the people who develop close and caring relationships and who promote independence and self-care of the person, not their condition.
Well, there’s some fantastic work that Janet Marsden, Professor of Ophthalmology and Emergency Care at Manchester Metropolitan University and Mary Shaw are doing. There’s ophthalmic nurse representation on the Ophthalmic Public Health Committee, the Clinical Council for Eye Health Commissioning, Wales Vision Strategy and now the England Vision Strategy Executive Group – it is worth mentioning, that this representation only came after an RCN ophthalmic nurse representative requested she be added to the board, not as a rite of passage.
However, there are also many boards where ophthalmic nurses aren’t represented: there isn’t nurse representation on regional boards equivalent to England Vision Strategy in Northern Ireland and Scotland. In addition, I spoke to Mercy Jeyasingham, the CEO of Vision 2020 UK, the umbrella organisation which leads collaboration and co-operation between organisations with an interest in eye health and sight loss, and there isn’t nurse representation on their boards, however, she did explain there was nurse input with the work they do with NICE.
After the Francis report in 2013, that highlighted the failings of practice at Mid Staffordshire Foundation Trust, Francis concluded, ‘There should be at least one nurse on the executive boards of all healthcare organisations, including commissioners.’ It also said in the table of recommendations, ‘All healthcare providers and commissioning organisations should be required to have at least one executive director who is a registered nurse. And should be encouraged to consider recruiting nurses as non-executive directors.’
CCG’s are obliged to have a nurse representative on their committee. This can either be an executive role or a non-executive role or layperson, it should be said the executive role is a much more working role as they are paid positions and they are expected to sit on or chair other committees including quality, performance and auditing. I tried to find out how many nurse representatives there were on CCGs in England – both ophthalmic and general practice - but I couldn’t find anyone who could tell me, neither NHS England nor the Royal College of Nurses. Even the author of the report, The role of the nurse on the CCG Governing body couldn't tell me this figure but asked if I ever found out, he’d love to know too.
What I did do though is speak to a non-executive nurse (not ophthalmic) on a CCG in south London. She explained that to be accepted into a CCG, you need to have board experience which makes it impossible for anyone who hasn’t got this previous experience already to join. She explained she went into the role wanting to be able to represent her profession and bring the voice of nursing practice to the table. However, as the lay member, she said she feels tokenistic and during her interview, the panel seemed more interested to find out if she could get along with GPs than what her credentials were.
To conclude, if I play devil’s advocate, I could say that ophthalmic nurses don’t need to be part of these big conversations because patients don’t see ophthalmic nurses until they come into the eye clinic. That the primary setting does much of the initial service delivery and only those who need specialist care will ever meet with an ophthalmic nurse.
However, I don’t believe this to be the case. I believe ophthalmic nurses should be involved in conversations about planning primary and secondary care on a national level, about what happens on the high street and in the GP practice as well as within the eye clinic. Why? Ultimately, ophthalmic nurses are best placed to understand the patient’s needs and their journey. Nurses care for patient’s overall well-being and not just their eyes. As Mary poignantly said to me, ophthalmic nurses have to remind others that, “we’re dealing with people, not robots.” Nurses also have experience of working in multidisciplinary teams, interacting with many number of health professionals often outside of the eye unit including rehab workers and care home workers who may not know anything about eye care.
But the final reason I believe ophthalmic nurses should be involved in national agenda-setting conversations about eye care and to quote from The nature, scope and value of ophthalmic nursing’, ‘Ophthalmic nurses have an important role as teachers and advisors: in educating service users and carers; in providing health education in society; and by facilitating the development of other multi-disciplinary team members’ knowledge and understanding of ocular health.’
There is work to be done to raise the profile of ophthalmic nurses, and unless it comes from the people within the sector, I can’t see much changing any time soon.
I can’t claim this to be an exhausted list of reasons why ophthalmic nurses are left out of national agenda-setting conversations, but it’s good a start. The recommendations are also not definitive. I, for one, would like to see ophthalmic nursing given the representation the profession deserves on all the relevant eye health and sight loss boards, committees and groups. If you have any further thoughts on the matter, I’d love to hear from you.
This blog was updated on Tuesday 4 October.Tags Best of NB Online