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WQ.488/2019
WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY R.J. WARD OF ST. HELIER
ANSWER TO BE TABLED ON TUESDAY 12th NOVEMBER 2019
Question
How many patients have accessed a retinal screening appointment since a Government statement was released on 25th February 2019 to invite patients with diabetes to attend such screenings; and what progress, if any, has been made in increasing access to this service since that time?
Answer
In February 2019, a process of risk stratification was completed on all patients listed on the Diabetes Centre register. 778 patients considered the highest risk of Retinopathy were invited for screening. Of this cohort, 440 patients attended and their images were graded by a locum retinal consultant. These images have subsequently been sent to a specialist team at Gloucester NHS Foundation Trust for a second grading.
Screening was paused as of the 9 July 2019 to permit continued development of the service with anticipated recommencement of the service towards the end of November 2019. Unfortunately, due to a number of significant challenges around IT, long-term sickness and delivery on contracts, we cannot realistically expect the retinal screening programme to be operational until January 2020.
A project board has been established to oversee the continued development of retinal screening. This board meets monthly, with quarterly conference calls with specialists in Gloucester NHS.
• A retinal screening programme manager and quality assurance advisor to Public Health England with over 15 years' experience in the field had been seconded from the NHS for 12 months to support development of the local service. This individual is currently unavailable for the next 2 months, so a person within HCS has been sourced to give some support to the programme during this interim period.
• The contract with Gloucester NHS Foundation Trust to provide assessment of retinal images captured in Jersey is near completion. This will ensure Jersey benefits from the quality assurance measures and experience of a much larger programme. The data protection agreement with Gloucester will be finalised once the contract is signed.
• A Jersey service specification is being developed in consultation with stakeholder groups to tailor the service to the needs of patients and healthcare professionals. This will incorporate the learning and developments in this field which have occurred over the last 10 years so that the local service makes use of the latest technology to promote access, uptake, patient satisfaction and efficiency.
• The entire retinal screening pathway will be supported by a specialised software package in use by numerous programmes (both in the UK and other countries). This will enable accurate data collection so that Jersey outcomes and performance can be benchmarked.
To keep the momentum of the programme going, the decision has been made to take a two-phased approach:
Phase One:
- Deliver a retinal screening programme with 4 screening sessions per week to be held within the Ophthalmology Department.
- Grading/clinical outcome to be undertaken by Gloucester NHS, with clinical leadership and support for the development and sign off of retinal screening clinical pathways.
Phase Two:
- To establish local clinical leadership for the programme, preferably within Ophthalmology.
- Explore the option of community setting for screening clinics (one establishment sourced in St Brelade).
- Explore the option of OCT surveillance clinics which will reduce the number of consultant follow- up patients within Ophthalmology (equivalent of 1 clinic per week).
- Introduce structured failsafe systems which will avoid duplication of Ophthalmology referrals.
To conclude, high-risk patients have been recalled for screening with a robust grading quality assurance process and assessment of harm being undertaken by a specialist at Gloucester NHS Foundation Trust. The new redesigned service will mitigate previous risks and provide assurance to diabetes suffers that they are being provided with the best possible care in Jersey.