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Comment by Paula posted on
Hi I understand the responsibility sits with LA commissioning as part of the 0-19 healthy child programme, however as evidence suggests and the NSC recommend that this should be a national screening programme I do not understand why this is not part of the national screening responsibilities of NHS England. From the information provided above you state the majority of vision impairments are detected by parents and Teachers, therefore my question would be why you would then recommend a universal screening programme. What is the proportion of children picked up that would have been missed? would awareness raising with parents to take children to opticians, and a referral programme into targeted careening for those parents/teachers concerned be just as affective?
with increasing pressure on Local Authorities and public health funding reducing it is difficult to protect such programmes when its a recommendation and not mandated function. I therefore would suggest it would also be helpful for commissioners to provide tools and advice for a targeted programme where a universal programme can't be offered.Link to this comment
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Comment by Anne Mackie posted on
<a href="https://www.england.nhs.uk/commissioning/pub-hlth-res/">The public health functions agreement (Section 7A)</a> is an annual agreement between the Secretary of State for Health and NHS England that covers the screening programmes commissioned nationally. The decision about what is covered lies with the Department of Health.
The explanation about why a screening programme is recommended and what numbers are picked up can be found in the full <a href="https://legacyscreening.phe.org.uk/vision-child">UK National Screening Committee review</a>. Public Health England has committed to developing guidance to help local authorities provide a whole population screening programme. The UK NSC does not produce evidence or guidelines for high risk or targeted testing programmes. That would be a task for the National Institute for Health and Care Excellence (NICE) or other bodies that develop guidelines such as the royal colleges.
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Comment by Anna Horwood posted on
Amblyopia is not a "mild problem". An undetected and untreated amblyopia can lead to permanent loss of vision in one eye. If an untreated adult then lost their better eye, or more importantly an elderly person develops macular degeneration 70 years later, they would be registerable as blind, with subsequent many years of dependance on state services.
If the NHS is to make best use of its resources, it is vital that all children are screened, rather than a selected few going for a full eye test - the upshot of relying on parents taking their children to the optician is that is that the children who should be detected may well be missed (because they are more liklet to come from families unlikley to take them), while excessive NHS funding would go for full testing of many thousands of children when a quick screening is more appropriate.
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Comment by Anne Mackie posted on
Dear Anna, thank you for getting in touch. You make an important point. The purpose of using terms like mild is to get over to the reader that these are problems which the parent or child might miss themselves. You are right that if a person has poor or no sight in one eye then the loss of sight in the other is very serious. The <a href="http://legacy.screening.nhs.uk/vision-child">UK NSC review</a> (link) addresses that and estimates that the chances of that happening are just over 1% (one in every 100 children with amblyopia will go blind in their lifetime). Someone with amblyopia is 2 to 3 times more likely to become blind during their lifetime than someone without amblyopia. The aim of the vision screening guidelines development advisory group is to give advice and tools to enable the complex screening, referral and treatment pathways to be commissioned and delivered to consistent and excellent standards. Thank you for your comment.
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Comment by Tim Davies posted on
You have to ask why, if the evidence for such a programme is so strong, NHS England does not commission this service consistently across the country in the same way that it commissions other screening programmes.
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Comment by Anne Mackie posted on
Thanks Tim. Screening for vision and hearing problems in 4 to 5 years olds is part of the local authority commissioned healthy child programme and has been since 2013. The strength of evidence is not and should not be a key driver of who commissions it.
Hope that's helpful, Anne.
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