Category: Public Health

Next week is the second ever #GreenerAHP Week, an opportunity to learn and share what it means to be a more environmentally sustainable AHP, and to raise awareness of the links between health and climate change.

The week kicks off on Earth Day and consists of several free online presentations from health and social care, primary and acute trusts, Greener NHS and different Allied Health Professions. It is also an opportunity to highlight sustainable activities happening in your own trust and engage staff.

The link between climate change and health is well established yet the care we are delivering often contributes to the problem. Here is a chance to learn more about how climate change is affecting health, how health systems are affecting climate and what we can do about it.

The NHS was the first healthcare system in the world to set a target to be Carbon Net Zero and we can all play our part in achieving this. As health professionals and care organisations we have a duty to ensure that the care we are giving is not playing a part in damaging our patient’s health. AHPs are well placed to play a role in getting to Net Zero while ensuring high quality care for all.

The actions we take to improve health and reduce ill-health and inequalities also benefit our planet. As part of the larger AHP care group, made up of 14 distinct professions, orthoptists have the power to implement changes that can make a real difference. Amending the way we work and our actions at home, even in small ways, will help build towards the target of being Net Zero. Find out more about change you can make here.

How can you get involved?

As the third largest clinical workforce in the NHS, AHPs play an important role in delivering a Net Zero Carbon NHS.

The full programme of activity for the week is available here. Sign up to attend the various sessions throughout the week and gain inspiration from fellow AHPs.

To get involved in your team you may want to:

• Take the 30-minute e-learning for health session on sustainable healthcare and have a quiz on it.
• Make a sustainable goal part of everyone’s PDR/CPD and add it to your meeting agendas as a standing item
• Submit a case study to add to the Greener NHS case studies
• Sign up to a Centre for Sustainable Healthcare network
• Arrange a team walk or cycle to work day in the week
• Plant a tree on site from NHS Forests
• Nominate a project for the CAHPO Green Awards

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If you are interested in finding out more:

The full programme of events is available here

Sign up to a Centre for Sustainable Healthcare network

Find out more about the contribution orthoptists can make here.

Public Health England (PHE) have published the first ever Vision Atlas, looking at the geographical variation in risk factors and healthcare for eye health across England.

The new vision atlas represents the first PHE output solely focused on eye health.

The atlas brings together 32 indicators across the whole vision patient pathway, from describing populations at risk of poor eye health, through screening to healthcare services, and health outcomes. The atlas provides new analyses of hospital eye services including outpatient appointments, intravitreal injections, cataract and retinal detachment surgery.

As with all Atlases of Variation as well as providing up to date analysis PHE has worked closely with expert clinicians to provide the context, reasons for variations, options for actions and resources for healthcare providers and commissioners.

This Atlas presents data and advice to support CCGs, ICS, commissioner and providers in tackling the key issues in eye care to support the National Eye Care Restoration and Transformation Programme to rapidly recover eye services and to drive forward long-term developments and solutions to improve services and cater for future demand.

This Atlas brings together key information for local areas on actions they can take to tackle the key risk factors for eye disease – preterm birth, smoking, obesity, physical activity, and diabetes.

The Atlas also presents provisional data for 2020 and 2021 that show significant reductions in outpatient attendances and procedures for eye health during the pandemic.

Link to vision atlas:

Atlas of variation in risk factors and healthcare for vision in England

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If you are interested in finding out more:

Find out about the public health role of orthoptists here.

More information about the advanced and extended roles taken on by orthoptists is available on our CAG pages.

Read the full Atlas of Variation in vision here.

Key themes

In the past decade, the introduction of new interventions for previously untreatable eye chronic conditions has transformed service provision and clinical practice, generating multiple episodes of care. These have all contributed to the rising rates of service activity and their variations for example for outpatient attendances and intravitreal injection procedures. Ophthalmology is now the largest outpatient speciality in England. The atlas shows there were 9 million outpatient attendances for vision in 2019/20.

The atlas covers the years immediately prior to the coronavirus (COVID-19) pandemic, providing a baseline and resource for monitoring the impact of the actions to be taken subsequently for the recovery and transformation of eye health services, their organisation and delivery; and the implementation of integrated care systems.

The older you are, the greater the risk of sight loss. Of the 9 million all vision outpatient attendances in England 56% were for people aged 65 years and older. Men and women in the 85 to 89 year old age group have the highest age-specific population rates for outpatient attendances. Overall, nearly 1 in 4 individual people in the 85 to 89 age group had a vision outpatient appointment in 2019/20.

Highlights from indicators

indicators with high numbers:

• In 2019/20 there were 9 million outpatient attendances for vision in England
• 4 million individual patients of all ages attended appointments during 2019/20
• In 2019/20 there were 2.2 million outpatient first attendances for vision in England
• In 2019/20 there were over 380,000 cataract surgeries in those aged 65 year and over in England

indicators with increasing rates:

• All vision outpatient attendances have seen an increase of 37.6% in attendances from 2009/10 to 2019/20
• The England rate of all intravitreal injection therapy procedures in people aged 60 years and over has more than double in the past 7 years (over 600,000 in 2019/20)
• The England rate of admission to hospital for all cataract surgery in people aged 65 years and over has seen an increase of 16% from 2014/15 to 2019/20.
• The England rate of all rhegmatogenous retinal detachment surgery in people aged 18 years and over has seen an increase of 36% from 2014/15 to 2019/20.

indicators with high CCG variation:

• Variation in rate of all intravitreal injection therapy procedures in people aged 60 years and over (2019/20) was 188.6-fold difference between CCGs. Although it should be noted differences in organisational practice are likely to be the major, systematic factor contributing to the variation.
• Variation in rate of first intravitreal injection therapy procedures in people aged 60 years and over (2019/20) was 29.5-fold difference between CCGs
• Variation in rate of registered blind or partially sighted people aged 75 years and over (2019/20) was 26.2 fold difference between UTLAs

Covid period decreases:

• In 2020 there were 6.5 million all vision outpatient attendances, a 29% decrease from 2019
• In 2020 there were 1.4 million all vision outpatient first attendances, a 38% decrease from 2019
• There were 550,000 intravitreal injections in 2020, a 9% decrease on 2019. However, in the same time period the number of first intravitreal injections decreased by 19% (a decrease of 7,200)
• Cataract surgery has decreased by over 40% in the year 2020 compared to the previous year. In the 2020 there were 227,000 admissions for cataract surgery compared to 392,000 in 2019
• Rhegmatogenous retinal detachment surgery decreased in 2020 by 11% when compared to the previous year with 1,200 fewer surgeries being carried out

Age:

• Of the 9 million vision outpatient attendances in 2019/20, 5 million of them were seen in the over 65s which is 56% of all vision outpatient attendances.
• In 2019/20, 3.4 million people attended a vision outpatient appointment. The over 65 age group made up 51% of all vision outpatients, this age group makes up 17% of the population.

Indicator summaries

All vision outpatient attendances

• All vision outpatient attendances have seen an increase of 37.6% in attendances from 2009/10 to 2019/20.
• In 2019/20 there were 9 million outpatient attendances for vision in England, 15,960 per 100,000 population.
• CCG values ranged from 9,821 to 24,131 per 100,000 population, a 2.5-fold difference between CCGs.
• The median rate increased significantly from 2013/14 to 2019/20.
• In 2020 there were 6.5 million all vision outpatient attendances, a 29% decrease from 2019.

All vision outpatient attendances (persons based)

• Many patients require regular ongoing follow-up appointments and treatments to prevent further sight loss.
• Approximately 3.4 million individual patients of all ages attended appointments during 2019/20, 5,969 per 100,000 population.
• CCG values ranged from 4,404 to 8,248 per 100,000 population, which is a 1.9-fold difference between CCGs.
• The median rate increased significantly from 2013/14 to 2019/20. Both the 95th to 5th percentile gap and the 75th to 25th percentile gap widened significantly.

All vision outpatient first attendances

• First attendance rates are a proxy indicator of new demand for services in any one year.
• In 2019/20 there were 2.2 million outpatient first attendances for vision in England, 3,803 per 100,000 population.
• CCG values ranged from 2,266 to 8,027 per 100,000 population, which is a 3.5-fold difference between CCGs.
• In 2020 there were 1.4 million all vision outpatient first attendances, a 38% decrease from 2019.

All intravitreal injection therapy procedures in people aged 60 years and over

• Patients classified as having medium and low risk clinical conditions had their management delayed or rescheduled for at least 3 to 6 months later. This is reflected in the significant reduction in activity for first and all episodes during the first wave of the pandemic (April to June 2020).
• Approximately 608,000 intravitreal injection procedures were performed for persons aged 60 years and over in 2019/20, 4,411 per 100,000 population.
• CCG values ranged from 49 to 9,277 per 100,000 population, which is a 188.6-fold difference between CCGs. Although it should be noted differences in organisational practice are likely to be the major, systematic factor contributing to the variation.
• The median rate increased significantly from 2013/14 to 2019/20. Both the 95th to 5th percentile gap and the 75th to 25th percentile gap widened significantly.

First intravitreal injection therapy procedures in people aged 60 years and over

• Approximately 38,800 first procedures were performed on persons aged 60 years and over during 2019/20, 281.7 per 100,000 population.
• CCG values ranged from 16.6 to 490.2 per 100,000 population, which is a 29.5-fold difference between CCGs.
• The was no significant change in the median rate increased significantly from 2013/14 to 2019/20.

Admission to hospital for cataract surgery in people aged 65 years and over by CCG (2019/20)

• Since the onset of the coronavirus (COVID-19) pandemic in March 2020, clinical activity has been prioritised to manage conditions at high risk of losing sight, with all routine care including cataract surgery delayed. Inevitably, as seen in figure 3.1 of the atlas, this resulted in a sharp drop in surgical activity during the first (April to June 2020) and second (December 2020 to February 2021) wave of the pandemic
• Approximately 384,000 (3,660 per 100,000 population) cataract surgeries were performed for persons aged 65 years and over in 2019/20,
• CCG values ranged from 2,462 to 5,299 per 100,000 population, which is a 2.2-fold difference between CCGs.
• The median rate increased significantly from 2013/14 to 2019/20.

Admission to hospital for first cataract surgery in people aged 65 years and over by CCG (2019/20)

• The England value for 2019/20 was 2,086 per 100,000 population.
• CCG values ranged from 1,371 to 2,943 per 100,000 population, which is a 2.1-fold difference between CCGs.
• The median increased significantly from 1,948 per 100,000 population in 2013/14 to 2,152 per 100,000 population in 2019/20.

Admission to hospital for second cataract surgery within 12 months in people aged 65 years and over by CCG (2019/20)

• Over 123,000 operations were performed on the second eye within 12 months of the first eye operation. This represents 32% of all cataract operations performed in 2019/20 (384,000)
• The England value for 2019/20 was 1,175 per 100,000 population.
• CCG values ranged from 584 to 2,053 per 100,000 population, which is a 3.5-fold difference between CCGs.

Rate of rhegmatogenous retinal detachment surgery in people aged 18 years and over by CCG (2019/20)

• The England value for 2019/20 was 23.5 per 100,000 population.
• CCG values ranged from 6 to 40.5 per 100,000 population, which is an 8.9-fold difference between CCGs.
• The median increased significantly from 18.8 per 100,000 population in 2013/14 to 23.4 per 100,000 population in 2019/20.

Percentage of those offered diabetic eye screening who attend a routine digital screening event (where images were captured) in people aged 12 years and over by CCG

During the latest period (2018/19), CCG values ranged from 73.8% to 92.1%, which is a 1.2-fold difference between CCGs.

The England value for 2018/19 was 83.2%

Overall, uptake of diabetic eye screening met the acceptable standard in the financial year beginning 2018

Percentage of urgent referrals for diabetic eye disease (referred proliferative diabetic retinopathy ) seen within 6 weeks of screening event in people aged 12 years and over by DESP area

• DESP area values ranged from 33.3% to 94.6%, which is a 2.8-fold difference between DESP areas.
• The England value for 2018/19 was 77.9%.
• Approximately half DESP areas met the acceptable standard.

Percentage of routine referrals for diabetic eye disease (referred pre-proliferative diabetic retinopathy or maculopathy ) seen within 13 weeks of screening event in people aged 12 years and over by DESP area

• DESP area values ranged from 15.3% to 88.4%, which is a 5.8-fold difference between DESP areas.
• The England value for 2018/19 was 53.2%.
• The mean England value for review of routine referrals within 13 weeks was below the acceptable standard of 70%, with marked variation across England.

Incidence rate of uveal, retinal and conjunctival cancers by Cancer Alliance (2013-2018)

• It is possible that variation in the reported incidence may reflect previously undetected variation in the quality of submissions to the National Cancer Registrations Dataset.
• Cancer alliance values ranged from 0.8 to 1.7 per 100,000 population, which is a 2.2-fold difference between cancer alliances.
• The England value for 2013-2018 was 1.2 per 100,000 population.
• Ethnicity and skin type are important risk factors for ocular tumours in adults. The variation seen within England may be partly explained by differences in demography throughout the country and in differences in patient’s willingness to seek hospital care.

Public Health England’s (PHE) new mental health campaign ‘Every Mind Matters’ launched on 7th October.

It supports everyone to feel more confident in taking action to look after their mental health and wellbeing – promoting a range of self-care actions to promote good mental health and tackle common problems, as well as signposting wider resources and services for those in greater need. Through use of the campaign’s content and navigation tool, PHE’s aim is for 1 million adults in England to be better informed and equipped to look after their own mental health and support others.

The campaign’s online tool and content

There is a free NHS-approved online tool on the Every Mind Matters website which will help people build an action plan to deal with stress and anxiety, boost their mood, improve their sleep and help them feel more in control.

For those who want to learn more about common problems there will be more in-depth modules on stress, sleeplessness, anxiety and low mood. Each module contains information on what can cause changes in people’s mental health, possible signs to look out for, advice on things you can do and importantly, explains what’s OK and when people should seek further support, including links to IAPT services (Improving Access to Psychological Therapies). Advice is also available for those who want to support others who are struggling with their mental health.

This campaign builds on the achievements of anti-stigma-focussed mental health campaigns by offering simple advice for self-care and encourages individuals to take action. It is not a treatment service and has been designed to complement wider services, with appropriate signposting for those who would benefit from additional support.

Find out more and access the online tool here.

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If you are interested in finding out more:

For more information and resources, go to the ‘Every Mind Matters’ website.

Read the blog from Linda Hindle, Deputy Chief AHP Officer for England here.

Find out more about the ways in which Orthoptists are engaged in public health here.

Today saw the launch of the consensus statement, “Supporting professionals to have healthier weight conversations”, published by Public Health England.

This represents an intent to work together to maximise support for population behaviour change and includes a core set of principles which outline how professional organisations can support the public health workforce to help individuals and communities significantly reduce their risk of obesity in order to support the national ambition to halve childhood obesity rates by 2030.

This joint approach will support the commitment in the NHS Long Term Plan to ensure nutrition has a greater place in education and training for continuing professional development (CPD) and will assist the public health workforce to utilise their skills to contribute to the NHS Five Year Forward View commitment to ensure every child and young person has optimal health.

The British and Irish Orthoptic Society is 1 of 14 professional organisations for the public health workforce who have agreed to be listed as a supporting partner demonstrating our commitment to taking action to prevent and reduce childhood obesity.

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If you are interested in finding out more:

You can read the full Consensus Statement here.

Find out more about the ways in which Orthoptists are engaged in public health here.

Launch of new Social Prescribing Framework for Allied Health Professionals

The Royal Society for Public Health (RSPH), along with Public Health England (PHE) and NHS Improvement, has developed a framework to support Allied Health Professionals (AHPs) to increase their social prescribing and to create a vision of social prescribing for AHPs.

In developing this framework, research found that nearly half (44%) of AHPs felt that their knowledge of social prescribing ‘required improvement’. This new framework aims to fill these gaps, and has been produced based on extensive consultation with AHPs and their professional bodies.

The framework, ‘Driving forward social prescribing’, will also provide a useful resource for other healthcare professionals, by providing practical information including:

• The spectrum of social prescribing, based on less time intensive ‘active signposting’, to ‘referring to a link worker’ and, at its most time intensive, ‘AHPs as social prescriber’;
• The role of AHPs as providers of services and groups that other professionals can socially prescribe people to;
• How to assess whether social prescribing might be useful for the person you are working with;
• Suggestions for finding out more about what services and groups are available locally;
• How AHPs can promote and develop social prescribing in their local areas; and
• The ability of social prescribing to support people of all ages with diverse needs.

The framework importantly includes a wide range of case studies from different AHPs working in a variety of settings. These case studies highlight the exciting work already being done by many AHPs to engage people with social prescribing and should encourage all AHPs of the value of social prescribing in their daily work.

The Framework includes a number of case studies, including one from Orthoptist Raz Choksi about the use of an eye clinic liaison officer (ECLO) in her Low Vision Clinic.

“I feel this service offers a more structured and sympathetic approach to patient care for the visually impaired which not only creates better communication with other local services but can offer the patient reassurance and the confidence that they are being fully supported.”

Linda Hindle, PHE Lead Allied Health Professional, said: “Social prescribing is fundamental to supporting people to manage their own health and wellbeing. This framework highlights how AHPs contribute across the spectrum of the social prescribing offer, helping people access the right services to meet their needs. We hope the framework will support AHPs, primary care networks and link workers to recognise what AHPs already contribute and where they could do more.”

The ‘Driving forward social prescribing’ framework is available at https://www.rsph.org.uk/our-work/resources/ahp-social-prescribing-frameworks.html. 

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If you are interested in finding out more:

You can read the full framework here.

Find out more about the ways in which Orthoptists are engaged in public health here.