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Visionary leadership


8 December 2014

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Across the NHS, it is crucial that managers can drive change in the health system. Commissioners need partners they can work with to help them overcome challenges and lead changes in services, bringing reform and efficiencies. But it is not only the retail sector that can offer leadership to the NHS. Commissioners also need leadership partners with frontline experience of health service delivery to help them identify where improvements can be made and design services that most effectively address patients’ needs.

Across England commissioners have been redesigning eye health services to introduce new and more efficient ways of providing NHS services. Until recently, services for people with eye health problems – including cataracts, glaucoma and minor eye conditions such as conjunctivitis – were overwhelmingly provided in hospitals, with patients either being referred by their GPs or presenting at A&E.
Yet many of these eye health conditions do not require the attention of hospital-based ophthalmologists. Requiring patients to go to hospital for these conditions, by not providing easily accessed alternatives, can be time-consuming and inconvenient for the patient, and makes it more difficult for hospitals to provide prompt care for the people that most need to be there. It also has financial implications, with the cost to the NHS of a patient’s attendance at A&E and hospital eye services typically being greater than the equivalent cost of their attendance at smaller facilities.
In response to this, commissioners are increasingly adopting alternative and more efficient ways of providing eye health services, by shifting them out of hospitals and into optical practices in high streets and shopping centres, taking advantage of the skills and facilities that already exist. Where these new community eye health services have been commissioned they have been found to benefit commissioners and patients. In Sheffield, for example, community-based services are available for patients with eye problems such as cataracts, glaucoma and minor acute conditions. The cost saving from this community-based approach has been estimated at £400,000 a year.
Redesigning services to provide them in the community is not straightforward. Commissioners need to thoroughly understand patients’ needs to make sure the new services are appropriate. Taking services out of hospitals and into smaller local settings presents challenges in terms of ensuring all practitioners have appropriate skills and training and access to the necessary equipment. 
In addition, providing services through independent practices, which are often in competition with one another for other services, introduces complexity for managing the contracts. None of these challenges are insurmountable, but commissioners need to be aware of and understand them when they provide community-based eye health services.
Leadership from the optical sector
Partnerships between commissioners and local optometrists and opticians are an important way for commissioners to navigate and address these risks. Members of these professionals can bring knowledge of the relevant eye health conditions and the care required to address them, as well as experience of the local practices able to provide the community-based services. This means that commissioners benefit from optometrists having the leadership skills necessary to co-ordinate the local practices who can provide the community-based services – yet these skills are not always already present, and need to be fostered.
One way optometrists and opticians are being helped build these skills is through a 20-credit postgraduate leadership skills course at Cardiff University, designed by the Local Optical Committee Support Unit for leaders and emerging talent in the optical sector. The course includes a development centre activity where delegates participate in a commissioning exercise: giving them experience of how they can help commissioners provide more effective services in their area. 
Delegates are also required to undertake a leadership project over the two terms that the course runs, with the project expected to bring real value to their local optical communities. The course is now in its third year and has demonstrated significant success in supporting delegates moving into regional and national leadership roles.
A recent participant was Angela Henderson, an optometrist from Newcastle. As part of the leadership training, Angela looked at the running of a local programme for screening children’s vision and concluded that there was an opportunity to make the service more effective and efficient. With the skills developed through the training, Angela has taken on a leadership role as chair of the North East and Cumbria Local Eye Health Network and is working with commissioners to help design services that better met the needs of her community. 
In response to pressures to find efficiencies, commissioners across England are now working with eye health professionals to improve the way they provide services. Optometrists are among the professionals being relied on to take on new leadership roles among their peers in this redesign of how eye health services are delivered. This can mean bringing together local practitioners, who are often competitors in the high street, to act as a single point of contact for commissioners. By working with those who are leading their sector, commissioners are helped to take services out of hospitals and supply them more efficiently in local communities.
Like other health professionals, these optometrists and opticians have extensive knowledge of patients’ health needs as well as experience of delivering services. With increasingly developed leadership skills, they are better able to help commissioners take advantage of that knowledge and experience – so that services are designed and delivered in ways that benefit patients and the wider health service, so helping the NHS make the best use of resources and ensuring A&E and hospital eye services are focused on the patients that have the most need.

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