Executive summary - Liverpool CCG - Home



Cataracts Engagement ReportMarch 2017Authors:Helen Wilkie – Social Value and Engagement OfficerKelly Jones – Social Value & Engagement LeadExecutive summaryBetween the period 16th January 2017 – 10th February 2017, NHS Liverpool Clinical Commissioning Group undertook a series of engagement activities to provide insight into how Liverpool people feel about proposed changes to pre and post-operative care for Cataracts. This involved commissioning 6 third sector organisations (community partners) to provide insights from specific communities, in addition to a more general and wide spread engagement approachThe engagement followed a quantitative research methodology.In total 686 satisfactorily completed questionnaires were analysed to provide the statistical evidence used in this report. The free-response section of the questionnaires generated a number of comments and these were thematically analysed to identify key issues.The engagement findings demonstrate substantial majority support for the two distinct elements of the proposed redesign, with 78% of respondents (n=535) supportive of initial cataract assessment being provided by Opticians in the community and 74% (n=508) supportive of routine post-operative follow up appointments being provided by opticians.There were some consistent objections made to the redesign which related specifically to concerns this was a step towards privatising cataract services, that opticians would not be suitably qualified to deliver the service and that patients would be expected to pay for this element of their care. The latter two of these concerns are misconceptions that can be addressed in future communications should the redesign be implemented.The engagement sought to identify potential barriers to access that may not be understood. It highlighted the future location of these services may be a barrier to access should there be inequity in Opticians delivering the service across the city. No other specific issues were identified that would prevent patients using the redesigned services.1. BackgroundA cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. It can cause cloudy, blurry, or misty vision and affect one or both eyes. The presence of cataract causes disability and increases the likelihood that individuals will suffer adverse events such as falls. It is the leading cause of blindness in the world.A review is being conducted of how best to deliver Cataract services in Liverpool. NHS Liverpool CCG is working with the Local Optical Committee Support Unit, Hospital Eye Services and Community Optometrists to plan how to manage demand for eye services, whilst also improving care for the future and meet new ways of working that are set nationally. The Cataract review focuses specifically on the initial cataracts assessment patients undergo and post-operative care received following surgery. The review proposes these elements of a patient’s care are delivered in the community by Opticians, rather than provided by Hospital Eye Services. A four-week period of public engagement, between the period 16th January 2017 – 10th February 2017, was undertaken to understand how the proposal would impact patients and to ensure the redesign meets patient’s needs.1.1What is being considered?Proposals are being put forward which would change the way routine initial cataracts assessments and post-operative care for cataracts are provided. The current cataract pathway starts with an assessment where a patient visits their high street optician, often because of a perceived visual impairment, or due to a need for an up-to-date pair of spectacles. A sight test is conducted and the cataract(s) is detected. It is at this stage were the cataract pathway becomes fragmented. Most patients (90.5%) will be advised to book an appointment with their GP to request a referral to be seen by Hospital Eye Services. The appointment is made, a referral generated, the person is then seen by the hospital eye service for an assessment. If suitable for surgery, they are booked for a pre-op assessment, following which surgery is scheduled. The process involves multiple appointments and can be lengthy. However, some opticians are accredited under the enhanced Cataract Assessment Scheme to provide an initial assessment of a person’s cataract. This streamlined service, bypasses the need for patients to return to their GP for a hospital referral as the Optician will perform the assessment and make the onward referral. If time permits, the cataract assessment is conducted at the time of the initial sight test, removing the need for the patient to return for another visit. If this is not feasible, an additional appointment is booked, following which the optician makes a direct referral into the hospital eye service. The pathway is designed to improve the patient journey by reducing the number of patient visits overall and to include as few visits to secondary care as possible.A total of 3,806 patients had a cataract procedures carried out during April 2015 – March 2016. Of these, only 362 people had their cataract assessment performed in a streamlined way by a community Optician. The proposal is to extend the existing enhanced Cataract Assessment scheme so that all routine cataract assessments are carried out by community opticians. It is also proposed; the scheme be extended to include all routine follow up appointments being carried out in the community by Opticians. Hospital eye services would only review patients post-operatively if there were complications during or following surgery. Examples of complications include: -During the operation:?inability to remove all of the cataract ?tearing of the lens capsule ?bleeding inside the eye ?a bit of the cataract dropping into the back of the eye ?damage to other parts of the eye, such as the transparent outer layer of the eye (cornea) After the operation:?swelling and redness (inflammation) in the eye ?swelling of the retina (cystoid macular oedema) – where fluid builds up between layers of the retina at the back of the eye, sometimes affecting vision ?swelling of the cornea – where fluid builds up in the cornea at the front of the eye; this usually clears itself ?retinal detachment – a rare complication where the retina (the layer of nerve cells inside the back of the eye) becomes separated from the inner wall of the eye ?infection in the eye.The Royal College of Ophthalmologist Commissioning Guide suggests that routine cataract operations which could potentially be followed up post-operative in the community are approximately 80%. While more local data from the same service already commissioned in Stockport, suggested that over 90% of patients where straight forward and could be followed up in the community.The revised pathways are shown in figures 1 and 2.Figure 1 – Current pre and post-operative Cataract pathwayFigure 2 - Proposed pre and post-operative Cataract pathway1.2 Summary of why this is being consideredIn their 2015 commissioning guidance, The Royal College of Ophthalmologists recognise commissioning much of the initial assessment and postoperative phases of the cataract pathway through community optometrists as best practice. This way of commissioning is also supported by the Clinical Council for Eye Health Commissioning (CCEHC), who wrote to all Clinical Commissioning Groups in July 2016 advising that primary eye care services (Opticians) should be the first port of call to manage and monitor Cataract cases prior to referral to hospital. This review aims to bring the delivery of Liverpool’s Cataract service is line with recommended guidance.Other key aspects of the review are to reduce wait times for initial Cataract assessments, reduce the number of unnecessary appointments people are asked to attend and make best use of the skills available within the existing workforce to manage demand for this service.Increasing demands on eye health services due to the ageing population and the availability of new treatments are creating capacity issues for local hospital eye services, especially in relation to age-related macular degeneration (AMD), diabetic eye disease and glaucoma. This trend for increased demand is set to rise further, which could lead to unmanageable capacity problems in secondary care. The proposal to better utilise the skills and resources of the existing workforce is expected to speed up treatment for patients, help relieve some of the pressures on hospital eye services, freeing up hospital resources for patients who require more complex input and offers cost-efficiency through best value for money. There are currently differences in pathways across providers with additional follow up appointments being undertaken which are no longer evidenced as being necessary. The proposed changes will streamline pathways, with patients undergoing either unilateral or bilateral procedures to undertake a one stop pre-op assessment and optimised follow up. Variation in practice will be removed and more appointments will be available within the local community.1.3 The benefits for Liverpool peopleThe specific benefits for Liverpool people should be better health outcomes and experience as follows:-Waiting times for initial cataract assessments will be reduced.More routine care will be provided closer to people’s homes with a greater choice of providersThere will be a reduction in the number of appointments people are asked to attend2. Methodology2.1 Aims and objectives of the engagementThe aim of the engagement was to understand what Liverpool people think about the proposed redesign of the pre and post-operative Cataract Service, in order to inform a service that is responsive to people’s needs.The engagement had the following objectives: -Share the proposed redesign of the pre and post-operative Cataract service with the publicUnderstand how the proposed reconfiguration may impact on Liverpool people and their views of the proposed changes.Understand whether there are differences of view among different communities and whether any adjustments \ mitigations can be made to the proposal, especially regarding meeting Equalities duties. Provide people with a range of mechanisms to share their views about proposals for these services.2.2 Research methodologies employedThis report is based on multiple engagement activities designed to provide NHS Liverpool CCG with comprehensive insights into people’s thoughts regarding the proposed redesign.To enable reach into diverse communities and hear from as many people as possible, six community partners were contracted to provide insights, each one providing the perspective of different communities. To ensure the proposals were understood by individuals, community partners held focus groups to explain the current service configuration and the proposal. The engagement partners were:-Bradbury FieldsHenshawsChinese WellbeingIrish Community CareMencap LiverpoolRotundWomen Reach WomenThe quantitative research methodology employed a semi-structured questionnaire designed by NHS Liverpool CCG – See appendix 1. This was administered:-Face to face through a combination of volunteer and professional interviewers.Online through a portal on NHS Liverpool CCG’s own website. In addition to this activity, NHS Liverpool CCG applied the following mechanisms for engagement: -NHS Liverpool CCG’s interactive engagement platform was used to share information about the engagement. This hosted the online survey.NHS Liverpool CCG’s stakeholder database was used to share details of the engagement opportunity to 4031 individuals registered on the system. These were a combination of VCSE organisations, professional stakeholders, local groups, members of the public and statutory bodies such as healthwatch. In the communication that was shared, people were signposted to the online engagement activity, activities partner organisations were holding and were offered paper copies of the rmation was shared on social media to increase awareness of the review and the proposed redesign. To maximise impact, all tweets directed people to the online survey.Local opticians were invited to share hard copies of the survey in their premised.In total 686 satisfactorily completed questionnaires were analysed to provide the statistical evidence used in this report. The free-response section of the questionnaire generated a number of comments and these were thematically analysed to identify key issues. 3. Qualitative FindingsThis section of the report details the findings from the semi-structured questionnaire developed by NHS Liverpool CCG. As well as quantitative data, it produced a large number of individual comments by respondents. These have been summarised thematically and are also presented here. The full list of all comments are provided in appendix 2. In total 686 respondents completed the questionnaire including those completing it online via the CCG website. 3.1 Question 1 – respondent’s postcodeIn order to understand respondent’s perspective, the survey asked people to identify their postcode. The map below shows the geographical location of respondents Figure 3 – Postcode of respondents3.2 Question 2 – respondent’s perspectiveRespondents were also asked to indicate what their interest in Cataract services was. The majority (46% n=316) of respondents either had direct experience of using cataract services, or indirect, as shown in figure 4.Figure 4 – Respondents interest in Cataract servicesOf those who answered other, they were either NHS staff, working in an optician’s, or associated with a voluntary organisation.3.3 Question 3 – Views on proposed changed to initial Cataract assessmentRespondents were asked to consider the specific changes being proposed and to indicate whether they agreed with the proposal for all routine initial cataract assessments to be carried out by opticians in the local community.78% (n=535) of respondents agreed with the proposal, 10% (n=69) did not and a further 10% (n=69) were not sure.Figure 5 - Views on proposed changed to initial Cataract assessment0000As a supplement to this question, respondents were offered an opportunity to explain the rationale behind their response. 7% (36 individuals) of those who were supportive of the proposal left a response to this questions. Reasons for support were largely due to the added convenience it would offer patients and the belief the proposal would offer a quicker service.78% (54 individuals) of those who did not agree with the proposal for all routine initial cataract assessments to be carried out by opticians provided a response to this question. Consistent themes for not supporting this element of the redesign were concerns about privatisation and removing services from NHS providers, a mis-perception that patients would be required to pay for the services, poor experiences of some larger optician chains, or concerns regarding whether staff would be suitably qualified to deliver the enhanced service.A sample of responses are provided below.“Moving more services in to the private sector”“The service ought to be free for all under the NHS, not subject to payment exemption certificates that I understand would be needed by opticians”.“Opticians are private businesses, that want to make profit, this will cost the NHS more”“Opticians are not professional eye care providers; they offer glasses”77% (53 individuals) of those who were unsure of the proposal provided a response to this question. Their rational was largely in line with the comments above. However, a few respondents queried whether the redesign would deskill the existing NHS workforce.3.4 Question 4 - Views on proposed changed to routine Cataract follow up’sRespondents were asked whether they agreed with the proposal for all routine post-operative cataract follow up’s to be carried out by opticians in the local community.74% (n=508) of respondents agreed with the proposal, with 14% (n=96) unsupportive of the proposal and 11% (n=75) unsure.Figure 6 - Views on proposed changed to routine Cataract follow up’sAgain respondents were offered an opportunity to explain the rationale behind their response.388 respondents completed this question. Common themes where:Those who agreed with the proposal believed it would reduce waiting times for patients, and ease pressure on hospitals.“Common sense to go to the opticians rather than people waiting and the added anxiety of going back to hospital”“Easier to access location. More familiar with staff and therefore less stressful - more likely to see same person. Less waiting time. Free up hospital time for complex cases.”20 respondents (2 who answered “yes”, 4 who answered “not sure” and 14 who answered “no”) mentioned in their reply that they were worried this service change was privatisation of NHS services.“It will contribute to the accelerating pace of NHS privatisation and divert necessary funds away from St Pauls”“I am concerned about this becoming a mechanism by which charges could be introduced for the appointments on the basis of them not falling under NHS control, thereby dismantling the NHS.”19 respondents, (13 who answered “not sure”, 5 who answered “no” and one who answered “yes”) expressed concern that the opticians would be adequately qualified, competent and equipped to carry out the follow up appointments.“I'm not sufficiently aware of the level of medical training required for this or to what level opticians are trained to.”“As someone who has had ongoing difficulties since a cataract operation I wonder whether community opticians would have been able to have the relevant equipment and expertise to make a quick diagnosis.”3.5 Question 5 - potential barriers to accessIn order to identify potential unexpected implications for the proposed redesign, respondents were asked if there was anything that would prevent them from using the Cataract assessment or follow up service at a community optician.The vast majority of respondents, 76% (n=521), did not feel there was anything that would prevent them from using the service. Figure 7 – Potential Barriers to accessOf the 22% (n=151) of respondents who felt there was something that would prevent them from using the service, 75% (n=114) of respondents went on to explain what would prevent them from using community opticians in this way. Common themes are identified below.49 respondents expressed concerns that a community optician would not be adequately qualified:“If there were complications related to cataracts or perhaps other un/related issues such as diabetes, would an optician be able to provide best medical advice / attention?”“I wouldn't trust them. I feel they focus more on selling glasses than eye health. I don't feel there would be the same standard of care.”7 respondents were concerned that they would have to pay for the follow up appointments:“If there was a charge involved”“In the future, the cost might, if charges were introduced as the service were no longer seen as free for all under direct NHS control.”12 respondents said they might find it harder to get to an appointment at an opticians than at a hospital:“Depends where optician is - many are not easy to get to”“It will have to be nearby, if it's further than the hospital then there's no point for it.”16 respondents expressed concern that this service change was a form of privatisation of an NHS service:“Lack of confidence in their ethical code. Do they even have one? My understanding is that they provide profit driven delivery.”“NHS services should not be handed to non NHS providers without the evidence to show that it is successful. Where has it been tried before? Did it work?”3.6 Question 6 – Others commentsThe final question was a free text option, were respondents were offered the opportunity to note any other comments they would like to make regarding the proposed redesign of cataract assessments and post-operative care.243 people responded to this free text question. These responses can be found in full in Appendix 2.One response from a health professional was as follows:“I work in an ophthalmic unit and I am responsible for examining post-operative cataract patients, yes whilst most patients do not have any problems post operatively there are still a number who have problems picked up this check, as the pt is already in the hospital setting they can be dealt with quickly.I also worry that patients may not attend these appts in the community as it may not feel the importance of the appt as they would a hospital appt.I think it may increase the number of patients coming through the primary care setting if any problems, putting added pressure on to an already busy clinic.”68 responses were classified as positive reactions to the proposed changes, with an additional 30 which were classified as qualified positive reactions, examples below.“The information given about this service looks to be very helpful for the patient and would be good if there were some reassurances about complications and support in the community. It seems the responsibility is to be transferred totally to the optometrist. I feel that vulnerable and elderly people living alone may need more support at home. How will the optometrist deal with this?”“On the whole it is a good idea, aimed at saving: time, specialised resources, costs, access improvement for patients. Downside is if it becomes a semi privatised service as Optical treatment now is under NHS. Will opticians exploit it? Will it have a lower priority with them than selling glasses & eye tests & will they have time & trained resources to deliver it?”19 responses were classified as negative objections to the proposed changes.“I personally have been told by one optician that I have cataracts and by another that there are no signs of cataracts but there may be retinitis pigmentosa!! This was a year ago and I can still see perfectly well. They may be able to do visual correction work but beyond that I am sure that many would not be up to it. Would be a dangerous move.”“Our eyes are special and need qualified care from a eye specialist at a hospital. This is a cost cutting service lining the pockets of the opticians. Why not pay to have extra staff in the hospital clinics?”13 responses posed questions concerning either the consultation itself or the proposed changes, examples given below.“Do you intend to use the results of this survey to roll out untried provision? The questions are impossible to answer should the respondent have no experience of being treated for cataracts. Most people do not - so if you seek to justify changes in provision based on responses from people who don't know what they are talking about I would be inclined to mistrust the purpose of this survey.”“My optician does not appear to be on the list. If this system is introduced will the number op opticians participating be increased? If not it will be more complex than the present system. If i had to go to 2 opticians I might leave my current one, losing them business which would be very bad.”21 respondents, 3 who were surveyed by Women Reach Women and 18 by Chinese Wellbeing, all made the point that access to an interpretation service would be needed at the opticians as well as the hospital.3.7 Demographic profile of respondentsThe demographic profile of respondents is outlined below in figures 8 – 13.Figure 8 – Age profile of respondentsFigure 9 – Gender of respondentsOf these, 73% (n=498) described their gender as the one they were assigned ay birth. 1% (n=5) indicated it was different to their assigned birth gender, >1% (n=2) did not understand the question and 26% did not answer the question.Figure 10 – Sexuality of respondentsFigure 11 – Ethnicity of respondentsFigure 12 -DisabilityFigure 13 – Religious belief of participantsOf those respondents who indicated they had a religion or belief, 80% (n=252) were Christian, 3% (n=9) were Muslim, 3% (n=9) were Buddhist, 2% (n=6) were Jewish, 1% (n=3) were Hindu, 7% (n=23) had another religion or belief and 4% (n=12) preferred not to say.4. ConclusionThere is considerable evidence of a positive response to the proposed redesign of initial cataract assessments and routine follow up appointments, with a majority of support for both initial cataract assessments and routine follow up appointments to be provided in the community by local opticians.Were respondents indicated they were not supportive of the proposal, three consistent themes emerged. These were:-The proposal is a move towards privatisation of cataract care and the NHSCommunity Opticians would not have the skills/training required to deliver the service adequately.Patients would have to pay for this element of their careThe training requirements community opticians looking to deliver the service would be required to undertake was outlined as part of the engagement but clearly, if the service is implemented, consideration needs to be given to how these fears are allayed for patients. Likewise, clear communication explaining the service will be free for patients should be considered as this misconception may become a barrier to access.Appendix 1 – Cataract surveyBelow is a word version of the electronic survey.So we can see which area of Liverpool you are from, please enter your postcode.50990592710020000Please tell us about your interest in cataract services. (Choose any one option)I have used/am using cataract servicesSomeone close to me is using/has used cataract services I am a Liverpool resident who hasn't used this service Other – Please specify _____________________________________Do you agree with the proposal for all routine initial cataract assessments to be carried out by opticians in the local community? (Choose only one option)Yes NoNot sure3a. If you would like to tell us why you answered this way, please enter below (optional).50990513906500Do you agree with the proposal for all routine post-operative cataract follow up appointments to be carried out by options in the local community? (Choose any one option)Yes NoNot sure 425303527463004a. If you would like to tell us why you answered this way, please enter below (optional).Is there anything that you feel would prevent you from using the cataract assessment or follow up service at a community opticians? (Choose only one option)Yes – if yes answer question 5a.No361507327601005a. Please tell us what would prevent you.Any other comments?2764468799900Questions about youNHS Liverpool Clinical Commissioning Group is committed to a fully inclusive and meaningful approach to engagement. We want to make sure we are involving you in the right way, over the right issues and to have a range of contacts that reflect the rich diversity of our city’s communities. We are setting out on a new approach increasing how we involve people and it would be helpful for us to know a little more information about you. Please complete the form below, providing as much information as you wish. A. What is your age? 17 or under18-2526-4445-6565-7475 or overB. Do you identify yourself as…Male FemalePrefer not to sayC. Is your current gender identity the same as the one you were assigned at birth? Yes NoNot sure what the question meansD. Which of the following options best describes how you think of yourself? Heterosexual or Straight Gay or LesbianBisexual OtherPrefer not to sayE. What is your ethnic group? Choose one option that best describes your ethnic group or background WhiteAsian / Asian British Black / Black British Chinese / Chinese British Mixed Ethnic Background Other ethnic group F. Do you consider yourself to have a disability? Yes – if yes answer question belowNoPrefer not to sayPlease tick if you have any of the following: Physical disability Visual impairment Learning disabilityHearing impairment/deaf Mental illness/distressLong term illness that affects your daily activity Other – please specify _________________________________________ G. Do you have a religion or belief? Yes NoPrefer not to sayIf yes, please select which:-Buddhist Christian Hindu Jewish Muslim SikhNo religion Prefer not to sayOther – please specify ___________________________________________Appendix 2 – full list of free text responsesQuestion 2.Those who answered other gave the following descriptions:health professional I am a Merseyside resident with elderly parents and a grandmother who suffers with Retinitis Pigmentosa. We are a charity organisation called (Liverpool Arabic Centre) working with Arabic communityI have small cataracts in both eyes and will need to use the service in the near future.diabetic patientI have made an operation before for my dry eyeEarly stage of cataract development detected at routine annual eye test.Work in OphthalmologyI have cataracts and am waiting for my optician to tell me they are at the stage of needing to be donenhs proffessionI work for St Paul'scommunity groupMy father had a cataract removed in December and is currently being care for by St Paul's.nhs employeeWork in the NHSneed cataract operationI have just been told I have a spot of cateract so this worries me, I have lots of friends who have gone through this or are going through itEx nurse Only aware of the situation from the mediaChair of the Fazakerley Health & Wellbeing ForumI'm awaiting to have cataract surgery.I am in an organisation, Mersey Pensioners Association so as cataracts are a problem for elderly people it is of interestQuestion 3a.3a. If you would like to tell us why you answered this way, please enter below (optional).Yes:More convenient to go to local opticians.More convenient.More convenient. Less travel, easy access to the service.More convenient, saves time.Because they can check my eyes thoroughly.Convenient, will immediately know if my eyes have a problem.Convenience, quick.Convenience.More professional and better equipment and training for the opticians are expected. Easy to meet optician in my living area than book appointment with GP.More convenient. Better service. Release the workload of hospital service but the optician should be equipped with skills and equipment to diagnose for eye assessments.My optician can help to monitor my eye disease (cataracts) regularly and refer to hospital for operation when appropriate and timely. It can be easier to optician than to book GP appointments. My immediate service & extended service by optician is good.Convenient, quick. Provides rapid access.No need to wait for hospital appointment, it takes ages.Convenience.I believe opticians specialise in the care of the eyes.Convenience, fast. Interpreter is needed for language barrier.Quick to have the assessments, less travel. Optician has the skills and equipment for the assessment.Convenient. Need interpreter for better understanding.Convenient, faster service. Agreed the proposal to have initial assessment by optician as long as doctor from hospitals will follow up.Faster service, more convenient. Good to widely use this service by optician, but make sure optician equipped with the skills, qualifications and advanced equipment.Save time and without going through GP.Opticians should equip with qualifications and skills; equipment for eye assessment should be the same as hospitals; agreed the proposal so that resources can be used on other urgent or different services for eye diseases. Better use of NHS resources.Convenience, fast. Interpreter is needed for language barrier. More simple information sheet is needed to show the procedure, flow chart in Chinese.Need interpreter so that the initial pre-assessment by optician will be better understood.Convenient, faster service. Faster to get appointment. Good to have information sheets in Chinese to show the simplified procedure. Need translation/interpreter.Convenience.More convenient, take less time. Opticians should have the skills, qualification and equipment. If have problem, the opticians can refer back to my GP.Professional, fast.Agree because the local optician provides and outstanding service and has interpreter.Quicker service and access to the service directly from professional healthcare staff.saves clogging up the NHS's other servicesconvenientif it’s fasteras long as its near to homenot bothered who examines eye's as long they are traineddoesn’t matter as as long as its done properlyNo:Moving more services in to the private sectorPatient should only be seen at NHS hospitalsMy dad required cataract surgery in St Pauls Dept RLH. He praised the treatment he received unlike the treatment he received at Spec Savers for his hearing aids. It took over 2 years of my Dad being unable to hear correctly.As far as I am aware these services are provided privately and so a cost would be incurred for this provision.I have had bad experiences with spec savers and hearing aids the service is incomparably better at Broad green I will need cataract operation and aftercare and would chose to go to hospital particularly as more invasive alright with independents carry out service but i don’t fancy sitting in the likes of Asda having this done and it will not be long before the big boys jump on the band wagonI had two cataracts removed at the Royal. Excellent service but I found it a daunting operation. Trained doctors are required. I doubt if the same level of skill would be available in community. Cost-cutting exercise dangerous when sight at risk.It should be done by NHSThis is a further privatisation of the service. If we need more opticians in hospitals, we should employ them.I wonder regarding the cost effectiveness of this and who will be monitoring the service. I work in the Dental field and am more than aware of the differing abilities of clinicians. Cataract may be deemed 'normal procedure' but nothing should be left to chanceI know people who have been referred by their optician with cataracts who when they got to the hospital where informed that they did not have a cataract at a stage which required surgery.What training have these opticians had to be able to do this, do they know what drops to administer if a infection etc sets in??I don't think they have the particular expertise to spot possible complications arising at or during surgery.Doubts about expertise and experience. Would patients be able to shop for new glasses anywhere or would they feel pressured to buy from opticians within the new scheme? I think all the people who have them should be seen by the people who do these operations so they get the best advice.I don't have much trust in options in the community so I would rather it be a specialist in a clinical environment Will contribute to the accelerating pace of NHS privatisation and divert necessary funds away from St Pauls NHS Free we already paidThe service ought to be free for all under the NHS, not subject to payment exemption certificates that I understand would be needed by opticians.It has not been proven and can be missedSafety. Gradual erosion of NHS provision which is leading to privatisationNeed to not privatise this service.I don’t agree with privatisation of health services. If there were community based health employed opticians that would be OK.I feel it would be better carried out by trained nurses.alright at small properly trained optician, but not somebody on minimum wage in Asda or bootsI do not know that it would be in the patient's interestThis effectively outsources the service to the private sectorBecause there is not enough information about whether this change will really be a benefit. Has it been tried before? Where is the evidence of its success?Desire best service. Also money needs to stay with NHS not private contractors.Some opticians are better than others. We have heard of some who have missed signsMy Aunty had them done and had a problem lucky enough Doctor on site I do not want for profit providers to be given National Health contractsOpticians are private businesses, that want to make profit, this will cost the NHS more.NHS services should remain in the NHS. This is back door privatisation.No NHS service should be contracted out to commercial concernsI do not think that many of the "qualified" opticians who work locally at private businesses are of a standard that would give me any confidence in their ability to do the job well.Opticians are not eye specialists.Opticians give out glasses.Would rather see an eye specialist not an optician.Optician did not pick up my glaucoma.Experienced a useless optician so would rather have care in a hospital.Do not feel confident going to the community optician, would rather go to the hospital.Would prefer to be under the official hospital as I am used to the familiar surroundings and process in St Pauls.I feel this process should be in a hospital due to the care I have more confidence in for this process as I have had experience.Specialist rather than support.I don’t think they will have sufficient knowledge, no matter how well they are trained.Opticians are not professional eye care providers, they offer glasses.Prefer to go hospital I have been under the eye hospital for over 50 years and therefore would always prefer to attend the hospital. It's what I'm used to.Because I am aware of cuts being carried out in all regions in the NHS and widespread privatisation to be complete in 2020 i.e. the STPs I am also in KONP and SLWH campaign.Hospital more professional than opticians.Go to hospital with more confidence.wouldn’t know if they had been trained properlyNot sure:I expect 95% of diagnoses are simply done. But there will be a percentage of cases which will be missed if they are done by people with less training. Further, it does no harm to have the eye viewed by an eye specialist who might spot some other emergingNot sure of the experience of opticiansI am happy to go for routine eye tests at opticians and pay where applicable.... Would this be free and part or separate to this? Then ok.... If not, then concern cost at opticians would reduce service for manyIs this second class care because it's mainly elderly clients It entirely depends on how thorough the optician is and if the patient trusts his/her opinion.Don't know about cataracts Is this simply a cost cutting exercise?We pay extra for opticians appointments whereas hospital appointments are completely on the NHS, so what are the cost implications for patients?The established process has been successful, I am not sure that the public will have confidence in opticians undertaking this work. What guarantees of training etc. would we have?Not all cataracts are routine. So how does the optician know the surgeon’s ability. If there is another eye condition, I think the cataract should be under care of specialistDon't have enough information to answer I do not have enough information about competencyIt’s a very skilled procedure in a delicate area. I would hate to see the level of skill downgradedWould need to know more about the service offeredWould expertise be lost?think i would rather have eye specialistHave known opticians get it wrong. So need assurance of their quality and also need to know more about their brief about when to refer on.It means trusting opticians and my family has had problems with opticians.Has it or will it involve privatisation?I have reservations involving any "private" business in our health service! I'm not sure how cataracts affect me at the present stage as I rarely get blurred vision, and it's never been mentioned to me at my local Boots OpticiansI am not sure whether an optician is qualified to do a routine initial cataract assessment. You need to provide more information.it depends upon the quality of service provided and how this is monitoredI am concerned about people who have no support at home post-op.Not enough detailed information - has this been tried & tested?Don’t know enough about it.I would have to be confident there are sufficient numbers of qualified opticians to provide this new service Not sure if they are qualified enough to do this.I would be worried about the capabilities of some (not all) opticians.it's down to a question of experienceI was diagnosed with cataracts at the opticians, and told that one needed urgent attention. I came to St Pauls and was told that intervention was not required, but if I felt it was needed it would be done. I felt it was a waste of everybody's time. It would depend on the ability of the ophthalmologist to conduct the tests Only if the opticians are full qualified to clinically take a decision Opticians are now largely commercial organisations and one wonders if say going to Asda opticians for aftercare would engender confidenceProviding the optician is well versed I would be quite comfortable with this. I would have to see the relevant qualifications! Hence, not sure!More secure going to the hospital.Everybody is different and professionalism. Smaller opticians may not have the facility.Standards of opticians compared to hospital.Quality of assessment I would ask my family what they would think is best. It was the optician who refereed me to hospital as he had picked up on the cataract. Registered blind and therefore not sure good or bad idea.Experience of bad optician Don't know what it might mean when it happens.Depending if appointments available - try to find opticians that will come out to the home.Because i don’t know how well trained they would be with regards to the need required. I would want to make sure that they had the capability and resources to refer to a hospital if required.Hospital consultants and surgeons are more experiencedMy concern is that opticians are not qualified, even with additional training and a hospital setting would be preferable with appropriate expertiseBad past experience with opticiansAdditional hand-offs usually introduce inefficiency, increased cost and extra point of communication failure, i.e. concerned would delay treatment and cost more.My eyes are very well. Don't have cataracts.Not sure the opticians have the professional skills & equipment for eye test as advanced as in the hospital but agreed this is more convenient and less waiting time. Doctors are better than opticians at diagnosis, I have more confidence in GP.Agreed if local opticians have interpretation provided, otherwise it will be difficult for me.No answer:The integrity and the adequacy of the right level of training must be of paramount importance in approving any optician who is to undertake any examination in this sphere.Question 4a.If you would like to tell us why you answered this way, please enter below (optional).yes the same as before time and money also you would like to know that the opticians were fully competent to carry out both pre and post assessments Would take the pressure of hospitals and also wouldn't be seen as such a big thing for older people who may find hospitals intimidating.To cut down on waiting times possibly, but as already stated, for the benefit of patients and not privatisationto quicken up the processI would want the reassurance that if there was a problem that the best possible advice would be close to hand. I suppose if the examination were in a hospital out patient setting this might be OKTakes pressure of HospitalsBecause it would mean people with their sight temporary restricted and vulnerable having to find their optician travel to them with very limited visionSame answer as 3aIn agreement, as long as there was a quick referral back to the hospital if required.they have all the skills to do this same as abovesame as previous answer.Same as above once op done less problem to check (i hope)Again charges questionI believe that services that have no need to be performed in hospital should be delivered in the community, but currently many services suffer from a reduction of quality when this occurs. Private contractors do not always have the same accountabilityit will make travel easier for post op patients, most of whom are elderly and have a temporary visual impairment.Save trip to hospital, releasing resourcesThis is specialised surgery and should be carried out by specialists not by opticians who are inexperiencedSame as 3aConcerned that most specialised practitioners might not be available locallyThere are more opticians than there is hospitals and it would enable people to be seen more quickly if they are needed to be seen by a specialist. I can't remember having a post op review and as I had no problems or concerns it was probably a waste of time to all concerned because the local community organisations are the expert in their own community and they know all health issues affecting their community, we at Liverpool Arabic Centre as a charity organisation have worked with NHS, we were commissioned to do heath awareAgain, it saves time for the patient. See 3abecause I will get the support of my own community organisation to relieve pressures on the NHSIs the care second class Don't know about cataracts Answer is in the question. Local community. This will save on time & travel.I'm not sufficiently aware of the level of medical training required for this or to what level opticians are trained to.Because their appointment times are shorter than hospitals more 1 on1See above answer. are opticians properly qualified to do this?Because most of the operations work well with no complication.Optician assessor have necessary skills & knowledge As above plus commercial organisations do cut corners to maximise profitNo need to go to the doctor and wait a long time for thisSamecan’t get nurses to visit now without somebody elses work to doI don't have any knowledge of what this might involve so unable to answerAs above. I am all for upskilling opticians and streamlining services but I really am not for the gradual privatisation NHS services that has been happening since the 1980sBECAUSE IT WOULD BE MORE CONVENIENT FOR THE MAJORITY OF PEOPLE AS WELL AS SAVING MONEYAs 3aSee above - the expertise established in hospitals and eye surgeons has ben proven.More practicalThis might well work.No it should be done by NHSIt would depend on who was going to carry out these appointmentsMakes sense to only have to go to hospital when you need to, especially as most people with cataracts are older peopleIf it's routine, generally it should be fine post op. If any complications, the surgeon would flag it up already. Often no problem. Referral to hospital only when needed means less inconvenience for patients and hospital staff time better utilised. Just hope no cost to patients.As aboveOften people needing this procedure are elderly and travel may be difficult.convenient, personal and effectiveSee above - privatisation by stealthFor the same reasons I state in 3a.Again easier accessNot sure of clinical standardssaving hospital time and travellingAs aboveIn my experience the after care was the easiest part of the whole procedure.As long as all ophthalmologists are fully qualified to do so.As above. If there is an associated eye condition should be under care of specialistWould save time and money.See answer 3aAs aboveThis procedure was always under the remit of ophthalmology specialists - hospital based. Finance etc should not lessen the need for the same trained specialist to carry on this service hospital basedI think it is safer to be followed up at the hospital where the surgery was performedAs it is a new service would like to know opticians response to it.It can be difficult to attend a hospital after the operation if the patient still cannot drive etc. and to be seen closer to home by local opticians would be a benefit, providing the quality of care is the same that would be provided in a hospital settingSame as in 3Again same reason due to further complexitiesAs someone who has had ongoing difficulties since a cataract operation I wonder whether community opticians would have been able to have the relevant equipment and expertise to make a quick diagnosis.Convenience and hopefully the opportunity to be treated by the same optician at all early treatment and post operative care.Local access. Frees up time in the NHSAs long as if there are complications patients will receive quick appointments with Hospital OphthalmologistTo free up hospital time.all my concerns are to do with level of experience --sight is preciousObviously simplest way to go. Takes strain off hospitals, easier for patients to access, good for local businesses It will be a benefit to the people of Liverpool Same reason as above. Convenient as before. As previous. Far kore convenientThere would be more choice for appointments As previous As stated earlier, dealing with the problem locally, the optician is skilled enough.Convenience As long as it was a fully qualified ophthalmic optician!It would be easier than having to travel to hospitals and being robbed with extortionate car parking fees!!!!Makes appointments easier to arrange I think so long as at the cataract op time, any difficult cases are kept in hospital for follow-up ease of serviceIf a optician is booked up and my cataract does not feel right or needs dressing etc, who do I turn to then??Provides more accessibility and flexibility for patients free up appointmentsSame as 3aI'm not so sure about this, I think most people would be happier with the hospital doing the first post-operative appointmentLess waiting, more efficient appointments, generally better service locallyI assume you mean opticians. Same answer as to question 3I don't think they have the particular expertise to spot possible complications arising post surgeryLocal optician, less travel timeLocal optician, less travel timeimproves capacity in NHSAs long as there was still the option of attending the hospital if a patient was concernedAgain - would need to know more. Patients may feel that by going to the optician they would have to paySee above. Hospital clinics are staffed by people who are trained to a very high level and always have facility to consult a senior colleague at any time. I would not be confident that all opticians are qualified to do thisaccess and local need,Local optician, less travel timeMore choice if you are working rather than waitSt Pauls long waits / AccessibilityReaches many people, cheaper?Like any operation you should been seen by the team that did this operationSee 3aIf they are carried out by qualified person, why not?I prefer to see doctor In order for patients to be seen quicker and hopefully referred on to a hospital consultant if need be. This would free-up consultants to see the more non-routine patients quicker.This would free up more clinical appointments in hospitalMuch easier & quicker than hospital appointment & no parking problem.Same principles answer as aboveLack of expertise?Follow up should be done by the doctor who carried out operation to avoid misinformation/interpretationSpeed of service They are qualified enough and not as overworked as the hospital staff is under the circumstances Same as above See aboveNot certain whether you mean options or opticians. Either way - do they have sufficient expertise?more convenient All above reasonsOnce a person has had an operation all routine post-operative care should be provided by the hospital and the physicians who did the operation. same as abovenot very well off in this area for places to goFollow up is much more straightforward unless there is a problem so less worried about quality and safety It will contribute to the accelerating pace of NHS privatisation and divert necessary funds away from St Pauls NHS Free we already paidIt means trusting opticians and my family has had problems with opticians.Has it or will it involve privatisation?opticians will be competent and fully trainedNot enough information about competencySame as earlier question! NO to NHS privatisation! It states that they will be trained to do this and it makes it convenient to do soSimpler more pleasant environments I am concerned about this becoming a mechanism by which charges could be introduced for the appointments on the basis of them not falling under NHS control, thereby dismantling the NHS.services within the community appear to be dealt with more quickly.Routine work needs to be carried out in the communityI am not qualified to answer this question.As before, routine appointments need not be at a hospital.i am not sure what the options are for post-operative appointments. You do not provide enough information to decide.it will decrease the waiting time in hospitals and would a better opportunity to monitor success of the operation and sight improvementsIt's not been proven to work and purely a money saving exerciseAs previousit depends upon the quality of service provided and how this is monitoredIn my opinion, the procedure is now quite routine.I do not agree with privatising this service, allowing private companies to make profits from the NHS.Are they experienced enough?I had my follow up checks by my optician It was quicker/more convenient than hospitalI do not agree with privatisation of health services. If they were NHS employed opticians based at a local clinic that would be OK,It's not clear if patients, and or carers are given a choice.If done by trained nurses.My checks were done by my optician. One caveat - the opticians need to be sufficiently experienced and skilled. I would want care from qualified doctorsI feel there should be at least 1 follow up appointment in hospital, As 3aNot tried & tested as far as I knowThis effectively outsources the service to the private sectori feel a follow up app should see the doctor who did op to safeguard the patients eyesight as opticians do not have a clean environment Post op. routine monitoring should be carried out in hospital/clinic contextWhere has it been piloted? Where can we see it working? There is simply not enough information about the proposed change. Who will provide the service? Will it be the NHS or private profit making organisations?Desire best service and best trained. No private contractors.More efficient use of skills and resourcesAgain less likely to have a long waitwould assume that post-operative appointments would be quicker and easier to arrangeEasier to get appointment and localLocal service is better easier to attend.See above. What would appointment waiting times be like if small number of qualified opticians Answer as aboveThe surgeon and or their assistants who did the op should perform post op treatment.Post op the surgeon responsible for the op should see you in clinic. ~Then refer to local clinic for dressing etc,Most people who have cataract are elderly and it would be much easierAgain local facilities are more convenient & save patients money in travel etcAgain local is best...but it has to be with the skill that is necessary.don’t know enough about itTo see if further deterioration has occurredYes it's not the operation it's a check up no problem hSo long as they are properly monitored.Not sure if all opticians are sufficiently experienced to do this, especially if there were problems with infection.As my comment to question 3again it's down to a question of experience & qualification The optician I use appears to be more competent and have better facilities that St PaulsI would be happy if the follow-ups were done in the walk-in centres, for instance. But would be worried that after agreeing to the change that the walk-in centres were closed or restricted.Probably be seen quicker than at St Pauls who seem overwhelmed with demand.It would be more convenient and would save time.Easy to accessSo long as there are no complications after the surgery this would free up consultantsI want health services to be offered by those employed by the Health Service. If they are 'in the community' is secondary.The nearer to home the betterI don't recall any after care when my mother had her cataracts removednot sureTo make it easier for patients to get to aftercare services.This option has to be specially definedMost cataract operations seem straight forward no doubt there could be exceptions.It's more convenientHave confidence with opticians.As above. The NHS should carry out the follow up appointments.Other parts of country already deal with this satisfactorily.not safeSee previous answer Post-operative follow ups should be done in the place of surgery, the hospitalI feel I've had exceptional services from my optometristSee previous answerIf the optician has been well versed to provide assessments for cataracts then I would hope that he would be able to provide aftercare.Beneficial for patients.I think the person who did the procedure i.e. in the Hospital is the best person to do it. Looked after before can look after you afterwards.Due to past experiences with opticians. Depends also where optician is based, hospital may be closer, makes it more convenient.As long as fully trained as makes the process quick.Would prefer St Paul's for my personal care where I feel safer.As they don't agree with it.Sounds easier.Easier for people to attend.Hospital has more experience.Easier plications.Again it is easier for people.Patients' interest at heart. Releases hospital doctor for more surgeries.Feel more confident going to hospital.As long as communications goes back to hospital, community opticians being well trained.Saves time and effort for hospital.Don't have faith in average optician.If opticians has done pre-op assessment it makes sense for them to do post op assessment.More accessible Same reason as question 3, need more experience.It is more convenient to go to a local community based optician rather than go to the hospital. ConvenientMoney and quicker treatment various reasons, on being you have had operation in hospital they have all your details. Would the optician be privy to these and would we still have confidentiality etc.I would feel more better about visiting a hospital after an operation.Again my family who advise me.Quicker waiting times Cut waiting lists downPost op by the doctor OS that it can be assessed if you have any sight problems and if any further treatment is necessarySaves going back and forward to hospitalDoes not have to worry about going back to hospital.Yes, it's easy for everyone.If optician has done pre op assessment it makes sense for them to do post op assessment.Previous bad experience Good ideaLooks good on paper but I'm not sure what it will mean when it happens.Depends on mobility - distance. Wheel chair accessible? Accessibility Good ideaIf everything i fine, then there's no need to go to hospital.Can provide same services.I would prefer to see the specialist at the hospital, I had complications from my surgery so I would like to see a specialist.So you dont have to always go the hospital Good to have them qualified to tell you what the problem is. I don't understand why they can't tell you if you have a problem with your eyes, they are opticians. Good to have them trained.I would want the first one to be done in hospital by a qualified doctor, to check surgery has been a success. All others would be happy with opticianUsually there isn't a problem. If you already have a visual impairment more likely to occure when it would be appropriate to return to hospitalSave waiting list at hospital - ease pressure on them.Providing they have the knowledge to recognise problemsGood plan, it will make it easier for the patient.I regularly see my optician so I’m sure if for any reason I needed to go back to hospital she would refer meGood plan.easier, more convenient & less expensivePeople only go to hospital when there is problem.convenient saves trip to hospital.Because this would be easier for people to be seen on a local basis and thefore reduce transport difficultiesCommon sense to go to the opticians rather than people waiting and the added anxiety of going back to hospitalIf there's no serious problem then that's fine.Efficient, speedyIt should be nearer to where people liveOnly go to the specialist if there's a problem, but you have to make sure the opticians are properly qualified.I feel post op should be at the hospital. I would want to make sure everything was ok.Rather go hospital - distanceSaves time and better than going to hospital.Quicker, easier Its easierLess waiting timeLess waiting, easier to get to if in the community & less stressful than a hospitalIt would be easier. There is always a long wait at the hospitalIt would free up the hospital and be more convenientHopefully be seen quicker. You have to wait a long time for hospital appointments, then they are cancelled.As long as optician is qualified I have no problem with the proposalMeans you don't have to go to the hospital unless you really need to go.Better to have people in the community so you can see them when you need to.It would save the hassle of going to the hospital and having to wait for hours to be seenI would take adviceLess waiting time for appointmentsLess wait saves time.Would cut down travelLess waiting!It will save time, be easier and save moneyTakes strain off hospital appointmentsFree up the hospital, easier to get to.Would save waiting timesIf there are no complications it would be pointless going to hospital againI believe this will be more time consuming and efficient for those who experience mobility difficulties.Provided they are routine and there are no other health implicationsTakes away fear of going to hospital. You get to know your opticianIf they are qualified I would be happy for them to give me this serviceEasier, more personal and less waiting time.I agree with this.More Local, Familiar FacesBad past experience with opticiansIf it's not a serious problem then it's better to be in the community.Not wasting doctors' time in hospital, so people who need more help can get help. It's less stressful and more friendly at the local place.Less waiting time at hospital, don't have to waste time if it's not important, better to see local optician.Again, good on paper, the diagram looks like a good plan - but not sure how it will be in real life.Specialist care from consultant It would be easier for me.Hopefully opticians will be based locally. Possibly not as long to wait for appointments. Less stressful environment.Opticians easier to access. Hopefully won't have to wait as long to be seen.Does not like the hospital at all. Feels it is rushed and more stressful.If there appeared to be no complications this would be easier post op.It would be a lot easier. The opticians are more local.it would save waiting time and organising transport.More convenient.As above - to take strain off hospital.Wouldn't make much difference if they did it at opticians rather than hospital and it is much easier to get to than hospital.Again, a lot easier and quicker to do in this way.Easier to see optician. Less waiting time on day.Prefer checks done by hospital.Closer to where people live and when only about cataracts, post-operative issues are minimal.Would be very good - as it would be quicker.I chose yes, because when you go to the hospital there is a long waiting time, usually, whereas the local optician appointment system seems more efficient.Yes because I would rather go back to the optician than the hospital.Yes because they will be qualified - if its a local optician he/she will know my case history.You have had treatment on the eyes and its for better if the specialist deals with your situation.As before, it will free up hospital services and be easier to access.Easier to get to and less stressful and more independent.The same reasons as number 3.Saves time and money.Presume if there is an issue an appointment would need to be made rather than immediate treatment.Easier to access location. More familiar with staff and therefore less stressful - more likely to see same person. Less waiting time. Free up hospital time for complex cases.For the same reason as in 3a, charges may be introduced in the near future under Simon Stevens' 5 Year Forward plan.More professional, quicker and better referral service and convenient.It's more convenient.Have confidence with opticians.Don't need to take time to wait for hospital appointment.It would be more convenient with the proposal for all routine post-operative cataract follow up appointments to be carried out by opticians in the local community.Easy to go to local opticians.No confidence with opticians.Save time (do not wait for the hospital appointment).No confidence with opticians.Don't need to wait a long time for the hospital letter.More convenient.More confidence with opticians.Don't know what's different about opticians and attending a hospital appointment.More convenient and agree with the proposal for all routine post-operative cataract follow up appointments to be carried out by local opticians.Have confidence with opticians for all routine post-operative.Confidence with opticians.Do need to take long time waiting for hospital appointment.Faster service.More convenient and saves time. No need to take transport to hospital, can use optician in city centre.I prefer to go back to the specialists care in hospital.Confidence in opticians, can access treatment more quickly.To reduce the waiting list in hospital.After operation it is also more convenient provided that I can have the referral and immediate booking with doctor if any side effect or complication existed after the operation.Agreed if the operation has no other side effect.Agreed but depends on the situation. Have a choice & refer by to GP for complications for my eye may be preferable.I prefer to have the post operation check up at hospital.Can get treatment immediately.Fast, no need to queue.I would prefer the care from hospital after operation.Convenience.Quick and fast and convenient.Convenient, less travel.Convenient, less travelling.Good to have the post operation check up by doctor.Prefer to do it in hospital with specialist around.Good and simple.More convenient, less travelling, faster service.Agreed the post operation check up by optician. Faster and more convenient if no side effects.Convenience.Convenience.If no side effects can go to have post operation check up at the opticians. More easy and easy for booking optician.Professional.Attending local opticians is more convenient because that will shorten the waiting time.Attend the same optician every year and follow up by a professional specialist.Quicker service and receive diagnostic results at initial assessment.for the same reasonas long as they are qualified don’t have a problem same as aboveas aboveprefer to be seen IN HOSPITAL.prefer to go to hospital - more convenientQuestion 5a.Please tell us what would prevent you.If there were extra burdens put on patients regarding costs and charging feesWhen having cataracts removed you are told not to bend forward so how are they the patient with restricted sight going to get to the opticians patients with complex eye problems If optician advised against it. experience againpoor quality of serviceDepends where optician is - many are not easy to get toRemembering for over 2 years my Dad was sent by his GP to Spec Savers for his hearing aids rather than to the audiology dept in the acute Trust. During this time he was unable to hear and 6 weeks prior to his death he was fitted with hearing aids by NHSIf the opticians became too busy because of the extra work load. This would make it a slower process.I would want to know how well qualified the opticians are in the communityLack of confidence in their ethical code. Do they even have one? My understanding is that they provide profit driven delivery.lack of confidence in high st. opticiansAs abovefear of amateurs doing a professional jobI would want an NHS professional to check me over.These services should be provided in the hospital directly by the National Health ServiceMy only concern would be that a private optician may have an interest in selling you un-necessarily expensive reading glasses if they were required after the procedure.Concerned pre existing eye condition may be affected or not fully reviewedI feel that this has probably already been decided so I would not have an alternative. I also feel that this is the thin end of the wedgeFear that an optician cannot be upgraded to deal with cataractsDistrust of advice from personal experience.If there was more complexity than just a cataract again level of experienceI would prefer to be seen by an eye specialist doctori wouldn't trust them. I feel they focus more on selling glasses than eye health. I don't feel there would be the same standard of care. Complications during surgeryMy faith in the training offered and the facilities available.Concern that they could miss something they had not come across before If it is at a community health centre I would be more confident to use the service, but if it was a private optician I am not so plications during surgeryI have cataracts and feel that I would be better if they where removed and has my last appointment with the optician he said I should not get my eyes tested for 2 years and i think this is too long and my distance sight would improve if they where removed.As aboveAs I said before I do not have very much trust in options in the community I am unsure if follow up with community opticians would be in the best interest of the patient. Opticians don't have the same expertise as ophthalmologists and I'd worry that they could miss post op problems. Pre op assessment is more acceptable.I would feel more confident using a hospital for initial appointments, but okay having an optician check up afterwards.Lack of confidence in assessment and lack of knowledge of pathway I support 100% public sector NHS services cost NHS Free we already paidHas it or will it involve privatisation?if there was a charge involvedIn the future, the cost might, if charges were introduced as the service were no longer seen as free for all under direct NHS control.Again, lack of information.Profit before patients is a no noit depends upon the quality of service provided and how this is monitoredMy concerns as to experienceI would not trust a optician employed privately in the same way that I would trust a NHS employed practitioner.I am concerned about the post-op provisionas mentioned in question 3Lack of skill and experienceI would not feel confident that they were qualifiedI would prefer for at l sat 1 follow up at hospitalBeing in it for profitA concern about this service being outsourced to the private sectorIf there were complications related to cataracts or perhaps other un/related issues such as diabetes, would an optician be able to provide best medical advice / attention? Less regulationNHS services should not be handed to non NHS providers without the evidence to show that it is successful. Where has it been tried before? Did it work?Comments aboveUse opticians for consultations but not sure about them doing themLocal opticians MUST be qualified for these procedures.Please see answer 4a.If I suspect that the optician is not fully qualifiedIf the there insufficient training of staff & it becomes a "paid for privatised service"If I felt that my local optician was ineffective and without the necessary skills.would rather have my optician who knows me and my history rather than a blank stranger He/she might be very good but it still doesn't erase that feeling of unsureYes really I suffer from allergies and you never know what can start it off Capabilities and expertise of some (not all) opticiansneed to be sure they are as experienced in this matter I do not have full confidence in all commercial opticians.Distaste for privatisation of the NHSAlways providing that the person undertaking is a competent and qualified practitionerThis option will cost more See above responses.I believe they can only have a vested interest in making moneyCompanies who I feel don’t employ the right level of professionalsno confidence in their ability to see anything that may be wrongI would like the follow up service to be in hospital.Optician's lack of knowledge.If they are not appropriately trained - as could be misdiagnosed.I would rather be under an official consultant at St Paul's.Older people would prefer going to the hospital.Feel uncomfortable as lack of experience.Clean. Distance.Housebound.Lack of experience.Would prefer hospital as more experienced.The specialist.Insufficient experienceProviding the community optician had all the relevant training and qualifications this is a good service to access.My daughters experience of the pre-op was terrible. Ended up speaking to PALS and meeting the head nurse. Operation cancelled at moment even after cooling off period of a few weeks. Will re address in a couple of monthsBad experience at pre-op even though my mum was with me and answered the questions when I did not understand. I was very upset and do not want the operation at the moment so asked mum to cancel which she hasOnly if couldn’t get there due to mobility issues.Opticians offer glasses not eye careI need support travelling with someone I like and do independent on my ownOpticians are not eye specialists, they sell glasses.I have a learning disability and would need someone to explain things to be clearlyI would need support and I would find it hard to find the area if it was far awayHave to be efficient, caring like the hospital, fully trained.If it's too far then it might mean to go to hospital is better.Mobility accessibility If wasn’t full I would prefer to go to the hospital.It will have to be nearby, if it's further than the hospital then there's no point for it.Location I have pre-existing sight conditions. It would not be routineI would rather have an initial assessment at hospital. I think it would be too much responsibility for opticiansI feel initial assessment should be done at hospitalIf I have to wait longer and it doesn't turn out the way I expected (longer wait)If the way I thought it would be doesn't happen like that (have to wait a lot).Only thing would put me off is long waiting list and complicated process.Physically getting to facilities in unknown areas (visually impaired already). Whilst my condition may not be covered through this proposal I do have caring responsibilities.If I had complex needs.Whether said 'community optician' was properly qualified, also with 3a and 4a in mind.What I worry is I may have other eye diseases & not sure if the opticians using equipment can detect these diseases. It is good that option with my GP and let me know my problem.Question 6Other commentsyes, just to remember that elderly people (these are usually the ones who use this service) like to have a chat and treat these visits as a day out so hopefully the people who are delivering will be friendly and emphatic to them. Although this would help take the pressure of hospitals I'm not sure how a high street optician would feel. Most opticians are fairly small and it is hard enough to get an appointment for a routine eye test never mind post operative surgery. If the level of care could be guaranteed...Liverpool needs to be able to have the equipment to allow patients to sit up, my brother cannot lie down and had to go to Manchester as they were the nearest trust to have the equipment for do the operationI agree in principle as long as it benefits local patients and not for the benefit of corporationsMore privatisation I already have hearing aids through an optician they just don't carethis is certainly the way forward My father had both of his cataracts removed in a mobile unit. Excellent. Could this be done in more areas. All falls on pay grade and experience of person checking my eyesGreat idea as long as cost implications on patients very clear....I think the cataract service is in need of a major overhaul. My Specsaver's optician referred me to St Paul's in April 2016. It is now January 2017 & I have been told I will still have to wait months for the procedure to be done. It is extremely uncomfortable & effecting my driving.My optician diagnosed my cataract at an early stage and monitored it's progression so I am confident in the service offered. I cannot speak to the competence of other practices and would expect them to have a process of assessment before selection to participate in the programme. I would also hope that any resources saved would be used to enable a reduction in waiting times for cataract and other eye surgeries Will there be more community opticians to deal with the increased work load or will the opticians we already have just be expected to work longer hours? If the latter is the case I can foresee lots of problems and the new system failing.I assume the local opticians are as competent as hospital ones and care is taken to avoid infections.I don't expect to have second class care in order to stay mobile eye sight is very important I have a very good optician and the ophthalmology dept. have said as such. Many patients don't. This would be a positive move for patients and hospital services.It is important that the community services help to reduce the pressure on the NHS services.I was delighted with all aspects of treatment, which was hugely successful I think the cuts to the NHS are appalling for everyone Evil for the poorNonemore privatisation in NHSIt seems like a good idea to save people making trips to hospitals particularly when they have problems with eyesight. Post operatively I would need to understand more what is entailed.Is this real? How does consultation actually influence decisions. If all the consulted said no should this change the decision. Have you made a determination about a required response rate / number and or a determination about a level of support or opposition that would change the outcome? I guess not. Please answer The service went very wellThis is privatisation of NHS by back door, same as Specsavers doing hearing tests. Put money into NHS cataract services to keep them in house. It would be good if you had a choice of opticians so that, for example, you could go to one near a relative's home or near work, or your regular optician if you preferred to do that.My optician does not appear to be on the list. If this system is introduced will the number of opticians participating be increased? If not it will be more complex than the present system. If I had to go to 2 opticians I might leave my current one, losing them business which would be very bad.I think we are lucky in Liverpool area. Majority of our opticians are well trained and have a good relationship with the hospitalsMany have to pay at opticians. Don't trust the government to maintain free cataract service.I have better eyesight than i have had for all of the rest of my life. it has been transformational.My personal experience was attention and care of the highest order and have assured several would-be patients of the simplicity and great care that this procedure entails. I broadly agree with the reasons as set out in the FAQs.For straight forward surgery. No other eye conditions then agree with proposal. Would need immediate referral back into specialists if complicationsGo for it!I hope that any opticians participating will be able to provide a fully accessible service to disabled customers.Possible reduction in waiting times for cataract operations.Would need to be reassured of competency of community optician.it could be fine but need to ensure all optians at same level as the optians Well done Liverpool I was telling a friend in Winchester who has to travel overnight almost to Southampton Brilliant proposalLocal opticians need to be used to help aging people conveniently get treatment and check ups. Waiting in hospital is too long & cost me a lot to get the sink would prefer my local optician does not cost me to get there & I don't have to wait too long for an appointment & when I do have an appointment I'm not waiting around to be seen for ages tooI think being seen at the opticians, instead of the hospital, would help a lot of people because it's easier to get to. It would also help the hospitals because they would then have more Drs appointments available It would be far more user friendly for elderly retired people to use this service!This would be far easier than trying to get follow up appointments at hospitals... or even your local doctor!!A brilliant step forward which will surely benefit patientsNoas long as medical trained staff are removing the cataract I think the option to have the post-operative appointment should be left to the patient and they should have the choice of where they have this.I have seen this process from both sides and much prefer the way my assessments and surgery went than the long delays and several appt cancellations my husband went through.Would local opticians need special training in this field.The convenience of a local optician with less journey time.While i can see the merits in offering this service. It would not be an easy fix. patients would need to feel confident about the whole structureI work in an ophthalmic unit and I am responsible for examining post operative cataract patients ,yes whilst most patient s do not have any problems post operatively there are still a number who have problems picked up this check,as the pt is already in the hospital setting they can be dealt with quickly.I also worry that patients may not attend these appts in the community as it may not feel the importance of the appt as they would a hospital appt.I think it may increase the number of patients coming through the primary care setting if any problems ,putting added pressure on to an already busy clinic .The key is improve access to community who have multi barriers to servicesLocal first line is great, but there should be guarantees built in so that people who need proper medical evaluations will get these. Opticians are not doctors.NoneI feel appointment service is very poor and they do forget to send appointments My father has received a first class service from the Royal. The clinics are really busy and the staff are lovely.As a health service provider this will help to provide additional eye servicers and eye complaints, to the more vulnerable members of our society. I would rather travel and be seen by a specialistI believe that after operation, follow up should be done by doctors who operated for sometime until discharged and referred to the local community opticians for continuous check up.Make local opticians do a few day refresher courses and this can increase the confidence of patients to seek them as first point contact Your eyes are the most important part of your life and needs to be done with care in a clinical manner I would expect there to be robust accreditation and c.p.d in place in order that I can have and maintain confidence in the service and regular and ongoing reporting of untoward events with appropriate action taken.thank you It is very difficult to come down on one side or the other. I assume that all community opticians are as fully trained hospital based opticians but the community based one's do not as far as I am aware do operations. This is why I am not keen but could be persuaded if more information on this matter was made available. noNHS Free we already paid for our NHSHas it or will it involve privatisation?The Royal Liverpool us very difficult to get to from our end of the city. Public transport directly to the hospital is very sparse and only for visitors, not for appointments at various times of the day. For this reason, I would like more routine services and tests in the community where people live.The only means of this survey to me is what I should be aware of with my vision, and what care you offer against getting cataract. At this stage I have short sighted vision, that changes slightly every time I go for a regular eye test - every 2 years, and next test is scheduled this coming March.If they are trained and it cost no more money and it is a potential saving then it can only be a good thingGreat idea everyone should be doing this I feel services within the community give people the opportunity to be dealt with quickly.Do you intend to use the results of this survey to roll out untried provision? The questions are impossible to answer should the respondent have no experience of being treated for cataracts. Most people do not - so if you seek to justify changes in provision based on responses from people who don't know what they are talking about I would be inclined to mistrust the purpose of this survey.Save the money it is costing the health service by getting rid of all the CCGs clawing money from the system, as we as all the private companies. Drawing off cash for profitI would hope that the accreditation process is rigorous as I worry that some people may not get the correct treatmentThe results achieved are so great, I feel it should be available as widely as possibleThe information given about this service looks to be very helpful for the patient and would be good if there were some reassurances about complications and support in the community. It seems the responsibility is to be transferred totally to the optometrist. I feel that vulnerable and elderly people living alone may need more support at home. How will the optometrist deal with this?I feel that all could be done at the opticians but that it should be carried out by trained nurses.The service I received from my optician and the service at st Catherine's was second to none. All were highly skilled and provided me with an efficient, skilled and effective experience. opticians already do checks for cataracts and send you to the day centre at St Pauls if any problem any other assessments would need a clean safe area plus would this service be free?? Opticians are not doctors they do know how to assess eye problems but not to perform or check surgery??what safeguards are being put in to protect the patients health? NHS care should not be handed to other providers without clear evidence that it gives real, measurable benefit to patient care.Keep our NHS. I have received great treatment at the Royal.Great ideaBig up to our amazing NHS!!!Opticians are there for profit so maybe more pressure on NHS.If the opticians are not overloaded then the system should work, as long as PROPER funding is in place.Identifying and referring to hospital for surgery or treatment can be done by an Optomotrist, but not in house surgery under G Anesthetic. No backup if anaesthetic procedure goes wrong especially as this type of surgery is normally performed on elderly folk with other complicated complaints.It would not be that way if not first approved by NICE.On the whole it is s good idea, aimed at saving: time, specialised resources, costs, access improvement for patients. Downside is if it becomes a semi privatised service as Optical treatment now is under NHS. Will opticians exploit it? Will it have a lower priority with them than selling glasses & eye tests & will they have time & trained resources to deliver it? I believe that we need to ensure that we think about the requirement over and above the service in relation to the people themselves. In today's world travelling to and from services can be difficult and expensive. Local has to be best but effective.Yes funnier enough I am waiting to have mine done I have been to opticians in whom I have no confidence either in their abilities or in the standard of their equipment and premises. There would have to be guidelines and qualifications visibly displayed on the premises for me to trust them I do have much more confidence in St Pauls and I do believe the service is second to none.Anything that speeds up the process without impacting on patients would be a good thing.Anything that helps patients should be considered. People are depressed at the amount of time spent waiting both for assessment, operation and post op consultantIf there are any complications that opticians can refer patients urgently for quick treatment and reassurance This is a very distasteful questionnaire. I appears to be about one this but is totally political and is not explicit about this.As it is mostly elderly people who have problems with cataracts it makes sense to have a service near to their homesearly treatment is important. Cataracts left my mother with the inability to read, knit or watch television. It hastened her dementia.I think the involvement of the opticians is a very good idea, as people are more likely to go to them instead of awaiting a hospital appointmentNoneNo comments.Provide booklet about optician's information with cataract reviewing services.Once these services are gone, they are gone and the NHS loses funding plus expertise when jobs are lost to the private sector.If the system was used then patients would have no option but to use it but I would prefer hospital follow ups.My optometrist is easier to access than the hospital (given my disability). Parking is also easier and cheaper than the hospital I personally have been told by one optician that I have cataracts and by another that there are no signs of cataracts but there may be retinitis pigmentosa!! This was a year ago and I can still see perfectly well. They may be able to do visual correction work but beyond that I am sure that many would not be up to it. Would be a dangerous move.I trust that the NHS will provide the necessary training etc to further an optician's skills. Would this be affected by "problems" in the NHS at the moment?Very good.I am against creeping privatisation of the NHS. Boots, Specsavers etc. Have pushed out the real local opticians and are making a fortune from profits that should be invested back into our NHS.Good idea because of waiting lists (4-6 months).Should be available to everybody.As long as they are qualified.Any other problems I would go to a normal opticians for an eye test however for personal care with cataracts I prefer St Paul's.I feel more confident with care and aftercare being with the Royal.Agree to lower hospital lists.Positive service.Op quicker, faster service.Good in the communityGood idea.Good idea.Need full training and overseen correctly.Think the new proposed changes will speed things up and take pressure off hospitals.Long term it will not save money.I think this is a good way of utilising resources in the community for routine cataract assessment and follow up.Staff training with pre-op department on listening to family of patient who is having treatment. they know what can be told and it does not need to be repeated when told, it has been addressed and patient is frightened and anxious about procedure.Staff need to listen and be more understanding. I am lucky to have my mum and brother to go to appointments with me and explain things to me and speak up to staff for me.Good IdeaThis confused me. You need to be more clear in what you mean so I can understandIt was very confusing. I didn't understand the difference at first.Opticians are not eye specialists It is very confusingThe worksheet confused me as it was laid out wrong and the questions were hard.Our eyes are special and need qualified care from a eye specialist at a hospital. This is a cost cutting service lining the pockets of the opticians. Why not pay to have extra staff in the hospital clinics? Thinks the new proposed changes will speed things up and take the pressure off hospitals.My mum is happy with her GP, they do eye checks there, so she won't need to go to the opticians in the community.Can we have the list of these opticians?If these changes are implemented there needs to be properly qualified professionals. Needs to have proper training and guidelines with regards to referrals.Will this reduce waiting time for the cataract operations?Will people still have access to interpreters at the local optician, just like in hospital?I believe that the proposed changes would benefit people, hopefully with reduced waiting times. Community services would be more accessible.It makes more sense to use opticians were they are suitably qualifiedMore and more people filling up hospitals so the proposal is a good one.I would like to know the opticians who do this service.My experience of cataract surgery was very good. Although this was several years ago.Looking forward to this service.I think this is a very good idea as you’re not sitting around waiting in a hospitalI would like to find out who the local opticians are.The proposed changes sound like a good ideaNOI have had both cataracts done and has no issues with the existing serviceMy own experience was private case in Spire Hospital. I feel its a step in the right directionMy experience was a good one. I was satisfied with the treatment and the follow up. However it does get very crowded at the hospitalthe new proposal would take less timeI like the service and would like it to get faster.It would take the strain of the hospital servicesTakes too long, the faster the better.Satisfied but agree with changes.The cataract service is quite straight forward the girls or nurses in St Pauls put you at ease right awayGreat IdeaThis is a change for the better, from one who knows sitting on hospital with my eye conditions all my lifeMy only concern is around complications. I know from experience with a family member that cataract operations are not always successful.NoI have recently had cataract operation - 3 weeks ago - and felt I received a fabulous service at RLUHTI think options in the community is great idea and the service should be in place as soon as possible for easier and quicker process.Positive service, helps hospital.How will the interpreters be at the local opticians, is it the same system as in hospital?NoWhere will they be? It will be easier if they plan for the opticians to be easy to get to and not at the other end of town. Our people may need interpreters, so will be good idea to make sure that they are available locally.Long waiting lists currently - will this reduce waiting times.I go every 4 months to St Pauls eye hospital.It is great to have a community opticians service, and have access to all other services on your doorstep. People feel at ease locally than in a hospital environment.Sounds a very good service.I have already had 1 eye done recently.I have just been diagnosed with cataracts and have been waiting for an appointment for more than two months.I attend St Pauls every 2 weeks for ingrown eye lashes.I have wasted a lot of time for appointments in relation to my eyes.Female opticians will be good to have trained up, for Muslims it is good and better.It's straightforward, shouldn't be a problem for people. Things are getting better for people. They have these electronic systems now that tells you you have an appointment, the time and where it is.Quite happy with survey.I think people need interpreters and for women, female opticians is better. But really it should be a problem.Cataract services were very good when I had cataracts done several years ago.I think the proposed changes will hopefully reduce stress for the patient and speed up the process from diagnosis to treatment.All for improved service.Feel the proposals are a step in the right direction.Times are changing - I'm not used to changed. I have an existing eye condition. I believe there should be individual choice. Those who are used to attending opticians regularly will prefer the proposed service.I think it is a good proposal.I think it would be a good change of process and would lessen need to attend hospital.I think this is a good proposal.It sounds as if it will be a lot quicker and easier with the changes.Think it's a great idea, I think also they should bring other eye conditions to the community to free up St Pauls for more complex issues.My experience of the cataract service is very good - St Pauls - overnight stay and discharged after operation. Very happy with the outcome.I would be worried with if regular use would make it slipshod, it wouldn't be the trained facilities.Overall I consider the new proposal to be a good one - providing most opticians take up training to allow them to do initial assessments and post-op follow ups.Recently had a stroke - would improve accessibility to appointments.Interpreters are much needed, particularly for the elderly.Provide booklet about opticians' information with cataract reviewing services.Please arrange Cantonese interpreter with opticians.Need to provide Cantonese interpreter when taking cataract assessments.Language barrier.Worry about the language barrier.Provide transport and interpreter if it is possible.Provide interpreter with opticians.Please arrange interpreter when attending hospital cataract appointment or with opticians.Please provide interpreter with opticians.Provide Cantonese interpreter with opticians.Provide interpreter with opticians.Provide Cantonese interpreter.Make information sheet in Chinese to show the steps, may be easy for us to follow.I agree the optician to refer me to the hospital rather than through GP.It's better to have interpreter provided.Agreed the hospital can make good use and more efficient to redesign the services so that more urgent cases of eye diseases can be treated timely but the extended services of the opticians should enjoy similar eye equipment, skills and qualifications, the same as the hospital.Extended service on optician will help patients in terms of time and also better use of hospital service.Agreed to refer the case to hospital through the optician.Please provide Cantonese translation.Convenience.Agreed better use of hospital service and extended service by the opticians.Going to the community opticians for initial assessment is the best choice.Agreed the extended service by community optician for primary eye care. Work closely with GP will be a benefit to patients.Provide Cantonese interpreter.Agreed that the proposal helps to lessen the waiting time, more convenient. The extended service by optician is welcome but good to work closely with GP to perform the primary care service.Agreed to have services in community opticians.My previous cataract operation was not doing quite well so it is important that the optician should have the skills and qualifications. Also the equipment for eye assessment should be the same standard as the hospital. More confidence to the service user.Good use of hospital service, the proposal helps to save NHS resources and put into more serious and urgent cases about eye care.The most important is professional advice with interpretation service.It is better if there is an interpreter provided for cataract services.Patient safety is crucial.Last patient in and told out of time for surgery. No staff knew about cancellation.in clinic for 5 hours - just for assessment - too many patients - felt sorry for consultants to high workloads at clinic.fine and all good.all fine.convenience importantEverything was great.appraisal in October - cannot get in touch with anyone to get info from clinics or appointment.choice of venue - chose Southportbrilliant.need cataract test - declined surgery.seen at eyesight clinic - but had eye scratched by consultant.Lots of put-backs and date changes and cancellations made at short notice by st. Paul's - 2nd eye op unsuccessful appointment staff not aware of changes or advice given.Long gaps between eye pre-op and surgery dates. pretty good all round experience. ................
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