Scope of this report

1 For centralised office function review see Quality Assurance Visit Report: NHS Diabetic Eye Screening Programme – InHealth Intelligence centralised functions 26 July 2022

Summary

The NHS Diabetic Eye Screening Programme aims to reduce the risk of sight loss among people with diabetes by the prompt identification and effective treatment of sight-threatening diabetic retinopathy, at the appropriate stage of the disease process.

The findings in this report relate to the quality assurance visit on 26 January 2023 to the Devon Diabetic Eye Screening Service which is commissioned by NHS England (South-West) Public Health Commissioning team. Any commissioning findings are outside the scope of this report and will be followed up directly with the commissioner.

Quality assurance purpose and approach

Quality assurance (QA) aims to achieve and maintain national standards, promote continuous improvement in diabetic eye screening (DES) and support reducing health inequalities. This is to ensure all eligible people have access to a consistent high quality, effective, equitable and safe service wherever they live.

QA visits are carried out by the NHS England Screening Quality Assurance Service (SQAS).

The evidence for this report comes from the following sources:

• monitoring of routine data collected by the NHS England
• data and reports from external organisations
• evidence submitted by the provider(s) and external organisations
• discussion with the commissioner in advance of the visit
• information collected during pre-clinical review visits to the Regus Rooms at Exeter Business Park and Bickleigh House in Exeter and on 29 November 2022, as well as pre-administration reviews at Bickleigh House, Exeter on 8 December 2022
• information shared with the south regional SQAS as part of the visit process.

The screening service

NHS England (South-West) Public Health Commissioning Team (PHCT) commissions the Devon Diabetic Eye Screening Service (DDESS) using the using the NHS public health functions agreement 2022/23 service specification No.22.

The service operates across 10 local authorities and one NHS England Integrated Care Board (ICB) – NHS Devon.

The DDESS is an InHealth Intelligence (IHI) hosted service established in April 2019 following the merger of the Plymouth Diabetic Eye Screening Programme, Torbay Diabetic Eye Screening Programme and North & East Devon Diabetic Eye Screening Programme.

IHI are the provider for 11 diabetic eye screening (DES) services across the country. All these services benefit from IHI’s centralised functions based at Winsford in Cheshire including central failsafe management, bookings for call/recall, letter distribution, grading and customer operations.

The IHI centralised functions office received their first Quality Assurance (QA) visit in July 2022 and a report with recommendations has been published. An associated action plan has also been developed and will be monitored accordingly by NHS England. The findings within this report should be read in conjunction with the centralised functions report.

A population of c.79,000 people with diabetes are registered on the screening database (as of June 2022).

People with diabetes access screening in Devon via 46 fixed-site locations in the community, including hospital sites, supermarkets, General Practitioner (GP) practices and high-street opticians.

The service is provided to the eligible populations in seven military bases, three prisons, and one mental health unit.

Screen-positive people with diabetes requiring ophthalmological assessment or treatment are referred to four treatment centres across three NHS Trusts: Royal Devon University Healthcare NHS Foundation Trust; Torbay and South Devon NHS Foundation Trust, and University Hospitals Plymouth NHS Trust.

Findings

This is an exemplary service. The latest quarterly (quarter 1) standards 2022-2023 data shows that of the 13 standards with thresholds, DDESS met the acceptable threshold for seven; three have met the achievable threshold (Appendix A). Whilst some pathway standards have not been met, performance issues are promptly addressed, or extend into the treatment pathway which is governed by the NHS Devon Integrated Care Board.

The screening test and grading was completed to a high standard.

Having restored ahead of schedule following the cessation of screening during the COVID-19 pandemic, the service now must address large fluctuations in their call/recall profile.

The screening service has implemented numerous screening inequalities workstreams following completion of the Health Equity Assessment Tool in 2020 but would now benefit from a refresh of this work.

Immediate concerns

No immediate concerns were identified.

High priority findings

The QA visit team identified one high priority finding as summarised below:

• Insufficient capacity for Slit-Lamp Biomicroscopy (SLB) pathway

Examples of practice that can be shared

The QA visit team identified several areas of practice for sharing, including:

• engagement of public health expertise and analysis to support health inequalities workstreams
• development of videos for slit-lamp examiner training, and patient experience
• screening images and results accessible to the wider diabetes healthcare community, including Paediatrics, Maternity, Endocrinology, and Diabetology
• professional development of staff as learning disabilities champions
• nursing home clinic with support from SLB examiner to encourage attendance and avoid repeat appointments
• review of urgent referrals that have been downgraded in priority by the local hospital eye service

Recommendations

The following recommendations are for the provider to action unless otherwise stated.

Next steps

The screening service is responsible for developing an action plan in collaboration with the commissioners to complete the recommendations contained within this report.

SQAS will work with commissioners to monitor activity and progress of the recommendations for 12 months after the report is published. After this point SQAS will send a letter to the provider and commissioners summarising progress made and will outline any further action(s) needed.

Appendix A: References

1. Approved cameras and settings Diabetic eye screening: approved cameras and settings
2. Assuring the quality of grading Diabetic eye screening: assuring the quality of grading
3. Cohort management Diabetic eye screening: cohort management
4. Diabetes prevalence estimates for local populations Diabetes prevalence estimates for local populations
5. Diabetic eye screening standards valid for data collected Diabetic eye screening standards valid for data collected from 1 April 2019
6. Managing patients not on the register Diabetic eye screening: managing patients not on the register
7. Managing referrals to hospital eye services Diabetic eye screening: managing referrals to hospital eye services
8. Managing safety incidents in NHS screening programmes Managing safety incidents in NHS screening programmes
9. NHS England Serious Incident Framework Serious incident framework
10. Optical coherence tomography (OCT) in surveillance Diabetic eye screening: optical coherence tomography in surveillance
11. Programmes that do not arbitrate on R0 or R1 Diabetic eye screening: programmes that do not arbitrate on R0 or R1
12. Public health profiles Health Profiles
13. Roles of clinical leads Diabetic eye screening: roles of clinical leads
14. Screening pathway requirements specification Diabetic eye screening pathway requirements specification
15. Slit lamp biomicroscopy (SLB) examiner framework Diabetic eye screening: slit lamp biomicroscopy examiner framework
16. Surveillance pathways Diabetic eye screening: surveillance pathways
17. Test and training participation Diabetic eye screening: test and training participation
18. The Royal College of Ophthalmologists: The Delivery of Diabetic Eye Care Diabetic Retinopathy Guidelines | The Royal College of Ophthalmologists