Scope of this report

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 to the InHealth Intelligence (IHI) centralised functions. The visit was held on 26 July 2022.  

Quality assurance purpose and approach

Quality assurance (QA) aims to achieve and maintain national standards and promote continuous improvement in diabetic eye (DES) screening. This is to ensure all eligible people have access to a consistent high quality 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 NHS England
• evidence submitted by the provider
• information collected during pre-review visits to the centralised functions office on 15 June 2022
• information shared with the North SQAS as part of the visit process.

The screening service

InHealth Intelligence (IHI) are the provider for 10 diabetic eye screening (DES) services across the country. They have been awarded the contract for a further service and are due to commence screening following mobilisation on 01 October 2022.

The centralised functions office is based at Winsford in Cheshire and provides central failsafe management, bookings for call/recall, letter distribution, grading and customer operations. Screening examinations, slit lamp biomicroscopy and referrals are managed by the individual linked DES services.

There is no single commissioning team with responsibility for the IHI centralised functions, instead each linked service responds to a regional commissioning team for incidents, programme boards, QA visits and recommendation oversight. The lack of formal coordinated commissioning arrangements has been escalated to the Public Health Commissioning & Operations team (PHCO).

Findings

This is the first QA visit to the IHI centralised functions office. Functions delivered were found to be patient centred and well organised from a team who are motivated, knowledgeable, and work well across all disciplines.

Immediate concerns

The QA visit team identified no immediate concerns.  

High priority findings

The QA visit team identified no high priority findings.

The following were made as standard recommendations:

• review and update the standard operating procedures listed within appendix C
• develop a job description for the Medical Director role which will promote oversight and assurance, and provides a clear distinction between this role and the linked services clinical leads
• develop and implement a standardised agenda, attendance register and terms of reference for the monthly clinical leads network meetings
• review and update the data continuity strategy to ensure this includes the latest details for data backup and disaster recovery processes

Examples of practice that can be shared

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

• embedded failsafe officers within hospital eye services who support the tracking and monitoring of referred individuals
• additional operational capacity to support services through the COVID-19 pandemic (the purchase of screening vans for low-uptake areas and the employment of 75 new screeners)
• extensive use of IT to automate and standardise reports and failsafe processes.

Recommendations

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

Next steps

The InHealth Intelligence Head of Diabetic Eye Screening Programmes is responsible for developing an action plan to complete the recommendations contained within this report.

SQAS will work with the provider and a nominated commissioner(s) 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 commissioner(s) summarising progress made and will outline any further action(s) needed.

Appendix: References

1. Roles of clinical leads Diabetic eye screening: roles of clinical leads
2. Screening pathway requirements specification Diabetic eye screening pathway requirements specification
3. Surveillance pathways Diabetic eye screening: surveillance pathways
4. Service specification no.22; NHS Diabetic Eye Screening Programme NHS Diabetic eye screening.pdf