Agenda item

Matthew Tait (Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) has been invited to present a report on Eyecare services in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Matthew Tait (BOB ICB Chief Delivery Officer) was invited to present a report on Eyecare Services in Oxfordshire.

Also, in attendance to support the Committee and answer their questions were Hannah Mills (Director of Delivery UEC and Elective), Sharon Barrington (Associate Director Acute Provider Collaborative), Ansaf Azhar (Director of Public Health at Oxfordshire County Council), and Karen Fuller (Director of Adult Social Services at Oxfordshire County Council).

Stella Hornby (Consultant Ophthalmologist at the Oxford Eye Hospital who initially spoke as a public speaker) also joined the Committee upon the Chair’s invitation.

The BOB ICB Chief Delivery Officer confirmed support for sustainable secondary care, highlighted challenges between NHS and private providers, and stated adherence to national policy on provider choice and tariffs. The Director of Delivery emphasised equal application of the national tariff and ongoing work in ophthalmology. The Associate Director explained that the single access model improved patient choice, cited responses to Healthwatch Oxfordshire recommendations on eyecare services, and listed enhancements in information, accessibility, and engagement.

Members raised the following questions and concerns:

• How did the ICB ensure consistency, quality, and good value across primary, intermediate, and secondary eyecare services, and what was the approach to procuring new services and reviewing contracts. Officers explained that the ICB held regular meetings with providers, monitored patient feedback and activity, and relied on national accreditation standards for clinical consistency and safety. It was noted that value for money checks were conducted when procuring new services or reviewing contracts, with more influence over local intermediate services, while national tariffs applied to acute and private providers.

• What mechanisms were in place to ensure that private eyecare providers adhered to the same rigorous standards as the NHS; as well as what contractual authority were exercised over private suppliers, and the processes for addressing instances of provider failure and patient complications.

The Director of Delivery stated that private providers were subject to the NHS standard contract and accreditation checks, with quality monitored through contractual mechanisms and feedback. However, it was acknowledged that when the ICB did not hold a direct contract, oversight was weaker, and there was no systematic way for NHS hospitals to report or track complications arising from private providers. Where incidents were reported, the ICB’s quality teams investigated and, if necessary, conducted multi-agency reviews for recurring issues.

• There were concerns raised about the destabilising impact of independent service providers (ISPs) on NHS ophthalmology pathways and training. It was explained that the growth of ISPs providing low complexity cataract care had reduced the number of suitable cases for NHS trainees, leading to the loss of trainees and affecting the quality of training.

Efforts were being made to arrange joint training opportunities with ISPs, but challenges remained, such as limited frequency of training lists and ISPs preferring more experienced trainees. It was noted that Oxford had been particularly hard hit, with training quality and appeal reduced, and that national work was ongoing to address these issues.

Members pushed further about how NHS trainees in eyecare were being trained, and what support the ICB provided for retaining ophthalmologists and optometrists, and the challenges faced around staff retention.

Officers indicated that recruitment and retention were key to service sustainability, with positive developments seen through closer collaboration among NHS trusts in the region, such as offering opportunities to work across different sites and services. However, it was acknowledged that further details on ophthalmologist recruitment would need input from the Trust, and that retention remained a significant challenge, especially in specialties like ophthalmology.

• Members expressed concern about the perception that the healthcare market, particularly in ophthalmology, had expanded beyond manageable limits. They were troubled by the suggestion that the ICB had limited ability to address the resulting challenges, such as the absence of a cap on service provision and the associated financial risks. In response, it was explained that national policy restricts the ICB’s capacity to control market size or impose spending limits.

However, measures like the implementation of a single point of access have been introduced to help manage referrals and enhance patient choice. While acknowledging the constraints of national policy, the ICB emphasised its ongoing collaboration with NHS Trusts to support departmental sustainability, despite lacking the flexibility to limit the number of providers or financial exposure.

• Whether there were any geographical differences in the provision of eyecare services and how such differences were measured. Officers explained that general optometry services were available across the area, including domiciliary options for housebound patients, and that onward referrals included arrangements for patient transport if needed. It was noted that the single point of access system allowed patients to choose from a range of providers, including those outside the immediate area, and that contracts existed with providers beyond the local footprint to ensure coverage for rural and cross-border patients.

Additionally, eligible patients could access patient transport services, and for those not meeting the national eligibility criteria, the service would signpost them to alternative options, including voluntary organisations and local offers, acknowledging that transport remained a significant issue, especially in rural areas.

• There were concerns about the use of Artificial Intelligence (AI) tools in the single point of access process, specifically whether patients interacted with real people or AI, and how this affected those who struggled with IT, learning difficulties, or hearing impairments. The Director of Delivery clarified that while an AI tool was used for some referrals, patients with identified difficulties could be referred directly to speak with a person, usually by their optometrist. Additionally, measures such as flexible call times and support from others were in place to help those unable to use the AI system, though availability in different languages was still being developed.

The Committee AGREED to issue the following recommendations:

1. For the ICB establish a localised dashboard to monitor contract outcomes and patient satisfaction across Oxfordshire.

2. To launch a targeted public information campaign to raise awareness of NHS-funded sight tests and eligibility for optical vouchers, especially among vulnerable and underserved populations. It is recommended that the ICB works with local authorities and voluntary sector partners to improve outreach in rural and deprived areas.

3. To explore the development of shared digital records between providers to reduce duplication and improve continuity of care.

4. For the ICB and Primary Eyecare Services to collaborate on a workforce strategy to recruit and retain optometrists and support staff, particularly in areas with known shortages. It is recommended that incentives are explored for newly qualified professionals to work in Oxfordshire’s community settings.

Lunch was taken at 12:21. The Committee returned at 13:14