The government is ploughing ahead with delayed plans to offer students in all special schools in England free NHS eye tests – but it has been warned it could create a “huge unfunded burden”.
In October, the government and NHS England re-committed to a pledge that eyesight checks would be carried out annually for students in all day or residential special education needs schools.
The Department of Health and Social Care (DHSC) said NHS England will provide up to £12.7 million in funding annually from next year to support this national rollout, following a pilot in 83 schools.
Sight tests will be done in participating schools, and children who need glasses will be given two pairs of their choice, with specialist frames included, free of charge, NHS guidance states.
SeeAbility, a charity, says children with learning disabilities are 28 times more likely to have a serious sight problem, and thousands across the country are missing out on eye care they need.
But it fears that the model from the pilot could be watered down, after the DHSC said the fee it would provide per child would be cut from £116 to £85.
Schools Week tagged along to health minister Stephen Kinnock’s visit to The Village School, a special needs school in Brent, north-west London, to find out more.
Labour takes forward delayed policy
The Conservative government promised in June 2023 that eye tests would be made available in all special schools from April 2024, but this was pushed back.
Labour is now progressing with the scheme and the DHSC said it has the potential to reach about 165,000 youngsters.
Integrated care boards (ICBs), NHS bodies responsible for planning health services for local areas, will be responsible for procuring the eyecare services, which will be opt-in for schools and parents.
The 2019 NHS long-term plan committed to sight tests in all special residential schools. This was extended to all day schools following a “proof of concept” pilot in 83 schools since 2021.
The model involved matching individual opticians to schools based on geographic convenience, with administration and training undertaken by NHS England.
SeeAbility used the NHS pilot contract in London to expand its “one-stop shop” model to 31 schools, but had already been working at The Village School for about a decade.
It visits schools weekly to deliver students’ annual sight tests, specialist glasses support and reports on vision that can be reflected in pupils’ education, health and care plans (EHCPs).
Schools ‘overwhelmingly positive’
A proof-of-concept evaluation report published in November 2022 considered 154 responses across 71 participating schools, plus 115 responses from pupils, parents and carers.
School staff were “overwhelmingly positive” about the model, and 75 per cent said the service made a “significant improvement in terms of social impact, on learning and behaviour”.
Respondents noted the strength of engagement between the eye-testing professionals and pupils and parents, and most observed little to no disruption in terms of hosting the service.
Some 82 per cent said the service was “excellent” and all residential school responses reported “significant improvement” in pupils’ interaction in school and social and educational progress after glasses were provided following in-school sight testing, the NHS report added.
Karol Stelmaszczyk, principal at The Village School, said the service had been “a really valuable thing for the students, enabling access to learning and improving their quality of life”.
Under the pilot, 23,832 sight tests were provided from April 2021 to August 2024, with 9,909 pairs of glasses issued, according to data provided by the DHSC.
“We have excellent examples where, because they have glasses, their behaviour changed, their access to education changed. How they are in the environment changes as well, so we see only benefits of using glasses for those learners,” Stelmaszczyk said.
However, a “minority of schools reported a significant additional administrative requirement in terms of arranging and supporting the service”, the NHS report noted.
Fees ‘insufficient’
The proof-of-concept fee, still in use until ICBs tender for it, is £116 per child, SeeAbility said.
This covers the eye tests and services of the dispensing optician who does follow-ups in schools to make sure children who need glasses get them and ensuring breakages are repaired.
In May, the Association of Optometrists warned that, by reducing the cash sum, the government risked “becoming the architect of the service’s collapse before it has even been built”.
Lisa Donaldson, SeeAbility’s head of eye care and vision, added “the promise of a service could ring very hollow and we are urging the minister to bring everyone around the table again now he has seen the service for himself”.
But the DHSC said the £85 fee “aligns with wider domiciliary services”.
‘Huge impact’
Kinnock said: “NHS England have got to look at this in terms of the big picture and put together a scheme that works, given the resources that we have at our disposal, and given their understanding of what is going to work in different parts of places across the country”.
But Stelmaszczyk is worried that parents will stop engaging with the service if they have to subsidise it, warning this could have a “huge impact”.
“We have quite a lot of parents who would find this difficult [to pay towards the service], especially because our young people break their glasses quite often.”
Paul Carroll, chair of the Optometric Fees Negotiating Committee, said the service differs from a traditional domiciliary visit because at inception it was “meant to provide ongoing care for a cohort of patients with unique challenges”.
For instance, practitioners may need to visit patients on several occasions to build a rapport and gain their trust so that a successful examination could be undertaken.
“The newly proposed fee for this service is insufficient to provide that unique, ongoing care; instead, the proposed fee will only allow for a simple, single-visit type examination,” Carroll added.
“We fear this will mean that either a huge unfunded burden will be placed on those delivering the service, making it unsustainable, or the service as delivered will not match that which was intended and evaluated during the proof of concept.”
More must be done to raise awareness
SeeAbility has also raised concerns that the bulk of the £12 million allocated to eye health in special schools for 2024-2025 could go unspent by the end of the year.
It argues more must be done to provide support and communications for the programme to gain traction with providers, schools and ICBs.
But Kinnock said NHS England would be reaching out to “raise awareness of this service”, adding it will “gain traction as people start to use it”. He said: We believe that this is a really compelling programme, and it will, once you start rolling it out, kind of just take on a life of its own”.
Parents, or the patient as appropriate, will need to provide written consent before each sight test, and sight-testing providers will need to work with schools to obtain this consent.
What about mainstream schools?
In a separate initiative, Glasses in Classes was rolled out to 225 mainstream schools in five disadvantaged ‘Opportunity Areas’ by the Department for Education in 2021.
School staff were trained to support four- and five-year-old pupils to get glasses and encourage them to wear them. Funding was also provided for a second pair of glasses to keep at school.
The aim of the scheme was to boost the literacy and numeracy skills, as well as the vision, of children in reception.
In one area alone, Bradford, the government said 2,500 children were not getting “the glasses they need, and that schools are unaware of their uncorrected eyesight issues”.
An Education Endowment Foundation evaluation of the pilot scheme for reception-aged children found it can add one month’s progress for children eligible for free school meals.
But pandemic disruption meant it was “harder to accurately estimate the size of the impact on pupils in the trial”.
The Department for Education said the trial ran for a year as intended.
A step-by-step process’
But Kinnock indicated the new scheme might eventually be expanded to SEND students in mainstream schools too.
“We are looking at a step-by-step process here, and we’ve got to embed this system for children with complex needs,” he said.
Kinnock had been struck by how many cancelled eye test appointments there are for young people with complex needs in hospitals, compared to the “really high engagement” in schools.
A study found 54.8 per cent of children at special schools don’t attend their eye clinic appointments. Close to 200,000 children’s eye hospital appointments were either missed or cancelled last year. The average wait for children’s outpatient eye clinics is 97 days, with an appointment to see one professional costing £140.
“So I think we’ll probably, given the finite resources that we have, we’re going to be focusing on this issue of hospital-to-community and addressing this, this sort of crazy waste of resources, and get that fixed and sorted. And then, step by step, why not look at a broader target group?”
