Friday September 25, 2020

We are so far behind in our model of delivering healthcare, particularly eye care

The main problem is that we are so far behind in our model of delivering healthcare, particularly eye care that it is going to be very difficult to play catch up‘ says Lynda McGivney-Nolan, Optometric advisor to the Association of Optometrists Ireland.

3rd February, 2020

What is your name?

Lynda McGivney-Nolan

What position do you hold?

I am professional and optometric advisor to the Association of Optometrists Ireland. I am basically the “go-to” for all matters relating to optometry and vision.

What are your day to day responsibilities?

The Association of Optometrists is a membership body representing the profession of optometry in Ireland We have over 600 active members, all working in different modalities of practice from independent practitioners to multiple high street practices.

My role varies on a daily basis. I work closely with our CEO, Sean McCrave and handle all queries to the Association both from our own members and members of the public with regard to the profession of optometry. Our own membership will seek advice on clinical, legal or business matters. I am responsible for developing evidence based standards of care for the profession in Ireland and I am constantly conducting research into the profession of optometry and eye care globally. Its important to look at how our profession delivers eye care in different jurisdictions.

In recent times, matters with respect to CORU (the regulator), CPD requirements, Children First legislation, Data protection and legal issues would make up a large part of the advice and guidance that I would give to optometrists.

I also act as spokesperson for the profession and regularly speak to the media about eye care in Ireland. I am involved in running public health awareness campaigns on issues such as AMD awareness and children’s vision.

As Optometric clinical lead for the North West post cataract scheme I liaise with members and hospital staff with regard to day to day running of the scheme. This role was very active at the start of the project but now that it is well established and running smoothly, I am not as busy as before.

What is your professional background?

I am an Optometrist. I qualified from DIT Kevin St (now TU Dublin) in Optometry in 1992. As was the norm at that time, once I left college, I proceeded to work in the family business in Henry St Dublin 1. It was difficult for small independent optometrists when the large multiples came to Ireland. I had to find a USP to help our business develop and move forward. Every business can find a space to develop, you just have to identify a need and go for it!

In 2000, I was appointed the role of Clinical Director for Special Olympics Opening Eyes programme for Ireland and Special Olympics sent me to the US where I trained under some of the top eye doctors and paediatricians in the world. I was ultimately responsible for setting up the Opening Eyes programme for the world summer games in 2003.

My family sold our business in 2008 and I came to work for the AOI as optometric advisor and went on to set up my own practice (you cannot advise colleagues professionally if you are not practicing yourself).

I completed a Master’s degree in Clinical Visual Science with University Ulster Coleraine in 2016. My particular area of interest is children and adults with intellectual and learning disabilities. In my private practice, I specialise in paediatrics and specific learning and developmental disabilities.

Tell us something that very few people know about you?

I met my husband on a blind date for charity. 300 couples were set up on blind dates and the money raised was donated to Harcourt St Children’s hospital. My husband was my blind date and we hit it off straight away (even though I thought he was a bit of a nerd!).

When I was doing my masters research and studying, I worked on various film productions, designing and fitting special effect contact lenses to boost my income. The lenses are the final part of the “look” when creating a character for crime, history, fantasy or horror movies. I have worked with some big names in the movie world. It was fun but not as glamorous as one would think!

You are speaking at the 2020 Health Summit. What are you speaking about?

Given the year is 2020, and optometry is claiming this as the year of vision, I am speaking about the role of Optometry in an enhanced community eye care and how our profession can deliver a reduction in public health waiting lists for eye care while saving on costs to the HSE. I will be talking about how we achieved this in the North West of Ireland with our community optometry post cataract scheme. In some parts of Ireland patients are waiting up to five years for cataract surgery. This has a huge impact on quality of life. However, as a result of our post-cataract scheme, the north-west of Ireland has the shortest waiting lists. Our programme has been so successful, that the NHS has taken our model and rolled out the scheme throughout Northern Ireland.

What challenges do you see for the healthcare sector in Ireland?

The main problem is that we are so far behind in our model of delivering healthcare, particularly eye care that it is going to be very difficult to play catch up. Demand is outstripping delivery at an almost exponential rate. The two main areas of high demand on public eye health are children and the over 60’s. Both sectors of these populations are growing fast and with this comes increased demand on the provision of eye care in the public system. A complete paradigm shift is needed to meet these demands and eye care needs to be devolved out into the community. However, Ireland is traditionally very hospital-led in health care delivery and enacting the change needed for modern healthcare pathways is not moving at the pace that it should. The programme for Slainte care is flawed in that it does not utilise existing resources, and moving eye-care out into satellite clinics is going to be very expensive, difficult to staff and will only serve to move the waiting lists from one location to another. Same problems, different locations. This is not the answer. While these clinics will have a role in delivering eye care, outside the hospital centred model, it will only be effective when used in conjunction with community optometry.

The other big issue which is impeding the development of a modern health care system in Ireland, is the systemic failure to use joined-up thinking when approaching a solution to a particular problem. Everyone wants to do it their way, the way they have always done it and change has to be on their terms or it just won’t happen. Everyone, across all professions and in all areas of healthcare needs to sit down, open their mind and get going. Patients can’t wait.

As an optometrist specialising in paediatrics, it frustrates and upsets me that Irish children have to go onto waiting lists of up to two years, to access public eye care, when they can go to an optometrist local to them, without waiting a significant length of time. Currently to do so, parents must pay privately to bring their child to an optometrist. This means that the state is failing its duty of care to our children, which is enshrined in our constitution. Paediatric waiting lists would be drastically reduced by releasing paediatric eye care out into community optometry, as is done in other jurisdictions. Irish optometrists together with optometrists in the UK are the most highly qualified in Europe and amongst the most highly qualified in the world. The HSE repeatedly fails to recognise and utilise the skill set of optometry, trained here in Ireland, regulated here in Ireland and available at the doorstep. Uncorrected vision problems in children can have lifelong consequences for learning and development, particularly if not identified by the age of 8 which is the critical limit for vision development.

Where would you like to see the health service in 10 years’ time?

I would like to see a first class apolitical health service that will draw the best of professions in ot the country, rather than drive them out. I would like to see a health service where the words “Health” and “Care” are not a contradiction when used in the same sentence. We need a cross disciplinary team approach with evidence based care pathways that make clinical and economic sense. We need a health service that makes sense to and works for, the professionals engaged in the system, as well as the patients accessing it. I would like to see as much care as is realistically possible being delivered at community level, where the different health care professionals are collaborating together and liaising with other professionals in education, disability and home services to ensure our most vulnerable citizens are accessing the care they need and no person, patient or professional, is left behind because they don’t tick a particular box. I firmly believe this is possible once pride and prejudice are left aside.

Lynda will be speaking at Health Summit on February 6 in Croke Park, Dublin.

See for more information.

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