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D01/S/e 2013/ 14 NHS STANDARD CONTRACT FOR NATIONAL ARTIFICIAL EYE SERVICE (ALL AGES) SCHEDULE 2 – THE SERVICES – A. SERVICE SPECIFICATIONS Service Specification No. Service Commissioner Lead Provider Lead Period Date of Review
evidence base that relates entirely to the way it manages patient care. However, the service regularly carry out literature reviews from providers in other countries and have links with bodies such as British Oculoplastic Surgery Society (BOPPS). Regular review of practice via international comparisons as proposed in the NHS Outcomes Framework 2012/13 will provide a more detailed benchmark for the Service. The evidence base for the design and manufacture of artificial eye prostheses, as required by the Medicines and Healthcare Products Regulatory Agency (MHRA) for Medical Device Directive purposes, is accepted as appropriate due to many years of experience and monitoring. This has allowed the Service to build its own evidence base regarding manufacturing and fitting practice with regard to artificial eye prostheses. There is also recognition of a standard manufacturing model across the sector; using the same production processes and materials that are accepted as appropriate by the dental manufacturing industry and check the service methods against these on an ongoing basis. The service also purchases regular assessments of finished products by external assessors to ensure product safety in terms of processing and curing methods. National Service Framework for long-term conditions The service provides full training for Orbital Prosthetists in the UK and other countries, as requested.
This service is for patients of any age requiring any type of artificial eye prosthesis, in order to improve the aesthetic appearance of a missing, damaged or disfigured eye; supporting the socket to maintain optimum cosmesis. The conditions this group encompass include cancer, trauma, congenital eye diseases.
team. New patients - New patients will have appropriate access to the service in their own locality. Established patients - These patients will require input from the service in order to review and maintain their prosthetic provision as there will be minimal input from Primary and Secondary care. Changing needs - Children, young adults and other patients with more complex problems require a more flexible model of care which provides more frequent appointments and prosthetic replacement. Non Prosthetic Eye Users – These patients may access the service at any time for advice. A basic routine patient pathway is as follows: • following referral post surgery, the patient is seen for an initial 90 minute appointment. The socket is checked for healing and if deemed ready, a halfsphere prosthesis is cut, shaped and fitted • approximately 3 months following surgery, if all swelling has reduced and the socket is ready, the patient attends a longer appointment (between 2 and 2 ½ hours) to have a mould taken of the socket and colour match the iris to the remaining eye. The order is sent to the Manufacturing Laboratory in Blackpool where the bespoke artificial eye is made. Once returned to the clinic, the eye is fitted at a further 30 minute appointment • Following fitting (and excluding occasional additional visits for newer patients), the patient is seen approximately every 18 months for a check-up and the prosthesis may be polished. The appointments are completed in clinics as near to the clients home as possible. General Paediatric care When treating children, the service will additionally follow the standards and criteria outlined in the Specification for Children’s Services (attached as Annex 1 to this specification)
2.4 Any acceptance and exclusion criteria Acceptance criteria The service will accept inward referrals from primary or secondary care doctors. Patients will generally be under the care of a Consultant Ophthalmologist or Oculoplastic Surgeon. The service will accept referrals for all eligible patients requiring ocular prosthetic treatment. All referrals are managed by NAES Blackpool HQ and allocated to a clinic according to the patient’s individual geographic location or specific request. Exclusions There are no exclusions to access the service. (Funding for veterans with service attributable injury may be sought from the veteran’s prosthetic panel under current arrangements. Treatment for serving military personnel may be sought from the Ministry of Defence under current guidelines).
2.5 Interdependencies with other services are no co-located services for the NAES There are no interdependent services for the NAES Related services include • The ophthalmic departments of referring hospitals • General Practitioners • Charitable organisations, as mentioned previously
9001:2008 standard. There are a number of provisions within this standard which must be managed, including the necessity to have an ongoing internal audit schedule (carried out by an internal audit team) and various patient satisfaction measures. The service is also required to monitor various manufacturing processes to ensure ongoing safety and traceability of all items produced. In addition, the service is audited by the British Standards Institute to ensure continued compliance with the Standard. The NAES holds a Patients Forum in Blackpool, Birmingham and Exeter and is working to develop groups in other areas of the country. Professional guidelines Equity and excellence: Liberating the NHS: section 3 Putting the patients and the public first, Department of Health, London, 2010
4. Key Service Outcomes
This specialised service seeks to empower patients, providing them with relevant information about their treatment pathway(s). The ability to return to normal life and work is a key service outcome thereby improving the individual’s quality of life. The Key Service Outcomes for the NAES relate directly to domains 2, 4 and 5 of the NHS Outcomes Framework 2011/12. Domain 2: •
By enhancing the quality of life for patients with long term conditions by the provision of high quality, bespoke ocular prosthetic services
Domain 4: • Quality of patient experience by monitoring and review of Patient Experience Surveys Domain 5: •
Improving safety by reporting any Untoward Incidents and monitoring staff training and development
Choice: • The patient works with the Orbital Prosthetist to choose the management of their treatment based on information, advice and personal circumstance within the frame work of the practical and financial limitations of the service Timing of treatment: • Appointments are as flexible as possible and include priority to certain patients (e.g. children). Urgent appointments are provided for replacement of lost prostheses or if a patient is experiencing problems with their current prosthesis Service provider outcomes All patients offered prosthetic rehabilitation services and re-ablement support • Improved access • Improved outcomes related to patient centred choice Increased patient satisfaction • Monitored by regularly audited Patient Experience Surveys to new and established patients using prepaid envelopes
ANNEX 1 TO SERVICE SPECIFICATION: PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (HSC 1998/238) requires that: • Children are admitted to hospital only if the care they require cannot be as well provided at home, in a day clinic or on a day basis in hospital. • Children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimize complications and mortality. • Families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • Children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day care. • Good child health care is shared with parents/carers and they are closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; Accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway • • •
All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. Services should therefore be organised and delivered through “integrated pathways of care” (National Service Framework for children, young people and maternity services (Department of Health & Department for Education and Skills, London 2004)
Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health Imaging •
All services will be supported by a 3 tier imaging network (‘Delivering quality imaging services for children’ Department of Health 13732 March 2010). Within the network: • It will be clearly defined which imaging test or interventional procedure can be
performed and reported at each site Robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements Robust arrangements will be in place for patient transfer if more complex imaging or intervention is required Common standards, protocols and governance procedures will exist throughout the network. All radiologists, and radiographers will have appropriate training, supervision and access to continuing professional development All equipment will be optimised for paediatric use and use specific paediatric software
Specialist Paediatric Anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co-morbidity. However those working in specialist centres must have undergone additional (specialist) training2 and should maintain the competencies so acquired3 *. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example MRI scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References • • •
Guidelines for the Provision of Anaesthetic Services (GPAS) Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) 2010 www.rcoa.ac.uk Certificate of Completion of Training (CCT) in Anaesthesia 2010 CPD matrix level 3
who may be at risk or managing the risk by removing the opportunity for abuse to occur, where this is within the control of the provider. • reporting the alleged abuse to the appropriate authority. • reviewing the person’s plan of care to ensure that they are properly supported following the alleged abuse incident. Using information from safeguarding concerns to identify non-compliance, or any risk of non-compliance, with the regulations and to decide what will be done to return to compliance. Working collaboratively with other services, teams, individuals and agencies in relation to all safeguarding matters and has safeguarding policies that link with local authority policies. Participates in local safeguarding children boards where required and understand their responsibilities and the responsibilities of others in line with the Children Act 2004. Having clear procedures followed in practice, monitored and reviewed in place about the use of restraint and safeguarding. Taking into account relevant guidance set out in the Care Quality Commission’s Schedule of Applicable Publications Ensuring that those working with children must wait for a full CRB disclosure before starting work. Training and supervising staff in safeguarding to ensure they can demonstrate the competences listed in Outcome 7E of the Essential Standards of Quality and Safety, Care Quality Commission, London 2010 All children and young people who use services must be • Fully informed of their care, treatment and support. • Able to take part in decision making to the fullest extent that is possible. • Asked if they agree for their parents or guardians to be involved in decisions they need to make.
(Outcome 4I Essential Standards of Quality and Safety, Care Quality Commission, London 2010).
psychology, social work and CAMHS services within nationally defined access standards. All children and young people should have access to a professional who can undertake an assessment using the Common Assessment Framework and access support from social care, housing, education and other agencies as appropriate All registered providers must ensure safe use and management of medicines, by means of the making of appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines (Outcome 9 Essential Standards of Quality and Safety, Care Quality Commission, London 2010). For children, these should include specific arrangements that: ensure the medicines given are appropriate and person-centred by taking account of their age, weight and any learning disability • ensure that staff handling medicines have the competency and skills needed for children and young people’s medicines management • ensure the medicines given are appropriate and person-centred by taking account of their age, weight and any learning disability • ensure that staff handling medicines have the competency and skills needed for children and young people’s medicines management • ensure that wherever possible, age specific information is available for people about the medicines they are taking, including the risks, including information about the use of unlicensed medicine in paediatrics. Many children with long term illnesses have a learning or physical disability. Providers should ensure that: • They are supported to have a health action plan • Facilities meet the appropriate requirements of the Disability • Discrimination Act 1995 • They meet the standards set out in Transition: getting it right for young people. Improving the transition of young people with long-term conditions from children's to adult health services. Department of Health, 2006, London