Chairman’s Report

CONTENTS COMMENT

A Year in Retinal Screening 1

Spring Newsletter

Chairman’s Report 4

Kirsty Moseley Completes Challenge

6

Message from Paediatrics

7

The O’Haire Family Raise over £6,000 Le Gallais Real Estate’s Generous Donation

8

9

600 Application Form

11

Dine4Diabetes 2021 13

Forthcoming Events 14

N2S Walk 2022 Application

15

It would be, perhaps, a little too optimistic to state that as Spring marches on, our lives are very nearly back to normal although that a fourth vaccination against you-knowwhat is available for certain groups implies that you-know-what hasn’t actually gone away!

As I stated in the Autumn 2021 newsletter it is likely that you-know-what, just like the flu, will be with us from now on as a fact of living. I tried, in this introductory paragraph, not to mention Covid by name and almost succeeded.

We reported in the Autumn newsletter that it had been confirmed that there would be a diabetes centre in the new hospital but since there are still many obstacles to be overcome (and more seem to become apparent every week) before that hospital becomes a reality (wherever it might be), for the time being the current Diabetes Centre stays where is it, although it would seem that there will still be a move in due course to the former Les Quennevais School.

A thought from the famous actress the late Ingrid Bergman: “Happiness is good health and a bad memory.” Keep well and keep safe. Peter Tabb Editor peteretabb@gmail.com

A YEAR IN RETINAL SCREENING - 2021

Diabetic retinopathy is a complication of diabetes affecting the eyes and is one of the top five causes of blindness and sight loss in both the working age population and developed world. Retinal screening of patients with diabetes has been shown to reduce the risk of sight loss by allowing prompt identification and treatment of diabetic retinopathy. There are approximately 4,500 patients with diabetes in Jersey. This number is increasing, in keeping with the international rise of this disease.

Over the last 12 months the Jersey Diabetic Retinal Screening Programme has gained traction and fully launched. As a result the number of patients referred to ophthalmology from the service has been reduced by over 90% and wait times for our diabetic patients have reduced significantly. The RSP has also started repatriating patients from ophthalmology’s digital surveillance clinic. All these factors result in both cost and medical time savings for Jersey Health, along with improved outcomes for patients.

Retinal screening programmes (RSP) are described as complex compared with other screening programmes. This is due to various factors - including that entry onto the programme is predicated by a clinical diagnosis rather than an age, also that patients will require screening for their entire lives - and the service needs to make provision for these factors. In addition, the monitoring of any retinopathy may transfer between ophthalmology and RSP numerous times over the years. A RSP has a variety of possible outcomes, including surveillance pathways rather than a more distinct yes/no outcome. A robust RSP reduces the number of patients that need to enter ophthalmology by keeping them within the RSP until the point of treatment.

The RSP appointed a programme manager and clinical lead in March and a specialist optometrist in July. The appointment of these staff members ensured that strong governance was developed and maintained. The RSP adheres to most guidance by Public Health England (PHE), whilst taking advantage of being our own jurisdiction to make upgrades to our programme and develop a surveillance programme.

As a diabetic person you will be invited for, routine digital screening (RDS) this involves taking a 2D image of the retina to look for diabetic changes, the appointment will start with you having you vision measured then some dilating drops are used to make your pupils larger. Once your pupils have dilated then we take a photograph of the back of the eye. The drops will make your vision blurry and you must not drive for at least 4 hours after your appointment.

Once the photo has been taken, it is sent to Gloucester NHS Trust for it to be graded by highly trained specialists. The grading involves looking at the photos, in high definition, magnified to search out signs of diabetic changes. Once your photograph has been reviewed by one grader, it will be secondary graded by another person to ensure nothing is missed, 10% are further graded by a third person to ensure quality and assurance across all graders. The results are entered in the computer system and a result letter is printed in Jersey and sent to you and your GP within 3 weeks of your appointment.

If there are no diabetic changes then you will be recalled in a years time (possibly going forwards this will change to 2 years, if you have 2 consecutive screenings with no retinopathy). If diabetic changes are found at the back of the eye you will either be referred to ophthalmology for treatment or more likely into one of our surveillance clinics.

The effect of surveillance clinics has excellent benefits for both the health service and the patient. For the patient, waiting times are much shorter within the RSP compared to ophthalmology and for Jersey Health, it saves £152 per patient.

Surveillance clinics take on two forms, Optical Coherence Tomography (OCT) clinics and Slit Lamp Biomicroscopy (SLB) clinics. OCT is a scan of the retina which allows the clinician to view the retina in 3D to see if any further treatment is required. In the last 6 months of 2021 we have referred 7% of our RDS patients to our OCT clinic.

SLB clinics take patients who were unable to have clear photographs taken at RDS. Currently there is a long wait for cataract removals, and due to the older demographic of our patients many will fall into this category. The slit lamp usually allows a view of the retina even if the camera does not. In the last 6 months of 2021 we referred 8% of our RDS patients to SLB clinic and only 1.5% of those required referral to ophthalmology for further treatment for their diabetes. Although the improvements to clinical timetabling allowing more patients to be seen and the setting up of surveillance clinics has been our primary driver this year, there have been many other improvements. Staff development has been important. The two screeners and the Programme Manager have undertaken and passed the University of Gloucester Higher Certificate in Diabetic Retinal Screening, our specialist optometrist has started additional courses with the University of Gloucester on OCT grading and both the specialist optometrist and clinical lead have been enrolled on the iTAT (International Test and Training) which provides external quality and assurance of their grading skills. Both business support officers are also due to undergo a University of Gloucester course in screening programme administration and failsafe.

Policies, protocols and procedures have been written to cover all area of the programme. Leaflets have been designed and translated into both Portuguese and Polish. An easy read leaflet has been developed for our patients with learning difficulties. Engagement with stakeholders has been advanced and a steering group established.

The main battle with our service is the high number of patients who do not turn up for their appointments or cancel at last minute, whilst we understand events do happen that mean you can’t make your appointment please do provide us with as much notice as possible on either 444590 or retinalscreening@health.gov.je so we can offer that slot to one of your fellow diabetics. Currently we waste between 10-20% of our capacity due to non-attendance.

And for 2022…there’s always more to do: improvements can always be made to ensure we are offering the best, research driven care to our patients. Research over the last 10 years has pointed to moving to a two year screening cycle for those patients who have had two normal (R0M0) grades, we are working with our software providers to bring this in, in a phased approach from April 2022. Enhanced communications with patients will come with use of SMS appointment reminders scheduled for later in the year.

It must however be noted that none of this would be possible without the very generous donation of two retinal camera from Diabetes Jersey in 2020 and the hard work and vision of my predecessor the late Alain du Chemin who also bequeathed monies to purchase a slit lamp to ensure surveillance clinics could take place.

Sarah Evans Programme Manager 18.01.22