Clinical Programme

The Division of Strategy and Clinical Programmes was established by the HSE in 2009 with the aim of improving and standardising patient care by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to patients. Thirty three National Clinical Programmes, including ophthalmology, have been established by the Division.

Mr William Power was appointed Clinical Lead for the Clinical Programme in Ophthalmology in 2016 following Mr Paul Moriarty's leadership in the role since 2012.

The Programmes are based on three main objectives; to improve the quality of care delivered to all users of HSE services, to improve access to all services and to improve cost effectiveness, which is particularly important in the present economic climate.

According to the World Health Organization (WHO) up to 80% of global blindness is avoidable or treatable. The corresponding figure for Europe is approx 50% of visual impairment being avoidable with earlier and more targeted interventions, as almost 90% of blind and visually impaired people live in low- and middle-income countries where access to eye care is often unavailable. 

In 1999 Vision 2020 was launched by the WHO and the International Agency for the Prevention of Blindness (IAPB). The vision of the global action plan is a world in which nobody is needlessly visually impaired, where those with unavoidable vision loss can achieve their full potential, and where there is universal access to comprehensive eye care services.

The aim of the NCP for Eye Care is to reduce and ultimately eliminate the number of annual cases of preventable blindness and vision impairment in Ireland. 

Prevention requires appropriately resourced early detection and treatment approaches. It is also important to consider that with Ireland’s expanding ageing population, the impact of sight loss or vision impairment will become more evident. Several international studies have demonstrated the effects of population growth on the current level of care needed and it is likely to continue to lead to a significant increase in the demand for the eye care and the direct costs of eye care.

The NCP for Eye Care has been tasked with reviewing the current delivery of eye services in Ireland and developing a plan for the future delivery of care. Within that design of the model of care for service delivery, the Programme aims to develop care pathways and referral protocols for the treatment of the main eye conditions in Ireland.

Eye Care in Ireland

Ireland has experienced and continues to experience significant population growth. The total population is expected to increase by around 22% or 28% between 2011 and 2026. The greatest increases are projected in the over 65 year age groups 

Increasing patient numbers and the growing incidence of chronic diseases are placing an enormous strain on the current model of eye care. Hospital centres are overburdened by chronic diseases, most of which could be appropriately diagnosed, treated and managed in the community by eye doctors in a decentralised model.

The overall aim of the NCP for Eye Care is to rebalance the delivery of care to a more community based model. The objectives of the NCP are to eliminate avoidable sight loss, improve cost effectiveness and provide equitable access to efficient, high quality care, supports and treatment.

The total percentage of the Irish Health care budget spent on eye care is 1.17%. The comparable figure for the UK is 2%. The eye care per capita expenditure for Ireland is €34 while the UK figure (using average 2011 exchange rate) is €46.30.

In line with the government policy such as Future Health, the majority of services should be provided within the primary care setting. As such, integration of acute and primary care services is essential to allow for the rebalancing of access and delivery of eye care services from acute hospital to the primary care setting.  Integration is key to ensuring a high quality, consistent, efficient and effective care. The development of a regionalised model is the best means of achieving this aim. 

The NCP for Eye Care has established the following key enablers for change to achieve the objectives for the programme

  • Restructure of manpower balance between hospital and community with increased numbers of eye doctors in the community, enabling most patients to be seen in their own locality and a better response from the surgical centres keeping waiting times to a minimum
  • Increased role for optometrists and orthoptists in structured model of care
  • Investment in community clinics, both in medical manpower numbers and equipment
  • Investment in Information Technology and Electronic Patient Records to enable a hub and spoke regional delivery of care