Impact case study database

Research led the Department of Economics, University of Aberdeen has (1) shaped the focus of current and impending raising-awareness campaigns and (2) influenced methodology and changing practices on how information is presented by Public Health Scotland Data and Intelligence division (previously Information Services Division Scotland), (3) established the Scottish Eyecare for Everyone (SEE) network which seeks to improve access to eyecare through collaboration with practitioners and policymakers across Scotland, and (4) informed discussions on the current and future funding of General Ophthalmic Services through the Scottish budget.

In 2006, the NHS introduced free eye tests in order to provide more comprehensive eye health examinations. Although this initiative sought to enable optometrists to assess a patient’s eye health, research led by the University found evidence that it inadvertently widened pre-existing socio-economic inequalities in eyecare utilisation. Similar disparities are reflected in the wider health benefits that an eye examination can achieve (i.e. detection of hypertension).

Raising-awareness campaigns

Based on the research findings, Zangelidis and colleagues made policy recommendations to the Chief Medical officer (CMO), outlining the need for a targeted raising-awareness campaign. Following dissemination of the research findings, the idea of a targeted campaign has been featured in policy documents and argued for by stakeholders.

RNIB Scotland acknowledged the findings stating that “there is a need to highlight that there is a much lower up-take of eye health checks by those in areas of deprivation and hard to reach groups” [S1]. Responding to the need for an awareness campaign, RNIB Scotland ran the 'Eye Health Matters' campaign in September 2019, during the National Eye Health Week [S2]. The campaign used special coasters featuring iconic Scottish landmarks as seen through different sight loss conditions. The coasters were distributed to selected pubs and cafes throughout Scotland with a message urging people to go for regular eye examinations. Stuart McMillan MSP also placed a relevant motion to the Scottish Parliament, which ‘commends RNIB Scotland on its Scotland-wide campaign, Eye Health Matters, which raises awareness of free eye health checks through cardboard coasters’ [S8].

The Scottish Government also recognised that there were important issues that needed to be addressed in order to get the message to the wider population [S3]. In May 2018 Zangelidis and colleagues presented evidence to the Scottish Parliament’s Cross Party Group on Visual Impairment [S4]. Based on this testimony, the chair of the committee, Stuart McMillan MSP, wrote to the Scottish Government asking a public awareness campaign. He reiterated this point again when addressing the Scottish Parliament (September 2018) [S5]. The Minister for Public Health, Sport and Wellbeing, Joe FitzPatrick MSP, acknowledged the issue of socio-economic disparities and confirmed that, based the on evidence of Aberdeen researchers, the Government plans “to run targeted awareness-raising campaigns for specific patient groups among whom take-up of free eye examinations is lower, including those living in more disadvantaged communities” [S5].

Changing practice

Zangelidis’ research informed the way in which eye examination dates is reported. In 2018, the Public Health Scotland Data and Intelligence division reported patient uptake of eye examinations by regional deprivation. This has been cited as an important change in methodology as the information will now be used to identify deprived areas that are potentially harder to reach and will inform policy. Minister for Public Health, Joe FitzPatrick stated, “ This will further help identify which patients would benefit most from targeted campaigns promoting the range of services provided in Scotland” [S5]. Given their expertise in this area, representatives from the Scottish Government invited the Aberdeen team to participate in discussions regarding further data improvements for the 2019/20 ISD report on eye examinations.

Establishment of SEE network

In September 2019, during National Eye Health week, Zangelidis and colleagues organised, jointly with Optometry Scotland, a summit at the University of Aberdeen. The summit, ‘Spotlight on Scotland's Eye Health – breaking down barriers and collaborating for a more inclusive future’, brought together representatives from the Scottish Government, Lord Provost of Aberdeen, NHS, RNIB Scotland, academics, the International Glaucoma Association (IGA) and Aberdeenshire Visual Impairment to discuss about the future of eyecare in Scotland and how to address socio-economic disparities in demand for eyecare. The summit received considerable media attention and led to the announcement of Scottish Eyecare for Everyone (SEE), a new nationwide network and forum for the advancement of eyecare in Scotland. SEE will enable the group of stakeholders to collaborate in tackling the issue of socio-economic inequalities, and other eyecare issues on an ongoing basis [S6], [S7].

Scottish Budget 2020-2021: General Ophthalmic Services (GOS) Priorities

The Scottish Budget 2021-2021: Equality and Fairer Scotland was announced on 6^th February. The report, published by the Cabinet Secretary for Social Security and Older People, stated “ To ensure regular, free eye examinations of high quality are available to all Scottish residents, the Scottish Government is continuing to invest in General Ophthalmic Services (GOS). In 2020-21, the estimated budget for providing GOS will be [GBP110,000,000]. Evidence also suggests that people are less likely to attend an eye examination if they live in a more deprived area. Of those people who attended a primary eye examination in 2018-19, 28.6% were in SIMD one (most deprived) compared with 33.6% in SIMD five (least deprived). In order to tackle health inequalities, a national group is being formed with Optometry Scotland and other key stakeholders.” [S9]

In addition, an Expert working group has been set up to review the performance of Scotland’s community eyecare services and explore ways to maintain and enhance service delivery. Zangelidis was invited to participate in this group, which met on three occasions in October-December 2020. The findings of the Expert working group culminated in a report (for release early 2021) that argued that the universal NHS-funded eyecare in Scotland should be sustained and recommended to the Scottish Government a rolling three-year funding settlement with a minimum budget increase of 3% annually in real terms on fees [S10]. The report was presented to Minister for Public Health, Sport and Wellbeing, Mairi Gougeon MSP and was subsequently distributed to all Members of the Scottish Parliament.