Background
Owen is a gentleman with profound learning disability, he has epilepsy, autism and communication difficulties, leaving him unable to use verbal communication and he is unable to use Makaton, he has lived in supported accommodation since March 2001. The case concerns the care Owen received from his local opticians, where he had received routine eye care since 2017.
In May 2021 he had a routine check-up and received glasses. In August 2021, his behaviour changed considerably. The supported accommodation staff took him back to the opticians where it was discovered that he had a Brunescent cataract on one eye, which had caused visual impairment.
Following subsequent treatment at Moorfields Eye Hospital, Owen was registered as blind on 23 February 2022.
Safeguarding concerns:
- Owen’s vulnerability re his learning disability and the absence of an appropriate and reasonable adjustment to his care
- wider implication for practice, both in relation to access to health provisions for adults with learning disabilities, and in relation to professionals being confident to access additional specialist resources when that becomes necessary
- lack of initial candour and disclosure from the optometrist who saw Owen
Key lines of enquiry:
- case information provided by individual agencies from case records
- exploration with practitioners as to how they saw events at the time - supplemented by additional interviews to fill the gaps
- there is an ongoing internal investigation into the optometrist, being undertaken by the General Optical Council - the case has now been closed, with NFA and no adverse fitness to practice record against the optometrist
Conclusions and learning:
- Owen has a range of complex issues linked to his learning disability, all of which he has weathered and has achieved a positive quality of life in a very stable home environment
- the situation changed dramatically following the visit to a routine eye appointment on the 24 May 2021 - that appointment resulted in Owen being offered a follow up in two years it me and was recorded as normal
- some three months later on the 27 August 2021 he returned to the opticians having experienced significant difficulties with his sight. As a result of seeing a different optician he was referred to secondary care. On the 7 December 2021 under anaesthetic his left eye was noted to be blind and despite the removal of a cataract on his right eye, Owen was eventually registered blind on the 23 February 2022
- in the months between his operation in December and being registered blind in February, Owen experienced a confusing and distressing time; the impact on his quality of life has been significant
- the findings of this Review are that if Owen had received a more thorough examination on the 24 May 2021, or if the optician had recognised that completing such an examination was impossible given Owens behaviour and that he needed to involve secondary care the outcome may have been different. Access to a timely intervention to assess both eye pressures, and the development of cataracts may have facilitated an improved quality of life or a different outcome
- advocacy for Owen is an issue in any discussions to compensate for the changes in his quality of life as a result of these events - this should be taken forward by those working closest to him and discussed with the family
- agencies to make reasonable adjustments ( such as practical adjustments or process changes) to ensure that people with learning disability can access services in the same way as other people
Points to initiate change:
- consideration should be given to improving the quality of information made available to health practitioners on an individual with learning disabilities health
- recording that is accurate, complete, dated and signed by the practitioner should be a standard in recording in ALL health records and in this case the private provider should remind store directors and practitioners of their responsibilities and of the standards set by the GOC
Implementing change:
The SAR author was keen to reinforce that safeguarding is not just about acts of commission, but it is also about acts of omission, particularly when these cause significant harm to those with additional vulnerability, and where there is a detrimental impact on the quality of life for the individual.
Resources and further information
Having an eye test (easy read), SeeAbility