Specialist Teaching Service Southend-on-Sea

Interview with Mrs Tracey Meddle, Eye Clinic Liaison Officer (ECLO) at Southend University Hospital

We are lucky to have an ECLO at Southend University Hospital, and we met with Tracey to talk about her role, about the challenges and rewards of such an important job.

Thank you for meeting with us at the Eye Clinic today. Can you tell us a little about your role at the hospital?

I have been based in Ophthalmology at Southend Hospital for six years. I provide support to patients, their family and friends. I provide advice, information and practical and emotional support. This can vary from talking to a patient about their eye condition and treatment, telling them what is available in the local community, to attending appointments and treatments with patients. If a patient is anxious about having injections, I can go in with them to offer moral support. I have been in to surgery with a lady who was anxious and wasn't going to have her cataract procedure, but said she would go ahead if I went with her. So, I held her hand through the procedure and got to watch the operation which was very interesting. Often, I get patients who have complained to PALs that they haven't received their treatment by a certain date or if something hasn't gone as they had hoped, the governance manager will ask me to give them a call to cover the wellbeing side to make sure they are supported and they know what's available. These are the types of things I do, it's very varied, no day is the same.

How are patients referred to you?

I get referrals for various sources - reception, doctors, nurses, consultants, health care assistants and the stroke team. Externally I get referrals from Southend In Sight and other charities, the sensory teams and opticians. I also get a lot of referrals for patients who come in for a low vision assessment, I will see them afterwards and that works well. I give them a bit of support, talk to them and give them relevant leaflets.

I don't have a long form to refer to me - it can be a Post-it, email, letter, phone call - I don't mind. I don't want to give people more things to do to get through to me. Families can also refer; they will make contact to see what we can do to help.

How many patients do you support?

I complete the statistics for the RNIB, April 24 - Oct 24 I have had 1009 sessions - that could be a telephone or face to face, 621 of them were for people I have seen before.

Is there any vision impairment awareness training available to hospital staff?

Yes, I also provide training. I am about to complete some training with the stroke team because a lot of patients who have had a stroke do experience sight impairment. I train staff on the impact of that, what they can do to support their patients. I also work with the community stroke team and support the macular group.

I was particularly pleased to be asked to go to talk to restaurant staff who take food around to patients, I often go to a ward to support a patient and their families, where they feel their sight impairment isn't recognised on the ward. The wards are very busy places, but they find they have been left something to eat or drink and the staff have gone off and they don't know where the food/drink is. Reminding staff to say who they are when they enter the room, so that the patient is aware of who is there. Educating staff to be a bit mindful and to tell the patient where food and drink has been placed and what it is, putting a band around the water jug so it's more prominent, adding colour contrast to make it easier for patients.

How do you support family and friends?

I support families and friends by giving tips on daily living, information, and what they can do. It is important not to do too much for people but empower them to do things for themselves. If a couple comes in and they are worried about their partner, I can inform them about what is available and give them tips. I get phones calls from people who are worried, and I can reassure them.

Do you have many children coming to see you?

I can go to appointments with children, but I don't get as many child referrals. The number of children that are registered is small compared to those being registered with Macular Degenerations and Glaucoma etc. Sometimes this may be due to consultants waiting a bit longer to see what they can do before registering the child.

The child would come in through orthoptics or the consultant, Mr Geh, or a member of his team and then they would be referred to me if it were for registration. I usually see children at this point, but I don't get as many as I would like to.

Do you work with siblings of children with VI?

I don't work with siblings of children with VI. I think the time factor is the biggest problem, but I am more than happy to talk to siblings. If a sibling was struggling, I could always talk to them and also signpost them to Southend In Sight to get involved in some of their activities. I would be happy to liaise with them.

Are you involved in completing Certificates of Vision Impairment?

A big part of my role is to complete Certificates of Vision Impairment. I am very passionate about, when I started the role the rate of certification was very low which meant people couldn not access the support they were entitled to. I've done lot of work with this and now do all of them. It is the consultant's decision if they are registered, I know what levels to look for so I can do the certificate and forward it to the consultant. If they feel the patient does not fit the criteria, I will find other ways of offering the patient support. Sometimes we disagree, some consultants feels that while a patient is waiting for treatment that they shouldn't be registered, which I understand. However, if that patient is waiting a year, then it's not fair, they might not be able to work for a year. If we put the registration in place, it can always be retracted at a later date.

How is a Certificate retracted?

Retracting Registration is a simple process, a letter to the sensory team saying that the person's vision has improved so we would like their registration rescinded. We would always talk to the patient first. But if their vision was at a level where they were able to drive then they shouldn't be registered. That is the conversation I would have with them.

How many Certificates of Vision Impairment have you completed in the last year?

April 2023 - March 2024 - 366 Certificates of vision impairment, April 2024 - November 20024 - 190 Certificates of vision impairment.

After covid the numbers shot up, I'm proud of the number we are registering so that patients can receive the correct support. We also now have an ECLO at Orsett Hospital, Sarah Jayne Piper. She works there on a Thursday and Holly Munsey is at Broomfield Hospital, which means I don't have to cover those areas as well. It's so important to promote registration.

What are the benefits of being registered?

Depending on the age of the person, if you are registered severely sight impaired you are entitled to apply for a blue badge, blind person's tax relief, tax exemption on goods, half price TV licence, attendance allowance and other benefits. They can have an assessment from the sensory team - I will always promote this. If there are things suggested that you don't want, you don't have to have them but listen to what is available and make an informed choice. It's important to register your sight needs with the council so even if you don't want to access the support available, they are aware that you have a sight impairment that makes daily living more difficult. You don't have to be registered to have a sight assessment and access some support but being registered acts as supporting evidence and gives you more power.

Is there VI specific counselling available?

There is VI specific counselling available from the RNIB who offer free counselling for any eye condition - there is a 6-month waiting list for this service. The Macular Society are very good and there is not such a waiting list, they provide telephone counselling, they will also ring the patient regularly for a chat, a bit like the service offered by Southend In Sight; more social interaction than counselling, which is quite often what someone needs. Glaucoma UK don't provide counselling, but they do provide a buddy system - they will match people who have had the same condition or procedure, who offer tips and moral support. Therapy for You through the GP is also available.

I had one lady who was nearly 90, she was feeling low and called me. I tried to get her to accept counselling, but she rejected it but I made sure I called her again to check in and see how she was doing. Eventually she began counselling with the Macular Society. Sometimes people need time and support to make these decisions. I like to think I provide a bridge when people are waiting for treatment or counselling, I can stay in contact and talk to people, making sure they have a little bit of support.

Is there a specific condition you are more passionate about?

I am passionate about talking to patients about Charles Bonet Syndrome. It is incredibly common, so many patients are walking around thinking they have mental health issues, so I make a point of talking about this condition. I spoke with one elderly patient about the condition and his face changed, I asked if he had experienced it before, he hadn't told his wife because he thought he was going mad. Every day he was seeing giant insects that he would have to pass on his way to go out and get his paper. This was obviously very distressing for him, and it brought him great relief to know what was causing these images.

Do you enjoy your role?

It's a very enjoyable job! I have an NHS contract, I'm funded by Southend In Sight, RNIB, a private donor and the NHS. I have met the lady who is the donor, she wanted to make a difference. She has come to visit the eye clinic and has met with a patient, who talked to her about the support I have provided. She stays in contact to see how things are going.

It is recognised that all hospitals should have an ECLO, but this isn't the case. I am very happy to provide the service for Southend Hospital.

Thank you, Tracey, for your time, and for all your hard work and dedication.