The Indigenous and Remote Eye Health Service (IRIS) has this week delivered on its two-year government contract to perform 500 cataract surgeries, as the organisation warns of the disastrous implications if the program loses funding.
A specialist IRIS team travelled to Katherine, in the Northern Territory, earlier this week to conduct the final round of cataracts as part of the IRIS 2.0 program that also services Indigenous communities in Western Australia, New South Wales and Queensland.
Vanguard Health, operated by CEO Mr Tim Gallagher, was awarded a $2.2 million Federal Government grant in August 2018 to deliver the 500 cataract surgeries in priority areas by 30 June 2020.
The deadline was extended to 31 December 2020 due to COVID-19, with the organisation expected to slightly overdeliver on its contractual agreement with more than a month to spare.
“I’m very proud of what IRIS has achieved, and proud of the professions of optometry and ophthalmology that have made a big difference to people’s lives,” Dr Bill Glasson, the IRIS co-chair and Queensland lead, told Insight.
“What I love about the program is, with the dollars we get, 99% of it goes into treating patients in their communities – no one’s being paid to sit in committee meetings, and those people who do sit on committees and advise do it for nothing because we think it’s such a great service.”
The origins of the IRIS program can be traced back to 2009 when the Rudd Labour government and then Health Minister Ms Nicola Roxon reached a settlement with Australian Society of Ophthalmologists (ASO) over its ‘Grandma’s not happy’ campaign.
The ASO successfully called for a reversal of the Federal Government’s decision to halve the Medicare rebate for cataract surgery. As part of the settlement, Roxon asked ophthalmologists to help fix the disastrously low cataract services in Indigenous and remote Australian communities. The ASO decided that money saved by the cataract rebate cut would go towards Indigenous cataract surgery and paediatric eye services.
This led to the IRIS 1.0 program, which performed thousands of eye health services and surgeries until 2014 when the funding expired.
According to the ASO, the Australian Institute of Health and Welfare Indigenous Eye Health Measures 2016 report showed how the gap between Indigenous and non-Indigenous eye health had increased following the end of IRIS 1.0.
Between 2012–13 and 2013–14 – during IRIS 1.0 – the median waiting time for elective cataract surgery for Indigenous Australians dropped from 140 days to 112 days. After IRIS 1.0 ended, this then rose to 142 days in 2014–15. Over the same period, the median waiting time for non-Indigenous Australians remained stable at around 84–88 days.
In 2017–18, Indigenous Australians waited a median of 132 days for cataract surgery, while non-Indigenous Australians waiting 84 days.
Funding conundrum
With IRIS reinstated in 2018, Glasson, a past president of the Australian Medical Association, hoped the government would continue to recognise the importance of the program and renew the contract for 2021 and beyond.
“Funding finishes at the end of this year and if we don’t have any more then we can’t deliver the service. I keep saying to the government it’s costing you bugger all money for the outcomes that we are delivering, so please continue to fund it,” he said.
“If it loses its funding, the service will fall apart and all these patients who already have three times the rate of vision loss compared to non-Indigenous Australians could blow out to six times more – we will have more people losing vision, losing confidence in themselves and sustaining falls and becoming depressed.
“Visual loss from cataracts is very treatable and cataract surgery I believe is the most cost-effective procedure on the Medicare schedule, without a doubt, in terms of the independence and self-esteem that it restores to the patient.”
A unique service
Glasson said the program’s strength was its agility to deliver services to people in their own rural and remote communities. It removes the need of trying to take patients to services which is often fraught with logistical issues and fear of the unknown, leading to disengagement and failure to turn up to their appointment.
IRIS also places emphasis on establishing structures, with the local health workers playing an instrumental role in organisation and logistics so that the visiting team of eyecare possessional can provide an efficient service and see more patients.
“We also focus on having the same team going to the same population, such that relationships are developed between the eye surgeons and the patients requiring the service. When the surgeon returns from his or her outreach clinic to their home practice the health worker in the community can call that surgeon at any time about any queries relating to the patients that have just been treated or need treatment in the future,” Glasson said.
“Relationships between the eye health workers and those that live within the communities form the basis of a functional system that is sustainable into the future.”
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