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IN TOUCH – David Rathband and Moorfields Video Consultations
TX:Ìý 14.07.20Ìý 2040-2100
PRESENTER:Ìý PETER WHITE
PRODUCER:Ìý KEVIN CORE


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Good evening.Ìý Tonight, the rise of the video appointment – the latest on the eye consultations which take place in your front room.Ìý And why new speeded up planning laws could pose a threat to visually impaired pedestrians.

But first, it’s 10 years ago this month that PC David Rathband was shot and blinded by Raoul Moat.Ìý It was the culmination of a manhunt after a previous shooting and David’s story gripped and touched the nation; played out, as it was, not only on the conventional media but on what was then relatively new social media.

Five months later, as David struggled to come to terms with what had happened to him, he agreed to give me a long and frank interview.Ìý I remember leaving really feeling deeply concerned about how a man used to seeing himself as the solver of other people’s problems was going to cope.

Rathband

I’ve avoided blind people having had this happen to me and I’ve done it on purpose, purely because I wanted to deal with what happened to me and how I find myself on my own.Ìý I have lots of offers of people who have kindly got in touch with me – speak to me, I’m blind, I’ll help you, if there’s anything you need – there’s lots of things I need but at the moment I need to do them for myself.
I do feel vulnerable and I’m sure other blind people do.Ìý It’s not very nice, I don’t like it.

White

But it is, as you said, to some extent it’s due to what you did as a job and the fact that you don’t feel able now to defend yourself in the way that you would have done in the past.

Rathband

Yeah, I think somebody gave me a Superman vest because I always thought I was invincible and now I realise that, having been shot in the face and nigh on killed, is that I’m not invincible, I’m just very lucky.

White

Sixteen months after that interview I was being asked to comment on David Rathband’s suicide.Ìý It’s a story which also touched writer, Christopher Hogg, and the award-winning play that he wrote is now being performed on Zoom by the theatre company Extant.Ìý I asked Christopher what had moved him to write the play.

Hogg

It was actually your interviews because there’s an incredible sub-text to the conversation between you two, it really touched me.Ìý I was going through my own experience of post-traumatic stress disorder at the time and what I heard was two men talking to each other – one of them being incredibly truthful, which was David, and communicating so clearly, having gone through something far worse than I had done.

White

In some ways I was worried that he was talking about solving other people’s problems but not addressing his own – did that strike you?

Hogg

David really liked the limelight; he was a great communicator.Ìý And I think that he gained a new sense of identity from all of the connections that he made with the people that were following his story online.Ìý I was slightly concerned about what would happen when that initial wave of publicity ended and he was left very much alone without that identity that he was building up at the time.

White

My impression of David was that he was quite a macho man – police officers were supposed to solve other people’s problems – did that make it difficult, do you think, for him?

Hogg

Yes, I think that knowing when to reach out to other people isn’t something that would have come naturally to him.Ìý He was having to discover his entire life again at the age of 46, from having been a certain type of man he now had to be a different man and that’s a very difficult journey.

White

Tell us about the novel way you approached the structure of the play.

Hogg

It took two years to write the play and one of the facts that I found out was that even 18 months after the shooting he had 153 fragments of metal still inside him, from where Raoul Moat had shot him at point blank range.Ìý So, I decided I wanted to try and create a piece of work using that number of fragments and so that led me down the road of looking at all the social media posts that he made and all of the conversations that he was having.Ìý People were just starting to learn how to use social media for the first time and David had the added incentive that it was his outlet in a way of connecting with the rest of the world.Ìý So, the way that he was learning to use social media was more powerful than most, it had a real incentive behind it.

White

His world had radically changed but the world of communications was changing as well.

Hogg

I totally agree.Ìý One of the things that comes out in the play is that everybody is making mistakes with this new form of communication, nobody quite knows how to use it.Ìý One of the climaxes of the play is when David announces that he has split up from his partner – Kath – and he does that on social media.Ìý And so, what you have is having these incredibly private conversations happening in public and that’s very much what celebrities do – the boundaries between public and private are mixed up.Ìý And so, I think that we were looking at celebrities as a kind of guide as to how to use social media.Ìý Whether that was a good thing or a bad thing I don’t know.

White

We’re also joined by Robin Paley-Yorke.Ìý He’s hosting the event and is visually impaired himself.Ìý Robin, how did you get involved with this?

Paley-Yorke

Yes, so, this was quite out of the blue actually.Ìý I’ve been working with Extant on their directing pathways programme, which is to help train theatre artists in directing and training and learning new methods for visually impaired artists and I got a phone call a couple of weeks ago from Maria Oshodi, the Artistic Director, she wanted me to be involved because quite serendipitously we found out that this happened in the same year that I lost some of my sight and also I used to live on the housing estate where the tragic event happened of the first shootings byÌý Raoul Moat.Ìý So, it’s quite a strange situation – so many links to this world and this play already.

White

Given your own experiences of losing some of your sight in violent circumstances, what do you take from David’s story?

Paley-Yorke

I lost some of my sight due to a traumatic accident.Ìý Somebody smashed a guitar through a window.Ìý When you hear glass smash you instinctively look for it – my advice is don’t!Ìý But I lost sight due to a dislodged lens, detached retina and my cornea was also quite badly damaged.Ìý Again, it comes down to this question of rebuilding your life back up in this framework of masculinity but especially within the framework of North-eastern pride.Ìý To lose your sight, to lose your work and routine on top of this traumatic stress disorder it’s a lot for him and that’s something that, I think, is quite relatable for a lot of people.

White

Just to go back to Christopher Hogg.Ìý Do you think we’re anymore likely to be able to help someone like David Rathband now than we were 10 years ago?

Hogg

I think things have changed so much in this decade and if I wanted to say what people should take away from the play is that in an age where there is so much information, so much vying for our attention, it’s perhaps easy to miss the signals from people that we know that are going through difficult life moments.Ìý And so, if people take anything away from the play it’s about the power of listening in a world where there’s too much noise.

White

That was Christopher Hogg and Robin Paley-Yorke.Ìý And you can catch up on that Rathband Zoom event by searching for Extant Theatre Company and Rathband.

Now the government wants to use simplified and speeded up planning laws to help the struggling hospitality industry.Ìý Its new bill would enable pubs and café owners in England and Wales to turn pavements into outdoor seating areas very quickly.Ìý It would be cheaper to apply and the waiting time for permission would go down from 28 days to five.Ìý And if no response is received from the local authority within 10 days, owners can just go ahead anyway.

Well Lord Low of Dalston has campaigned, with the National Federation of the Blind, for more than 50 years on the problems caused by street furniture.Ìý I asked what worried him about this bill.

Lord Low

It leaves far too short a time for consultation about these changes, it doesn’t really give nearly enough time for people who are concerned about the proposals to make representations.Ìý There’s no provision for the proposals to be in an accessible format, which makes them accessible to visually impaired people.Ìý And if the local authority doesn’t respond, applications for changes to the street environment are automatically approved for a year, which is far too long and we’d like to see that reduced to a much shorter time – three months – so that they would lapse after three months if the local authority hadn’t responded.

White

Now the government says councils will need to ensure pedestrian areas won’t be compromised, do you think they’ll be able to do that?

Lord Low

That’s what the government say, that’s the sort of ideal but the expression of ideals in legislation and regulations and their realisation in practice are often a long way apart, as we know.Ìý They can issue that as an expression of wish or put it in guidance but its realisation in practice is a very different matter.Ìý And we’d like to see the legislation firmed up so that it was much more a matter of law than guidance, as it is – as the government is proposing.

White

The charity Guide Dogs is asking for a barrier to be made around new pavement areas of seating, would that help do you think?

Lord Low

Well I’m not sure about that, it depends about what kind of barrier but a barrier can be an obstruction just as much as the thing that it’s supposed to be guarding against.

White

Lord Low.

Well the government has told us:Ìý Any licences issued under this new fast track process will have both a no obstruction condition and conditions explicitly requiring clear access routes.Ìý This, they say, will be supported by robust enforcement measures which mean that licences can be revoked where conditions are broken and guidance for councils is being developed in consultation with RNIB and Guide Dogs.

Now, as soon as lockdown occurred you were telling us of your concerns about how to receive essential eye treatment, while at the same time remaining safe from coronavirus.Ìý One idea is that of the video appointment, so that initial examinations of the eye can be made without the need for a hospital visit.Ìý We featured one such scheme operating in Scotland.Ìý And now Moorfields Eye Hospital in London is telling us that since lockdown they have conducted over 10,000 video eye appointments.

Jennifer Slater has been a patient with eye problems for over 60 years at Moorfields and I asked her why she had tried the new service.

Slater

I had a problem with my left eye and I’ve been under Moorfields because I have a condition called Fuchs’ Dystrophy, that actually affects the corneas.Ìý I was worried in case one of my corneas was failing.Ìý I’m not that great with a computer but it was really straightforward.Ìý And I booked a slot and within about 15 minutes one of the consultants came through.Ìý I did actually lean forward and she was able to say to me – yes, your eye does look a little bit glassy.Ìý She said she thought I had an infection and it wasn’t anything to do with the cornea condition.

White

How did you know the video appointment was a possibility for you?

Slater

Well, to be honest, it flashed up on Facebook, because obviously I follow Moorfields, and it flashed up that they were doing these video consultations.Ìý But, as I say, for me it was excellent because if I go from my local station up to Moorfields, and I always have to take somebody with me because quite often they put drops in your eyes that dilate your pupils, it’s £56 on a cheap day return, if not it’s an hour and – about an hour and 20 minutes car drive.Ìý The cheapest place we found to park near Moorfields is £9 a day.Ìý As I say, within half an hour I had meds at my local chemist.Ìý So, for me it was really successful.

White

Jennifer, thank you.

Well Pete Thomas is a consultant paediatric ophthalmologist and Moorfields Director of Digital Innovation.

What happens, from your point of view, in a video appointment?

Thomas

What the doctor does is they get a thorough history from the patient.Ìý If that’s a patient who’s known to us we can access their electronic records.Ìý Sometimes we’re able to do some level of examination of the eye.Ìý So, in my own specialty, I’m a squint surgeon, so, I’m able to observe pretty well how the eyes move over a webcam and, as in this case, it’s sometimes possible to see what’s going on in front of the eye.Ìý So, we’re sometimes able to do a bit of examination as well.Ìý And then we need to come to our clinical decision making and during the Covid lockdown one of those main questions with these emergency presentations is – does the patient need to come into hospital.Ìý If so the video consult service, that’s allowed us to significantly reduce the number of patients coming in to our A&E, so when they do come in it’s an emptier and safer waiting room for them.

White

When people develop eye problems, I mean they’re naturally worried and scared, isn’t something key lost in the lack of human contact, even at an early stage?

Thomas

It’s on two levels really.Ìý I guess the question is do you get a benefit from face-to-face contact rather than just voice?Ìý And we do find that coming through from the sort of satisfaction surveys we’ve been running after video consultations.Ìý So, we find that many of our patients express, in some cases, a fairly strong preference for the face-to-face element that you get during a video consultation, the ability to demonstrate a problem to the doctor and put a face to the person who’s giving the advice.Ìý So, video consults actually do let us get a large part of that body language and empathy element.Ìý The second question is – what you lose in terms of things you can do when you have a patient there in person.Ìý We’re used to examining many of our patients on a microscope, when they come in to see us, with access to all kinds of scans of the eye.Ìý Now that kind of examination isn’t necessary for some of our patients, patients with a known diagnosis in whom we’re mainly tracking symptoms, for example.Ìý And in other cases, the decision we’re trying to make is – does this patient have a history, so symptoms, that suggest they really do need to come in.Ìý While you do lose the ability to get a patient on a microscope, for everyone we still do have these options, just because someone has a video consultation doesn’t mean that they can’t come in for a face-to-face.Ìý And in my paediatric video consultation clinics on several occasions over the last few months a patient’s said something or something’s come out on the history that makes me think – yes, I should get this patient in for a face-to-face visit and I’ve done so in a timely fashion.

White

Now that you’ve done this, how likely is it to become standard procedure, do you think?

Thomas

I think it’s very likely to become standard procedure.Ìý I think, realistically, we expect there to be some level of disruption to healthcare services for some time and it’s going to be sensible to try and manage patients remotely where that is safe and possible.Ìý A lot of my clinical colleagues are finding they’re very satisfied with video consultations and they’re building that in to their long-term plans.Ìý And certainly, if you look at our A&E service, we’re able to manage up to about 80% of patients remotely and that’s a really fantastic way of making sure that we’re preserving our clinical estate, our capacity in the hospital, for those patients who really need it.Ìý So, all the evidence we’re getting – measuring safety and measuring the clinical outcomes – all of it suggests that this is a long-term sustainable service.

White

Is this really perhaps more about money saving than patient care?

Thomas

It’s attractive for patients as well.Ìý We get a lot of feedback, a lot of what comes from the satisfaction survey is how pleased patients are to be saved a visit into hospital, which costs money – we just heard a visit from Essex there.Ìý A lot of our patients come from a reasonable distance away and it can be quite costly to come into London for the day.Ìý So, certainly the patients are reporting they’re able to save money from this.Ìý And for the hospital, as well, it’s expensive to run a hospital and it makes sense to preserve your clinic rooms for those patients who most need them.Ìý So, if there are groups of patients who can be well and safely managed by video, yeah, that makes sense and we need to preserve finances where possible.

White

That was Pete Thomas, Consultant Paediatric Ophthalmologist at Moorfields Eye Hospital.

And that’s it for today.Ìý We always welcome your input, as you know, you can email intouch@bbc.co.uk and you can go to our website bbc.co.uk/intouch from where you can also download tonight’s and previous editions of the programme.

From me, Peter White, producer Kev Core and studio manager Jonathan Esp.Ìý Goodbye.

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