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IN TOUCH

TX:Ìý 08.11.2022Ìý 2040-2100

PRESENTER:Ìý ÌýÌýÌýÌýÌýÌýÌýÌý PETER WHITE

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PRODUCER:Ìý ÌýÌýÌýÌýÌýÌýÌýÌýÌý BETH HEMMINGS

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White

Good evening.Ìý Tonight, we talk to two women, both celebrating firsts, both with new jobs, both aiming to make a difference.

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Master treasurer, I introduce Jessikah Rodine Inaba.

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Miss Inaba, in the name of the masters of the bench, I call you to the degree of the utter bar.

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White

And later, we’ll be meeting Jessikah, believed to be the country’s first blind and black woman barrister.Ìý Perhaps the question we should be asking her is – why has it taken so long?Ìý Which might be an equally legitimate question to put to our first guest – Louisa Wickham.Ìý Louisa is England’s first national clinical director for eye care.Ìý So, Louisa, that’s the question – why has it taken so long?

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Wickham

Well, I think it’s interesting, isn’t it?Ìý I mean the role of the clinical director for eye care has taken some time but it’s really great that eye care’s been recognised by putting back into the sort of national table to represent eye care.Ìý We all know that eye care’s been facing a number of challenges, it’s one of the largest volume outpatient specialties with over 10 million appointmentsÌýÌý And my role, really, now, is to provide some national clinical leadership to help sort of foster collaborations across the healthcare that can able transformation and help to remove blocks and improve efficiencies.Ìý Really for ophthalmology what we want to focus on is the prevention of irreversible loss of vision and that’s why, I think, there’s been increasing recognition that we need this leadership to help address the challenges of increasing demand.

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White

So, what do you see really as your role – what are the things you are really determined to do?

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Wickham

So, some of that will be about delivering national policy and guidance and standard pathways and contractual frameworks but obviously, there’s other parts which is looking at funding and commissioning and addressing national workforce issues.Ìý So, all of those things will work together to try and transform eye care.

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White

So, let’s look at a couple of the things that you’ve mentioned.Ìý I mean there are some well acknowledged problems – waiting times, in particular.Ìý A report out earlier this year claims over 24,000 people have been waiting longer than a year for appointments in the UK.Ìý What needs to be done there to tackle this and where are the biggest logjams?

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Wickham

I mean my priority at the moment is to work and start working with regional local teams to see how we can address these significant challenges.Ìý But we’re not going to achieve that by just doing more of the same.Ìý Eye care needs to transform and do things quite differently.Ìý No one single focus is going to do that, it’ll involve many initiatives.Ìý I know you recently had Melanie Hingorani on your show talking about the possibilities of using digital services to help us identify patients at risk and monitor those with chronic conditions.Ìý So, we want to use some digital tools to support the workforce to do what they do best and more efficiently but it’s about using those to enable the best care so that patients are seen at the right time, at the right place and by the right person.

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White

You are, as well as your current job, you’re a consultant ophthalmologist and medical director at Moorfields, under that you’ve proven you can do something about waiting times, one example being a cataract drive.Ìý I mean, first of all, can you tell us what that is and what that actually achieved?

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Wickham

What we did at Moorfields Eye Hospital was essentially repurpose the whole of the hospital to provide one operation in terms of cataract surgery so that we could allow as many patients as possible to be safely operated on by all of the surgeons working together, together with our optometry and nursing colleagues and that allowed us to do over 720 cataract operations in one week.Ìý And it was a real example of how working together in the NHS, how we can transform services.

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White

But what does that achieve in the long term because you obviously can’t take over all those resources permanently?

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Wickham

Yeah, it did a couple of things for us.Ìý Firstly, it showed us the art of the possible, it showed us how a streamlined cataract pathway could be used in a much smaller scale.Ìý So, we continue to use many aspects of that streamline pathway in a day-to-day high volume, low complexity surgical list that are now happening throughout the country in a number of hospitals have used the blueprint that we developed from that system.Ìý In the cataract drive for Moorfields, it allows us to really kickstart post-covid recovery to really address those patients that have been waiting the longest but it’s trying to integrate that more frequently within the general processes of the hospital.

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White

We’re always told that the most important element in treatment is early diagnosis, would you acknowledge that we’re missing some people’s diagnoses because of those waiting lists that we’re talking about – bluntly people are losing sight which could be saved, aren’t we?

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Wickham

Well, I think, what we’re trying to do at the moment is to use data collection to try and risk assess and triage patients as much as possible to recognise those patients who have urgent conditions.Ìý So, it’s no longer the case that if you have a referral, it just sits with a whole load of other referrals without being looked at.Ìý What we try and do is assess the referral by need and then bring in those patients that are most vulnerable and more likely to suffer problems.Ìý Without a doubt it’s a big challenge, there are a huge number of patients on the waiting list and that’s why, as I said, we need to really think about doing things differently and transform the way we do things and part of the answer is to use diagnostic hubs, which we’re beginning to bring online in a number of different areas where we can invite patients to come in, have some data collection that can be reviewed by optometrists, doctors and extended nurse practitioners to ensure that patients who do have risk factors or causes for concern can be brought in earlier.

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White

Now it is, potentially, an optimistic time to have an eye problem, if there is such a thing, probably there isn’t, you know, but with many new treatments around – stem cell, new drug therapies, gene therapy – we’ve talked about the problems, where do you think the best hopes are?

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Wickham

I think that’s a great question.Ìý I mean it is, as you say, a really exciting time.Ìý I think the fact that we have a number of possibilities is really due to research in eye care and for me, the most important thing with this is to really ensure that we have a continued support of the research agenda within eye care and really work on bringing those fantastic innovations and discoveries into clinical practice as quickly as we can to prevent sight loss.

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White

In recent weeks, we’ve reported on the Eyes Have It, which is a partnership between many of the sight loss organisations, which I’m sure you know about, they’re calling for a national eye care plan.Ìý What would you say such a plan could achieve and what would it look like?

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Wickham

Well, certainly, the introduction of my role will further establish a conversation at the heart of the NHS about a national approach to eye care.Ìý But we do need to build consensus around the [indistinct word] model for eye care and I’m committed to working with the whole eye care sector to identify those opportunities, to try and find things which are best done centrally, at a national level, whilst also making the most of regional and local opportunities.Ìý So, it means that the NHS can work together on a shared goal for eye care, while also making sure that local teams have the flexibilities to support the specific needs of local people.

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White

Now we’ve touched on this and we always come back to it – all these things you’ve talked about depend on resources and amongst the people we talked to at the Eyes Have It parliamentary event was Cathy Yelf, Chief Executive of the Macular Society.Ìý She welcomed your appointment but she did have a concern:

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Yelf

We’re slightly worried that perhaps she hasn’t got the resource that she may need to be able to make a big difference on this but it is a huge step forward.

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White

So, do you have the resources, Louisa?

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Wickham

Well, it’s a very difficult question at the moment, isn’t it?

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I think, for me, what is critical is that we need to find mechanisms that are cost effective and efficient, not just in terms of finance but also time and workforce resources.Ìý The challenges we face will not and, I don’t think, cannot be addressed by keeping everything exactly as we have it now, we need to work together as a sector to figure out how we really transform the patient pathway, to make sure that the patient is supported and educated.Ìý And in those initiatives, in themselves, will bear fruit in terms of less requirement for more advanced treatment if patients are able to have the educational resources to deal with their conditions early on.

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White

Louisa Wickham, thank you very much indeed.

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Now, it’s no surprise, that we’ve had a big response to our item about public bodies being unwilling to communicate with blind people using email.Ìý When Clive Lever needed to kickstart the receipt of his retirement pension, he found he had to go online to fill in the forms but there was nowhere where he could ask for ways to get the information in a form accessible to him.Ìý There was a helpline:

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Lever

When I finally got through, I told them I had no useful reading vision, the agent told me that unfortunately, they could not act on my request because their computer system only allowed them to process requests that would change the amount I was due.Ìý I was then surprised to hear her say – but don’t worry, we’ll be sending you a pack of forms to fill in within the next three weeks, I’m sure you’ll be able to read them by the time they arrive.Ìý

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White

Well, at the time of writing, Clive still has not got an accessible way to read them, now has he miraculously got his eyesight back.Ìý Meanwhile, Hazel’s quarrel is with the NHS.Ìý She says:

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Hazel

I’ve been fighting Buckinghamshire NHS for this very thing, even quoting the accessible information standards, they still just about manage to send emails every now and then.Ìý They seem to ignore the fact that we need privacy, just like sighted people.Ìý I’ve had attachments sent as PowerPoints and ones that need passwords or codes.Ìý I’ve had in-depth medical reports sent in print, which end up in public eyes.Ìý The excuses they use are that their computers don’t speak to each other, the person has not been in the job very long and, the most shocking one, was that the manager would not let the staff email anyone.

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White

Sounds like that could be a job for a lawyer.Ìý And we might have the very person joining us now.Ìý The law’s been one of the earliest of the professions to become open to blind people but most of the blind people who’ve established themselves have been male and white.Ìý They’ve also been predominantly solicitors.Ìý So, there is some excitement at the achievement of Jessikah Inaba.Ìý Jessikah, as well as being blind, is a black woman and she’s been called to the Bar, so she is reckoned to be the first black blind woman to qualify as a barrister.

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Jess, first of all, are you surprised it’s taken so long for someone in your position to make it to the Bar?

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Inaba

It is surprising in 2022 but I am happy to be the first one and I do hope there will be many to follow.

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White

Why the law, what was it that attracted you to it in the first place?

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Inaba

I feel like it’s always been in me.Ìý There was a doctor that used to deal with my eyes, when I was a lot younger, and the last time I saw this doctor I was about three years old and I saw her again 15 years later, when she invited me to one of her lectures and the first thing she said to me was – Hey, Jess, do you still want to be a lawyer?Ìý And I said – What?Ìý And she said – Yeah, when I saw you at three, the last time I saw you, I asked you what you wanted to be.Ìý And I said to her – How does a three-year-old know what a lawyer is?Ìý And she said – Exactly my thoughts.Ìý So, apparently, it’s always been in me.Ìý I did deviate in my thinking as I was growing up.Ìý When I was about nine, 10, 11 I learnt to play the piano and I used to love singing and composing music and I thought, yes, I could be the UK’s answer to Stevie Wonder.Ìý So, I was convinced I would be a musician.Ìý But in the end, when it came to applying for uni, I came back to my roots, I guess.

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White

Did it strike you, at that point, that you could be entering a job where you could encounter prejudice for a whole number of reasons?Ìý As we’ve said, you know, you’re a woman, you’re black, you’re blind – it’s quite a package.

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Inaba

I must say it didn’t cross my mind until I started to actually go to detention centres and prisons as a student lawyer.Ìý I was blind to the fact that discrimination would be this steep in 2022.Ìý So, before I could gain access to my clients, the first thing I’d have to prove is that I was the lawyer, I was always assumed to be the sister or relative of a client and I was always told it’s not visiting hours yet, you can sit and wait.Ìý So, I had to establish to the prison guards or to anyone at reception that I was a lawyer.Ìý Once that was done, I had to explain why I needed to bring in my specialist equipment.Ìý So, normally lawyers are only allowed to bring in a notepad and pen but, obviously, that wouldn’t work for me, being completely blind, so I had to bring in my braille notetaker in order to take notes of what the client’s saying and to prepare their case or to give advice.

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White

But the point about when you saw detainees that you were a relative, do you think that was due to your colour?

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Inaba

Absolutely, because there is only one of me.Ìý When you think of a lawyer, I’m not the typical type of person that comes to your mind and I do feel like being black definitely had a huge part to play in that.

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White

Can we talk about the practicalities of doing the course and doing the work?Ìý You are working in an area of law where you need to absorb a huge amount of information, you studied for your law degree in braille, how easy has it been to actually get the materials that you needed?

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Inaba

My whole university experience was quite horrendous.Ìý I did an accelerated course.Ìý Prior to starting the course, I spoke to the university and explained that these are my access requirements.Ìý But, unfortunately, for the entire duration of my Batchelors I didn’t have a single textbook or a single piece of accessible material translated into hard copy braille or braille that can be read on my braille note devices.Ìý So, the way I passed my Batchelors was a miracle.

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White

I mean we did put this to the University of Law, where you went, they told us they were able to provide additional support to ensure you were able to succeed on your course and that they were, eventually, able to provide braille.Ìý Do you understand why the delays took place?

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Inaba

Quite frankly, no.Ìý It took for me to scream and shout before they could start making the changes.Ìý I continued to do my Bar professional training course and my masters at the same university but prior to starting those courses I sat down with the university and explained to them – these are everything that has gone wrong during my Batchelors, these are what I need you to do to rectify this in order for me to access my next courses.

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White

And was it better?

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Inaba

No.Ìý

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White

Though we asked in our request to them for information they haven’t explained why the delays took place to us in their statement, I afraid.Ìý Can I just ask you why braille?Ìý A lot of people now would tend to use audio synthetic speech, why is braille so important to you?

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Inaba

I’m quite a visual learner in the sense that I need to feel what I’m reading in order to retain it.Ìý As a barrister, in court, it’s so important that I listen to what’s being said around me.Ìý So, now, if I familiarise myself with using screen reader software, I would have an earpiece in, in court, listening to what my computer’s saying and I feel like I would miss key information and that’s not me having my client’s best interests at heart.

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White

So, how confident are you that when it comes to doing the job, you’ll be able to get the information in a format that you need?

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Inaba

That is something that plays on my mind quite a lot.Ìý I’m just hoping that I can work alongside the chambers that I end up being with to find a strategy where everything will be accessible.

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White

In spite of all that, this is a good news story, I’m just wondering how you feel about having made it?

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Inaba

It still feels quite surreal, I don’t think I’ve given it time to sink in.Ìý Perhaps when I get my pupillage then I will realise that I really did it but right now, it’s still like a wild dream.

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White

And what’s your long-term aim because the law can lead to all sorts of things, is this the road you want to stay on or have you got other ideas?

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Inaba

I would like to stay in the law, I would like to, eventually, become a QC and perhaps a judge one day, that would be amazing and perhaps a partner in chambers also, that would be great.

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White

Judge Jessikah Inaba has a certain ring about it, doesn’t it?

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Inaba

Definitely.

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White

Jess, thank you very much for talking to us and good luck.

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And that’s it for today.Ìý We love to hear your opinions and your experiences.Ìý Email intouch@bbc.co.uk, leave a voice mail on 0161 8361338 or go to our website bbc.co.uk/intouch.

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From me, Peter White, producer Beth Hemmings and studio manager Nat Stokes, goodbye.

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