Eye care services: an urgent call for reformation

Ophthalmology is the busiest outpatient speciality in the NHS ( ¹ ) with well over half a million patients in England waiting for treatment as of April 2022. More than a third of them had been waiting in excess of 18 weeks, including over 26,000 waiting more than a year ( ² ). The COVID-19 pandemic has served only to worsen the situation and waiting lists are now inevitably longer than they were in 2019 ( ³ ).

The devastating consequences of delays to treatment for certain eye conditions should not be underestimated. For example, a patient with wet AMD (age-related macular degeneration) can experience rapid and complete central vision loss within a few weeks if left untreated. ( ⁴ )

It is therefore critical that eye care services are urgently reformed. Patients are our priority and we must work tirelessly to address the backlogs and lack of capacity in the system to save the sight of those who are losing their vision because they are unable to access timely treatment.

A new national clinical director for eye care

It was announced this year that the first ever national clinical director for eye care would be appointed. It is expected that the successful candidate will be named in the coming months. The appointment will be widely welcomed by stakeholders in the eye care sector who have long campaigned for clinical leadership at a national level, not least by The Eyes Have It (TEHI) partnership.

The Eyes Have It was launched in 2021 to campaign for improvements on behalf of patients living with sight loss. Made up of The Royal College of Ophthalmologists, the Macular Society, Fight for Sight, the Association of Optometrists and Roche Products Ltd, the group wants a comprehensive national strategy for eye care to bring together primary, secondary and community services to address fundamental issues in the system, such as standardising diagnostic and care pathways and ensuring eye care services and the workforce they depend on receive the investment needed. This, we believe, will improve outcomes and quality of life for thousands of patients.

How will a national strategy help?

To deliver service transformation, the whole healthcare system needs a shared vision for reform, and a sustained long-term focus. A national strategy or plan would provide that unified blueprint for transformation, building on current recovery activity.

It is shocking to learn that accurate, up-to-date data is simply not available in many trusts and that clinicians in some hospitals are resorting to going through hospital notes by hand to re-prioritise the most vulnerable patients

Managing long-term disease is mission critical and the first priority should be to identify the most vulnerable patients waiting for treatment. But this is easier said than done because data collection and management is sporadic and inconsistent across different trusts in the NHS. Data is, however, routinely collected in primary care, so with a joined-up service could be shared across the treatment pathway. It is shocking to learn that accurate, up-to-date data is simply not available in many trusts and that clinicians in some hospitals are resorting to going through hospital notes by hand to re-prioritise the most vulnerable patients because no-one really knows how many patients are in the queue, where they are on the treatment pathway, or in many cases, even who they are.

Equity and consistency

The national strategy should also address current incentives for treating patients to ensure more equity and consistency. There is something really fundamental here about where we put our resources. We need government guidance on how to reduce waiting list numbers that prioritises patient needs rather than political targets. Bringing down cataract waiting lists, for example, is all well and good, but it must not be at the expense of higher risk patients being diagnosed for conditions such as glaucoma.

The National Eye Care Recovery and Transformation programme will go a long way to address some of these issues and could indeed blaze the trail for NHS transformation more widely

The National Eye Care Recovery and Transformation programme will go a long way to address some of these issues and could indeed blaze the trail for NHS transformation more widely. But it is vital that regional NHS teams and commissioners work with ophthalmologists to deliver services locally. The move to integrated care systems (ICSs) will undoubtedly provide an opportunity to review what services need to be prioritised locally and ensure services are clinically and financially sustainable.

In line with current planning guidance ( ⁵ ), ICSs, supported by NHS England, should prioritise actions which will alleviate pressure on hospital eye services and save capacity. For example by delivering surgical care hubs and community diagnostic hubs; working with primary care optometrists to support patients in the community where appropriate; risk stratifying patients; providing remote consultations; and utilising virtual clinics. Innovations in how to manage demand within the secondary care centre should also be considered, for example by changing treatment patterns. The guidance also states that each ICS should promote research on matters relevant to the health service and use evidence obtained from research.

As part of its drive for change, The Eyes Have It partnership is calling for widespread support from anyone with an interest in eye care. What can you do to help improve eye care services? Join the partnership and others to make a pledge on our digital pledge wall.

Stephen Scowcroft is director of services at the Macular Society. You can follow Stephen on Twitter @sscowcroft