Delays in treatment and follow-up care at overstretched hospital eye clinics across England are resulting in people losing their sight, according to the latest research from the Royal National Institute of Blind People (RNIB).
A new report, Saving money, losing sight, revealed that a worrying 37 per cent of hospital eye clinic staff said patients were ‘sometimes’ losing their sight unnecessarily, due to delayed treatment and follow-up care caused by capacity problems, with a further 4 per cent stating they believed this sight loss was happening ‘often’.
The survey of 172 eye health professionals including 91 ophthalmologists and 59 ophthalmic nurses, showed over 80 per cent said their eye department had insufficient capacity. Ninety-four per cent stated that future capacity would not meet rising demand, driven by an ageing population and demand for services across a range of conditions.
Eye clinic staff described their working conditions as ‘chaotic’ and ‘running from one crisis to another’, with half of respondents stating that the problems were so significant they had to undertake extra evening clinics and at weekends to keep up with demand.
The RNIB warned that many commissioners and hospital managers were clearly failing patients and it called on the public to know and exercise their legal rights, suggesting that a lack of capacity could lead to hospital trusts facing many more clinical negligence claims.
Commenting on the statistics, RNIB chief executive Lesley-Anne Alexander described them as shameful. ‘Nobody should lose their sight from a treatable condition simply because their eye clinic is too busy to provide care in a clinically appropriate time-scale.
‘Hospital managers are ignoring the capacity crisis, often to save money, and are putting patients’ sight at risk and their staff on course for burnout.’
She added that the shocking results should be a wake-up call to commissioners and hospitals, warning that if they did not act soon they could be at risk of clinical negligence claims.
Additional research into commissioning found that there was no consistent approach across England and some CCGs made decisions on very different levels of evidence. It was also found that a quarter of CCGs had no lead for eye care, while poor dialogue between CCGs and ophthalmology specialists was reported to be hampering commissioners’ ability to plan and deliver high quality eye care.
Responding to the report, the College of Optometrists urged commissioners to improve community eye care and integration of community and hospital IT systems as other ways of addressing the capacity issue.
College president Dr Kamlesh Chauhan highlighted the role optometrists could play in expanding capacity and improving the use of NHS resources. ‘The NHS is helping more people to combat eye disease than ever before. However, because we are discovering new treatments for what were once incurable conditions and our population is ageing, demand for NHS eye care is rising significantly.
‘Smarter commissioning of eye care services using optometrists to treat more people in the community and dovetailing this with care provided in hospitals meets this demand effectively. Across the UK, community optometrists are already working with commissioners to reduce the number of people referred in to hospitals and to treat people close to home. This boosts capacity and lets hospital specialists focus on providing care to those that require the specialist skills of ophthalmologists.’
The College highlighted its joint guidance with the Royal College of Ophthalmologists for commissioners of glaucoma services. It plans to publish guidance to improve age-related macular generation, low vision and urgent eye care services and added that implementing this would help commissioners meet rising demand.
Access to eye care services in the community varied significantly across England, said the College. While all patients in Scotland and Wales could get urgent eye problems seen and treated by local optometrists who were funded to provide this service, patients in many parts of England had no option but to use hospital services or to pay for care which should be free at the point of delivery as well as accessible.
Katrina Venerus, managing director of LOCSU, said pressures on NHS budgets meant it was often impossible to expand existing services to meet the need from the ageing population. ‘Instead we have to find more efficient ways of providing eye care.’
Relieving over-stretched eye clinics was not just a question of more resources. ‘Some areas are adopting new ways of providing eye health services, allowing patients to be seen more quickly at lower cost to the NHS.
‘One solution is to take some eye health services out of expensive hospitals and provide them locally – in high streets and shopping centres. CCGs across England now increasingly work with LOCs to provide community eye health services through opticians and optometrists based in local practices, rather than in hospitals. The result is services that are more convenient for patients and cost less for the NHS.
‘If we are to avoid people losing their sight unnecessarily, we must make better use of the skills of health professionals who work outside hospitals. This will also bring wider benefits for the public’s eye health.’
By Rory Brogan.