Glaucoma patients are being left to go blind on the NHS due to lengthy delays for appointments, a damning report by watchdog Healthcare Safety Investigation Branch (HSIB) has found.
The HSIB said it had found more than 150 patient-safety incidents involving eye conditions reported by the NHS between April 2017 and December 2018 for which problems with monitoring and follow-up appointments were to blame. The watchdog estimated that as many as 22 glaucoma patients a month suffered severe or permanent sight loss because their follow-up appointments did not take place quickly enough.
It was warned that there was inadequate capacity within hospital eye services to meet the needs of glaucoma patients. The HSIB also revealed how the NHS had failed to act on previous warnings dating back more than 10 years.
Alan Tinger, director of Regulatory Affairs at FODO, said: ‘This is a longstanding and unacceptable scenario, as over 10 years ago national recommendations were made to address similar root causes but people are still suffering from avoidable sight loss.
‘We have long called for action to transform eye care services and by offering more NHS care in primary and community care settings it will be possible to liberate capacity in secondary care for the highest risk patients and those that need access to consultant led care as soon as possible.’
The report’s reference case was a 34-year-old woman who lost her sight completely due to delays she experienced in seeing specialists over the course of 11 months. The mother of three, who was not named, was awarded £3.2m by the NHS last year as compensation for the delays in her treatment and subsequent sight loss.
Findings
The report authors suggested ‘smarter ways of working’ should be introduced to maximise the current capacity, sharing that measures have been implemented in some areas but had not been widely adopted.
Most suspected glaucoma referrals were made by optometrists, said the HSIB, and many patients were subsequently found not to have glaucoma. Filtering schemes commissioned locally to reduce the number of these false positive referrals were not standardised and rolled out locally. In addition, competing priorities in financially stretched commissioning environments could inhibit development of such schemes, said the report’s authors.
Highlight the positive role optometrists can play in relieving pressure on hospital services, the reported cited a study in Bradford investigating optometric referrals which found as the referring optometrists gained experience, false positive referrals decreased at a rate of 6.2% per year. Those who conducted further investigations as part of an enhanced service were also 2.7 times less likely to make false positive referrals. A scheme in Bexley in which the referring optometrist conducted repeat tests prior to referral found this resulted in 76% of patients with suspected glaucoma patients not being referred.
Other findings included increasing capacity through redesigned pathways that enabled trained members of a multidisciplinary team to take on tasks previously performed by ophthalmologists and virtual clinics to assess new referrals and to follow-up with patients.
Chief investigator at HSIB, Keith Conradi, said: ‘Our investigation offered an independent view on why current systems and processes have not adequately addressed the problem. It identified learning that can positively influence practice across the NHS.
‘By highlighting the pertinent issues, our safety recommendations direct organisations to make changes to help reduce the burden on hospital eye services, and lessen the personal loss and distress suffered by patients and their families.’