“The demand on ophthalmology is increasing like never before”

Post date: 
Friday, 18 March 2016
Prof Carrie MacEwen

Eye specialists believe we can no longer ignore the pressure mounting in hospital eye services especially when people are losing their sight, Hannah Adams reports.

The President of the Royal College of Ophthalmologists has warned that patients are losing their sight due to a rise in demand of eye care services and delays in follow-up appointments.
In an article for BBC’s Online Scrubbing Up series, Professor Carrie MacEwen wrote: "Many eye diseases which can cause sight loss are more common in older people and our aging population means the demand on ophthalmology, like all areas of healthcare, is increasing like never before.”
MacEwen said the college is set to carry out a national study to see how many patients have experienced deterioration to their sight while they wait for an appointment. 
Initial results indicate that across the UK at least four patients per week have severe sight loss as a result of waiting long periods for appointments, she added
She cited that recently a Care Quality Commission report into Addenbrookes Hospital (Cambridge University Hospitals NHS Foundation Trust) stated that “unsafe delays to ophthalmic follow up in clinics” was causing serious incidents and harm.

The problem

MacEwen attributed the rise in eye clinic appointments to patients with chronic eye diseases, such as macular degeneration and glaucoma.
“These patients are the most vulnerable and at the greatest risk of irreversible loss of vision. These conditions require long-term ‘return’ or ‘follow-up’ appointments for repeat monitoring and regular treatment procedures,” she said.
Alarmingly, she pointed out that these follow-up appointments are “more likely to be postponed or simply be lost in the system for months, and sometimes years, to accommodate new referrals in already oversubscribed clinic.” 
Hospitals are fined if patients wait more than 18-26 weeks (depending on what part of the UK you are in) for an appointment and treatment for eye care. However, these targets only apply to new patients having their first appointments, not those needing follow-ups.
MacEwen believes this system does not reflect the true extent of the situation.

“As there are no targets for follow-up patients, data is not routinely gathered, making it impossible to determine the magnitude of this problem,” she added.

A search undertaken by the National Reporting and Learning System showed nearly 500 cases of loss or deterioration of sight as a result of delays between 2011 and 2013 in England and Wales.
In 2009, the National Patient Safety Agency (NSPA) received 44 reports of concerns about patient safety due to delays in appointments for glaucoma patients, of whom 13 went blind over a four-year period, she noted.
“The Rapid Response Report that followed asked for commissioners and providers to open dialogue about data collection and to introduce safety measures to prevent delays for patients who were waiting for treatments or monitoring,” she said.
MacEwen explained that hospital attendances have increased year on year in the UK, with over 100m outpatient appointments made in England alone during 2013-14, of which nearly 10 per cent are for eye care. And in reality, as people become healthier and start living longer, pressure on eye clinics will only increase further. 
She said: “Ophthalmologists, like all doctors want what is best for their patients, and whilst many hospitals are taking positive action to deal with these delays and to find ways to meet the demand on the limited capacity available in eye services, the response to this problem is variable amongst regions and across the devolved nations.”
Clara Eaglen, RNIB Eye Health Campaigns Manager said, “We are hearing from increasing numbers of patients whose follow-up appointments are being delayed or cancelled, leaving them worried and putting them at risk of losing further sight. 
"It is clear that ophthalmology departments are under acute strain. This new warning by the Royal College of Ophthalmologists underlines the need for urgent action, particularly for follow-up appointments.

The solution 

MacEwen is calling for a review of “of current targets so that more equitable care can be provided for new and review patients on the basis of urgency of clinical need, She also believes that “mandatory data should be collected and monitored for follow-up appointments, postponements and cancellations.”
In addition, she wrote that the sector needed to work to protocols and guidelines to ensure efficient care, use the extended skills of ophthalmic nurses, optometrists and orthoptists and educate and empower patients. As well as improving links between primary and secondary care.
Mary Ann Sherratt, President of the College of Optometrists, echoed some of MacEwen’s sentiments: “Optometrists working in community settings can help alleviate the pressure being experienced in hospital eye departments, but service organisation and provision will need to incorporate a range of professions working together.”
MacEwen concludes that the future of all health care involves chronic disease management.
“This approach requires close collaboration with health decision and policy makers, commissioning bodies and partners in the ophthalmic sector so that ophthalmic care is coordinated, cost effective and very firmly patient-centred,” she said.
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