Outpatient eye-care waiting list continues to increase reaching 41,600

Budget 2019 – Optometrists call for cataracts scheme roll-out, children’s eye-care programme and payments parity 

41,600 people were on the outpatient eye-care waiting list at the end of August 2018, with the list continuing to increase, up from 40,000 at the end of 2017 and 38,100 12 months previously.

16,100 of these people were waiting more than a year and 9,600 more than 18 months. This is also up from 13,800 waiting more than a year and almost 7,600 more than 18 months at the end of 2017. 

Making its 2019 Pre-Budget Submission, Association of Optometrists (AOI) Chief Executive Sean McCrave said Ireland’s eye-care services need to be reformed to meet ever-growing demand, as the population both increases and ages.

Furthermore, 10,400 people were awaiting inpatient eye procedures at the end of July – the second largest inpatient list of any medical speciality. There have however been slight decreases in the inpatient list over the past 12 months.

“While there was a slight reduction in the inpatients list, in contrast the outpatient list is spiralling further out of control. AOI welcomes some additional theatre space at the Royal Victoria Eye and Ear and Nenagh Hospitals this year, but these will not address this scale of demand and delays. And we also have a growing aged population year on year.

“We are recommending radical reform of eye-care to move towards a triaged pathway of routine public care provided in the community and specialised care in hospitals. In Ireland we have an unusual overreliance on hospital Ophthalmology Departments that will not meet the demands of our population,” AOI stated.

Mr. McCrave highlighted in particular the need for better organisation of cataracts surgery which accounts for a significant portion of the waiting lists backlog.

“A survey carried out by AOI earlier this year found that there are waiting times of up to five years in some parts of the country for cataract surgery. To address this we are calling for national roll-out of the Sligo Post-Cataract Scheme, which has reduced waiting times and costs in the region where it is available.

“Under the scheme patients’ follow up appointment is co-managed by Optometrists and Ophthalmologists, reducing the care pathway by one appointment. With over 20,000 cataract procedures a year, rolling out this protocol nationally would reduce outpatient cataract appointments by up to 20,000. This alone would make a significant impact,” Mr. McCrave said.

Optometrists call on funding for national children’s eye-care programme

In its submission AOI also called for the development and roll out of an Optometrist led national eye-care programme for 0-16 years olds to address major waiting times, gaps and inconsistencies in children’s services.

AOI calls for HSE payments to be placed on parity with PRSI

Furthermore, AOI called for HSE payments for optical services to be the same / in parity with PRSI payments made by the Department of Employment Affairs and Social Protection (DEASP).

The amount paid by the Department under PRSI was restored in line with pre-austerity levels in 2017. However, the HSE Medical Card payments remain at the same austerity level and are frozen under FEMPI. 

The HSE has said that it does not have the authority to return the rate to parity, but needs Ministerial direction or a Statutory Instrument for this to occur. In fact, AOI understands that the HSE is in breach of contract by not paying in parity with DEASP.

Historically both payments were in parallel. AOI said this discrepancy should to be resolved in Budget 2019 by restoring parity between the payments.

Mr McCrave concluded by saying that improvements for patients can be achieved by changing Ireland’s model of eye-care. 

“There are also other areas where Optometry could help with delivering evidenced based care pathways such as red eye management, glaucoma and AMD. Not all these patients need to be under the full-time care of Ophthalmology. Hospital waiting lists can be reduced further by directing some of these patients back into the community.

“AOI has estimated that in excess of €30m could be saved across services while at the same time delivering a more accessible and clinically effective service. That is because it is 50% less expensive to provide routine examinations, monitoring and care in the community than in the hospital system.” he said.

Read AOI’s 2019 Pre-Budget Submission in full at www.aoi.ie