Report warns of crisis in eye clinic capacity as cancelled appointments risks patients’ sight

The current eye health system is failing patients on a grand scale, according to a new report released today [1]. Up to 22 people per month are permanently losing sight due to delayed and cancelled hospital appointments for conditions like wet age-related macular degeneration (AMD), glaucoma and diabetic eye disease [2].

The situation is fixable if the NHS prioritises eye health and action is taken immediately, says the All-Party Parliamentary Group (APPG) on Eye Health and Visual Impairment.

The APPG’s report follows its inquiry into capacity issues in eye care, and the findings are being launched at a Parliamentary reception for MPs today. The inquiry and its calls for urgent action are supported by key organisations including Royal National Institute of Blind People (RNIB), the Optical Confederation, and the Royal College of Ophthalmologists. The inquiry received evidence from 557 patients and 111 organisations.

There were almost 7.6 million ophthalmology appointments in 2016/17 in England, a figure which has increased by more than 10 per cent over the past four years.

Just over half of patients told the inquiry they had experienced at least one appointment or treatment being delayed. Seventy-seven per cent of patients felt this caused them anxiety or stress, and 54 per cent felt it had a negative impact on their day-to-day life.

Patients also expressed concerns about long waiting times, problems securing appointments, a lack of continuity in their care, and poor communication from the clinic.

The report is calling for the Secretary of State for Health, NHS England, the Department of Health and Social Care, local authorities, commissioners, delivery bodies, NHS providers and Sustainability and Transformation Partnerships (STPs) to act now on eye health.

Lord David Blunkett, a member of the APPG for Eye Health and Visual Impairment inquiry, said:

“Urgent action is needed to ensure eye care services meet the needs of patients now and in the future. World class treatments are now available for conditions like wet AMD. It is vital that patients have access to them at the right time to save their sight.

“We have been able to identify a series of recommendations which will help improve capacity in eye care. We are calling on the Secretary of State for Health and Social Care to include eye health in the NHS England mandate.”

Eleanor Southwood, RNIB Chair, said: “Nobody should lose their sight from a treatable condition simply because their eye clinic is too busy to provide care in a clinically appropriate timescale.

“Implementing the recommendations in this report will help to meet the increasing demands for eye care services, deliver strategic and joined up eye care, and reduce the numbers of patients losing their sight because of delays.”

Michael Burdon, President of the Royal College of Ophthalmologists, said:

“The issues highlighted by the inquiry are all too familiar to ophthalmologists working in under resourced and overwhelmed hospital eye clinics. I welcome this report which raises awareness with government and health officials of the increasing crisis facing eye health services and patients.”

Michael Tupper, who shared his experiences in the APPG’s report said:

“I’ve got glaucoma and it’s vital for me to see the consultant ophthalmologists at my hospital’s eye clinic regularly and

promptly to make sure my treatment is working. All too often my appointments are delayed and cancelled, which causes me great stress and anxiety about my sight deteriorating.

“After a recent appointment the pressure in one of my eyes increased quite considerably. If I hadn’t been given a timely follow up appointment – which has happened in the past – I could have had very serious problems.”

The number of people in the UK that will be affected by sight loss is projected to increase by over 10 per cent by 2020 and by over 40 per cent by 2030. The total cost of sight loss to the UK economy was in the region of £28 billion in 2013, having increased from an estimated £22 billion in 2008 [3].

Further information

[1] See the light: Improving capacity in NHS eye care in England, the report of the All-Party Parliamentary Group on Eye Health and Visual Impairment Inquiry into capacity issues in eye care, June 2018, www.rnib.org.uk/appginquiry

[2] Foot B. MacEwen C. (2017) “Surveillance of sight loss due to delay in ophthalmic treatment ore review: frequency, cause and outcome”. Eye, 31: 771-775 (British Ophthalmological Surveillance Unit)

[3] Pezzullo L., et al (2016) “The economic impact of sight loss and blindness in the UK adult population”. BMC Health Service Research (2018); Office for National Statistics (2015) 2014-based National Population Projections, United Kingdom

Reason for the inquiry

Robust evidence indicates patients across England are losing sight due to delayed and cancelled eye care appointments. The inquiry has sought to identify solutions to help improve the commissioning and planning of eye care services in England to increase capacity.

Who took part in the APPG inquiry

The APPG inquiry was launched in July 2017. Evidence was received from 557 patients, 111 organisations including clinicians, eye care departments, commissioners, Sustainability and Transformation Partnerships (STP), Local Eye Health Networks, professional bodies, charities, health industry organisations, researchers, the Department of Health and Social Care, NHS England and Public Health.

The inquiry has also been supported by an Expert Advisory Group comprising:

Susan Blakeney, College of Optometrists

Mike Burdon, The Royal College of Ophthalmologists, President

David Hewlett, The Federation of (Ophthalmic and Dispensing) Opticians / Optical Confederation

Susan Hoath, Chief Executive, Birmingham Focus

Malcolm Johnson, patient representative

David Quigley, patient representative

Michael Sobanja (Chair), NHS Alliance

Alan Tinger, RNIB Trustee/ Honorary Treasurer

Keith Valentine, Chief Executive Vision UK

Stephen Vernon, The Royal College of Ophthalmologists, Vice President

Christine Wall, patient representative.

RNIB provided the independent secretariat for the APPG Inquiry into capacity issues in eye care.

Recommendations

The inquiry has identified a series of sixteen recommendations to help ensure patients don’t face delayed and cancelled appointments.

1. Prioritising eye health in the NHS Mandate for England
2. Asking MPs to write to their STP calling for eye health capacity issues to be addressed in the local SPT plan.
3. Inclusion of ophthalmology in the NHS Transformation programme;
4. Support for Local Eye Health Networks;
5. Improving data collection so waiting times, delayed and cancelled appointments can be measured and compared;
6. Changing the national tariff for ophthalmology which currently disadvantages patients with long term eye conditions that need follow up treatment;
7. Set a national target to ensure follow up patients get treatment and care when they need it.
8. Improving IT connectivity between community optometry, GPs and hospitals to speed up referrals and improve quality of patient care;
9. Improve the way drugs are made available for ophthalmology patients to prevent delays and cancellations to treatment;
10. Improve the way eye health needs are included in Joint Strategic Needs Assessments;
11. Change the way eye care services are commissioned to improve transparency of funding;
12. Improve the eye care pathway so it is clearer and more joined up for patients;
13. Enable patients to book their next appointment before leaving the clinic;
14. Increase the number of ophthalmologists (eye care doctors) trained;
15. Improve the training all doctors get in eye care;
16. Improve the consistency of training of optometrists, opticians, ophthalmic nurses and orthoptists so they can play a wider role in NHS care.