There are over six million outpatient visits to hospital eye clinics each year and this figure will increase as greater numbers of people live to an older age and are diagnosed with an eye condition. There will also be new and innovative treatments developed to help tackle the most common forms of sight loss such as Age-related macular degeneration (AMD), glaucoma, cataracts and diabetic eye conditions.
So there will be an increased number of patients and an array of new treatments - but will there be enough staff and resources to cope with the extra workload? And most importantly will patients who are on the verge of losing their sight be treated in time?
There are real concerns that eye clinics across England are struggling to cope with current demand meaning that many patients are having their appointments, treatment and follow up care delayed or cancelled. These delays can lead to people going blind unnecessarily. At the minimum people are experiencing extreme worry and anxiety.
RNIB has spoken to staff at eye clinics to ask them what they think and they have expressed serious doubts over the ability of clinics to meet demand. Over 80 per cent said their eye department has insufficient capacity to meet current demand, with 94 per cent reporting that future capacity will not meet rising demand.
A worrying 37 per cent of staff said that patients are 'sometimes' losing their sight unnecessarily due to delayed treatment and follow up care caused by capacity problems. A further 4 per cent said they believed this loss of sight is happening 'often'.
These statistics are shameful as 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.
We believe 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. These results should act as a wake-up call to commissioners and to hospitals. They should be aware that if they do not act soon, they could be at risk of clinical negligence claims.
Staff workload is also a real concern; over half said the problems are so significant that they have to undertake extra clinics in the evenings and at weekends to keep up with demand. Responding to the survey, staff described their working conditions as 'chaotic' and 'running from one crisis to another'. We want to be clear that that frontline staff are not to blame - they are doing all they can to save people's sight but are not supported with enough resources.
One patient we heard from, Dianne, has diabetic retinopathy and has experienced numerous delays and cancellations. She has suffered from bleeds in her eyes while waiting for her next appointment - bleeds that can result in permanent damage to her sight. Dianne told us that she once had to wait a whole year between appointments despite the doctor saying he should see her in three months. She constantly worries that her eyes will have another bleed and that it could result in her losing more of her remaining sight, something that impacts on her three children as well as her.
RNIB is encouraging patients to know their rights and be armed with the knowledge of their condition and its management. Patients need to understand the timeframes of diagnosis, treatment and follow-up care that expert bodies have set, and to take action when the system fails them.
We also have a number of recommendations that we believe should be actioned immediately to try and stop the current crisis from escalating.
RNIB is calling for:
• NHS England to undertake an urgent inquiry into the quality of care in ophthalmology
• National leadership must be established
• Hospital managers and staff must work together to identify and address capacity problems in their eye clinics
• Clinical Commissioning Groups should better understand the eye care needs of their local population
• NICE should prioritise the production of its eye health clinical guidelines and Quality Standards
• Eye Clinic Liaison Officers (ECLOs) must be an integral part of the patient pathway.
Sight is the sense that people most fear losing. Without it, people are at risk of losing their employment, their ability to travel independently and having to rely on carers to undertake day to day tasks. They are also at higher risk of experiencing falls and accidents which require further NHS and social care services.
It not only makes ethical sense, it makes financial sense to address these shocking findings now. It is completely unacceptable that even one person loses their sight from a treatable condition simply because their eye clinic is too busy to provide care in a clinically appropriate timescale. Action needs to be taken now.