The Royal College of Ophthalmologists would like to thank the patient who was willing to participate in important investigations, such as this report carried out by the Healthcare Safety Investigation Branch (HSIB) despite the devastating impact on her quality of life as a result of her sight loss.
The hospital investigated is not identified in the report. This is entirely appropriate because the same severe capacity issues are present in every ophthalmology department in the country and, unfortunately experience is by no means unique.
The Investigation has correctly identified a fundamental lack of capacity within hospital eye services to deliver glaucoma monitoring and treatment, exacerbated by inappropriate referrals, risk adverse behaviour, lack of glaucoma specialists and lack of continuity of care caused by locums.
The Investigation has made a number of important recommendations. The Royal College of Ophthalmologists, as part of its review of workforce, has already identified the need to undertake a review of the whole glaucoma pathway to ensure the efficient delivery of optimal care, and will work with all relevant stakeholders to ensure that this is done as soon as possible. The recommendations related to risk stratification and monitoring of outpatient performance are important, but do not address the fundamental issue of a lack of capacity.
The most recent ophthalmology workforce census revealed that there are just under 1500 consultants, of which approximately 10% are filled by locums. It also identified over 40 unfilled consultant posts, but this is almost certainly a significant underestimate because hospitals do not always advertise posts if they know there will be no applicants. The Royal College of Ophthalmologists believes that too few doctors and allied health professionals (who support the work done in outpatients) are being trained to meet current demands, let alone the 40% predicted increase in demand over the next 20 years. This is an issue that can only be solved with the support of Health Education England.
The capacity of ophthalmology departments is also critically compromised by a lack of physical space in which to work. The Royal College of Ophthalmology is looking to NHSE to find a sustainable solution to this problem that is consistent with the NHS Long Term Plan.
Mike Burdon, President
The Royal College of Ophthalmologists