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2021 Spending Review presents an opportunity for long term investment in NHS and eye care services

25 October 2021

RCOphth President Professor Bernie Chang assesses what we need to see from this week’s Comprehensive Spending Review and Autumn Budget to support a sustainable eye care service in the coming years.

Every three to four years the Chancellor conducts a Comprehensive Spending Review, where funding for government departments in England and the devolved administrations is announced for the coming years. On Wednesday the Chancellor should take the opportunity to learn the lessons of the pandemic, and put our health and social care system on a much more sustainable footing. The challenges the whole system faces to address backlogs and workforce shortages are clear, and we know these problems are particularly severe in ophthalmology.

Urgent investment is needed to tackle the backlogs

The latest data on waiting times in England makes for concerning reading. There are now 580,000 patients waiting for an ophthalmology procedure – over 10% of all those on the NHS waiting list. Our patients are also waiting a long time for a diagnosis. Those awaiting an ophthalmology outpatient appointment have on average been waiting 7 weeks, longer than the average in other specialties. The consequence of these delays are avoidable loss of vision and ultimately a devastating impact on the quality of life for patients.

As I was writing this article, I was therefore encouraged to see that government has recognised the scale of the backlogs challenge and will announce £5.9bn to tackle waiting lists on Wednesday. This new funding will support more diagnostic testing and equipment and physical infrastructure, including new community diagnostic hubs.

Success of Recovery and Transformation Programme depends on proper resourcing 

With others in the College, I have been making the case to leaders in NHS England’s Eye Care Recovery and Transformation Programme that we need urgent action now to address these backlogs. Following helpful feedback from clinical leads in eye departments, we were able to understand the barriers and where additional resource can have the most impact. We need more high volume cataract surgery and diagnostic centres. Investment is needed to grow the workforce – training technicians, improving routes to upskilling non-medical professionals (using the College’s Ophthalmic Practitioner Training Programme). Eyecare services need better IT to integrate community, primary and secondary care seamlessly.

NHS England was receptive on these points, and the £5.9bn made available this week should enable firm action and targeted investment to enable us to offer more timely care to patients in the appropriate setting. I would also encourage all members through their Clinical Leads to look at what opportunities there are to bid for funding to support the delivery of ophthalmology services.

Longer-term solutions for workforce crisis cannot be ignored

There cannot be any illusions that delays to diagnose and treat patients are new problems however. In a joint parliamentary select committee report this month assessing the UK’s response to the pandemic, MPs pointed to the fact the NHS ‘runs hot – with little spare capacity built in to cope with sudden and expected surges in demand’.

The August 2021 Atlas of variation in risk factors and healthcare for vision by Public Health England similarly highlighted the systemic pressures facing ophthalmology when stating that ‘rising outpatient activity has posed significant and increasing pressure on capacity for timely service provision’ and the ‘shortage of consultant and specialty training posts required to meet the increasing demand for specialist ophthalmic care’.

In short, workforce supply is not keeping up with patient demand. This is a problem facing nearly all parts of our health and social care system, but the challenge facing ophthalmology is particularly severe. As we outlined in our response to a recent HEE consultation on long term workforce requirements, this is to a large extent because the UK has a rapidly ageing population coupled with the fact that the “oldest old” are at greatest risk of sight loss – four-fifths of those living with sight loss are over the age of 64. Important treatments have also emerged in ophthalmology in recent years that help us preserve sight for longer.  These treatments, such as intravitreal injections to manage wet age related macular degeneration, require continuous care over many years and so increase the demand on the system.

To deliver sustainable patient care in the coming years we need to invest in our ophthalmology workforce now. That means expanding the number of ophthalmologists by increasing the number of training places available. It also must mean supporting innovative training pathways to develop eye care professionals in multi-disciplinary teams and release the potential of upskilled nurses, optometrists and imaging technicians. Retaining the current workforce must also be a priority.

As part of future-proofing our health and social care system, we need to see this week a commitment to investing in a multi-year workforce strategy that ensures the whole system has the staff it needs to cope with not just future surges in demand, but the ever-growing strain created by “business as usual”.

Making the right long-term decisions on workforce investment would also be made simpler through greater transparency and accountability. That is why, as part of the Academy of Medical Royal Colleges, we are supporting an amendment to the Health and Care Bill. If successful, this amendment would mean that regular independent workforce projections for England would have to be published, setting out the health and social care staff we need.

Spending Review investment needed to put eye care services and workforce on path to long term sustainability

I am proud to be part of such an incredibly innovative specialty, whether that’s implementing cataract hubs and high flow cataract lists or making greater use of AI to diagnose eye disease. But innovation will only get us so far given the rising tide of demand that we are facing and will continue to face into the future.

Investment in ophthalmology services and the eye care workforce is the key long term solution. All eyes will be on the Chancellor on Wednesday as we see what investment the government will be making into our health and social care system in the coming years. Given sight loss costs the UK over £25 billion each year, it is clear that giving our patients the services they need will not only improve their health and wellbeing but the public finances too.

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If you have any comments or suggestions related to the points raised in this article, please email [email protected].