RCOphth welcomes the recommendations from the Public Accounts Committee inquiry report ‘Managing NHS backlogs & waiting times in England’ as a positive step in focusing efforts to tackle backlogs, especially where the Committee has taken on board evidence from our submission. This article summarises key recommendations from the report and their relevance for ophthalmology services, while outlining what further measures the College believes are needed to bring down ophthalmology backlogs.
What was this inquiry looking at and what were some of its key conclusions?
The Public Accounts Committee (PAC) is a Parliamentary committee comprised of MPs from different parties, whose remit is to examine value for money of government programmes and hold government officials to account. Following an inquiry into backlogs and waiting times in England that RCOphth submitted evidence to, PAC has this month published a report with its conclusions.
One key point the committee makes is that elective recovery targets are not being met due to ‘a dearth of advance planning to ensure the NHS has the staffing and other resources it needs to deliver additional diagnostic and treatment capacity, much of which was already needed before the COVID-19 pandemic’. The Committee notes that RCOphth, as well as other royal colleges, ‘stressed the need for strategic workforce planning’ in its submission. This is something we have consistently argued for, with government now committed to publishing a comprehensive workforce plan shortly.
Another important area covered by the inquiry was the role that independent sector providers (ISP) should play in managing NHS backlogs. We were pleased that the report has listened to RCOphth’s evidence in this area, including in its report a commitment from NHS England that ISP capacity would be ‘genuinely additional’.
The committee goes on to say that NHS England ‘has more work to do to demonstrate how additional capacity will be sufficiently staffed without detracting from other NHS services’. RCOphth will continue to work with all stakeholders to ensure we have a better commissioning system in place that delivers ISP capacity where it can improve patient care, while not undermining the sustainability of comprehensive NHS ophthalmology services. More detail on this work is available in this article summarising outputs from College-led task and finish groups.
The PAC report goes on to set out a range of specific recommendations to improve evidence based decision-making and assessment of initiatives. These key recommendations are explained and analysed below.
What specific recommendations did the committee make and how are they relevant for ophthalmology?
Three important recommendations PAC made were:
- NHS England (NHSE) and the Department for Health and Social Care (DHSC) should revisit planning assumptions for the recovery – specifically regarding how achievable it is to hit the 52-week wait target for elective care – and publicly report any updates to targets.
- NHSE should provide the committee with descriptions of the real-world impact of programmes like diagnostic centres, surgical hubs, increased use of the independent sector, and its understanding of the extent to which these initiatives have generated additional activity, rather than displacing NHS capacity elsewhere.
- DHSC should publish the underlying assumptions of its workforce projections alongside forecasts in the upcoming workforce plan. This should include quantification of key assumptions including on domestic training and overseas recruitment.
Taken together, these recommendations can help ensure planning for ophthalmology services is focused and effective. Impact assessments of policy measures like diagnostic centres and use of the independent sector will help learning across ophthalmology, and may highlight areas in which ophthalmology services can take action to increase capacity.
Given our particular concerns about long ophthalmology outpatient backlogs, and the need to ensure there is a proper focus on these waits as well as surgical backlogs (those waiting for follow-up and diagnostic appointments are often those at highest risk of avoidable sight loss), impact assessments of diagnostic centres will potentially help us understand more about their contribution to reducing these waits.
The recommendation to provide more transparency on assumptions behind workforce planning will also provide greater certainty as to how we can best create an ophthalmology workforce fit for the future. The upcoming long term workforce plan for England should clearly set out the additional medical school and specialty training places that are needed to meet demand, and provide the funding to deliver what is needed.
More broadly, rigorous evidence-based decisions and a thorough assessment of the impact of initiatives should help to ensure effective measures are being taken to reduce backlogs. These recommendations are therefore welcome, but we know reducing ophthalmology backlogs will require a range of measures beyond improved impact reporting and revised targets.
What else is needed to tackle ophthalmology backlogs?
There are other simple ways in which policymakers can look to tackle ophthalmology outpatient backlogs. Publishing more granular data on outpatient waiting lists including risk stratification and follow-up delays – as Wales does – would help eye services plan better and prevent more avoidable blindness. As an image and data-reliant speciality, relatively modest investments from NHS England and DHSC in roles such as ophthalmic image graders and technicians would also help to rapidly expand diagnostic capacity in ophthalmology.
National-level coordination of eyecare services in each of the four UK nations is also needed to appropriately direct transformation funding locally for proven innovations, upskilling of the existing workforce to meet current and future patient need, and support for the implementation of integrated pathways across primary and secondary care.
RCOphth will continue to work with policymakers across the UK to ensure effective measures are supported to address ophthalmology backlogs. Please contact us on [email protected] if you have any comments or questions.