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Lord Hunt: ‘Perverse’ NHS targets regime ignores practical realities of eye care

27 April 2016

Shadow Deputy Leader of the House of Lords, Lord Hunt of Kings Heath, in an article authored for PoliticsHome, warns that  the current NHS targets regime prevents patients with chronic eye diseases from receiving necessary care.

Eyesight is the one sense people fear losing the most. Many eye diseases which cause sight loss are more common in older people and the demand on ophthalmology, is increasing like never before. Fortunately, common eye conditions which were previously untreatable can now be treated successfully.

With an increase of up to 30% in eye clinic attendances over a five year period, nearly 10 million eye care outpatient appointments were made in England during 2013-14. More than 600,000 intra-ocular injections were administered for age related macular degeneration last year in England alone.

Huge pressure is building up in ophthalmic services, and this is exacerbated by lack of a considerable number of consultant vacancies and inadequate space to deliver consultations and treatments.

Whilst the NHS has targets to avoid long waits before receiving hospital treatment, they do not apply to patients with chronic eye diseases such as glaucoma, diabetic eye disease and macular degeneration, that require long-term ‘return’ or ‘follow-up’ appointments for repeat monitoring and regular treatment procedures.

The perversity of the targets regime means that these follow-up appointments are more likely to be postponed or simply be lost in the system for months, and sometimes years, to accommodate new referrals in already oversubscribed clinics. This is despite the knowledge that patients requiring follow up appointments, are eight to nine times more likely to have a potentially blinding condition than new patients.

As there are no targets for these follow-up patients, data are not routinely gathered, making it impossible to determine the magnitude of this problem. However, a search undertaken by the National Reporting and Learning System (NRLS) identified nearly 500 incidents describing loss or deterioration of vision (130 severe harm and 350 moderate harm) from such delays between 2011 and 2013.

More recently, the Addenbrookes Hospital CQC report made repeated mention of unsafe delays to ophthalmic follow up in clinics causing serious incidents and harm.

The Royal College of Ophthalmologists is carrying out an important national study to identify patients who have come to harm due to hospital initiated delays for follow up appointments. This study has not yet formally reported but preliminary results indicate that at least 20 patients per month suffer severe visual loss.

The Royal College of Ophthalmologists is calling for a review of current targets so that more equitable care can be provided for new and review patients on the basis of urgency of clinical need.

Professor Carrie MacEwen, its President is calling for mandatory data to be collected and monitored for follow up appointments, postponements and cancellations. She also argues that safety mechanisms should be introduced to identify and appoint patients who are falling outwith their review time and data regarding hospital initiated deferrals should become an outcome measure for all ophthalmic services.

The last decade has seen fantastic advances in eye care. But, immense pressure is being put on already stretched services. We cannot allow an insensitive and perverse use of targets which totally ignore the practical realities of eye care. It’s time for the Government to step in.