NHS patients at risk of avoidable sight loss because of staff shortages

Posted: 06/04/2023

The Royal College of Ophthalmologists (RCOphth) has recently published the outcome of its latest census of ophthalmology services in the NHS, taken over three weeks towards the end of 2022. The results suggest a stark deterioration over the previous 12 months and increasing concerns over backlogs in NHS outpatient eye care.

In ophthalmic services, as in other clinical specialties, the NHS has increased outsourcing to independent healthcare providers in recent years to try to reduce waiting lists. But the growth in provision through the independent sector has affected both NHS services and staff. While some waiting lists have shortened, for example, for cataract treatment, other surgical and outpatient care faces backlogs that have not been addressed and are getting worse. Most of the respondents considered that independent provision is having a detrimental impact on NHS ophthalmology services and patient care.

Despite these concerns, increasing numbers of consultants reported that they plan over the next five years to increase the time they spend working in independent practice. Around a quarter of consultants plan to leave the profession altogether.

As a result of increasing staff shortages, over three-quarters of eye units completed the census to report that they do not have enough consultants to meet the demand for services, and two-thirds are having to pay more for locum cover to try to mitigate for consultant shortages. The result is that the NHS is having to divert resources to fund greater costs than a stable workforce would require.

Inevitably, the result is reduced NHS capacity to treat patients on a timely basis and to provide appropriate follow-up. The census found that these NHS capacity challenges are growing. Compounded by workforce shortages, almost two-thirds of NHS eye units expect that it will take more than a year to clear the current outpatient backlog; a quarter estimate it will take longer than three years.

The NHS ophthalmology services facing the greatest pressure are highlighted as urgent eye care, retinal surgery and uveitis (inflammation within the eye). These are all conditions that can develop quickly, progress rapidly, and lead to permanent damage to vision if they are not treated promptly. Any delay in diagnosing ophthalmic disease or injury, or not following up on a timely basis puts patients at risk of avoidable sight loss.

Andrew Clayton, a managing associate in the personal injury and clinical negligence team at Penningtons Manches Cooper, who handles complex ophthalmic claims, comments: “It is four years since the results of the last RCOphth census were reported. Given the Covid-19 pandemic, it is unsurprising that unforeseen demands on resources have affected many NHS services, but the scale and extent of backlogs in ophthalmic care are alarming. As the RCOphth itself states, without action now to address NHS capacity challenges, patient care will suffer. Any loss of sight has a profound personal and social impact on those affected. The RCOphth report is accompanied by five key recommendations for policymakers to implement and it is imperative that action is taken to deliver cost-effective care to prevent avoidable sight loss.”

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