NHS delays mean 4 patients lose their sight every week

Eye specialists say hundreds of patients may suffer irreversible sight loss every year in England because services are overstretched and under-resourced. NHS negligence compensation claims are increasing as a result

Around 10% of the 100m outpatients' appointments in England are now for eye care. Common eye conditions, such as age-related macular degeneration, which were previously untreatable, may now be treated successfully, but this adds to the demand on eye clinics - with an increase in attendance of 30% over the last 5 years.

This higher demand for services is putting pressure on resources - leading to delayed appointments for some patients.

To identify any patients who may have come to harm whilst waiting  for an appointment a national study is being carried out by the Royal College of Ophthalmologists.

Although not yet formally reported, preliminary results indicate that at least 20 patients a month sustain severe visual loss due to delays.

Hospital targets missed

Although hospitals have targets to ensure patients do not have long waits for care - with fines if they are missed - the targets apply to new patient referrals only.

Many of those requiring eye clinic appointments are already in the system, having received treatment for chronic eye diseases - such as macular degeneration, glaucoma and diabetic eye disease. As such, any appointment is classed as a "follow-up" appointment - for which there are no targets.

That being so, it is these appointments that may be most likely to be postponed in order to accommodate new patients within the prescribed time frame.

Impact of delays

Chronic eye conditions require long-term close monitoring and care, with regular appointments to observe and treat any deterioration. Postponing appointments may put vulnerable patients at risk of irreversible loss of their sight.

Without targets though, data is not routinely gathered, making it difficult to determine the magnitude of the problem.

However, in a search undertaken by the National Reporting and Learning System (NRLS) it was found that in England and Wales between 2011 and 2013 there were almost 500 incidents where patients had lost or experienced a deterioration of their vision due to delays.

Unless urgent action is taken the situation may not improve as demand on ophthalmology clinics, caused by an ageing population, continues to rise.

Addressing the issue

Many hospitals are taking positive action to deal with delays, with the NHS in Wales and Scotland working with ophthalmologists to address the problems. In England, however, the situation is more fragmented.

It is thought that expanding the skills and roles of other specialist eye staff such as ophthalmic nurses, optometrists and orthoptists may help spread the workload effectively. Increasing networks between primary and secondary care is also important.

Helping patients to understand their conditions and the importance of keeping to timely follow-up appointments may also help solve some of the issues.

Reviewing targets

 In recognition of their critical importance in longer term patient care, the minimum waiting times target for appointments needs to be extended to include follow-up appointments,

Better data collection will also help healthcare staff to identify the more vulnerable patients and enable those managing service provision to be able to plan more effectively.