The report highlights the case of a 34-year old woman who lost her sight as a result of 13 months of delays to follow-up appointments.
Lack of timely follow-up for glaucoma patients is a recognised national issue across the NHS. Research suggests that around 22 patients a month will suffer severe or permanent sight loss as a result of the delays. In HSIB’s reference case, the patient saw seven different ophthalmologists and the time between her initial referral to hospital eye services (HES) and laser eye surgery was 11 months. By this time her sight had deteriorated so badly, she was registered as severely sight impaired.
The investigation identified that there is inadequate HES capacity to meet demand for glaucoma services, and that better, smarter ways of working should be implemented to maximise the current capacity. The report highlights that there are innovative measures implemented by some trusts that have reduced the risk, but this good practice is yet to be implemented more widely.
As a result of the national investigation, we have made several safety recommendations focused on the management and prioritisation of appointments. This is to ensure that those most at risk of sight loss aren’t delayed and that the scale of the problem is continually highlighted and monitored at a national level.
Living with the effects
Keith Conradi, HSIB Chief Investigator, said: “Glaucoma is the world’s leading cause of irreversible blindness. We know that the delay to appointments once patients are diagnosed exacerbates the risk of sight loss in patients across England. Our case highlighted the devastating impact; our patient has suffered immeasurably, living with the effects each day, including not being able to see the faces of her young children or read books to them.
“Despite some national recommendations being made 10 years ago, this continues to happen and will only worsen as the population ages – a 44% increase in the number of people with glaucoma is predicted by the year 2035.
“Our investigation offered an independent view on why current systems and processes have not adequately addressed the problem. It identified learning that can positively influence practice across the NHS. By highlighting the pertinent issues, our safety recommendations direct organisations to make changes to help reduce the burden on hospital eye services, and lessen the personal loss and distress suffered by patients and their families.”
Royal College of Ophthalmologists
Mike Burdon, president of the Royal College of Ophthalmologists, said: “We have been campaigning for some time on how the delays to follow-up appointments results in the loss of vision for patients. The HSIB report and the recommendations are extremely welcomed and must not be overlooked. With demand for ophthalmic services predicted to rise by more than 40% over the next 20 years, urgent action is needed, and we look forward to working with NHS England and other key stakeholders to the transformation of ophthalmic services to safeguard the sight of patients.”
Getting It Right First Time (GIRFT)
Dr Lydia Chang, Consultant Ophthalmologist and Clinical Advisor for GIRFT Ophthalmology, said: “Delayed follow up due to the lack of capacity in ophthalmology services is one of the biggest challenges in ophthalmology we face during this next decade.
“Whilst the report narrates the tragic story of one individual who has suffered harm due to delayed follow up, others continue to be at risk. The report's recommendations are designed to support ophthalmology services focus on the risk and protect patients as much as possible from unnecessary harm.
“The report reinforces the recommendations made in the Getting It Right First Time national ophthalmology report and NHS England's Elective Care Transformation High Impact Intervention for ophthalmology.”
Helen Lee, RNIB Policy and Campaigns Manager, said: “This report has brought vital attention to a serious and dangerous lack of specialist staff and space in NHS ophthalmology services across the country. We know that thousands of patients in England are experiencing delays in time-critical eye care appointments, which is leading to irreversible sight loss for some. But, suggestions on how to tackle the problem have been continually ignored.
“Without immediate action, the situation will only continue to deteriorate as the demand for appointments increases. RNIB urges full and immediate implementation of the recommendations set out in this report to improve the capacity, efficiency and effectiveness of ophthalmology services.”
Read the report
For more information, including the safety recommendations in full, download and read the ‘lack of timely monitoring of patients with glaucoma’ report.