10 January 2020

Sight loss due to delays in eye care

The Healthcare Safety Investigation Branch (HSIB) has revealed the "devastating" impact of delays and pressure on national glaucoma services.

In a new report, the HSIB warns that delays to follow-up appointments for glaucoma patients leaves them at risk of sight loss. It highlights the case of a 34-year-old who lost her sight because she waited over a year for follow-up appointments.

About 22 people a month now suffer from severe or permanent sight loss due to delays in care. The HSIB acknowledges that the lack of timely follow-up for glaucoma patients is a national issue across the NHS.

The investigation also validated longstanding concerns raised by the eye health sector that there is inadequate capacity in the Hospital Eye Service (HES) to meet demand for glaucoma services. It also reiterates the urgent need for "better, smarter ways of working" to "maximise the current capacity".

The national safety agency has made safety recommendations which prioritise appointments "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".

Keith Conradi, HSIB's 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."

Alan Tinger, Director of Regulatory Affairs at FODO, said: "This is a longstanding and unacceptable scenario, as over 10 years ago national recommendations were made to address similar root causes but people are still suffering from avoidable sight loss. We have long called for action to transform eye care services and by offering more NHS care in primary and community care settings it will be possible to liberate capacity in secondary care for the highest risk patients and those that need access to consultant led care as soon as possible."

Mike Burdon, president of The Royal College of Ophthalmologists, said: "The HSIB report and the recommendations are extremely welcome 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."

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."

Source: HSIB press release 'Lack of timely monitoring of patients with glaucoma' (9 January 2020)