Community Eyecare

Viewpoint: Reducing the burden

Recent news that more than one in six NHS trusts across England has declared critical incidents has signalled that priority services are coming under further pressure, once again placing the spotlight on NHS waiting lists and the strain of backlogs on key services.

Those waiting lists are now longer than ever before, while at the same time people show a reluctance to add to the workload of over-worked staff in hospitals and clinics with health issues perceived – sometimes wrongly – to be minor. There’s clearly a need to find ways to release pressure from the system and improve the quality of life for hundreds of thousands of people.

Just prior to the emergence of Omicron late last year, the impact of Covid-19 had already pushed up the total NHS waiting list to a record six million, with over two million of those waiting more than 18 weeks for treatment. Among these patients were over one million in need of ophthalmology treatment. That figure is higher now, but it stems from a situation that could be alleviated using infrastructure that is already in place in our local communities.

Progression adds urgency

The NHS actually recommends an 18-week maximum wait for cataract surgery but, due to the pandemic, that has now grown to an average of nine months.

The challenge for the NHS is how to reduce, if not clear, that backlog of treatments and operations against the backdrop of the pandemic, which raises the risks for vulnerable older patients in hospitals. The urgency seemingly increases by the day.

Lengthy waiting lists and delayed operations can have a profound impact, whatever the condition, and that’s the case too with cataracts, which are progressive over time. Therefore, the longer the wait, the worse the condition and the harder it is to correct. It’s not just waiting lists, it’s the waiting time in the hospital before being treated. In December, the number of patients waiting over 12 hours in corridor trolley beds for admission increased to a record-high 10,646, up 51% from October.

A study of the average waiting time between referral and cataract surgery at 12 NHS trusts around London was found to be 204 days in 2020. This rose to 278 days in 2021, up 36%. Those confronted with those delays faced a significant deterioration in their quality of life, such as being no longer able to drive, more susceptible to falls and possibly being unable to read.

By comparison, the average NHS waiting time nationally for all procedures carried out during the first half of 2021 was 10 weeks, with the waiting time for ophthalmology-specific procedures at 11 weeks. The problem for those needing cataract surgery is that it’s a procedure that is of relatively low clinical priority, meaning it tends to get pushed back when more urgent cases arise.

With or without the pandemic, the UK’s ageing population means waiting lists for cataract operations and treatment for other eye conditions will grow.

Shared model solution

One way to bring down the pressure on the NHS in the field of eye care is, in some ways, so obvious it goes unnoticed. It lies in expanding a practice already in place and working well. The NHS already adopts a shared partnership model approach with community-based services where they exist. They offer proximity to local communities, along with specialist expertise, without the Covid-related health risks that may be associated with larger hospitals.

Offering high-quality care right in the centre of communities also provides a tailored patient experience while reducing the burden on the NHS. In addition, a focus on end-to-end care can mean patients do not have to see multiple providers. This means community-based care can offer patients a care experience tailored to their needs.

It’s worth remembering that a cataract can be fixed with a simple 10-minute operation using anaesthesia eye drops that make it a day-case procedure. So, there is simply no need to go to a hospital.

Community-based services are very helpful for dealing with these common eye conditions, generally delivered by a community optometrist. Here, the management is usually maintained within the primary care setting for as many patients as is safely possible, avoiding unnecessary referrals to hospitals.

The clinics can also undertake minor operations, besides cataracts, such as the removal of cysts on or around the eye. They can also deal with skin cancer on the eyelid, which can be very time-sensitive. In general, a malignant lesion grows more rapidly than a benign one. Where melanomas or squamous cell carcinomas are suspected, it’s important that patients are referred to a specialist urgently using the two-week wait referral system and get treated within 31 days.

The way forward

Community-based services can offer patients an improved experience while also supporting the NHS. The increased capacity of these services enables patients to receive high-quality care as quickly as possible. As a result, the burden placed on the NHS is relieved and patients receive a better outcome; that’s the ultimate objective of all healthcare.

Despite the government’s multi-billion-pound investment, the NHS is still set to face a backlog of 10 million patients by 2024. The shared care partnership model is already used and proven to be effective. It should now be expanded to help and support the NHS in tackling its treatment backlog.

  • Imran Rahman is CEO and a consultant ophthalmologist at CHEC.

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