Capacity problems in eye clinics
Policy Position Statement (England only)
What we think
People are losing their sight unnecessarily because of capacity problems in eye clinics across England. This is due to eye clinics being too busy to keep up with demand.
Urgent action is needed to prevent people losing their sight needlessly and ensure effective and efficient eye care services are in place to meet rising demand.
What’s happening now
Patients say they are incredibly grateful to the hard working staff in their eye clinics, but many have significant concerns about aspects of their care such as cancelled and delayed appointments, long delays to see a professional at each appointment and rushed consultations.
The rise in demand for ophthalmology services caused by an aging population, combined with an increase in the availability of sight saving treatments, is not being adequately resourced by NHS commissioners. This is resulting in insufficient resources and clinic capacity which is impacting patient's sight.
In a recent survey sent to eye clinic staff, 172 professionals responded and 41 per cent said that some patients are losing sight due to capacity problems in the clinic.
What effect does a delay to a follow-up appointment have?
Glaucoma – an eye condition which causes damage to the optic nerve - is a potentially blinding disease, but if caught early and treated effectively, patients are likely to experience minimal or even no sight loss at all. Glaucoma affects around two per cent of the population, generally aged over 40. It is often caused by raised eye pressure which can usually be lowered using eye drops. However, this raised pressure usually causes no pain or symptoms meaning patients need to be monitored regularly in order to ensure that treatment is effective.
Evidence collected by RNIB through Freedom of Information requests shows that over half of acute trusts did not know how many glaucoma follow-up (monitoring) appointments have been delayed in a given year. Around a quarter of acute trusts either knew the number of delays or estimated them to be significant. This means that glaucoma patients may be losing sight unnecessarily.
Wet age-related macular degeneration and other macular conditions involving new blood vessel growth, usually require frequent sometimes monthly treatment with relatively new anti-VEGF medications. Whilst having these medications, which are administered by an injection into the eye, most patients must be monitored regularly, often monthly. Failing to do so can result in expensive treatments being less effective and patients unnecessarily losing sight.
In addition, when new sight-saving treatments are approved for use on the NHS, capacity issues can prevent them being made available within the mandatory timescales, leading to inequality of access to these new therapies.
What should happen
Unnecessary sight loss should and can be prevented.
To achieve this:
· NHS England should establish national leadership, in the form of a National Clinical Director for eye health, who can address unacceptable variation in eye care provision.
· Clinical commissioning groups must properly assess capacity and adequately fund eye clinics so they can meet rising demand for services.
· Hospital managers and staff must work together to identify and address capacity problems in their eye clinic.
· The National Institute for Health and Care Excellence (NICE) must prioritise the production of its eye health clinical guidelines and Quality Standards.
· Eye Clinic Liaison Officers (ECLOs) must be an integral part of the patient pathway and should be in all hospital eye clinics. These professionals inform and empower patients about their eye health, provide referrals and support to help patients access services outside the hospital and so ease the time pressures on clinicians.
For more information please contact the RNIB Policy and campaigns team on 020 7391 2123 or email
January 2014
rnib.org.uk