Trust admits patients harmed due to huge follow-ups backlog

Torbay and South Devon Foundation Trust is reviewing its ophthalmology service after 22 people were harmed following “system failures” with their follow-up appointments.  

The trust’s initial investigation, obtained by HSJ (attached beneath this story) with the Freedom of Information Act, warned there were “potentially” other patients affected by the failures who had not yet been identified.

In response, the trust said its ophthalmology department had already “undertaken a significant amount of work to address a large proportion of the actions arising from the review”, including building another operating theatre and recruiting more staff.

Backlog rockets 

All patients should receive a follow-up appointment within six weeks of their treatment. However, at TSDFT the backlog of ophthalmology patients waiting longer than six weeks has grown from 600 in 2013 to 10,000 this year.

The two main affected patient cohorts are those receiving glaucoma and macular treatment.

The review, which examined an unspecified number of patients between 2021 and 2022, said the huge growth was due to increased use of a new treatment (Anti-VEGF), lack of staff and space, and restrictions on activity during the pandemic.

It described TSDFT’s ophthalmology service as “critically under-resourced” compared to Devon’s other acute trusts, with similar numbers of patients to treat but “much less staff”, especially at consultant level.

Additionally, guidance from the Royal College of Ophthalmologists states consultants should have two or three theatre sessions per week, but TSDFT’s eye consultants only have one session weekly because there is just one dedicated theatre for ophthalmology.

Lost follow-up appointments

The follow-up booking problems occurred after administration staff were moved from the ophthalmology clinic to the floor above and given other duties such as taking telephone calls or attending to patient queries. This meant their focus was “divided” and resulted in “distraction”.

This, in turn, meant patients’ clinic outcome forms were not processed efficiently, and had the potential to be “lost, misfiled or mislaid”, the report said.

It found: “The administrative process for booking follow-up appointments was not robust enough to ensure that patients were contacted to have follow-up appointments booked.”

HSJ asked the trust what severity of harm befell the patients and if more patients had been identified as having suffered harm, but the trust did not respond to those questions.

According to the review, the department has been reported as being “full to capacity” since 2012, with “no acknowledgement of this in terms of plans to address this issue”.

The investigators also found the department had been “open and honest about the lapses” that led to the patients suffering harm, and they added: “Incident reporting has been actively encouraged.”

They concluded: “Patients have and continue to come to harm. The trust needs to acknowledge this and rectify the issue of inadequate clinic space and staffing to allow for long backlogs to be addressed so that patients are being reviewed at the clinically appropriate time that was originally planned. This can only be achieved through investment in the department”.

Trust takes action

In response to the findings, the trust is working on several plans to address the “critical infrastructure issues” identified.

These include:

• Securing £15m of capital funding to create additional theatre space at Torbay Hospital by the end of 2023 which will help an extra 4,500 patients a year who need ophthalmology, hip and knee operations;
• Recruiting more consultant, nursing and theatre staff, including a specialist glaucoma consultant. The department needs at least two consultants, nine nurses, a number of allied health professionals, more administrative staff, six new clinic rooms and a second theatre to fully address the backlog of follow-up patients – the review estimated; and
• Running weekend clinics at the Nightingale Hospital in Exeter to clear its high-volume cataract list and using the facility’s glaucoma investigation unit.

A trust spokesman said: “We don’t want anyone waiting longer than necessary and are working hard, in partnership with colleagues across Devon and with the support of the national Getting It Right First Time team, to ensure people are seen and treated as quickly as possible.”