Watchdog tells NHS England to improve monitoring after "devastating" care failure

A report by the Healthcare Safety Investigation Branch, published today, says around 22 patients a month will suffer severe or permanent sight loss due to lack of timely follow-ups for glaucoma patients.

In a case highlighted by HSIB the woman, who has not been named, saw seven different ophthalmologists and the 11-month wait between her initial referral to hospital eye services and laser eye surgery led to her sight deteriorating so badly she was registered as severely sight impaired.

The HSIB is now calling for NHSE to require commissioners to agree, under their service contracts, that providers take action to meet minimum performance standards for follow-up eye patient appointments.

The specialty has seen a number of scandals in recent years and the report echoed a recent investigation from the Getting It Right First Time team citing a lack of senior staff. Last month HSJ analysis revealed 20,000 people had their sight put at risk from delayed follow-ups over the past year.

Keith Conradi, HSIB’s chief investigator, said: “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 per cent increase in the number of people with glaucoma is predicted by the year 2035.”

HSIB has urged NHSE to take action to ensure providers are complying with the follow-up performance standards set in Vision UK’s Portfolio of Indicators for Eye Health and Care.

NHS England has not confirmed whether it would adopt the recommendations.

The standards set by Vision UK aim to ensure hospital appointments take place within no more than an additional 25 per cent of the recommended follow-up period.

It sets a “minimum standard” of 85 per cent of hospital appointments being made in this time, and 95 per cent of patients as the “achievable standard”.

Where the standard has not been met, there should be a requirement for providers to demonstrate that they have reviewed individual pathways and taken action to mitigate risk, as well as to understand the causes of any unnecessary delays to inform improvement, the HSIB says.

HSIB also recommends NHSE commission NHS Digital to publish reports of hospital eye services’ compliance with the follow-up appointments performance standard included in the Portfolio of Indicators for Eye Health and Care.

Tom Denwood, executive director of data, insight and statistics at NHS Digital, said: “We welcome the recommendation for NHS Digital, which we developed in collaboration with HSIB and other stakeholders, to support the care of patients at risk of developing sight loss.

“We will work with partners to implement this recommendation in the next update of the national Commissioning Data Set, which we are currently developing.”

Investigators also recommend the Royal College of Ophthalmologists develop models and review workforce required for the optimal delivery of glaucoma care – HSIB’s report raised concerns “there is insufficient capacity to meet the demand for glaucoma follow-up appointments”.

Mike Burdon, president of The Royal College of Ophthalmologists, said there are “the same severe capacity issues” at ophthalmology departments in the country and the 34-year-old’s experience was “by no means unique”.

He said: “The Royal College of Ophthalmologists, as part of its review of workforce, has already identified the need to undertake a review of the whole glaucoma pathway to ensure the efficient delivery of optimal care, and will work with all relevant stake holders to ensure that this is done as soon as possible.

“The most recent ophthalmology workforce census revealed that there are just under 1,500 consultants, of which approximately 10 per cent are filled by locums. It also identified over 40 unfilled consultant posts, but this is almost certainly a significant underestimate because hospitals do not always advertise posts if they know there will be no applicants.

“The Royal College of Ophthalmologists believes that too few doctors and allied health professionals (who support the work done in outpatients) are being trained to meet current demands, let alone the 40 per cent predicted increase in demand over the next 20 years. This is an issue that can only be solved with the support of Health Education England.”