• NHS pays £106m in compensation to patients over three years
  • NHSE has not said whether it will follow safety body’s advice to measure follow-up appointments
  • HSJ investigation finds one patient waited five years for follow-up appointment

More than half the compensation claims in ophthalmology relate to late treatment or missed follow-ups, new data reveals.

Information collated for HSJ from NHS Resolution for ophthalmology over the financial years 2016-17 to 2018-19 showed 411 — or 54 per cent — of the 761 claims received concerned delayed treatment.

The total cost of claims was £106m, with £31.7m in 2016-17, £29m in 2017-18 and £45.2m in 2018-19.

The figures include money paid out and money NHS Resolution — which handles clinical negligence claims on behalf of NHS trusts — put aside in the expectation of a pay-out. Not all of the money reserved for claims was paid out.

United Lincolnshire Hospitals Trust had the highest amount of claims, at £8m. The trust’s medical director Neill Hepburn told HSJ: “Some of those claims have yet to conclude so may or may not result in actual compensation being paid.

“The particularly high reserve figure for ULHT is the result of the inclusion of a reserve estimate for one particular case, which the trust continues to work to resolve.”

University Plymouth Hospitals Trust had the second highest amount of claims, at £6.5m. The trust did not respond to HSJ’s request for comment. 

Five years for a follow-up

An investigation by HSJ found 3,384 cases between November 2018 and October 2019 where ophthalmology patients had waited more than a year past their intended follow-up date, while 11 trusts reported at least 38 cases of “severe harm” between them.

In the course of its investigation, HSJ discovered the case of one patient at University Hospitals Coventry and Warwickshire Trust who was seen in 2012 and was due a review in two weeks. They were eventually seen in October 2017 when their glaucoma had progressed and they had visual field loss.

At the same trust, another patient suffered permanent vision loss from untreated glaucoma when he was not listed for a requested procedure and dropped off the waiting list for nearly two years

Meanwhile, at Southport and Ormskirk Hospital Trust, a patient was told she would be referred on for surgery but, 10 months later, it came to light that this had not happened. Her eye lesion turned out to be a lymphoma and she needed radiotherapy.

A spokesperson for University Hospitals Coventry and Warwickshire said the trust had undergone an “innovative service redesign”, which would allow it “to assess a larger number of patients by using a virtual approach”. It had also increased capacity, while “any clinically ‘high risk’ patients identified are prioritised and managed in accordance with their follow up timeframe”. 

A Southport and Ormskirk spokesperson said they had put a “comprehensive action plan” in place, including recruiting a failsafe officer.

It is not known whether any of these patients made compensation claims.

Earlier this month, the Healthcare Safety Investigation Branch recommended NHS England mandate the collection of follow-up data to stop people losing their sight after the NHS lost track of their care. 

When approached by HSJ, NHSE would not confirm whether it would adopt HSIB’s recommendation.

Ophthalmology patients having their sight damaged by not getting a follow-up appointment was highlighted in 2017 by the Royal College of Ophthalmologists.

Meanwhile, a Getting It Right First Time report on ophthalmology, published last year, found: “Arguably the key factor in claims for ‘failure to make follow-up arrangements’ is the specialty’s capacity to meet the growing demand for activity — a central theme of this report.”

The review team also said: “There is evidence that in some cases claims may not be effectively defended because the provider lacks the documentary evidence to demonstrate correct processes have been followed and patient interests considered.”

It also pointed out that many hospitals had “little knowledge of the claims against them” and “as a consequence, very few lessons have been learned from the claims to inform future practice”.

Revealed: The trusts where patients lost their sight after follow-up delays