• Eleven trusts admit at least 38 cases of “severe harm”
  • Many trusts not able to say how many patients waiting for overdue follow-ups

Dozens of patients suffered permanent or long-term harm to their eyes after waiting too long for a follow-up appointment, HSJ can reveal — with thousands more waiting over a year longer than they should have.

Eleven trusts (see below) admitted at least 38 cases of “severe harm” between them over the past year, as ophthalmology departments across England struggle to cope with increased referrals and to keep track of follow-up appointments.

Responses to HSJ’s Freedom of Information Act requests also indicate many trusts have no proper oversight of their waiting lists. Many trusts — including the internationally-renowned Moorfields Eye Hospital Foundation Trust — were unable to say how many patients were waiting for overdue follow-up appointments or suffered harm, either because they did not have the information or it would take too long to extract it.

HSJ also 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.

Hull University Teaching Hospitals Trust is responsible for 879 of these cases, with 597 cases at Cambridge University Hospitals FT and 595 cases at Sandwell and West Birmingham Hospitals Trust. University Hospitals Birmingham FT said there were 479 such cases at the Queen Elizabeth Hospital, but it did not have figures for the other hospitals in the group.

University Hospitals Birmingham also had the highest number of confirmed harms — 20 severe and 20 moderate — in that timeframe, while neighbouring University Hospitals Coventry and Warwickshire had eight severe and 13 moderate.

In addition to the data in the tables below, Sheffield Teaching Hospitals FT said it had had 51 moderate and 10 major cases of potential sight loss due to delays in seeing glaucoma patients over a decade from 2009. However, the trust only broke down these incidents into calendar years, rather than for the period HSJ was analysing. 

“Severe harm” is defined as permanent or long-term harm, “moderate harm” is “any unexpected or unintended incident that resulted in further treatment, possible surgical intervention, cancelling of treatment, or transfer to another area, and which caused short-term harm to one or more persons.”

In some cases, trusts had ongoing harm reviews. For example, Northern Lincolnshire and Goole Hospitals FT said it was carrying out harm reviews on 83 patients.

HSJ approached the trusts which reported patient harms or had large numbers of patients waiting more than a year beyond their intended follow-up appointment.

Many said they had changed their procedures to make sure patients were followed up in a timely manner. Several mentioned they had appointed a “failsafe” officer to ensure this happened, which was one of the recommendations made several years ago by the Elective Care Transformation Programme. Service redesign and using different staff groups at points in the pathway were seen as ways to help trusts cope with the demand.

The trusts also pointed to the growing pressure on ophthalmology departments from an ageing population, with more people suffering from conditions which could lead to eyesight issues such as glaucoma.

HSJ’s research indicated procedural errors also play a part in delaying follow-up appointments. In 17 investigations completed at Birmingham, five were related to “procedural errors”. A report for University Hospitals Southampton, which had a series of patient harm incidents, found there was a failure to “validate and manage” a spreadsheet showing patients waiting, which eventually became unmanageable because there were so many patients on the list.

Eye appointments account for around 8 per cent of outpatient appointments across the country. It has been known for some time that follow-up delays are resulting in a significant number of patients losing their sight or experiencing deteriorating vision. For example, National Reporting and Learning System identified nearly 500 such incidents between 2011 and 2013.

HSJ approached NHS England for comment. It referred to its response to last week’s Healthcare Safety Investigation Branch report, in which it said “By streamlining referrals and assessment as the NHS will be doing in 2020 it should be possible to further speed up access to ophthalmology operations.”

Severe harm

 Trust Number of incidents
 University Hospitals Birmingham Foundation Trust   20
 University Hospitals of Coventry and Warwickshire Trust  8
 Royal United Hospital Bath Foundation Trust   <5
 Aintree Hospital (now part of Liverpool University Hospitals Foundation Trust)  2
 Mid Yorkshire Hospitals Trust   2
 Western Sussex Hospitals Foundation Trust   2
 Southport and Ormskirk Hospital Trust   1
 Doncaster and Bassetlaw Hospitals Foundation Trust   1
 Leeds Teaching Hospitals Trust   1
 Cambridge University Hospitals Foundation Trust   1

Moderate harm

Trust  Number of incidents
 University Hospitals Birmingham Foundation Trust   20
 Brighton and Sussex University Hospitals Trust   17
 University Hospitals of Coventry and Warwickshire Trust   13
 Aintree Hospital (now part of Liverpool University Hospitals Foundation Trust)  11
 Leeds Teaching Hospitals Trust   10
 Royal Liverpool and Broadgreen Hospitals (now part of Liverpool University Hospitals Foundation Trust)  5
 Western Sussex Hospitals Foundation Trust   5
 Royal United Hospitals Bath Foundation Trust   <5
 South Tees Hospitals Foundation Trust   4
 Southport and Ormskirk Hospitals Trust   3
 University Hospitals Bristol Foundation Trust   3
 Doncaster and Bassetlaw Hospitals Trust   1
 Lancashire Teaching Hospitals Foundation Trust   1
 Cambridge University Hospitals Foundation Trust   1
 Royal Cornwall Hospitals Trust   1
 Royal Free London Foundation Trust   1

 Level of harm unclear

 Trust Number of incidents
 Sandwell and West Birmingham Hospitals Trust   1 “lost vision”
 University Hospital Southampton Foundation Trust   15 “SIRI” cases
 East Sussex Healthcare Trust  1 uncategorised
 East Kent Hospitals University Foundation Trust  <5 severe or moderate 


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