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Patient safety is a global health priority, yet there is limited research into how ophthalmology is responding to this. There is evidence that a review of patient harm related to eye care and the associated patient safety incidents is needed. This study aimed to characterise patient safety incidents involving eye care by: identifying the most frequently reported incidents involving clinical care; and characterising the nature of incidents leading to severe vision loss. Of the 836 reports identified, insufficient care (416) and delayed diagnosis (234) featured most. Patient harm occurred related to vision loss (449), delays in treatment (182) and disease progression (121). Among 220 reports that resulted in severe vision loss, patients with glaucoma and age-related macular degeneration were impacted by delays in monitoring and management, loss to follow-up, disease progression due to insufficient care and system failures.

University Hospital Derby and Burton NHS Trust (UHDB) partnered with TPXimpact to make an informed choice in procuring the right electronic patient record system for the Ophthalmology team and make recommendations on implementing it successfully.

The pandemic has impacted on all aspects of NHS care, with elective and diagnostic activities among those services that have been disrupted. This has led to a considerable backlog of people waiting for NHS treatment.  This briefing, from the NHS Confederation, explores what lies ahead for the health service and patients, based on their modelling of referral-to-treatment waiting trajectories in 2021. It offers an outline policy framework, drawn up by their members, for starting to reduce waiting lists in an effective, equitable and efficient way.  Key points: The sustained impact of the pandemic will leave a backlog of care in excess of anything seen over the last 12 years. Although urgent and emergency procedures have largely been maintained, much of the growth in waiting lists comes from low priority, high-volume procedures for conditions ranging from painful bone and joint conditions, to ear, nose and throat and ophthalmology. Our modelling suggests that to maintain any sense of control over the NHS waiting list, the NHS will need to increase capacity considerably above levels than have previously been sustained. Our members are embracing best practice, as represented by the Getting It Right First Time programme (GIRFT), and innovating to support waiting list management but will need further support to make inroads into the backlog. The existing framework for elective care, which is based around organisations and tariff, is widely accepted as not being fit for purpose to resolve growing lists and the increasing backlog. Without a comprehensive new plan, the government faces the politically unacceptable legacy of hundreds of thousands of patients left on waiting lists with deteriorating conditions for the remainder of the parliament. Our members want to see whole-system thinking to manage waiting lists between trusts, and deeper partnerships with primary and community care, supported by real-time patient data. Small amounts of quick capital will help to create ‘hot and cold’ hospital sites, which will increase efficiency, while funding support for the voluntary sector will help patients to receive more care and support as they wait for their procedures. The intensity of the pandemic response has had a marked impact on NHS staff and left the healthcare workforce in a fragile state. In many areas, the same group of staff who have worked through the pandemic, and who are delivering the vaccination programme, will be asked to step up once again to recover backlogs. Any plan that fails to recognise this is unlikely to succeed. The additional £1bn agreed in the Spending Review for 2021/22 will not be enough to clear the backlog. The healthcare sector will need honesty from political leaders to help manage the inevitable change in public opinion when there are further delays in treatment. By creating a long-term framework for the recovery of elective care that is efficient, patient focused and equitable, the NHS can make fast progress on recovering its elective care position. As part of that, it will be important to rethink the way that waiting lists are measured, as many of the performance standards are no longer fit for purpose. This briefing focuses on the elective backlog. Similar pressures will be faced across the NHS, from a surge in demand for mental health support, to increased need for community services and increased demand on primary care. While our members are innovating and driving service improvement at local level, more support is required from government in its public messaging. This would help the NHS to clarify priorities and facilitate an honest public debate on the scale of the challenge and the measures to resolve it. Download the full briefing via the link below or the attached document.

NHSX's Innovation Team has released its latest digital playbook which focuses on eye care and directs clinicians and organisations to digital tools that can support patient pathways. The resource, which is extensive and features numerous case studies, can be used by eye care specialists looking to digitally enhance their ophthalmology pathways, remote monitoring and sharing of diagnostics. Areas and scenarios covered in the eyecare playbook include examples of digital tools and solutions to help with communication, improving referrals, setting up virtual clinics, remote consultations and self-monitoring, as well as sharing clinical data and images. A step-by-step, recommended eye care pathway is also featured covering stages from primary care, referrals and diagnostics, through to outpatients and day surgery, and finally, community care and supported self-care. Some of the innovative case studies featured include examples from: NHS Grampian’s Eye Health Network Moorfields Eye Hospital NHS FT County Durham and Darlington NHS FT The Royal College of Ophthalmologists Bolton NHS Trust FT East Kent Hospitals University NHS FT Gloucestershire Hospitals NHS FT The University of Strathclyde and NHS Forth Valley Digital tools and solutions highlighted stretch from home visual acuity testing and remote vision monitoring for macular disease, through to secure video messaging service examples, smartphone-based lenses for image capturing and referrals, virtual glaucoma clinics, and integration platforms.

The need for social distancing midst the COVID-19 pandemic has forced ophthalmologists to innovate with telemedicine. The novel process of triaging emergency ophthalmology patients via video consultations should reduce hospital attendances. However, the safety profile of such services were unknown.  This study, published by EClinicalMedicine, demonstrates comparable patient safety of video consultations at one-month follow-up to in person review and found the service to be acceptable to patients and to reduce the risk of COVID-19 transmission. Authors propose that video consultations are effective and desirable as a tool for triage in ophthalmology.

Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. This report seeks to address the challenge of rising demand for NHS ophthalmology services due to an ageing population. Ophthalmology provides over 7.5 million outpatient appointments a year, making it the the highest volume outpatient specialty in England. It also provides more than half a million surgical procedures, including the most common operation offered on the NHS - cataract surgery. The GIRFT Ophthalmology report makes 22 recommendations that focus on: freeing up capacity so that more patients can be seen. reducing reliance on consultant care by making greater use of the wider team. reducing the risk of avoidable sight loss and protecting people's vision. Watch a short video summary of the report

Diabetic eye screening (DESP) is a national programme which is designed to pick up changes in the retina, at the back of the eye, in people with diabetes. These changes, known as diabetic retinopathy, are usually detected long before eyesight is affected. The goal of screening is to find people with sight threatening retinopathy, so that advice and treatment can be offered to prevent sight loss, as diabetic retinopathy is one of the leading causes of blindness in the UK. In this presentation, Dr Elizabeth Wilkinson, Clinical Lead Devon DESP, discusses harm in diabetic eye screening,what a clinical harm review is and communication, including Duty of Candour.

In this research paper published in the Nature journal Eye, Foot and MacEwen determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 12-month period. They found that patients were suffering preventable harm due to health service initiated delay leading to permanently reduced vision. This was occurring in patients of all ages, but most consistently in those with chronic conditions. Delayed follow-up or review is the cause in the majority of cases indicating a lack of capacity within the hospital eye service.

The National Patient Safety Agency (NPSA) issued guidance on preventing delay to follow up for patients with glaucoma [NPSA/2009/RRR004]. This followed evidence of harm to patients with glaucoma suffering visual loss after delays to follow up appointments. This came to light from incidents reported by staff in the NHS relating to glaucoma. This paper provides background information and a checklist for organisations to help implement actions in the accompanying guidance to prevent harm from delayed follow-up appointments for patients with glaucoma. It presents details of incident data and litigation data. This work was supported by an interactive event in March 2009 with input from ophthalmic surgeons (and the Royal College of Ophthalmologists), nurses, service managers and patient representatives. Key recommendations from the report Treating clinicians should ensure that all people with ocular hypertension or suspected or diagnosed glaucoma are monitored within the monitoring intervals outlined in the NICE glaucoma guideline, and none of these monitoring appointments should be delayed or cancelled.