Understanding the ophthalmology backlog

The causes behind the ophthalmology backlog and the potential avenues for addressing long waiting lists were outlined by consultant ophthalmologist, Imran Rahman, at 100% Optical (London ExCel, 23–25 April).

The chief executive of Community Eyecare (CHEC) highlighted that there was a large backlog in secondary care that was increasing before the COVID-19 pandemic.

In March 2019, there were four million people who had been referred to hospital but had not been treated within 18 weeks.

Following the pause on elective services, as a result of the COVID-19 lockdown, this number grew to six million.

Turning to how CHEC approached the lockdown, Rahman shared that the provider of community-based ophthalmology services received around 1000 referrals per week before COVID-19.

After temporarily stopping elective services following the outbreak of COVID-19, Rahman noted that around 33,000 patients were waiting for CHEC care following the lockdown.

CHEC introduced a bilateral cataract surgery pathway, meaning that patients could be listed to have both eyes treated in the same sitting.

Rahman highlighted that CHEC was able to clear their backlog of patients by September 2020.

In contrast, by June 2021, there were 559,000 patients on the waiting list for ophthalmology services within the NHS.

Rahman added that 4.3 million fewer sight tests were performed in 2020 according to a Specsavers report.

Alongside “the biggest health crisis in over 100 years,” the UK also faced the impact of Brexit – which had resulted in supply delays as well as regulatory issues.

Rahman shared that within nursing, one in five posts are vacant, while up to 61% of European Union doctors have left the NHS.

He added that the number of GPs in the UK is also falling.

“That inherently causes a problem – how do we get a patient into secondary care if they can’t see a GP?” Rahman said.

Inadequate staffing levels within the NHS is resulting in burnout and low morale, he observed.

Rahman discussed planned changes to the NHS, with the health service implementing a integrated care system model from July 2022.

This will result in the NHS limiting procurement and making fewer decisions over the following year, he said.

In addressing the secondary care backlog, Rahman expects the NHS to focus on the specialities where the longest waiting times are – ophthalmology, ear, nose and throat and orthopaedics.

Rahman noted that there are misconceptions about the role of independent providers in performing cataract surgery – with over 55% of NHS cataract operations in England undertaken within the private sector.

“It’s perceived to be competition but actually it should be viewed as collaboration,” he said.

CHEC began offering cataract surgery in 2019 and Rahman expects the provider to be responsible for 33,000 operations in 2022.