Shropshire eye patients risk blindness through unnecessary delays  

elderly lady having eyes tested in hospital

Hundreds of patients in Shropshire are at risk of going blind as a result of delays to vital sight-saving treatment at Shrewsbury and Telford Hospital NHS Trust.

The Macular Society has obtained documents in which senior hospital staff confirm that there is a ‘significant issue’ in the ophthalmology department causing delays which could lead to ‘irreversible vision loss’ for some patients. One problem is that an agreement cannot be reached on whether the eye department should have its own fridge to store the drugs used to treat patients.

The documents chart the futile attempts to solve the problems from as far back as November 2016. In May 2017, the Trust papers show that 128 patients with deteriorating eyesight waited longer than they should according to national guidelines. Prompt treatment for wet AMD is vital as once vision is lost it usually cannot be restored.

In September 2017 an email notes that the Trust was ‘going nowhere fast’ in trying to reform services for patients with wet age-related macular degeneration (AMD).

A report the following month says that there is a ‘significant issue’ within the ophthalmology department and that ‘large numbers of (wet AMD) patients are waiting longer than clinically recommended for follow up appointments’. The problems are said to have been ‘ongoing for a number of years’. Yet another paper in November 2017 says that the delays could ‘lead to irreversible vision loss’.

There appear to be a number of reasons for the delays, including staff shortages and the increasing demand for wet macular degeneration treatment. However another issue appears to be a failure to implement effective working practices. For example, AMD patients requiring regular injections to slow their sight loss are currently forced through a time-consuming eight-stage process each time. Reducing this to a ‘one-stop’ system, as is used in many other hospitals, would mean patients have their follow-up appointment and injection in the same visit, rather than being added to a separate waiting list if an injection is needed.

Emails between the ophthalmology and pharmacy departments detail a lack of cooperation between them, particularly when it comes to stocking the wet AMD drugs. They must be kept in a fridge but the pharmacy has opposed the idea of the eye department having its own fridge as the ‘financial risk to stock is too big a risk’ if for example, ‘a fridge system was to fail’. The one-stop process cannot be introduced until this issue is resolved.

Introduction of a one-stop process has been discussed in the Trust since at least October 2016, and was “strongly recommended” by the Department of Health in August 2017 as a way to reduce delays and save more of patients’ sight.

Emails in November 2017 reveal a trial of the ‘one stop’ system was ready to go ahead, with support from the Shropshire Clinical Commissioning Group. In the same month, Healthwatch Shropshire published a report featuring several patients who had faced unacceptable delays in their treatment: “Other patients told us that, although the doctor had told them he wanted to see them in a certain number of weeks, there had in the past been long delays before an appointment was issued.”

The Macular Society understands the Trust ran a two-day pilot earlier this year, but has taken no further action to implement the system.

Cathy Yelf, chief executive of the Macular Society said: “We have been aware of shocking delays to treatments at Shrewsbury and Telford Hospitals Trust for a number of years and have expressed our concern many times. We’re extremely troubled that this situation is continuing and that patients are potentially coming to harm. It is very distressing for patients to be in a position where they are waiting for treatment, and when they go untreated for many weeks they will suffer irreversible sight loss. This is unacceptable and the Trust must now act to resolve this impasse between two hospital departments and introduce a system that is widely accepted across the NHS.” 
 
A timeline of delays

  • November 2016: A three-year contract to deliver a one-stop system is put out to tender, but no suitable provider is found (presumably)
  • May 2017: A meeting is held at the Trust which the minutes record that “a solution must be found today”
  • August 2017: Department of Health “strongly recommends” moving to a one-stop process
  • September 2017: A member of staff laments “we seem to still be going nowhere fast”
  • October 2017: Emails record “a continuing flow of complaints”
  • October 2017: In response to a series of complaints from patients waiting too long for treatment, the Macular Society submits an FOI request
  • November 2017: Healthwatch Shropshire’s inspection highlights numerous patients waiting longer than they should for appointments. The local clinical commissioning group states its support for a trial of the new one-stop process, to begin in December 2017.
  • Early 2018: Two-day trial of the new process
  • March 2018: Patients still trapped in old, eight-stage process. No progress on rolling out the one-stop system.