Tens of thousands of people at the greatest risk of irreversible sight loss are languishing on waiting lists for too long, with services woefully under-resourced, a committee heard.
The Senedd’s health committee took evidence from clinicians, charities and patients as part of a short inquiry into ophthalmology in Wales on March 20.
More than 80,000 patient “pathways” – which include those waiting for multiple treatments – were waiting too long for sight-saving treatment in January, according to the latest data.
Russell George, who chairs the health committee, asked about prevention given half of all sight loss is avoidable with early detection and timely treatment.
Ansley Workman, director of the Royal National Institute of Blind People (RNIB) Cymru, welcomed a new national clinical strategy but warned of a lack of commitment.
‘Frightening’
“There’s no investment, there’s no timeline,” she said: “And that timeline needs to be at pace and the reason for that is people are going blind in Wales now, so it is a matter of urgency.”
In its written evidence, RNIB Cymru voiced concerns about the lack of a significant investment and direction from ministers in Cardiff Bay.
The charity warned: “Without this, Wales’ eye care waiting lists will continue to rise as will the number of patients … needlessly losing their sight while waiting for NHS treatment.”
Ms Workman raised underreporting of the scale of harm befalling patients in Wales, with “shockingly low” reports despite 80,000 patient pathways being over their clinical target.
Senedd members heard powerful stories from patients who shared their frightening experiences of living in constant fear of losing their sight.
‘Under-resourced’
Rhianon Reynolds, clinical lead for ophthalmology within the NHS Wales Executive, pointed to the development of the national strategy but warned of a lack of support to drive change.
The consultant ophthalmologist said: “We can put the blueprint in place but without investment … it’s going to be difficult to show significant change.”
Ms Reynolds, who is president of the Royal College of Ophthalmologists in Wales, told Senedd members that ophthalmology is the biggest outpatient speciality in the NHS.
But she said: “We are often perceived as a small speciality because we don’t have inpatients, so … we’re often not overly prioritised in terms of how we are funded.”
Ms Reynolds warned: “In terms of consultant ophthalmologists we are woefully under-resourced in Wales right across the board. Some areas are like a desert.”
‘Ceilings falling in’
She added: “Even if we had more secondary care clinicians, we don’t have the space.”
Ms Reynolds, who works at Aneurin Bevan health board, raised “fundamental problems” with the estate, citing examples of ceilings falling in and plants growing through the walls.
On the £8.5m roll-out of the OpenEyes patient record system, which began in 2021, she explained that Digital Health and Care Wales (DHCW) is responsible for the project.
She told the committee: “We don’t have it across all the health boards, it’s available in Cardiff, it’s potentially being rolled out to other health boards.”
Last week, health secretary Jeremy Miles escalated intervention arrangements at DHCW due to serious concerns about its ability to deliver major programmes.
‘Huge frustration’
Asked if roll-out of OpenEyes is being prioritised, Ms Reynolds said: “No, I don’t think it is.”
She told the committee a digital transformation is required, saying: “It’s a huge area of frustration for us,” with services still receiving letters rather than digital referrals.
Ms Reynolds said Wales is well below the Royal College’s recommendation of 3.2 ophthalmologists per 100,000 people, with around 1.9.
“In terms of the consultant workforce, we’re extremely under-resourced,” she warned, adding that there is not a much-needed workforce plan in place.
Wales has the lowest numbers of consultant ophthalmologists of any part of the UK and, across Europe, only North Macedonia has fewer, according to the RNIB’s evidence.
‘Clunky’
Owain Mealing, chair of Optometry Wales, warned of “clunky” integration between primary optometry and hospital services, with fax machines and paper records still in use.
Andrew Pyott, a consultant ophthalmologist at NHS Highland, undertook a 2021 review on eye care services in Wales which described the situation as serious and fragile.
He said: “The biggest driver is for cataracts services, that’s what patients often see as a priority for them – many who are languishing on long waiting lists, with an impact on their daily lives because they can no longer drive or, in some cases, keep down employment.”
Asked about agreements for patients to be treated in England, he told the committee that Welsh taxpayers are effectively subsidising Bristol’s training programme.
Prof Pyott said: “It would be much better for the Welsh taxpayer to be preparing the next generation of vitreoretinal surgeons for your country.”