Agenda item

This report from Imperial College Healthcare NHS Trust provides an update on Western Eye Hospital and ophthalmology services and a planned £9m building project with additional operating capacity to help tackle the waiting list backlog created by the Covid-19 pandemic.

Councillor Natalia Perez introduced this item by way of reference to the Council’s focus on co-production and the importance of listening to residents voice whose contributions were welcomed and evidenced an inclusive approach.

Prof. Tim Orchard provided a short presentation identifying key highlights from the report.   Historically, the Western Eye hospital had been situated on Marylebone Road in its current building since 1930.  The building was not ideal for delivering 21^st century healthcare and a redevelopment of the facility had been considered for many years.  Imperial as an acute hospital trust was included within the “40 hospitals” development programme but it was recognised that this could not form the entirety of a viable and holistic solution for service delivery at Western Eye, going forward.

Western Eye had coped extremely well in delivering general ophthalmic and tertiary services given the condition of the estate.  Reflecting on the national register of outcomes for, for example, cataract surgeries, the output of the two eye centres based at Central Middlesex and Western Eye, placed them generally first and second, respectively, with the results at Western Eye being particularly impressive having cleared the backlog of cases that had accumulated during the pandemic.  Independent experts had evaluated the site and highlighted concerns about fire safety, precipitating a decision to close it.  Some services had been relocated to other floors and Charing Cross hospital.  Currently, there were no patients who were waiting longer than two years for treatment, and about a 100 people waiting for a year.  In general, the waiting time for a cataracts operation was about two to three weeks but the need to expand outpatient capacity was recognised.

Prof. Orchard confirmed that £9 million in funding had been secured as part of the national Targeted Investment Fund (TIF) as capital spend for a particular project. Site work had commenced and would eventually include an additional operating theatre increasing capacity to three theatres.  Pre-assessment areas would be refurbished as would pre and post operative areas to offer improvements in the patient experience by Spring 2023.

Prof. Orchard acknowledged that the current provision of ophthalmology services in NWL was fragmented and that the variation in rates of avoidable blindness in the different NWL Boroughs was concerning. A key focus in transitioning from the pandemic was to ensure that health inequalities affecting groups with protected characteristics were eliminated. It was acknowledged that patient transport in this context was also a concern, and a potential response would be predicated on building a more responsive, sector wide ophthalmology strategy with a tailored hub and spoke model.  Including optometrists and high street opticians in a digitised network could offer enhanced diagnostic capabilities in secondary and tertiary provision.  Informing this with the patient voice was an important aspect of ensuring that service would be co-designed and help to achieve consistent standards across the system.

Bryan Naylor, a resident, commented that national and local caseloads were likely to increase the need for ophthalmology services, underpinned by improved future techniques.  As the Integrated Care Board (ICB) sought greater integration within primary care, there were opportunities to improve links to tertiary and secondary care.  The pressure on A&E stemmed from treating people that did not require emergency treatment. Professor Orchard’s integrated approach was welcomed as it advocated for a whole systems approach that also included social care, pharmacists, optometrists and the third sector.

Stephen Scowcroft from The Macular Society outlined the organisations perspective on future developments and treatment that might become available.  This added pressure highlighted the need for more advocacy and to raise awareness about the challenges of having ICBs. He welcomed the innovative, local NHS developments at Imperial, and the transformation and recovery work from covid currently being undertaken locally and nationally.  While he recognised that there were workforce challenges, there was a need to better utilise the services available through high street opticians and other allied health professionals.  He outlined his support of the national Eyes Have it campaign and the formation of a national plan supporting local delivery and national accountability.

Andrew Hodgson, a H&F resident and President of the National Federation of the Blind UK, a campaigning charity that provided support for those experiencing impairment or sight loss, focusing on rehabilitation. The pathway from diagnosis to treatment and how services could be improved were key areas of interest. Recognising the existing pressures and barriers, he also indicated his support for the Eyes Have It campaign and welcomed news of the work currently being undertaken at Imperial.

Co-optee Victoria Brignell referenced her personal experiences as a patient at Western Eye and enquired if its A&E service could be reinstated as 24 hours as there was a need for a night time service. Recounting the Charing Cross A&E experience of a friend whose treatment been compromised due to ineffective signposting to Western Eye reflected a need to address the issue.

Councillor Amanda Lloyd-Harris welcomed the report and enquired why referrals historically were not accepted from the hubs.  Co-optee Keith Mallinson observed that there was an impact on A&E as a consequence of the difficulties people had experienced in accessing primary care services. He enquired how the NHS trusts could liaise with primary care to ease the pressures, and how hubs could be better signposted.  Addressing an earlier comment regarding presentation at A&E, these could be eased by ensuring clearer signposting of patient pathways.  As an ex-teacher, he also observed that he had identified eyesight issues in children but the tools to spot these issues were limited and it was important to support schools in undertaking early intervention work.

Professor Orchard reiterated that eyecare service provision was fragmented, and although most people understood basic primary care provision they were not always aware of treatment pathways and interconnectivity between providers. There was an opportunity to model a service specification with the Integrated Care System (ICS) to consolidate current provision into one service specification. Referrals from different sectors varied and there were specific pathways for wet macular conditions. There were 270 optometrist practices in the NWL area and Professor Orchard ambitiously envisaged these as the front door for accessing services.  There was potentially greater equity in unifying sector provision through establishing diagnostic hubs networked through the same digital platform, which could help tackle high volume low complexity surgeries.  Imperial as a trust included the patient “voice” into all improvement and strategic, capacity building development work.  Prof. Orchard offered Bryan Naylor an opportunity to be further involved in the development of the North West London sector strategy work to shape future ophthalmology services.

Co-optee Jim Grealy endorsed the point made about early intervention work in primary schools, having had a similar experience as a former teacher. He asked about the integration of the ICS and the ICB, whether each of the trusts operated autonomously, and how widely this approach was replicated across other trusts.  He observed that it was important to address the diversity and health inequalities issues strategically. Professor Orchard concurred regarding the value of early intervention work in primary schools. He explained that a sector wide approach was being developed and led by a clinical director at Western Eye and clinical reference group. Innovations such as this could be undertaken autonomously of NHS England, but a co-ordinated sector wide approach was required.

ACTION

Victoria Brignell to share information about signposting services with Professor Tim Orchard.

RESOLVED

That the report and actions were noted.