With public satisfaction in the NHS falling amid rising waiting times and staff shortages, RCOphth President Professor Bernie Chang outlines the urgent need to increase ophthalmology workforce capacity alongside investing in recovery services.
Last week we heard the disappointing news that public satisfaction with the NHS had fallen to its lowest level in 25 years. The well-respected British Social Attitudes Survey also found that of those dissatisfied, waiting times were cited by two thirds (65%) and staff shortages by almost half (46%) of respondents.
While we have all been working as hard as we can to deliver high-quality timely care to patients, it is not surprising that patients are increasingly unhappy given rising waiting times. In England, there are now almost 600,000 patients waiting for ophthalmology services, 9.7% of the entire NHS backlog and up 22% on this point 12 months ago.
A key reason for this steep rise now is that many patients did not come forward for treatment during the initial stages of the pandemic, or their treatment was delayed as services had to be cancelled or rearranged.
What do we need to address ophthalmology backlogs?
We are therefore continuing to emphasise to policymakers across the four nations that ophthalmology needs to be front and centre of their respective plans for ‘recovery’. For example, the funding in England to enable the rollout of community diagnostic centres and surgical hubs has to support ophthalmology services to expand their capacity. We highlighted this point in our recent analysis of the elective recovery plan.
With an eye to the longer term, we expect to have positive news to report from Wales soon on the Welsh Government’s support for important recommended reforms for eyecare, including investment in regional centres of excellence.
Another quick way to increase capacity though is to enable and support the multi-disciplinary team (MDT) to expand both in number and the types of tasks they can perform. The College helps to provide Ophthalmic Practitioner Training, which allows ophthalmic nurses, optometrists and orthoptists to develop their skills further to deliver patient care. With the support of NHS provider organisations and education bodies, the OPT programme could be expanded to help further increase capacity.
Other roles such as technicians and image graders can also be quickly trained. This is particularly important in the context of delivering more virtual consultations where large volumes of diagnostic data will need to be collected and analysed quickly. Investment in these roles by NHS organisations across the four nations could provide a rapid boost to capacity, alongside a longer-term plan for their career development with the NHS.
More training places and proper workforce planning needed for the long term
Speaking of longer-term thinking, we can’t ignore the fact that we are desperately going to need more consultant ophthalmologists in the coming years as patient need continues to rise. In fact, there are many areas across the UK that are struggling to fill posts now. And while we can plug some of these gaps by using locums, that is not a long term solution in terms of either NHS finances or service stability.
Put simply, we need to start training more consultant ophthalmologists now. We have had a big increase in medical school places in recent years – 7,500 places in 2020 rather than the previous 6,000, and 9,000 in 2021 as the cap was lifted.
That increase is welcome, but it has not gone along with increases in training places in the respective training programmes, including ophthalmology. We need to address this urgently if we are to ensure that the doctors of the future we have spent years expensively educating have a pathway to becoming consultants where they are needed. We made these points strongly in a recent Health Education England call for evidence on workforce and will continue to do so in all our conversations with policymakers.
The government’s Health and Social Care Levy came into effect on Wednesday, meaning an increase in tax for many individuals and businesses. They have pledged that this will raise £36bn over the next three years to be invested in the NHS and social care. This money needs to be well spent, and investing in the doctors we are going to need in the future must be part of that investment package.
We also need the government to take a much more strategic approach to workforce planning across the health and care sector. With other health organisations, RCOphth is supporting a proposed amendment to the Health and Care Bill that would require the publishing of regular projections of the health and care workforce requirements in England.
If we prioritise this long term approach of proper overarching health workforce planning, including creating more training programmes places where they are needed, alongside shorter-term actions to clear backlogs and upskill the MDT, then we can again make the NHS a service the public can be satisfied with.