Imran Rahman, CEO and Consultant Ophthalmologist, CHEC, spoke to Chris Henson about tackling the COVID-19 backlog, community-based support for the NHS, and the digitisation of healthcare.

Without major intervention, will we ever see an end to the COVID-19-induced NHS backlog, and its effects on patients waiting for surgery, within eyecare?

Our healthcare system is under more pressure than ever, with the NHS currently facing record waiting lists of more than six million patients, and these are predicted to continue rising until 2024. Whilst the impact of COVID-19 has certainly exacerbated the situation, the backlog was already profound – four million people were waiting for treatment before the pandemic even started. But there are steps we can take.

The government’s decision to increase funding – including a £36bn increase from National Insurance rises – is helpful, but this alone will not be enough to provide a long-term solution to this crisis. But new strategies offer hope – by adopting a shared-care partnership model, for example, community-based services will be able to step in to relieve some of the pressure on the NHS. We see this approach as absolutely key to reducing the burden on the NHS and helping ensure patients get treatment faster.

What are the key effects the backlog has on patients? Are these mainly physical or psychological impacts?

Research has highlighted that for every 82 patients spending between six and eight hours in A&E, one would come to avoidable harm. It’s clear, then, that backlogs are having a profound effect on patient health.

This is especially true for patients who require eye care treatment – where the turnaround for surgery often needs to be quicker. For example, the NHS recommends that cataract surgery patients do not wait for more than 18 weeks for treatment, but the average wait time for cataract surgery was nine months in 2021.

Research has revealed that a delay in treatment can lead to further eyesight issues and an increased risk of complications – which can have severe effects on the quality of life of patients – on mental, emotional, and physical levels. In fact, 22 patients a month lost their vision in 2021 as a result of waiting too long for surgery. Therefore, it is essential that the delivery of high-quality and efficient care for all patients is prioritised.

Which community-based services can support the NHS?

Community-based healthcare offers a variety of services and already provides support for around 100 million patients a year. And since community-based services have increased capacity, they are likely to be able to offer efficient and high-quality care within their communities more quickly – which can help to reduce pressure on the NHS. 

Community-based care supports the NHS by offering elective care in local settings. CHEC’s ophthalmology services, for example, provide essential eyecare treatments in the heart of local communities – with CHEC treating more than half a million patients waiting for eyecare services in the UK.

CHEC is helping to digitise healthcare with their patient booking app – how does the app improve the patient journey?

We recently launched a patient booking app as one of our key initiatives to reduce NHS backlogs. The fact that the app allows patients on-the-go access to booking appointments means that they can be seen as quickly as possible. The app also determines how urgent an appointment is by allowing patients to instantly book the best slot for them.

Here at CHEC, we are always looking for new and innovative approaches to offer the best possible service to our patients. Improving the patient journey is at the heart of all we do, and with the introduction of the app, we have been able to minimise the likelihood of cancellations or missed appointments – which makes a difference to the accessibility and efficiency of our services.

Do you think it will catch on around the country, and is technology the key to beating the backlog?

Our world is increasingly reliant on technology, and the pandemic prompted an acceleration in the uptake of digital services across all sectors. However, a digital revolution specifically in healthcare is integral to making services accessible to all. Prioritising this will help healthcare leaders to implement more effective, and long-term, solutions to tackling backlogs.

CHEC’s patient booking app is already being used by over 50% of our patients, and we have already seen how successful it has been in reducing the number of cancelled and no-show appointments within our services. If the NHS app, for example, was developed to include the option for users to book appointments with alternative services, like community-based care providers, this could make a massive difference to the current waiting times.

It’s critical, however, that when increasing digital uptake, we do not overlook patients who are unable or unwilling to use technology. Many prefer to use traditional methods of communication and engagement and it’s imperative that providers recognise that.

Could you tell us more about CHEC’s Home to Hospital™ transport services?

A recent survey revealed that 31% of adults found it hard to access healthcare during the pandemic, so our Home to Hospital™ service is another initiative that focuses on tailoring healthcare services to meet the individual needs of patients. Our Home to Hospital™ service offers our patients transportation to and from their eyecare surgery and appointments. Our minibuses are run by local drivers who have received training to enable them to support patients before and after their appointments. The service has been particularly beneficial in making treatment and surgery more accessible for patients who are elderly, and those with disabilities. Addressing healthcare inequalities is one of our main priorities, and the Home to Hospital™ service is another example of our mission to deliver patient-focused care in action.

Imran Rahman, thank you very much for speaking to Eye News.

See the original article here.

Dear patients,

In line with government guidelines, please follow the guidelines below:

If you are having an outpatient appointment for any reason, please follow point 1 below:

1. If you have any of the following symptoms, please do not attend your appointment.  Please cancel the appointment and arrange a lateral flow test (LFT). Let the clinic know that you will need to rebook.
   • A temperature of greater than 37.8 degrees
   • Persistent new cough
   • Loss of sense of smell and taste

If you are having cataract surgery, undertake a COVID-19 test prior to your surgery.  Please follow the instructions below:

1. Please order a test at least 10 days before the appointment to allow time for the test to be undertaken.  This can be ordered from the link here: https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests
2. The test should be undertaken 3 days before the procedure date.
3. You should socially distance yourself for 3 days prior to surgery.
4. Please provide proof of the test by logging the result on the gov.uk website, where you will receive an email or text to verify the test result once you have entered your result. This must be brought with the patient on the day of admission.

We thank you for your patience and understanding. Stay safe!

CHEC has announced the launch of a new centre in Gateshead Metrocentre. With 100,000 people currently waiting for treatment in Newcastle and Gateshead hospitals, the new centre will provide vital eye care services to help ease the regional backlog in the North East.  

Commenting on the new centre, Jon Dore said: “The launch of our new Newcastle Gateshead site is a very exciting step in our ongoing aim to provide efficient and high-quality ophthalmology services across the country. Our local eyecare services will offer support in addressing the regional backlogs faced by Newcastle and Gateshead. And with some patients facing waiting times as long as two years for crucial services, our new centre will help ensure that patients receive the care they need.”

In the wake of the pandemic, ophthalmology is facing significant backlogs, with over half a million people currently waiting for ophthalmology services. The NHS cannot be left to deal with these backlogs alone, so CHEC’s new treatment centre in Gateshead will support the NHS in addressing these growing delays by providing eye care services for the local community.

To mark the upcoming opening of the new Newcastle Gateshead treatment centre, CHEC will be hosting a face-to-face CPD open evening on Tuesday 28^th June 7 pm-9 pm,  where local optometrists will be introduced to the new site – register for your place today.  

Attending optometrists will also have the opportunity to gain one CPD point by taking part in a highly anticipated CPD seminar discussing Global Perspectives on Glaucoma, which will be hosted by CHEC’s CEO and Consultant Ophthalmologist, Imran Rahman.

With the first patients expected in the Gateshead Metrocentre in early June, this new centre opening follows other recent openings and forms part of CHEC’s wider drive to deliver new centres across the country, as well as its continued ambition to support the NHS in reducing backlogs and providing patients with efficient and high-quality care.

This week, CHEC New Cross is celebrating one year since its first cataract surgery.

In the last 12 months, the hospital staff have treated an incredible 6,664 patients, providing a wide range of ophthalmic services:

We are so proud of our hard-working team for making the first year a success.

The New Cross team had a fantastic time celebrating with patients.

Congratulations Samea and team New Cross, roll on the next 12 months!   

• The Centre will help ease local and regional ophthalmology backlogs
• Roll out of new CHEC centres aims to provide faster support for half a million patients waiting for ophthalmology treatment in the UK

CHEC, one of the largest providers of community-based ophthalmology services in the UK, has announced the launch of a new treatment centre offering eye care services in Northampton.

CHEC’s latest clinic is conveniently located in the centre of Northampton in Sol Central and will provide the NHS with increased capacity to help tackle the backlog of some half a million ophthalmology-related treatments, such as cataracts. The launch of CHEC’s services in Northampton will offer a much-needed option for patients in need of treatment in the region.

CHEC’s new treatment centre in Northampton will play an important role in clearing regional eyecare backlogs in the East Midlands, which has been one of the hardest-hit areas, seeing a 39% drop in elective admissions throughout the pandemic. CHEC’s expanding network of clinics is also playing an increasingly vital role in reducing the burden on the NHS and allowing patients to receive treatment as early and efficiently as possible.

Like CHEC’s other centres, the Northampton centre offers CHEC’s free Home to Hospital™ transport service, which offers patients transport to and from appointments and surgery, helping patients reach their appointments efficiently and without stress. The opening of the Northampton centre also follows the release of CHEC’s booking app, which can determine the urgency of an appointment and allow patients to book the most convenient time for themselves, speeding up the booking process and minimising cancellations and missed appointments.

The Northampton centre follows recent site openings across the Midlands, including in Leicester, Nottingham and Coventry, as part of CHEC’s continued rollout of new centres to help the NHS and provide high-quality, efficient eye care. Throughout the pandemic, CHEC has provided much needed support to the NHS as a trusted partner and has received positive feedback with 99% of patients happy to recommend CHEC to friends and family.

Jon Dore, Chief Operating Officer at CHEC, said: “The launch of our new treatment centre in Northampton is a welcome addition to our recent site openings. We believe it is essential to expand our services in regions where the NHS faces crippling backlogs and pressures, and the opening of the centre illustrates our priority – supporting the NHS and of course, local patients who are in urgent need of our services. At CHEC, high-quality, responsive care always comes first, and this site will play a role in building a strong partnership with the local community for many years to come.”

Recent news that more than one in six NHS trusts across England has declared critical incidents has signalled that priority services are coming under further pressure, once again placing the spotlight on NHS waiting lists and the strain of backlogs on key services.

Those waiting lists are now longer than ever before, while at the same time people show a reluctance to add to the workload of over-worked staff in hospitals and clinics with health issues perceived – sometimes wrongly – to be minor. There’s clearly a need to find ways to release pressure from the system and improve the quality of life for hundreds of thousands of people.

Just prior to the emergence of Omicron late last year, the impact of Covid-19 had already pushed up the total NHS waiting list to a record six million, with over two million of those waiting more than 18 weeks for treatment. Among these patients were over one million in need of ophthalmology treatment. That figure is higher now, but it stems from a situation that could be alleviated using infrastructure that is already in place in our local communities.

Progression adds urgency

The NHS actually recommends an 18-week maximum wait for cataract surgery but, due to the pandemic, that has now grown to an average of nine months.

The challenge for the NHS is how to reduce, if not clear, that backlog of treatments and operations against the backdrop of the pandemic, which raises the risks for vulnerable older patients in hospitals. The urgency seemingly increases by the day.

Lengthy waiting lists and delayed operations can have a profound impact, whatever the condition, and that’s the case too with cataracts, which are progressive over time. Therefore, the longer the wait, the worse the condition and the harder it is to correct. It’s not just waiting lists, it’s the waiting time in the hospital before being treated. In December, the number of patients waiting over 12 hours in corridor trolley beds for admission increased to a record-high 10,646, up 51% from October.

A study of the average waiting time between referral and cataract surgery at 12 NHS trusts around London was found to be 204 days in 2020. This rose to 278 days in 2021, up 36%. Those confronted with those delays faced a significant deterioration in their quality of life, such as being no longer able to drive, more susceptible to falls and possibly being unable to read.

By comparison, the average NHS waiting time nationally for all procedures carried out during the first half of 2021 was 10 weeks, with the waiting time for ophthalmology-specific procedures at 11 weeks. The problem for those needing cataract surgery is that it’s a procedure that is of relatively low clinical priority, meaning it tends to get pushed back when more urgent cases arise.

With or without the pandemic, the UK’s ageing population means waiting lists for cataract operations and treatment for other eye conditions will grow.

Shared model solution

One way to bring down the pressure on the NHS in the field of eye care is, in some ways, so obvious it goes unnoticed. It lies in expanding a practice already in place and working well. The NHS already adopts a shared partnership model approach with community-based services where they exist. They offer proximity to local communities, along with specialist expertise, without the Covid-related health risks that may be associated with larger hospitals.

Offering high-quality care right in the centre of communities also provides a tailored patient experience while reducing the burden on the NHS. In addition, a focus on end-to-end care can mean patients do not have to see multiple providers. This means community-based care can offer patients a care experience tailored to their needs.

It’s worth remembering that a cataract can be fixed with a simple 10-minute operation using anaesthesia eye drops that make it a day-case procedure. So, there is simply no need to go to a hospital.

Community-based services are very helpful for dealing with these common eye conditions, generally delivered by a community optometrist. Here, the management is usually maintained within the primary care setting for as many patients as is safely possible, avoiding unnecessary referrals to hospitals.

The clinics can also undertake minor operations, besides cataracts, such as the removal of cysts on or around the eye. They can also deal with skin cancer on the eyelid, which can be very time-sensitive. In general, a malignant lesion grows more rapidly than a benign one. Where melanomas or squamous cell carcinomas are suspected, it’s important that patients are referred to a specialist urgently using the two-week wait referral system and get treated within 31 days.

The way forward

Community-based services can offer patients an improved experience while also supporting the NHS. The increased capacity of these services enables patients to receive high-quality care as quickly as possible. As a result, the burden placed on the NHS is relieved and patients receive a better outcome; that’s the ultimate objective of all healthcare.

Despite the government’s multi-billion-pound investment, the NHS is still set to face a backlog of 10 million patients by 2024. The shared care partnership model is already used and proven to be effective. It should now be expanded to help and support the NHS in tackling its treatment backlog.

Imran Rahman is CEO and a consultant ophthalmologist at CHEC.