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South East Clinical Senate. Review of the pre-consultation business case for Ophthalmology Services for East Sussex CCG. (Sep. 2021)

More than 1.5 million people in England have reduced vision. It is estimated that this figure will double by 2050. The population is ageing and one in five people aged over 75 and half of people aged over 90 live with sight loss.[1] Lack of IT connectivity causes difficulties receiving referrals directly from optometrists and sharing information for advice, guidance and shared care. Nevertheless, ophthalmology referrals to hospital eye services rose just over 12% from 2013/14 to 2017/18 and now account for 8.2% of outpatient appointments.[2] More treatments for chronic ophthalmic disease are available that require regular, timely attendance to prevent permanent visual loss, contributing to capacity issues. The processes for the commissioning and provision of eye health services across pathways of care are fragmented, with fragmented solutions for different parts of a pathway of care operating in silos. This results in inconsistency, delays, waste and unwarranted service variations, with governance and quality assurance issues at boundary handovers between steps along the care pathway. To reduce variation in access and outcomes, systems are expected to implement whole pathway transformations and improve performance in Eye Care with support via the National Pathway Improvement Programme.[3]

The East Sussex population has an elderly, multiply comorbid, demographic driving demand for ophthalmic services which include diagnosis, treatment and prevention of conditions that affect the eye and visual system. While there are many clinical conditions that can affect the eye and its surrounding structure in people of all ages, many eye conditions are age-related, making eye health (ophthalmology) services increasingly important as people get older. The prevalence of medical retinal disease (macular degeneration and diabetic retinopathy), glaucoma and cataracts are all significantly higher in the East Sussex population than the England average. East Sussex CCG currently commissions ophthalmology services from the 3 hospital sites in East Sussex Hospitals Trust (ESHT) and through community and primary healthcare providers (optometrists and minor eye conditions services).  The changing needs of the population, the changing nature of ophthalmology care and the associated challenges in providing ophthalmology services have made the redesign of ophthalmology a key priority for the East Sussex system.

[1] Key information and statistics on sight loss in the UK https://www.rnib.org.uk/professionals/knowledge-and-research-hub/key-information-and-statistics

[3] NHS England Eye Care Planning Implementation Guidance 2021-22 Summary https://www.rcophth.ac.uk/2021/06/eye-care-planning-and-implementation-guidance

Clinical Senate

Kent Surrey Sussex

Date:

16/09/2021

Status:

Completed

Types of Work:

Clinical Review