Subscribers Only
People 
Betti Hunter, Communications Officer at RNIB Cymru explores how clearer communication and improved awareness of sight loss could save NHS costs and people’s sight.
Imagine waiting to attend an essential appointment at your local hospital, knowing that each day that passes increases your risk of irreversible sight loss.
Unfortunately, this is the case for almost half of the most at-risk patients with chronic eye conditions who are waiting for treatment.
In 2018, the Eye Care Measures for NHS Outpatients in Wales (ECM) introduced a new way of managing waiting lists by categorising all patients based on their level of clinical need to prioritise those most at risk of irreversible sight loss.
But data from December 2022 shows that fewer than half of the 137,301 patients categorised as highest risk were being seen within their target date. This means that over 66,000 people with serious conditions like glaucoma and age-related macular degeneration waited longer than is considered medically safe and are at real risk of needlessly losing their sight.
We know that waiting times are an NHS-wide issue, and that staff are working around the clock to ensure that patients receive the best possible care. However, this is a particular struggle for hospital eye care services. No one should have to lose their sight because of waiting time backlogs.
At RNIB Cymru, we believe it is important to consider potential creative solutions that NHS Wales could implement, leading to a healthier, happier Wales.
Identifying wasted capacity
One way to alleviate waiting time issues could be to look at the areas where time and resources are currently being wasted – such as when patients do not attend their scheduled appointments.
Latest available data from 2018/19 showed that 6.5% of ophthalmology appointments were recorded as ‘Did Not Attend’ (DNA). However, this data was paused during the pandemic, so we don’t know how much wasted capacity could be used to reduce waiting lists and save people’s sight. Our conversations with health boards suggest that DNA rates are now much higher.
This data is an invaluable tool that could help NHS Wales to understand the scale of the problem. More work will be needed to identify why people are missing appointments and how to reduce DNA rates, thus freeing up key resources to tackle appointment backlogs. In many cases, the solution might be very simple.
Small changes, meaningful communication
RNIB Cymru has been working with people with sight loss to find out about their experiences of receiving information from health services. In a soon-to-be-published piece of research, we discovered that inaccessible information is a key contributing factor behind DNAs.
All too often, patients receive information in formats they cannot read. This inequality is a patient safety issue and puts visually impaired people at serious risk of harm. It can be the difference between attending or missing an appointment.
This is why it’s important to empower patients by sending information about their treatment in a format that suits them best. Some people prefer receiving their appointment letters in an email or text, allowing them to use screen reader software to read the information to them. Others might need their letters in a larger font or in braille.
Such small improvements to patient communication could go a long way to reducing wasted appointments and maximising the capacity of the health service, delivering the dual benefit of saving NHS costs and people’s sight.
In addition, patients should be provided with clear information about their condition and their level of clinical need. Increased public awareness of conditions that lead to permanent sight loss could also help to improve attendance rates, provided it is communicated in an appropriate and accessible way.
RNIB Cymru will continue to focus on raising awareness of sight loss, along with the importance of prevention and early detection, in our upcoming campaigns and work with key stakeholders, including Welsh Government and NHS Wales. We would like to see a return to collecting and publishing DNA data as a matter of urgency. This could be a significant step towards unlocking the unused capacity not just in eye care, but across all clinical areas.
