Written question WQ89403

We continue to work with health boards to explore all viable options to reduce waiting times within ophthalmology. This includes ensuring that strategic planning and operational delivery are focused on delivering optimum, clinically agreed pathways as well as utilising additional resources to treat as many patients as possible such as utilising community services and advanced practitioners to manage both acute and chronic ophthalmic conditions.

The legislation required to implement new clinical pathways in primary care to support demand came into force on 20 October 2023. Pathways that have been introduced and are immediately available for health boards to implement include Certification of Visual Impairment in primary care and acute eyecare independent prescribing pathways. Independent prescribing pathways are currently at different levels of maturity across health boards. Further implementation priorities will be rolled out in the coming months including medical retina and glaucoma pathways.

Whilst waiting times are not where I expect them to be, NHS Wales is however, delivering improvements in the reduction in the number of pathways waiting over 2 years. These have reduced from 9,300 in March 2022 to 2,746 in August 2023, a 70% improvement. Performance against the eye care measures (R1) however remains challenging with 49.7% of patients waiting within their target date or 25% beyond their target date in August 2023.

Additional financial support has been given to health boards to support their waiting lists. Health boards have used this in different ways, including commission private capacity, funding optometry staff to undertake reviews of patient pathway and assessment of referrals to identify patient pathways suitable for community enhanced services.

Health boards are being encouraged to redesign services and pathways through the use of primary and community eye care services to support chronic disease management. The essential pathway redesign will ensure that patients are seen in a clinically appropriate time and by an appropriate ophthalmic practitioner it will also free up finite capacity within a hospital setting for patients who are at the greatest risk of sight loss or harm.

I am concerned about the performance against the eye care measures and raised this in the Ministerial Ophthalmology Summit in November 2022. I was very clear on my expectations that we cannot do more of the same and expect different results. Health boards must look to work differently, making use of the technology available to them and working together across health board boundaries and regions. The summit report can be found here. A follow up summit is being planned for next year.

The Ophthalmology Clinical Implementation Network (CIN) is working with health boards on implementing actions required to support the shorter to medium term improvements and the implementation of the Getting it Right First-Time (GiRFT) reviews of Glaucoma and Cataract. The CIN is in the process of undertaking detailed demand and capacity activity as part of the development of a clinical strategy – this will include an assessment of the ophthalmic workforce.

As part of integrated quality performance and delivery meetings, officials have asked health boards to present their local plans and progress. Ophthalmology specific meetings have been escalated within health boards and will focus on addressing the backlogs across the waiting lists, ensuring they our maximising the use of the new ways of working.

The Welsh Government remains committed to reducing waiting times for the people of and to reducing the risk of sight loss and irreversible harm.