NHS0011

 

Written evidence submitted by Optical Express

 

About Optical Express and Anglia Community Eye Services (ACES)

 

Optical Express is a provider of a broad range of ophthalmology services including cataract surgery, lens replacement surgery, glaucoma, oculoplastics, management of other eye related diseases including but not limited to macular degeneration, and laser eye surgery in the United Kingdom and Europe. For over 30 years, millions of patients have trusted Optical Express with their eye care. As a leading private provider, our surgeons undertake more eye surgery procedures collectively than any other individual independent sector provider in the UK and Ireland.

 

Optical Express is focused on delivering exceptional patient care, outstanding clinical outcomes and continued investment in our people and technology. We have over 100 clinics across the UK and Europe and we employ over 1,000 highly trained and qualified staff. We are proud to provide our patients with the highest standards of clinical care.  Our extensive clinical outcomes data is testament to the quality of care we provide and to our commitment to continuous improvement.

 

Our teams are keen to do more to support our colleagues in the NHS. To help achieve this, in January 2021, Optical Express formed a strategic partnership with Anglia Community Eye Services (ACES), a community eye care provider which has over 15 years of experience providing high quality eye care services to NHS patients in East Anglia. ACES have held NHS Contracts for a number of years in the East of England. The aim of the strategic partnership was to expand the delivery of ACES services across England, making use of Optical Express established and CQC accredited treatment centres throughout the country to bring high quality eye care to NHS patients nationwide. 

 

The ACES and Optical Express partnership is already delivering benefits to patients at a joint clinic in Cambridge, and our combined partnership has the potential to benefit huge numbers of patients in every region of England. We are in no doubt that our expert clinicians and high quality treatment centres across England could play a key role in helping to reduce the increasingly lengthy waiting lists for cataract surgery. Unfortunately, opaque bureaucratic processes and systemic issues have prevented the NHS from making use of the surgical capacity we have available.

 

 

Why we are submitting evidence

 

Optical Express and ACES have written to local health leaders explaining how we can assist the implementation of elective surgery recovery plans. A core part of which must include expanding capacity for cataract surgery, and the most effective method to achieve this is through greater use of independent sector providers. As a provider of all ophthalmology services, we have experience of the procedural and bureaucratic issues that the independent sector faces in engaging with integrated care systems (ICSs) and integrated care boards (ICBs) as well as the impact this has on patients waiting for urgent care.

 

 

 

 

 

The situation in ophthalmology

 

The number of NHS patients waiting for ophthalmology treatments is currently unacceptably high, with more than 650,000 patients currently waiting for eye care[1].  Further patients are on waiting lists across the devolved nations. This backlog has been exacerbated by the pandemic, but the excessive waiting lists existed prior to COVID and continue to grow today. Patients are waiting too long for routine procedures such as cataract surgery, while hospitals struggle to treat those with more complex and difficult-to-treat conditions such as glaucoma. Longer waiting times can lead to poorer outcomes and increase the risk of dangerous complications. We routinely see patients who are growing desperate as they struggle to be treated on the NHS and are at increased risk of long-term health complications as a result of their wait.

 

The longer patients go without treatment, the more likely it is that both mental and physical health will deteriorate and the likelihood of the patient suffering a trip or fall is greatly increased. Trips and falls, especially among older people, are themselves a major cause of hospital admissions and in some cases can sadly be fatal.

 

 

How the Independent Sector could help

 

In order to tackle waiting list backlogs, a key part of the answer must be to significantly increase capacity for cataract pre-assessments and cataract surgery. Maximising the use of the independent sector when NHS patients are waiting too long for treatment is the only way to ensure patients are treated in a timely manner and to reduce waiting times. Independent providers are located in the community, making this convenient for many, especially older and more vulnerable patients. Delivering more routine eye care, such as cataract surgery, in the community will free up hospital ophthalmology teams to focus on complex and higher risk cases.  While the Independent Sector has significantly increased its share of cataract delivery in recent years, there is an opportunity to increase patient accessibility to care locally in the communities across England.

 

From our experience as an independent provider, those who commission services locally are not always making the most of the capacity in their areas. Our strategic partnership of Optical Express and ACES is well-placed to help plug the gap in the delivery of eye care. Our treatment centres have been rated either outstanding or ‘good’ by the Care Quality Commission and we are able to treat NHS patients at the current NHS tariff rate. We can provide surgical treatment as well as aftercare and are in a position to treat hundreds of NHS cataract patients each week. We can typically treat the cataracts of NHS patients within four weeks. This would cut NHS waiting times significantly. NHS cataract patients are currently routinely waiting more than 52 weeks, with many waiting more than 78 weeks and some waiting to be treated for as long as 4 years.

 

With effective use of independent providers, backlogs could be eradicated in a matter of months.

 

 

Our experience of trying to work with ICBs

 

We believe that the newly formed ICBs offer a step forward for the way care is commissioned in England. They have the potential to greatly improve the lives of people who live and work in each ICB area, and the formation of these new systems recognises the important role that partnerships of organisations can play in delivering joined up health and care for patients.  However, while the concepts that underpin integrated care systems are sound, in our experience they are not yet delivering on their potential. The practical reality of working with ICBs has so far been challenging, and patients are missing out and suffering as a result. The main obstacles we face in engaging with ICBs have been due to excessive bureaucracy and a lack of clear procedures, processes and lines of responsibility for commissioning desperately needed NHS services.

 

Our experience has been as follows:

 

 

 

 

 

 

 

Case study: Our experience of working with Birmingham and Solihull Integrated Care System

 

Optical Express has been providing independent eye care services in Birmingham and the surrounding areas for over 25 years. In spring 2021, we opened a new clinic and treatment centre in central Birmingham. This new £3 million facility is equipped with the latest diagnostic and treatment technology, and it is staffed by an exceptional multi-disciplinary team of optometrists, ophthalmologists, specialist nurses and others. The clinic recently received the highest possible rating of ‘outstanding’ following inspection by the Care Quality Commission (CQC). The inspectors said: “Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.”

 

The clinic offers cataract treatment and has the capacity to treat up to 300 NHS patients per month.  Other ophthalmic services, for example the delivery of glaucoma outpatient care, will be supplementary in patient number to this. Since the new clinic was opened, we have been requesting a dialogue with commissioners in Birmingham and Solihull ICB, where waiting times for cataract surgery are currently over 78 weeks.

 

Since the outset, we have experienced considerable delays in getting replies and information from commissioners in Birmingham and Solihull. We have frequently supplied information as requested, only to have then, several weeks later, been informed that different information is required or that the ICB now needs the same information in a different format. Instead of the process being set out clearly from the outset, additional layers of bureaucracy have been added at every stage of our contact with the ICB. We have been given conflicting information by different team members within the ICB, the first commissioner we spoke to informed us that we could provide services without a contract in place, however – five months later – a different commissioner informed us that the ICB would refuse to allow services to begin without a contract.

 

During this time, a change in commissioners took place which we were not informed of, following which, we were informed that our services could not to be delivered without a contract. We were then burdened with extensive requirements for an assurance framework, requiring information on cyber security and data protection which we had no prior knowledge we would need to provide. We are currently in a position where the commissioning team have declined to provide a timescale on the production of a draft contract and are unable or unwilling to progress until the assurance framework is submitted.

 

It has been over six months since we first approached Birmingham and Solihull ICB to offer our services, and yet we still do not have a contract in place with them, and have not treated a single NHS patient at our clinic. Throughout this time, we have had capacity to treat hundreds of patients there.

 

Timeline of engagement with Birmingham and Solihull Integrated Care System

 

Date

Progress in Activity

27 Apr 2022

First contact acknowledged by Birmingham and Solihull Clinical Commissioning Group (CCG now ICB)

18 May 2022

First Teams call between members of Optical Express and ACES team and commissioners to discuss services we could provide for patients in Birmingham. The ICB requested supporting documentation including a copy of our existing contract with Cambridgeshire & Peterborough ICB, as well as a reference from Cambridgeshire & Peterborough ICB. This was sent to the ICB immediately following the meeting

24 May 2022

Optical Express followed up with the ICB after sending supporting documentation (copy of Cambridgeshire & Peterborough ICB contract, reference from C&P ICB) having received no response from ICB

 

17 June 2022

Optical Express sent photos and floorplans of the Birmingham Clinic and evidence of CQC registration to contact at ICB and requested a further call to progress discussions

 

4 July 2022

ICB raise referral process for us to follow with additional admin requirements

12 July 2022

Call held with ICB staff members involved in referral process

 

17 July 2022

Contract particulars detail requested (part of standard NHS contract, requires copies of policy documents, CQC registration info, contact names etc)

 

21 July 2022

Conversation about YAG laser with ICB and tariff and contract particulars submitted

 

10 August 2022

Queried draft contract timeline with ICB.  Response stated that prior supporting info was deemed unsuitable (contract reference and copy of C&P ICB contract).  Additional request for letter of commissioning intention from C&P ICB.

 

30 August 2022

Updated reference and letter of intention sent

 

5 Sept 2022

Sent copy of Monitor Licence to ICB (requirement on contract particulars)

 

11 Oct 2022

All prior conversations confirm the Optical Express and ACES service could start without a contract, sent email confirming a date we were planning on commencing services in the clinic in Birmingham

 

12 Oct 2022

ICB contact seconded to University Hospitals Birmingham and have to deal with different commissioning staff.  The ICB refuses to allow services to be delivered without a contract.

Additional extensive requirement of assurance framework of information supporting cyber security and data protection is requested, requiring extensive effort across various teams within Optical Express and ACES. ICB refuse to enable eRS (electronic referral system) location for clinic in Birmingham.  Commissioning team refuse to provide a timescale on draft contract production and refuses to progress until the assurance framework is submitted.

 

 

 

Our recommendations

 

We make the following recommendations informed by our clinical experience and understanding of procedures and care in ophthalmology, our experience of the independent sector and coordinating with ICSs and ICBs, as well as our direct experience of seeking to implement this in practice.

 

Recommendation 1

 

Recommendation 2

Recommendation 3

 

Recommendation 4

 

Recommendation 5

 

 

Conclusion

 

There are currently hundreds of thousands of patients suffering with cataracts and other eye conditions, while also living with the anxiety of not knowing when they might receive treatment. Ultimately unnecessary delays in care not only impact upon the patient from an ophthalmic (eye) perspective but by way of a wider array of areas, to include a negative impact on mental health and an increase in avoidable trips and falls.  These wider areas place an unnecessary burden on the NHS more widely. There is plenty of treatment capacity in the independent sector, which could transform these patients’ vision, and allow them to lead happy, healthy lives once again. It is a tragedy that these patients are being let down by opaque bureaucracy and a lack of clear procedures, processes and lines of responsibility for commissioning desperately needed NHS services.

 

However, the problems are not insurmountable and with some straightforward changes, as set out in the recommendations above, ICSs could quickly harness the full potential of independent providers in their areas. This would cut waiting times and mean more patients can be treated in a timely manner, reducing the backlog and current stresses on overburdened NHS services.

 

November 2022


[1] NHS referral to treatment (RTT) waiting times data, September 2022: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2022/11/Sep22-RTT-SPN-pre-release-version-34691.pdf