Agenda item

The Chief Operating Officer (COO) and the Divisional Director and Glaucoma Consultant (DDGC) at Moorfields Eye Hospital NHS Foundation Trust delivered a presentation on the proposal to provide additional eye care at a new site in Stratford from Spring 2023, which would bring together in one place a range of eye services for the local community including glaucoma, medical retina and cataracts, a specialist pharmacy, diagnostics, face-to-face and surgical treatments. The existing site at Barking would become a centre offering diagnostic tests for eyes, jointly operated by Moorfields, BHRUT and Barts Health. All face-to-face eye clinics provided at Barking would relocate to the new Stratford facility.

The presentation detailed the case for change, the proposals and feedback from patients. In response to questions, the COO and the DDGC stated that:

• Whilst there was an eligibility criteria, the Trust did provide patient transport, which would continue under the new proposals and those eligible would be able to be transported from their homes to Stratford. Nevertheless, the Trust’s aim was to support the majority of patients who currently received their care at Barking, to remain at Barking for their care. It was looking to expand the number of patients that it could see at Barking, where patients wished to be seen there. Whilst there was a small number of patients that would have to go to Stratford for their care, the Trust would assess each patient on an individual basis to look at how it could support them.
• The Trust had a close working relationship with colleagues at BHRUT and Barts; in the future, it may be possible for patients who lived near to one of these sites, to receive their care there.
• The Stratford site would provide better and additional facilities for patients. The Trust was also hoping to offer some low visual aid appointments, so that patients did not need to travel outside of the Borough for these.
• The proposal would enable patients to receive a range of diagnostics within the community, through a separate pathway that meant that they would not need to travel to a hospital site.
• The Trust hoped to operate the Barking Ophthalmology Community Diagnostic Centre (CDC) five days a week, seeing around 21,000 patients per year. This was significantly higher than the 8,000 currently seen at Barking.
• The Stratford site would be based at the former MIND charity offices, which was a four-floor 13,000 square foot building and a four-to-five-minute walk from Stratford train and bus stations.
• Cataracts patients were currently seen at Barking for the initial part of their patient pathway and would then need to travel to St. Ann’s for their surgery, outside of the Northeast London area. The proposal would enable a “one-stop” model for cataracts patients, who would be able to receive all of their care and treatment at the Stratford site.
• Medical retina and glaucoma patients would have periods of stability where no intervention was required, with these patients being able to continue to receive care at Barking during this. If they were found to require injections or had queries about changing their treatment, then they would go to the Stratford site to meet the clinicians face-to-face. Once the patients had stabilised, they would be able to return to Barking. As such, the new proposal would have a mixed pathway for patients, based on their need.
• Patients were currently having to travel much further for surgery than proposed under the new model. The Trust had mapped out parking areas for the Stratford site; whilst this was not as straightforward as for Barking, there was parking available due to the proximity of local shopping centres.
• Ophthalmology was generally an outpatient or day patient service. Whilst there were currently six inpatient beds at the City Road site, these were for overnight-stay patients with a co-morbidity.
• The Trust was currently looking at exploring its emergency care model of delivery. It was piloting a model that enabled it to triage patients that had been referred to its A&E, which had been developed at its City Road site. The Trust was looking into how it could roll this model out to the other areas that it served. Patient feedback had been received as to having emergency support at the Stratford site and the Trust would look into this in future years.
• Diagnostics was divided into lanes, with each service designing the investigations that were required to make a decision about the patient’s stability. No clinical decision would be made at this point, with the patient receiving a letter at a later date as to the findings of their diagnostic tests.
• The Glaucoma service ran across various sites; however, all staff had service meetings and received the same service teachings, so that the same standard of care was kept across all of the sites. The Trust worked hard to offer the same standards, with the same imaging devices, diagnostic tests and set-up.
• The Trust had undertaken a lot of work around ‘Did Not Attends’ (DNAs). This had peaked at 30 percent during the Covid-19 pandemic, with the Trust now striving to reduce this to ten percent. A lot of work was being done to improve the patient portal, in order to digitise reminder letters and guarantee that patients received these. The Trust was also starting to aim for a more predictive model to show which patients were most likely to not attend appointments and to reach out and work in partnership with them. Where there were spikes in DNAs, the Trust was working to understand the reasons for these, such as through socio-economic circumstances.