The NHS in North Central London (NCL) has decided to implement proposals which will allow an estimated additional 3,000 eye (ophthalmology) surgery procedures to take place a year and could reduce waiting times for patients that are in need of sight saving surgery by up to four weeks.
From 21 August to 16 October 2023, we asked for the views of patients, the public, and partners on the proposed changes and how we could provide the best possible experience for all patients, if they were implemented. We heard from over 600 people and organisations and the feedback we received was analysed and considered as part of our decision-making process. You can read the findings and what we have agreed to do next in an engagement report.
The changes
We will implement the following changes:
Create a hub for eye (ophthalmology) surgery at Edgware Community Hospital which provides surgery for adults for common, usually straightforward (low complexity) conditions like cataracts. This will bring together all eye surgery currently provided by the Royal Free London NHS Foundation Trust at the Whittington Hospital and some activity from Royal Free Hospital and Chase Farm Hospital into a single ophthalmology hub site at Edgware Community Hospital where a higher number of surgical procedures can be done.
A number of complex eye surgeries and procedures provided by the Royal Free London NHS Foundation Trust that need input from other specialist clinicians, such as plastics, will remain at both the Chase Farm Hospital and Royal Free Hospital.
It is important to note that patients will continue to be able to choose to be referred to any provider that has an NHS contract to provide the service they need.
Patients who will have their surgery at the Edgware Eye Surgery Hub will continue to attend their local optometrist or preferred hospital for tests and outpatient appointments before and after having surgery.
Existing ophthalmology surgery services at North Middlesex University Hospital, Moorfields Eye Hospital sites and relevant independent sector providers will continue as they are.
The additional surgical capacity created at Whittington Hospital and Chase Farm Hospital will be used to help tackle waiting lists in other surgical specialties.
FAQs
What changes are being made for eye surgery?
So the NHS can carry out an estimated additional 3,000 eye surgery procedures a year in NCL, two changes are being made:
- The creation of a hub for eye (ophthalmology) surgery at Edgware Community Hospital to provide surgery for adults for common, usually straightforward (low complexity) conditions like cataracts. This brings together some eye surgery services from Chase Farm Hospital, Royal Free Hospital, Whittington Hospital and Edgware Community Hospital into one hospital site where a higher number of surgical procedures can be done.
- The move of any eye surgery currently taking place at Whittington Hospital or Chase Farm Hospital that is not suitable for Edgware Community Hospital to other sites including Royal Free Hospital.
Patients will continue to attend their local or preferred hospital for tests and outpatient appointments before and after having surgery.
Existing planned eye surgery services will continue at North Middlesex University Hospital and at all Moorfields Eye Hospital sites (City Road Campus, Potters Bar and St Ann’s Hospital) and patients will continue to be able to choose which NHS Trust they are referred to for care inside or outside NCL.
Where can patients have planned NHS eye surgery in North Central London (NCL)?
- The Royal Free London NHS Foundation Trust, which delivers the majority of eye surgery services at Edgware Community Hospital, with more limited and specialised procedures at the Royal Free Hospital or Chase Farm Hospital
- North Middlesex University Hospital NHS Trust
- Moorfields Eye Hospital NHS Foundation Trust at Moorfields Eye Hospital (City Road Campus), Moorfields Eye Unit at St Ann’s Hospital or Moorfields Eye Unit at Potters Bar Community Hospital
- Independent sector providers contracted to provide services for the NHS.
Why are changes being made for eye surgery?
The NHS has been working extremely hard to tackle waiting lists for planned care, which were made much worse by the impact of the Covid-19 pandemic.
Good progress has been made in NCL and the number of people waiting the longest for care has been significantly reduced.
Despite these efforts, waiting lists for surgery continue to grow. This is because the number of people needing surgery is increasing at a faster rate than the number of surgical procedures we can do.
The longer people wait, the greater the risk their health deteriorates and the complexity of care they require increases. This can potentially impact on their ability to work, connect to their community, care for others, and live their life to the fullest.
We want to do everything we can to tackle this and have developed these proposals to help us to carry out more eye surgery procedures and reduce wait times.
How could patients benefit from the changes?
The changes will allow us to carry out an estimated additional 3,000 procedures a year which means that many patients could be seen faster following their referral.
We have reviewed existing relevant patient engagement to understand what matters most to patients and a regular theme is that patients are willing to travel further if they can be seen quicker. By increasing the number of surgical procedures we can do, this should reduce waiting times by up to four weeks for some patients.
Patients will benefit from the shared expertise and experience of clinical teams working together, leading to better outcomes for patients. Through services operating in a more efficient way, we expect there to be fewer last minute cancellations or delays for patients on the day of their surgical procedure.
Will patients still be able to choose which NHS Trust they are referred to?
Yes, patients will continue to be able to choose which NHS Trust they are referred to. GPs are able to provide information about options, including waiting times, when making a referral. Read more about the choices available to you in the NHS on the GOV.uk website.
What do the changes mean for people currently on eye surgery waiting lists?
Royal Free London patients who have currently been booked into a specific hospital (for example, a patient booked to attend the eye surgery service at Whittington Hospital) for their eye surgery will remain at that hospital, unless the appointment needs to be rebooked. After the changes have been made most patients who have not been assigned a hospital will be booked into Edgware Community Hospital, with a small number of more complex procedures booked into Chase Farm Hospital or Royal Free Hospital.
Do the changes include emergency care?
No, the changes only relate to planned eye surgery for adults. No changes will be made to where emergency eye surgery is provided in NCL.
Do these changes impact on wider Oriel plans to move Moorfields Eye Hospital, currently at City Road, to St Pancras?
No, these changes are separate to Oriel. Oriel is a joint partnership between Moorfields Eye Hospital NHS Foundation Trust, the UCL Institute of Ophthalmology and Moorfields Eye Charity. It will move services from Islington to a new, integrated centre on part of the St Pancras Hospital site in Camden to create a world-leading centre for advancing eye health.
How many eye surgery procedures will the changes affect?
Around 25,000 eye-related surgical procedures currently take place in NCL each year. The changes will affect approximately 5,000 procedures (around 20% of the total).
What will happen to any space created at Whittington Hospital and Chase Farm Hospital?
Any additional surgical capacity created at Whittington Hospital and Chase Farm Hospital would be used to help tackle waiting lists in other surgical specialties.
How have clinicians been involved in developing the proposals for change?
The NCL Ophthalmology Board has led on developing the proposals for eye surgery. The Board has clinical and operational representation from all NCL acute trusts (Royal Free London NHS Foundation Trust, North Middlesex University Hospital NHS Trust and Moorfields Eye Hospital NHS Foundation Trust) and is chaired by the Deputy Medical Director at Moorfields Eye Hospital NHS Foundation Trust and NHS London Clinical Director for Ophthalmology, Dilani Siriwardena.
The work is overseen by a NCL Surgical Transformation Programme Board, which also has representation from all NCL acute trusts, and reports into a NCL ICS System Management Board.
How might staff benefit from the changes?
National evidence suggests that working in surgical hubs, where planned procedures are separate from emergency care, can have benefits for staff including improved satisfaction through:
- more predicatable working hours and workload due to fewer delays and cancellations
- opportunities to observe and try new roles and develop knowledge and skills around surgery.
Have similar changes like these been made before in NCL?
Yes, the NHS in NCL launched Elective Orthopaedic Centres in 2021 which have doubled the number of surgeries done for hips and knees each year locally and improved outcomes for patients.
The proposals for eye surgery aim to tackle waiting lists by developing a third ophthalmology surgical hub in NCL, in addition to existing Moorfields sites.
How did we engage with patients and the public on the proposed changes?
From 21 August to 16 October 2023, we asked local patients and the public for their feedback – with a focus on how to reduce or avoid any negative impacts from the proposals.
Activity included a discussion group, attendance at community and patient group forums, and visits to speak to patients at Whittington Hospital and Chase Farm Hospital.
Materials were made available in a range of formats including:
- English: information leaflet and feedback survey
- Easy Read: information leaflet and feedback survey
- Bengali: information leaflet and feedback survey
- Polish: information leaflet and feedback survey
- Romanian: information leaflet and feedback survey
- Somalian: information leaflet and feedback survey
- Spanish: information leaflet and feedback survey
- Turkish: information leaflet and feedback survey
You can read the findings and recommended actions to improve the proposals or mitigate potential issues in an engagement report.
Are similar proposals being considered for any other areas of surgery?
Through a Surgical Transformation Programme, clinicians and operational staff are considering how we can build on the success of Elective Orthopaedic Centres – surgical hubs for orthopaedic care – in other specialities where large amounts of surgery take place. The programme is beginning with proposals for eye surgery.
If proposals are developed for other areas of surgery in the future, we will engage with staff, patients and the public, and wider stakeholders at an early stage.