The Southern District Health Board’s ophthalmology service is nearing crisis point, and clinicians are scrambling to try to avoid waiting lists becoming so long that patients suffer irreversible harm to their eyesight.
In 2018, the service was the subject of a highly critical Health and Disability Commissioner report into harm suffered by patients after the number of patients with overdue procedures topped 1500.
In November, board chairman Pete Hodgson warned the service’s statistics had once again become troubling.
Yesterday, the board’s hospital advisory committee was told more than 1000 people on the waiting list were in the upper range of seriousness and about 3000 people were at the lower end of the scale.
While only slightly higher than the total number of patients waiting for procedures in June, that was far too many people and the service was trying urgently to avoid a repeat of where it was five years ago, surgical services and radiology service manager Brad Aitcheson said.
"At the end of January we had 3166 patients who were due for an appointment who were more than 1.5 on the acuity scale, but we always book the most urgent patients first," he said.
"On the scale, about 1.5 is about the nationally acceptable range to be overdue."
Higher up the scale, 1383 cases were rated 2-3, 598 were rated 3-4, 312 were rated 4-5, 26 people were rated between 5 and 6.
Clinics staffed by out-of-town locums, a way the service used to ease the historic backlog in the past, were scheduled this month.
However, SDHB chief executive Chris Fleming warned that such clinics, while necessary in such circumstances, were expensive and were not a long-term solution to the service’s problems.
Mr Aitcheson acknowledged it was a "Band-Aid solution" but did address a serious issue in the very short-term.
"People can suffer irreversible harm and we don’t want to have that: my personal view is that I would rather that they saw someone than no-one, even if it’s not the best person. But it’s not the preferred option in the long-term."
The service was fully staffed but was hoping to recruit two senior medical officers, two registered nurses and several other positions, Mr Aitcheson said.
Although Covid-19 posed recruiting challenges, the service had also successfully hired an optometrist and an orthoptist.
The combined service treats almost 17,000 patients annually, Dunedin clinicians taking 130 appointments a day and Southland staff 160 appointments a week.
Mr Aitcheson said demand was high and would only increase, in part due to the ageing population and in part due to the increasing number of diabetic patients with associated vision issues.
Surgical services and radiology general manager Janine Cochrane warned that the social distancing requirements of the Covid-19 Red traffic light would make it difficult for the service to maintain its current number of appointments.
However, clinicians were hoping to introduce a range of initiatives, including a second site and having primary care absorb more ophthalmology work, to try to ease pressure on the service.
"We have quite a high rate of follow-up appointments and we are trying to make sure that we do the right thing and have the same pick-up rate as other DHBs are managing to do," she said.
Committee chairwoman Jean O’Callaghan said that the service’s waiting list was worrying and would need to be managed carefully.
"We don’t want anyone going blind or not getting their treatment in a timely way ... we have to make sure that the solutions are worked through carefully and in a timely way because as a board it’s not something we can live with, that so many people could be put at risk."
