The Darzi report: what does it mean for ophthalmology services?

Lord Darzi’s report into the state of the NHS in England is set to shape the new government’s approach to reforming the NHS, including a forthcoming 10 year plan. Senior Policy and Public Affairs Officer Greg Ellwood-Hughes analyses the implications for ophthalmology services.

Following its publication last week, the Prime Minister promised ‘fundamental reform’ and ‘the biggest reimagining of our NHS since its birth’. But what will Lord Darzi’s report , commissioned by the Labour Government, mean for ophthalmology services and what will happen next?

What we liked:?

The focus on capital investment

When we surveyed ophthalmology clinical leads in early 2024 , they told us that having sufficient clinic space was one of the most important factors in helping departments deliver a better service, alongside being better able to recruit new staff.

So we hope that Darzi’s focus on the ￡37bn shortfall in capital investment since the 2010s will lead to an overdue shift in priorities. This not only led to ‘crumbling buildings’ but is also a key reason that ‘parts of the NHS are yet to enter the digital era’.

Which brings us onto another thing we liked.

Calls for ‘a tilt towards technology’

Darzi argues this is key to unlocking productivity and, importantly for us, stresses the need for digital systems outside hospitals. We have consistently highlighted how essential it is to have interoperable electronic patient records and shared imaging standards across the entire eye care pathway, including in our manifesto before the general election. The College has already published electronic medical records standards for ophthalmology services that we expect NHS organisations to meet.

The untapped potential for artificial intelligence (AI) to revolutionise service delivery was also emphasised. As an image-based specialty, ophthalmology is going to be at the forefront of this shift. Our recent position statement outlined how AI tools can help clinicians to strengthen patient care, streamline processes and advance clinical research.

The need to better support services outside hospitals

We recognise that hospital eye services cannot treat all eye care patients, and earlier this year published a joint vision with the College of Optometrists setting out how we can collaboratively deliver better-integrated eye care services. Darzi points to the need to shift some care out of hospitals – if done effectively, this can help relieve some of the pressure on hospital eye care services, while ensuring capacity remains in place to deliver more complex diagnostic and surgical care.

What was missing:

A focus on follow-up waiting lists

Our submission to the Darzi Review highlighted the need for a much stronger focus on follow-up waiting lists, including by integrating data on follow-up cases and risk rating into the decision-making process of commissioners and NHS trusts.

Since the pandemic there has been a narrow focus on cutting cataract waiting lists through independent sector provision, at the expense of resourcing for conditions such as glaucoma and AMD that can cause irreversible sight loss if not treated swiftly. A 2023 report by Reform found ophthalmology was the specialty with the most follow-up waits, at 10,000 per NHS trust, and importantly these had grown over the previous two years. While Lord Darzi did flag the ballooning number of patients waiting to begin treatment, we mustn’t overlook the need to better prioritise follow-up care.

The Long Term Workforce Plan

While it is true that Lord Darzi’s brief was to examine the current state of NHS performance in England, it is striking that NHS England’s Long Term Workforce Plan is not mentioned once in the 159-page report.

The plan commits to doubling medical school places by 2031 and increasing specialty training places in line with this. It was published in 2023 under the last government and Labour pledged to deliver it in its manifesto. Fixing the problems in ophthalmology services won’t be possible without tackling the workforce crisis – our position paper published earlier this year outlined the need for an additional 382 ophthalmology training places across the UK by 2031.

What will happen now?

The government will consider the findings as part of developing a 10-year plan for the NHS ‘to radically reform the NHS’. This 10-year plan is expected next spring, and Health Secretary Wes Streeting has indicated its direction in his call for three shifts – from hospitals to community, analogue to digital and from treatment to prevention.

Before then, on 30 October will be the Autumn Budget, where the Chancellor will have the opportunity to make spending decisions that affect the NHS.

As the government considers its long-term policy direction for healthcare, we will continue to ensure that the voice of ophthalmology is heard. That means advocating for well-resourced comprehensive NHS ophthalmology services, with the right facilities, workforce and digital infrastructure in place so we can prevent irreversible sight loss.

The government has taken an important step in admitting the scale of the crisis facing our health system. Delivering the long-term improvements needed to change course will be a bigger challenge altogether. It will require working closely with clinicians, and as one of the largest and most innovative specialties in the NHS the ophthalmology community stands ready to offer our expertise and shape this change.