We respond to Welsh Health and Social Care Committee's consultation on Priorities for Seventh Senedd

The College considers that the Welsh Government’s emerging priorities broadly reflect the pressures facing NHS Wales. The focus and investment on reducing waiting times, strengthening primary and community care, prevention, workforce sustainability and health inequalities is welcome. 

Ophthalmology has one of the largest waitlists in NHS Wales. Demand will increase as the population ages, with conditions including cataract, glaucoma and age-related macular degeneration becoming more prevalent.

Approximately 112,000 people live with sight loss in Wales, projected to rise to around 133,000 by 2032. Wales has approximately 1.97 ophthalmologists per 100,000 population, compared with the Royal College of Ophthalmologists’ recommended minimum of 3 per 100,000. However, future demand cannot therefore be met simply by increasing hospital consultant numbers. Community optometry is an important part of the solution with more than 300 practices now delivering the full WGOS service: reducing unnecessary hospital referrals and enabling secondary care to focus on patients requiring specialist intervention. 

1. Make care closer to home a reality
   WGOS provides a strong foundation for community-based enhanced eye care, in glaucoma, medical retina and urgent eye care pathways. Health Boards should have the mechanisms to easily move more care from hospitals to appropriate community pathways. Community and secondary care capacity must develop together, with hospitals retaining sufficient capacity for complex and sight-threatening conditions. 
   
   The Committee should scrutinise whether capacity exists at every stage of the pathway, what the bottlenecks are for transfer of care and whether investment effectively follows patients into new models of care.
2. Develop the workforce Wales needs
   Wales needs a skilled, sustainable ophthalmic workforce equipped to meet growing demand 
   and make full use of available clinical expertise. This requires:
   • advanced clinical skills and career pathways for optometrists
   • multidisciplinary working between optometrists and ophthalmologists
   • development of the wider ophthalmic workforce
   • retention of skilled professionals within Wales.
     
     Using professionals according to their full clinical capabilities is essential to improving 
     productivity, reducing unnecessary referrals and ensuring patients are seen by the right 
     professional.
3. Deliver integrated digital care
   Patients move between community optometry, primary care and hospital ophthalmology. However, without effective information sharing, the benefits of community-based care are limited.
   
   The Seventh Senedd should prioritise enabling electronic referrals, two-way communication between hospital and community, secure sharing of relevant records and diagnostic images, and timely communication of clinical outcomes.
   
   Digital transformation should be judged by whether it improves patient journeys and enables professionals to work effectively together.
4. Make prevention and health inequalities meaningful for eye care
   Eye health should form part of the prevention and population health agenda. Earlier detection and treatment can prevent avoidable vision deterioration and help people remain independent, reducing wider consequences for employment, wellbeing, falls and social care.
   
   Community-based eye care can reduce practical barriers to accessing services, but this will only reduce inequalities if access is consistent across Wales and the public know what is available. The Committee should consider how eye health can be incorporated into prevention strategies and whether access to community eye care is equitable.

Capacity: Demand is increasing while specialist services remain under pressure. Expanding community care without adequate hospital capacity would simply move pressure elsewhere; continuing to rely primarily on hospitals is also unsustainable. Both sides of the pathway must develop in parallel.

Fragmentation: Community optometry needs to be treated as part of the wider NHS pathway. Better integration is needed across clinical information, commissioning, workforce planning and data. Without effective digital interoperability, duplication can occur and opportunities to manage care outside hospital can be lost.

Inconsistency: Variation between Health Boards can result in different access to community eye care depending on where patients live. The Committee should examine why successful approaches are not consistently adopted and whether stronger national mechanisms are needed.

The Committee should consider a clear set of measures to assess whether these barriers 
are being overcome and whether the system is delivering more integrated, community-based 
care. These should include:

• patients safely managed in community settings
• appropriate hospital appointments transferred into primary care
• initial, follow-up and condition-specific waiting times
• variation between Health Boards
• patient outcomes and avoidable sight loss
• workforce capacity and development
• effectiveness of digital information sharing

• Monitor delivery of the Community by design programme
• Monitor rollout of WGOS, including glaucoma, medical retina and urgent eye care pathways
• Examine progress towards transferring 30,000 appropriate hospital appointments into primary eye care while protecting specialist capacity
• Assess whether Health Boards are fully utilising optometrists’ skills and supporting advanced and multidisciplinary roles
• Support a whole-workforce approach to NHS planning
• Make digital interoperability a priority
• Investigate unwarranted variation between Health Boards
• Embed eye health within prevention, awareness and health inequalities strategies
• Broaden NHS performance measures beyond headline waiting lists to include outcomes, community activity, workforce capacity and follow-up waiting times