Case Study – Ophthalmology Turnaround March 2018 to March 2019

GWH and HBSUK – A Public/Private Partnership – an example of how things can work


The Trust had been having problems in Ophthalmology for several years. The Royal College of Ophthalmologists had reviewed and reported on the Trusts problems in 2013 but, by 2018, few if any of their recommendations had been implemented and the Trust CEO and Board were introduced to HBSUK by NHSI to see if there was a way of driving improvements. Amongst other things, the Trust had been losing money in Ophthalmology for many years and increasing pressure had been exerted from Non Executive Directors and the Trust Board of Governors.

RTT performance was below 80%; the backlog in admissions and hold file were continually increasing; large numbers of NHS patients were being treated in the private sector and the Department were unable to provide key services such as corneal graft and squints. This was all exacerbated by problems with staff recruitment and retention; poor utilisation and optimisation of infrastructure and resources.

HBSUK pathway review

The HBSUK Team was asked to carry out an independent review of the entire Ophthalmology Directorate and to present proposals to turnaround the service.

  • Over 6 weeks, using process walk-through with six sigma methodology, the team revealed a number of issues in addition to the ones already known, identifying some of the root causes. There was a broken relationship between ‘management’ and ‘clinicians’, a lack of clinical and managerial leadership and a poor basic understanding in how to manage Ophthalmology. There were few visible targets and tracking tools and no visibility of performance. However, no medical competency issues were evident.

  • GWH appointed HBSUK to manage the service for an initial 6 month period and agreed a set of KPIs around the areas to focus on, particularly RTT and backlogs.

Within 9 months, HBSUK achieved a turnaround in performance to deliver the Trust’s best ever reported position for Ophthalmology:


  • RTT (from 78% to 92%)

  • Discovering more than 1000 patients not recognised or followed up in the system

  • Removing all 52 week waiters

  • Establishing corneal graft and squint services, including recruitment of key staff who the Trust had been unable to recruit historically

  • Developing dashboards to track and monitor KPI’s

  • Achieving a 30% improvement in clinic and theatre utilisation


  • Establishing a 7-day service through weekend clinics and operating lists

  • £450k over-delivery to plan by end FY2018/9

  • Directorate reporting profit for the first time in its history

Governance (including Clinical and HR)

  • New doctors appointed (e.g. paediatrics and squint)

  • Extended use and integration of Optometry

  • Cultural change moving to ‘can do’ attitude

  • Paper-light system – IT system upgrades interfaces between systems

From Compliance to Excellence

Having started to achieve performance targets, in a sustainable manner, the platform was then established for developing the service in line with RCO Clinical Guidelines, GIRFT and the NHS Long Term Plan. A number of projects are now being developed to re-design pathways and migrate Ophthalmology to a ‘best-in-class’ service that is patient centric.

  • CCG/Trust joint working together to align community pathways, including MECS and community Orthoptics

  • Plans for further re-patriation of patients back from the private sector

  • Partnering with neighbouring Trusts and CCGs to create an STP approach to Ophthalmology with GWH as the Centre of Clinical Excellence

  • Targeted savings of 10% between CCG/Trust

  • Re-designed pathways for all sub-specialities for high-volume throughput, optimal flow and maximised utilisation, including restructuring the workforce

  • We have our own software platform which integrates with eRS and DOCMAN


The HBSUK Team now manages the GWH Ophthalmology Directorate by providing an in-house management team working in partnership with the Trust, continuing to target increasing budget surplus and throughput to achieve all targets, and transitioning the service so that it fits the 10-year plan for Integrated Care Systems.

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