An appointment at Moorfields
How the pandemic has seen one hospital boost productivity
On Friday, just as my post about GPs and remote consultations was being published, I was on my way to a face to face appointment at a hospital. As I sat on the tube reading the comments the interview provoked I reflected that some medical issues really could not be dealt with remotely - as Dr Hussain Gandhi himself made clear in our conversation. One example is my regular checkup at Moorfields Eye Hospital.
In 2005 I was diagnosed with a malignant melanoma behind my left eye, a rare and frightening cancer. I then spent a week in the hospital where I was treated by the insertion of a radioactive plaque behind the eye, which shrank the tumour.
Ever since, I have returned to the hospital every few months so that the doctors can monitor the tumour and make sure it is not growing again. They have been quick to act when they spot even a hint of trouble. On three occasions I’ve had laser treatment, a simple procedure which involved three hour long visits to the hospital over a number of weeks.
But in 2019, after deciding that the tumour was growing again, my consultant decided on a more radical approach - proton beam therapy. This involved spending a week at an amazing place, the National Centre for Eye Proton Therapy at Clatterbridge on Merseyside. I documented my treatment there in a video diary.
Now, proton beam is supposed to have a 95% success rate with my kind of tumour, but it does work slowly. I have continued to visit Moorfields every four months for an assessment of progress, and very gradually the doctors have grown more upbeat about what the treatment has delivered.
Over the years, I have got used to my visits providing a typical National Health Service experience. The medical staff and the treatment are excellent but the whole process seems desperately inefficient.
The routine was always the same. Turn up at your allotted time at the oncology clinic in a stuffy basement to find a message on a whiteboard telling you that there are 43 patients today and to expect to be there for some hours. Find a seat, then wait half an hour to be called by a nurse for a sight check - “yes, I’m still effectively blind in the eye that you radiated” - and have stinging eye-drops inserted so that your pupils are dilated for later examination.
Back out to reclaim your seat and wait awhile, finding that the eye-drops have made it impossible to read, before being sent to the imaging service’s waiting-room on a different floor. There, you queue up to have pictures of your eyes taken by a couple of very expensive looking machines, sometimes in different rooms operated by different technicians.
Back to the clinic to wait again, before being sent to another waiting-room on another floor, this time to have your tumour measured by an ultrasound machine. This is a real bottleneck because there is apparently only one ultrasound device in one large room, operated by one technician.
Finally, back down to the basement to wait again until at last you are summoned behind a curtain to see the consultant, who examines your eye once again, looks at the ultrasound and the photos, and gives you a verdict on your tumour. This is either reassuring - “it’s looking stable’ - or worrying - “hmmm, I think we might need to do something more”.
What was comforting, after all the palaver, was that you were seeing on the NHS someone who was probably one of the world’s leading experts on your condition. My first consultant had pioneered the use of radioactive plaques for the treatment of ocular melanoma, and had been instrumental in starting the use of proton beam therapy for eye cancer.
For 15 years, I got used to writing off three or four hours on my Moorfields days, emerging on one occasion when the staff at reception who fix your next appointment had already shut up shop and gone home.
But in the last two years things have begun to change. When I arrived on Friday, there were only a handful of people waiting and I was quickly ushered in for my eye test and drops - yes, I still can’t see your hand when you wave it in front of my radiated eye. From then on the process accelerated, with the key being that all the technology was right there in the clinic. A technician took me into a side-room to have pictures taken on two machines - no going to another floor, or shuttling between different machines in separate rooms.
Ah, but what about the ultrasound up on the second floor? On a recent visit that too had been brought down into the clinic although it looked like the operator was using a less sophisticated machine. But this time I was summoned by the doctor to find that she, not a technician, was going to do the ultrasound scan, using a brand new machine.
Very quickly, after looking at the scan and the photos and conducting her own examination, she was able to give me good news. The tumour was stable, the proton beam therapy was continuing to do its work. Even better, I did not need to return for another checkup for nine months.
I was in and out of Moorfields in one hour and 15 minutes, a new record. So what has changed? As far as I can see, it’s all down to the pandemic. During the first shutdown in the Spring of 2020, Moorfields staff were deployed on the Covid frontline and one of my appointments was cancelled. But it seems that since then, every effort has been made to give outpatients an experience that is both safe and efficient.
At the entrance you are given a fresh mask. there is a one way system in operation in the hospital corridors and appointments seem to have been organised to avoid overcrowding. Crucially, bringing the technology to the patients rather than vice-versa has cut down on the traffic around the hospital and saved time.
Other industries have found that new technology does not really have a major impact on productivity until systems are reorganised around it. Covid has imposed extraordinary demands on our health service and the response at hospitals like Moorfields has been heroic. But the pandemic may have also accelerated the kind of changes in ways of working that have been needed for years, but only happened when a crisis meant there was no alternative.
What I would also like to make clear is how grateful I am for the excellent treatment I have received over the years from the brilliant and kind staff at Moorfields and at the National Centre for Eye Proton Therapy at Clatterbridge. Thanks also to Hynes Optometrists in Ealing, where my melanoma was first spotted during a routine eye test.
Unfortunately my first post Liverpool appointment at home was not so good. I was asked to look through one of those h things where you look in one side the Dr the other. The Dr then looked at a copy of my eye photo Liverpool had sent her. She said there doesn't appear to be any change, I said had it not shrunk, she said is it meant to.
She then decided I was at the wrong place and they would book me somewhere else in four months time.. but I have missed a check up, I don't know who to contact off I have problems.
Rory. i had similar experiences. i have had multiple eye operations and loss of vision in my Right eye. in the past I have had fantastic care combined with very long waits in out patients. my last visit was a new experience. An empty waiting room, minimal waits between eye tests and various consultations. Lets hope this change persists or was it due to the ability to cancel appointments and therefore have less people in clinic and therefore we had a better experience at others on increasing waiting lists.