Edinburgh's Eye Pavilion: Former director Hector Chawla spells out why Scottish Government plans are an act of vandalism
Edinburgh’s Eye Pavilion is the gold standard of modern healthcare; high-quality treatment on the doorstep of a capital city, the unit of choice for trainees from all over the United Kingdom, Edinburgh is the only Scottish University with a clinical academic chair. It is a jewel in NHS Lothian’s crown.
It is from such integrated units that the ideas of today turn into the common practice of tomorrow, but it is to be dismantled; the promise to build a replacement beside the Royal Infirmary has been broken by the SNP government, not because of some inspired new concept of care for the 21st century but apparently because there is no money.
Yet £15.8m was found to open a specialist eye centre in Clydebank’s Golden Jubilee hospital last year, and of course there is the fiasco of what should really be renamed the Sick Hospital for Children. The eventual bill for the unfolding Rangers malicious prosecution scandal might fund two new Eye Pavilions.
The proposal now to disperse ophthalmic provision over the Lothians is a step back into the dark ages, an expensive attempt to spend less money which defies the proof of clinical experience.
When the Eye Pavilion opened in 1969 it had 70 beds and one operating theatre, but now has 10 beds and four theatres. These numbers tell their own story; more and more complex surgery available and most of it on patients who go home the same day.
These advances demand increasingly sophisticated equipment - expensive, fragile, temperamental kit in need of protection and constant expert maintenance which can’t just be kept in a cupboard beside the stationery. The high purchase and maintenance costs prevent casual duplication in multiple sites.
Non-existent until very recently, this refined technology now gives hope to thousands of people when before there was none. Three dimensional retina scans have made the traditional ophthalmoscope almost obsolete. Macular degeneration can respond to intraocular delivery of drugs. Cataracts are sonically broken up. There are lasers for diabetic eye disease and post-cataract membranes. Surgical manipulation of the retina from within the eye, unimaginable in 1969, is now commonplace.
All this needs an army of specialist ancillary staff who are very difficult to find, and such units tend to be separate because ophthalmology is that unique branch of medicine comprehensible only to those who work in it. An Eye Pavilion theatre could immediately switch to general surgery but a nurse coming in the other direction could not.
This assembly of new instruments generates more day patients and the greatest numbers come from Edinburgh. The move to day care with minimal in-patient activity, clearly requires a site closer to the main source of these patients, an imperative even more compelling when circumstances require re-examination in a hurry.
Most of these people tend to be older, frequently infirm and from the very reason of their referral, visually handicapped in some way. For them, to get to a centre in Edinburgh centre can be hard enough. Travelling miles beyond the city boundaries would very predictably result in failed attendance and preventable visual loss. Vision is the most precious of the special senses. By what yardstick is its value to be measured?
It has become fashionable to believe that optometrists should take over a large part of eye care, but.
It is hard to understand how they could do much more here. Edinburgh was ahead of the field long before optometrists were encouraged to extend their expertise with the eye in health to the eye in sickness. They would be the first to acknowledge that they are not doctors and could not function in the community without the secure presence nearby of a major centre, fully staffed and fully equipped.
The proposed scheme would transfer ophthalmic surgery to West Lothian, splitting the site and transferring vast numbers of the anxious elderly up the M8 and back again, and possibly back again should everything not go to plan.
Ophthalmic operations require theatres and nursing staff exclusively committed to the speciality. Were it otherwise, there could be the horrifying possibility of an emergency patient already anaesthetised waiting for a nurse from general surgery to learn how to work the Vitrectomy apparatus from the user manual.
Emergencies under the present régime end up in the Edinburgh Eye Pavilion after a journey through A&E at the Royal Infirmary. If their ultimate destination were to be somewhere in West Lothian then loss of time will affect their final visual outcome, especially if the nurse can’t understand the user manual, as would certainly happen.
Is it only by chance that units in Dundee, Glasgow and Aberdeen are unthreatened by any proposal to transfer their operating theatres to another county, and this damage planned only for Edinburgh because it has been run down in anticipation of the move to Little France?
In 1998, the plan to move services to West Lothian was abandoned because it was recognised that most patients lived in Edinburgh, but at least that proposal envisaged a single hospital in one place.
Under today’s scheme, there would be no hospital at all. Surgery would be in West Lothian, services dispersed to who knows where, but the patients will still live in Edinburgh.
This is no Scottish Government master plan for ophthalmology to benefit the people of Edinburgh. It is vandalism.
Hector Bryson Chawla is a consultant ophthalmic surgeon (retired) and former director of the Princess Alexandra Eye Pavilion.