Moorfields Eye Hospital

Source: Exec Digital UK

Date :19/02/2008 09:22:39

Moorfields Eye Hospital has been providing eye care for more than a century. General Manager Ann Arnold tells Exec about its ‘incremental improvements’ and long distance outreach

Written by Lucy Mowatt and produced by Paul Radbourne

With 13 sites across London, Moorfields Eye Hospital is capable of taking patient referrals from across the UK. In 1994 the hospital became part of the NHS, which not only increased the number of targets to hit but also the amount of funding available for investments.

With much controversy in recent years surrounding NHS waiting lists, there is currently a program to reduce the time taken to be treated. Although, in general terms, Moorfields is only a small hospital, in terms of ophthalmology it is one of the largest organisations in the country.

Ann Arnold, general manager, explains that there are three routes into the hospital: through the GP, optician or A&E department, which could mean that services become stretched. As part of an NHS initiative for reducing waiting times from referral to treatment to 18 weeks, Moorfields is working with Primary Care Trusts (PCTs) to reduce referral times; patients tend to be referred by their GP, even if they are initially seen by their optician. Also, by offering training to those employed by PCTs, patients whose conditions can be managed on a local level will be filtered out of the system until it becomes absolutely necessary to move them onto a tertiary healthcare provider, such as Moorfields.

Ms Arnold goes on to say: “The clock starts ticking as soon as the patient is referred. If they are sent to a local optometrist and they receive the first appropriate treatment, the clock stops there. Even though they may come into us later, it counts as a new care pathway.” This reduces strain upon the system, which is ultimately best for the patient. The NHS is looking to roll this system out as soon as all of the details, such as Patient Choice, are considered.

Incremental changes

Investments are also important to the hospital’s day-to-day operations, “not just for the big things,” Ann Arnold explains. “Even the basic tool, a slit lamp, is worth about £9,000 and we have 236 of them.” Before becoming a Foundation Trust, the hospital did not have access to the funds it does today.

“It’s about incremental improvements of all technology,” she says. The hospital not only purchases new equipment but repairs and maintains its facilities where possible. “Slit lamps are a very stable technology and we have some that are very elderly. We keep them going because the optics are wonderful. We’ve replaced the bits that wear out, but we want to hold onto the optics for as long as we can.”

Moorfields Eye Hospital also has access to funds raised by charitable organisations. One of the testimonies to the importance of these funds is the Richard Desmond Children’s Eye Centre. Opened in 2007, the architect-designed children’s hospital was paid for by the by a charitable fundraising effort which in conjunction with Moorfields Trustees, who, Ann Arnold explains “...fund things we wouldn’t be able to afford if we relied on our NHS income. They don’t fund the day to day operations of the hospital but they will fund research and the extra things that improve life for staff and patients.”

Approximately 1,300 people are employed by the hospital at various locations in the London area, including many that are actually employed by other organisations, such as the Institute of Ophthalmology, but are based in the hospital.

“We have an interesting staff profile; there are a large number of people who work with us who want to stay here for the rest of their working lives, and then there are others that inevitably move on,” Arnold says. “There aren’t many people who work here purely because it’s a job.” She attributes this loyalty to the fact that it’s a small organisation, which makes people feel like they are part of something, a factor which may contribute to Moorfield’s ranking at number 34 in The Guardian’s Top 100 Employers list.

Clinical research

There are 69 consultant ophthalmologists working for Moorfields Eye Hospital, who are involved with research programs to some extent. “Some are leaders in their field, but there are others involved with general research,” the General Manager says. The Institute, part of University College London, can be accessed via the main City Road site, and provides interaction between clinical research and application.

“We’re working with the Medical Research Council on translational therapy and taking research out of the laboratory and into clinical situations. It’s quite a big project,” Ann Arnold states, although it is one with opportunities for success.

Moorfields Eye Hospital also runs a number of outreach sites, which operate in various ways depending on local needs; they can either be run by Moorfields or by host hospitals, to which they provide staff and equipment on loan.

Nearly all procedures carried out by Moorfields are on a day-case basis. As such, the hospital only has five beds in the observation ward, which is linked to the 24-hour A&E, along with night time beds in the private wing where necessary. However, if patients have far to travel before their operations the hospital has the use of hostels beds, one for the main hospital and one for the Richard Desmond Children’s Centre, providing rooms for people that have had to travel.

There is also a transport service offered for patients that have difficulty travelling to Moorfields. “We involve the patient’s GP to see what is appropriate,” Ann Arnold says. “There’s always a balancing act between making use of a resource efficiently and inconveniencing people,” she continues. The longest distance that the hospital has had to transport a patient is from Penzance, demonstrating how popular the facilities are and the logistical challenges the hospital faces.

Developing facilities

Arnold explains that the hospital’s main problems are space-related, mainly because the City Road site was not built with modern technology in mind. The Victorian building has had to change quite significantly because of the times. Significant changes have had to be made to allow disabled access. Lifts have had to be installed in small spaces and ramps have had to be added. The hospital was not built with computers in mind either, and as such, cannot cope with the heat that these systems emit. “Just managing temperatures in the building is a problem,” Ann Arnold says.

Recently, the hospital set up Moorfields Dubai, which Ann Arnold says “is a lot like a long-distance outreach”. The facility opened in July 2007 and is an individual trading unit. “We get quite a lot of patients privately from the UAE, which was sufficient to make us feel that it was justifiable to open a facility there,” Ann Arnold explains. A video linking system is in operation between the two sites, while consultants also visit the site on a temporary or permanent basis.

The hospital has also set up Moorfields Pharmaceuticals. This company operates in the open market and is able to provide drugs to any organisation or Trust, and is able to produce specialist drugs, which are for example, preservative free, small runs and one-offs that larger companies would not be capable of. Although the hospital does not give the company preferential treatment, Ann Arnold explains that the company, based very nearby, can “supply pharmaceuticals we couldn’t obtain anywhere else.”

Going forward, the hospital will implement environmentally friendly ways of working, increasing the levels of waste recycled and minimising the amount of road transport for the inner city hospital. It will also focus upon working with PCTs and reducing waiting list times by the end of 2008.

Click here to read the corporate brochure on Moorfields Eye Hospital