No Deal, No Disposables

When people talk about what a “no-deal” Brexit means for the NHS, they don’t tend to talk about ophthalmology. And that’s understandable in some ways. Our stories aren’t dramatic like those in other specialties. Our patients don’t die on hospital trolleys or on the floors of A&E; instead, they go blind quietly, at home, on their own. They are old and do not complain, and because of that, they fly under the radar. But like every other patient in the NHS, they deserve the highest level of care – care that could be compromised in the event of a no-deal Brexit.

A national directive has told NHS Trusts that they cannot stockpile medicines, devices or other consumables. We have been assured that there is at least six weeks’ worth in the supply chain – all of which is being handled on a regional and national level. But what if they haven’t stocked enough? I wouldn’t be surprised if they have underestimated just how busy a medium-sized ophthalmology department can be.

We see 50 patients a day in eye casualty, and perform at least 20 cataract operations and up to 40 intravitreal injections. That is outside of the 140,000 outpatient appointments each year. And we’re only a medium-sized department.  In my mind, there are two key areas of concern for ophthalmologists – medicines and consumable. It is the latter that worries me most.

Ophthalmology is unique in the high volume of consumables we use. Dilating drops. Anaesthetic drops. Tissues. Low levels items, yes, but ones we couldn’t function without. If those were compromised by a disruption to the supply chain, what would happen to our patients? Let’s imagine we start to run out of diagnostic drops. Who would we choose to dilate, who would we not? Would we have to relax our infection control protocol and stop limiting our drops to one dropper per patient? The worst-case scenario is for consumables to be rationed to the point that they were only used in cases of emergency, such as retinal detachments or emergent uveitis.

Now, let’s think about medication – most of which is not made in the UK. Once one drug goes, the others soon follow, as doctors suddenly begin prescribing much more of the alternative than before. If we ran out of steroids or antibiotics, we’d have to stop doing intraocular surgery altogether. And what about lenses? We need one for every single cataract operation we do. Though we have a bank in-house, some lenses need to be specially ordered. Those with special requirements would have to wait until stocks are replenished.

Our hospitals are struggling to accommodate the number of appointments we have now; would we be able to cope with the patients displaced by supply shortages? Rearranging appointments will inevitably lead to mix ups and worse: patients lost to follow up. But it’s not just the chaos of it all, patients with AMD are on a very strict schedule and any delay to their treatment could damage their outcomes significantly.

There are no two ways about it; supply shortages could lead to irreversible sight loss. The worst part is there is nothing we can do about it as physicians. How can an individual prepare for something like “no deal?” It is unprecedented. Of course, a no-deal Brexit might not happen at all and, if it did, everything might be fine… But what if it’s not?