Uveitis: I tried for a long time to set up a tertiary referral centre within Wales for uveitis, and I've been to many, many NHS-style meetings, as I know other people have as well. And the NHS loves meetings to discuss things; it does meetings very well indeed, but rarely do actual solutions come from simply meetings, because I've been to many regional meetings about the health boards working closer together, and the end result? Uveitis patients still go to Bristol as a tertiary referral centre, which is far away.
Photodynamic therapy for a condition that is called central serous chorioretinopathy: there's only one laser that does that in south Wales, which is in Cardiff. We can't get access to it from Swansea, and we can't buy our own laser, the lasers are very expensive, and the drug is very expensive. It makes sense to join everything together.
Corneal transplants: not every health board has a corneal surgeon. Cross-linking for a condition called keratoconus. It's completely a postcode lottery as to whether you can get to it. Even cataracts—. We do 500,000 cataracts a year in Britain. Cataracts, the commonest operation. Everyone in this room will end up having cataract surgery. Wouldn't it be a wonderful thing if they could have it done in a timely way? If we could do it, one day when I need cataract surgery, in a timely way within Wales itself, rather than having to pay out of my own pocket to have it done privately, or wait 100,000 years to have it done in my local hospital.
We need to adapt with the times, and we need surgical hubs, efficient surgical hubs, but also we need the free flow of patients. It's a wonderful thing, for example, having a wonderful surgical hub in Swansea, but if you live in Carmarthen, you can't get to it because it's in a whole different health board. We have to have the free flow of patients.
And this, what we've ended up with, is from decades, decades, decades of neglect of the NHS in general, and including ophthalmology. A part of this is due to the lack of an electronic patient record. If there's no light shone on anything, bad things fester. If proper numbers aren't being collected as to the delays in surgery, the delays in transplants, the delays in injections, the delays in treatment for diabetic eye disease, the commonest cause of blindness in working-age people; if it's not recorded, it goes unanswered, unchallenged, untested. It's been terrible trying to set this up, because I've been, again, to 100 billion NHS meetings trying to get this organised. Whereas Digital Health and Care Wales mandate OpenEyes, which is what they unimaginatively called the electronic patient record, it has to go through every single health board separately. And even though the same risks would be present everywhere, every single health board has onion-like layers of accountability and different forms of managers and people who say, 'Well, this isn't right, that isn't right, we need to adjust this, adjust that.' And the curious thing is, whereas the problems should be the same everywhere, each health board comes up with a whole different list of problems that need to be addressed independently, which is inefficient, expensive, and sadly leads to blindness. That is the thing.
So, the health board system is letting us down on multiple different fronts. So, that's the background to it. People going blind in Wales because of a lack of access, because of artificial boundaries, and an out-of-date system. But then comes the background, and this is where another conflict of interest comes in, because the current llywydd of the Royal College of Ophthalmologists in Wales, the inestimable Rhianon Reynolds, has called for just this very solution: an EPR, joined-up ophthalmology, the breaking down of the health board barriers and the implementation of the national clinical strategy for ophthalmology. All of which, really, were suggested by another inestimable person who chaired the Health and Social Care Committee report, which was published last year, into the failings of Welsh ophthalmology.
But now comes the time to put all this into action, because people out there are relying on us, and I also feel very guilty myself, of course, because I've caused direct harm to my own patients by being in this place. There are many skills required of a person being in here, but an advanced knowledge of ophthalmic surgery isn't really one of them. [Laughter.] So, that aspect of my training is—[Interruption.] Perhaps for this debate alone. So, I feel guilty for that as well. So, I want to show, on multiple levels, that our being here—not just me, but Safa as well—is making some sort of difference to things.
We need joined-up working, and if we can't—. If it was up to me, I would take all of ophthalmology out of all the health boards and merge it together, cull the hideous levels of managerial excess and overlap, and grow the system again. This is what I would do. This is the best thing. And many people would say, 'Ah, but this would apply to other specialties in medicine as well', and I'd say, 'yes'. There's a whole issue with the health board system duplicating things everywhere. If it is not possible, for whatever reason, to break down the health board barriers, let's just think of some way of squashing them together, so that we don't have these hard and fast blocks to patient and staff flow. Otherwise, we will repeat the mistakes of the past. And I trust Mabon ap Gwynfor to deliver the goods, to see the thing through.
So, we need three things, in summary, because my 10 minutes is coming to an end: the implementation of the national clinical strategy for ophthalmology; to break down the health board barriers; and, in my view, merge all of ophthalmology into one single health board to escape from those barriers altogether and to get rid of expensive, duplicative administrative work that isn't really administrating anything because we don't have an electronic patient record, which we need to track things. Thank you very much.