1.127 Consultees proposed several mitigations that could strengthen any chosen model:
- invest in digital systems to share scans and results with optometrists.
- strengthen community provision through, for example, expanded roles for community optometrists, mobile units for cataract or screening services, and upskilling nurses to deliver eye injections and other routine procedures.
- partnerships with private providers to clear cataract backlogs.
- better appointment management processes.
- better facilities at hospital sites to attract and keep staff (current buildings were said to lack basics like changing areas and staff kitchens).
- offer both day cases (cataracts) and outpatient services (eye injections) in Amman Valley Hospital, rather than one or the other.
1.128 Consultees proposed other potential alternatives and suggestions, including the following:
- three regional sub-hubs (one per county) rather than one centralised site.
- joint working with Betsi on shared treatment centres across mid and north Wales.
- offer cataracts at Cardigan ICC; and cataracts at Aberystwyth every three months.
- offer some services on an alternating basis between hospitals, with consultants travelling rather than patients.
- a hybrid model with emergency and complex care centralised at Glangwili, plus enhanced outreach clinics
- a model in which Glangwili would be used for tertiary care; Prince Philip for outpatient care; Amman Valley Hospital for cataract and Intravitreal Therapy (IVT) services; Cardigan and North Road for IVT services; some basic outpatient work in Withybush
- remove emergency eye care from Hywel Dda and instead deliver it regionally.
1.129 For further details, see the ophthalmology sections in the individual consultation method chapters.