Before the pandemic (2019), 3,384 ophthalmology patients in England suffered follow-up delays > 1 year, with 1% of these people suffering severe loss of vision. Since the declaration of the pandemic, over one million NHS ophthalmology appointments have been delayed, creating a huge workload backlog and the potential for thousands of cases of avoidable blindness. Overall, NHS surgical waiting lists have risen from 4.4 million pre-pandemic to 5.8 million (Dec 2021) and are projected by the National Audit Office to rise to between 7 and 12 million by 2025, giving a measure of the scale of the challenge facing UK healthcare. The 2013 direct cost of NHS eye care was £3 billion, with a further £6 billion/year of indirect costs of sight loss. People fear blindness more than severe angina or kidney dialysis.

In this context, we created The Moorfields Brent Cross diagnostic hub as a clinical innovation laboratory to create foundational knowledge on the most efficient methods of running diagnostic hubs, while creating a safe and pleasant environment for both staff and patients. Additionally, HERCULES (Healthcare Exemplar for Recovery from Covid19 Using Linear Examination Systems) has delivered 21,379 NHS appointments between Sept 2021 and Dec 2022.

Since its inception, we have proven that we can rapidly establish a diagnostic hub in non-NHS estate, employing and rapidly training healthcare-naïve technical staff to carrying a battery of tests used in monitoring diabetic retinopathy, macular degeneration and glaucoma, while generating a rich, multidisciplinary dataset (covering operational efficiency, air quality, staff and patient questionnaires, economics, regional impact) which lays the foundations for future development diagnostic hubs in ophthalmology, and across other outpatient settings in the NHS. At the end of 2023, HERCULES hub at Brent Cross will transition to a service facility serving MR, glaucoma, cataract and keratoconus patients. The hub will deliver 600 appointments per week.