Innovation under pressure: rethinking eye care delivery during COVID-19
23 December 2025
The COVID-19 pandemic led to unprecedented challenges for healthcare systems. Infection prevention and control protocols were rapidly established across the NHS to protect patients and staff, while hospitals prioritised urgent care.
Waiting times for routine diagnostics spiralled as hospital capacity became strained.
In response, clinicians and researchers at Moorfields Eye Hospital NHS Foundation Trust and several departments of UCL – including the Institute of Ophthalmology, the Bartlett Faculty of the Built Environment, and the Institute of Epidemiology and Health Care – explored new care models to ease pressure on the NHS, reduce infection risk, and improve patient flow – all outside traditional hospital settings.
The project, led by Professor Paul Foster – professor of ophthalmic epidemiology and glaucoma studies at the UCL Institute of Ophthalmology and consultant ophthalmic surgeon at Moorfields Eye Hospital – is called HERCULES: Healthcare Exemplar for Recovery from COVID-19 by Use of Linear Examination Systems.
Project HERCULES – initiated by the NIHR Moorfields Biomedical Research Centre (BRC) – was supported by Moorfields Eye Charity through a ‘transforming future service delivery’ springboard award, which was used to help design efficient and safe spaces in high-volume settings.
The result was a community-based ‘pop-up’ eye clinic, launched in 2021 in north London’s Brent Cross shopping centre. A key innovation of the model was to recruit people with transferable skills and train them as technicians.
Some of the new recruits had been unable to work in their previous roles during lockdowns, such as flight attendants and retail workers.
These technicians were trained to perform routine eye scans for conditions such as glaucoma, diabetic retinopathy and age-related macular degeneration.
Siyabonga Ndwandwe – research fellow in health economics at the UCL Research Department of Primary Care and Population Health – led aspects of the project’s evaluation. He said:
The technicians largely had some form of client-facing role previously. They were trained to take the images and were supported by senior clinicians; these were not high-risk tests.
The images were sent to clinicians for analysis, and results were shared with patients later.
The findings informed patients whether they were to be discharged, continue their regular monitoring via the hub, or be referred for face-to-face appointments. Siyabonga noted that the clinics had a significant impact on appointment delays.
The average delay across the network as a whole in 2021 – before the site opened – was about six months. By April 2022, it was down to two months.
This model saw waiting times at Moorfields fall by over a week each week, expanding capacity by opening up the workforce. Having technicians conduct tests freed clinicians for urgent and complex cases. Siyabonga added:
We believe this model could be scaled up for other high-volume, low-complexity diagnostic services. This aligns with government policies for a future-ready NHS – moving care closer to patients, leveraging technology, and focusing on prevention as well as treatment.
Dr Angus Ramsay – principal research fellow at the UCL Department of Behavioural Science and Health – said evaluation was built into service development.
The evaluation was codesigned with a whole range of researchers spread across different departments of UCL, with different specialties including operations research as well as qualitative and quantitative health research.
He explained that the clinic was reorganised several times, with careful consideration of equipment placement and patient flow.
It also included architectural experts from the Bartlett School, with people wearing little tags to capture movement and flow through the system.
This ensured maximum efficiency and adherence to infection prevention protocols. Dr Ramsay emphasised that the charity’s support led to better outcomes:
Contributing to this service potentially will have saved people’s eyesight or improved their ongoing independence and quality of life. It’s an important intervention that has given back dramatically to patients.
