“The role of the independent sector has been associated with significant challenges which pose an increasing risk to the sustainability of comprehensive eye care services in the NHS.”
That is the view of the Royal National Institute of Blind People (RNIB); ministers should take such a warning seriously.
Independent, or private, sector providers now deliver almost 60% of NHS-funded cataract procedures. This has more than doubled since 2019.
According to the Centre for Health and Public Interest (CHPI), 78 new private clinics have been established to deliver cataract surgery in the last five years, and some senior clinicians have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need, but by the commercial interests of the companies delivering treatment.
Professor Ben Burton, the president of the Royal College of Ophthalmologists, has said that the entire commissioning process needs looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with “very mild cataracts getting surgery at the expense of other patients going blind.”
The current approach, he has argued, means that “the NHS is losing consultants, money and trainees to the private sector” and is resulting in the next generation of cataract surgeons not getting any straightforward cases to train on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.
The CHPI has argued that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Age-related macular degeneration is the biggest cause of sight loss in adults in the UK.
Clinicians are also concerned about the impact of the increased use of the private sector on staffing levels in relation to the delivery of cancer care, urgent treatment and conditions affecting some newborn babies.
While use of the independent sector has helped to bring down cataract waiting lists, the Royal College of Ophthalmologists has found that 67% of NHS ophthalmology departments reported that the impact of independent sector providers on patient care in their area is negative.
The aspects they are most worried about are training opportunities for junior doctors, funding for the NHS ophthalmology department in which they work and the available workforce.
There is concern that the detrimental effect of independent sector provision on these areas will reduce NHS departments’ long-term ability to deliver the full breadth of sight-saving care for patients.
A key concern is that new independent sector clinics focussing on cataract operations are drawing staff away from the NHS where the full range of conditions are treated.
One senior ophthalmologist told me he fears that in the future we will be facing eye care ‘deserts’.
While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether they should be prioritised over the delivery of other sight-saving treatments.
The Royal College of Ophthalmologists has found that only 25% of NHS ophthalmology departments feel able to meet patient need, and that 70% of departments are more concerned about out-patient backlogs compared with 12 months ago.
The RNIB has said that it shares the view of the Royal College of Ophthalmologists that the rapid expansion of the independent sector is having a destabilising effect on NHS eye care services.
For a leading national charity and a professional body to take this stance shows just how serious the situation is.
In its 2023 Elective Recovery Taskforce Implementation Plan, the government made a commitment that NHS England will develop a mechanism to ‘track, monitor and evaluate the independent sector’s impact on the long-term NHS capacity landscape.’ Clearly, the development and use of such a mechanism right across the NHS is needed as a matter of urgency.
The government should bring forward a national eye health strategy that establishes eye health as a public health priority and aims to prevent irreversible sight loss.
The strategy should take action too to make sure that NHS ophthalmology departments across the country are supported to deliver high-quality and timely care for all patients, and it should increase the number of ophthalmology training places so that we can have an eye care workforce fit for the future.
It is vital that the NHS is comprehensive in the range of treatments that it provides; to do that, it must retain the expertise and training opportunities it needs.
As things stand, and as Professor Ben Burton has warned, “There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”
We cannot allow that to happen.
Increased use of the independent sector threatens the future of comprehensive NHS eye care
