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Ongoing concerns that cataract surgery being cut to save cash

Fears that health secretary’s clear message to base decisions purely on clinical need will be ignored

Caroline White

Monday, 15 August 2016

Despite a clear message from health secretary Jeremy Hunt that eligibility for cataract surgery should be driven purely by clinical need, and that any elderly person in need should be treated without delay, senior ophthalmologists and eye charities continue to be concerned that cash-strapped CCGs are disregarding his words amid the pressing need to save money.

“Our research continues to show that cataract operations are being restricted due to financial pressures on the NHS. This is forcing patients to live with unnecessary sight loss and a reduced quality of life,” said charity RNIB last week in an open letter sent to the health secretary.

Referring to the decision made by St Helens CCG to temporarily restrict cataract surgery to help it plug its financial deficit, the letter continued that this was “just one example of decisions being made as a result of cost-cutting rather than clinically-led. Whilst St Helens CCG has now dropped these plans, they are still exploring ways to save money and we’re concerned this could include cataract surgery.”

Cutting cataract surgery was a “false economy” for the NHS, the letter emphasised. “Denying treatment leaves patients at risk of social isolation and falls. Spending now to save someone’s sight makes financial sense as it costs health and social care budgets more to treat someone who has lost their vision,” wrote Dan Pescod Head of Policy and Campaigns at RNIB.

The letter urges the health secretary to call on CCGs to implement NICE guidance on cataract surgery.

The Royal College of Ophthalmologists has since issued a statement expressing concern that second eye cataract surgery might also fall victim to the financial squeeze.

College President Professor Carrie MacEwen said: “The [College] understands the financial pressures the NHS faces but we believe that any restriction, postponement or delay in cataract surgery made through commissioning decisions will not produce the efficiencies or cost savings expected.”

In February last year, the College published a NICE-accredited Commissioning Guide for Cataract Surgery to optimise cataract surgery services and help commissioners to work with a range of stakeholders, including the hospital eye service, community optometry services, general practice, social care, adjacent clinical commissioning groups, health and wellbeing boards, service users and carers.

“Recommendations about first and second eye surgery are made clear in our [guide] which is specifically aimed at CCGs. We know that hospital eye services are over-stretched along with a number of other specialties experiencing shortfalls in capacity. Meeting the demand has to be a priority for the NHS,” Professor MacEwen continued.

The College anticipates an increase of around 50% in the number of cataract operations needed over the next 20 years due to the aging population. 

The evidence suggests that an older person with reduced vision from cataracts is twice as likely to fall, while vision impairment is recognised as a contributing factor in increased levels of depression and anxiety and has a wider financial and social care impact on local community and health services, it says.

“We ask the Department of Health and NHS England to work with The Royal College of Ophthalmologists to implement the solutions we are advocating in our Three Step Plan to raise the priority of hospital eye services and deliver a sustainable service to meet the inevitable increase in demand and reduce the risk to patients.”

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