Ophthalmologists say private cataract surgery is damaging the NHS

Research has shown that the vast majority of ophthalmologists believe that the increasing outsourcing of cataract surgery to private clinics in England in recent years has had a negative impact on their NHS departments.

Nearly three quarters of ophthalmologists surveyed said that outsourcing cataract care to the private sector had had a negative impact on their NHS eye care departments, with 54% saying the negative impact was large and 16% saying it was small.

The survey among 200 ophthalmologists by the Centre for Health and the Public Interest (CHPI)shared with the Guardian, came after Wes Streeting, the new health secretary, promised to shift billions of pounds from hospitals to GPs to “fix the front door to the NHS” and met junior doctors on Tuesday to try to end a long-running pay dispute.

Nearly 60% of ophthalmologists surveyed said outsourcing had a negative impact on NHS staffing levels, 62% said the same for staff training and 46% said it damaged the ability of public eye care departments to treat patients with more complex conditions. Issues raised about staffing levels included the loss of consultants, nurses and optometrists to the private sector.

While eye care budgets have risen by just 15% over the past five years at 43 NHS trusts, spending on ophthalmology has increased by 52%, partly due to a rise in cataract operations, research by the CHPI has found. Hundreds of thousands of NHS patients a year are having cataracts removed in England in a boom driven by private clinics but funded by taxpayers.

In May, when he was shadow health secretary, Streeting warned of a “poor service for poor people and anyone going private” if what had happened to NHS dentistry spread to the whole of the NHS.

A decline in the number of dentists doing NHS work has contributed to the creation of ‘dental deserts’, where patients cannot get treatment, and has led to some people turning to ‘DIY dentistry’, including pulling their own teeth.

David Rowland, director of CHPI, said: “The ‘hollowing out’ of NHS eye departments due to the loss of income and activity from cataract care risks making NHS eye departments a ‘poor service for poor people’ and significantly undermines the training of ophthalmic staff.”

The Royal College of Ophthalmologists warns that the NHS is spending more and more money and people on cataracts. This leaves fewer resources – money and people – available to treat more complex eye conditions that can lead to irreversible vision loss, such as glaucoma and wet macular degeneration.

“The problem so far has been the unplanned and uncontrolled way in which private providers have been awarded contracts, particularly in England,” said Prof Ben Burton, the college’s president.

“The use of the private sector is draining NHS staff from hospitals and increasing the volumes of profit-driven activity. We are actively urging policymakers to reform commission, fee and data reporting systems to ensure that independent sector capacity can support, rather than undermine, sustainable ophthalmology services.”

On average, NHS hospitals are performing around 20% fewer cataract operations than they did five years ago, with some hospitals performing more than 40% fewer operations as they outsource more to private providers, the CHPI said. This has led to an average 21% drop in cataract surgery revenue for 26 of the 50 NHS eye departments.

When an NHS trust performs fewer cataract operations, it receives less income from commissioning bodies, known as Integrated Care Boards (ICBs). Because trusts have outsourced almost 60% of cataract operations to the private sector, the financial viability of NHS eye departments has been affected.

These departments must also be able to provide 24-hour emergency services, which is expensive and not offered by private eye clinics.

Rowland said: “It is often thought that bringing in the private sector provides extra capacity to support the NHS, but this research shows conclusively that the mass outsourcing of cataract care has taken money, staff and training opportunities away from NHS hospitals, leaving them with fewer resources to treat poorer and sicker patients.

“NHS England and the next government must take urgent charge and, if necessary, reverse the outsourcing of eye care until it can be demonstrated that patients, training and the strained NHS workforce will not be negatively impacted.”

David Furness, policy director at industry body the Independent Healthcare Providers Network, said: “Because independent providers are increasingly carrying out NHS cataract and other ophthalmology procedures – at NHS set prices and to high quality standards – more patients are getting the eye care they need.”

He claimed that “good progress” had been made in increasing the amount of training offered by private providers, but did not give figures.

A Department of Health and Social Care spokesperson said: “There are 600,000 patients waiting for eye care, and some are losing their sight while they wait.

“The choice is to make patients wait longer, or to show them where there is extra capacity more quickly. This Government will put patients first, using all the levers at our disposal to show them in time, while building capacity so that the NHS can be there for all of us when we need it, once again.”