The survey found that the majority of eye surgeons in England believe that the increase in the outsourcing of cataract surgery to private clinics in recent years has had a negative impact on the NHS sector.
Almost three-quarters of eye doctors surveyed said that outsourcing cataract treatment to the private sector has had a negative impact on the NHS eye care sector, with 54% saying it had a big negative impact and 16% saying it had a small negative impact.
In a survey of 200 ophthalmologists, Center for Health and Public Interest (CHPI)The comments came after new Health Secretary Wes Streeting promised to redirect billions of pounds from hospitals to GPs to “improve the doorstep of the NHS” and met with junior doctors on Tuesday in an attempt to end a long-running pay dispute, The Guardian reported.
Nearly 60% of eye doctors surveyed said that outsourcing had a negative impact on NHS staffing, 62% said it had the same impact on staff training, and 46% said that outsourcing had undermined the public eye sector’s ability to treat patients with more complex conditions. Issues raised regarding staffing included the movement of consultants, nurses and optometrists to the private sector.
While eye care budgets across 43 NHS trusts have risen by just 15% in the past five years, eye spending has risen by 52%, partly due to a surge in the number of cataract operations, CHPI research has found. Hundreds of thousands of NHS patients in England have cataract surgery every year, driven by a taxpayer-funded boom driven by private clinics.
When she was shadow health secretary, Ms Streeting warned in May that if what happened in NHS dentistry was spread across the NHS, it would “lead to worse services for the poor and encourage everyone else to turn to private care”.
A reduction in the number of dentists working in the NHS has created “dental deserts” where patients cannot receive treatment, leading some people to turn to “DIY dentistry”, such as extracting their own teeth.
David Rowland, director of CHPI, said: “The ‘hollowing out’ of NHS eye care sectors due to reduced income and activity from cataract treatment is risking turning it into a ‘poor service for poor people’ and is severely undermining the training of eye care workers.”
The Royal College of Ophthalmologists warned that soaring NHS spending on cataracts is leaving fewer financial and staffing resources available to treat more complex eye conditions such as glaucoma and wet macular degeneration which can lead to irreversible vision loss.
“The problem so far, particularly in England, has been that private providers have been commissioned in an unplanned and uncontrolled way,” said the university’s president, Professor Ben Barton.
“The use of the private sector has led to an exodus of NHS staff from hospitals and increased profit-margin driven activity. We are actively calling for policymakers to reform commissioning, fees and data reporting systems to support independent sector capacity rather than subsuming sustainable eye care services.”
On average, NHS hospitals are performing around 20% fewer cataract surgeries than they were five years ago, and some are performing more than 40% fewer procedures due to increased outsourcing to private providers, CHPI said. As a result, 26 of the 50 NHS eye departments have seen an average 21% drop in income from cataract surgery.
When NHS trusts perform fewer cataract surgeries, they receive less income from commissioning bodies called Integrated Care Boards (ICBs).The financial viability of the NHS eye department is hit hard, as trusts outsource around 60% of cataract surgeries to the private sector.
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These departments should also implement 24-hour emergency services, which are costly and not offered by private eye clinics.
Rowland said: “It is often thought that using the private sector strengthens its ability to support the NHS, but this research conclusively shows that mass outsourcing of cataract care has taken money, staff and training away from NHS hospitals, leaving them with fewer resources to treat poorer and sicker patients.”
“NHS England and the next administration must rapidly assess the situation and, if necessary, reverse the outsourcing of eye care until it can be proven that there will be no adverse impacts on patients, training and the reduced NHS workforce.”
David Furness, policy director at trade body the Independent Care Providers Network, said: “Independent providers are delivering NHS cataract and other eye procedures to high quality standards at prices set by the NHS, meaning more patients can get the eye care they need.”
He claimed “significant progress” had been made in increasing the amount of training provided by private providers, but did not provide specific figures.
A Department of Health and Social Care spokesman said: “There are 600,000 people on a waiting list for eye care treatment and some are losing their sight while waiting.”
“We have a choice: make patients wait longer, or see them sooner where there is capacity. This Government will put patients first and do all it can to get them seen on time, whilst building capacity so the NHS can be there for all of us again when we need it.”
