Risk the NHS will lose ophthalmology completely Health Service Journal

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Sat, 23 Dec at 15:05

POLICY AND REGULATION

NHS risks losing specialty to private sector, says royal college
By James Illman21 December 2023

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19 Comments





· Ophthalmologists’ leader: “There is a risk that the NHS loses ophthalmology completely”

· But private sector bosses’ group rejects criticism and says comments “feel like an attack on hard-working colleagues”

A royal college has sparked a row with independent sector bosses after warning ophthalmology risks becoming largely privatised unless NHS England radically changes the specialty’s “chaotic” commissioning arrangements.

Royal College of Ophthalmologists’ president Ben Burton told HSJ the specialty was at risk of becoming like dentistry, where patients face charges for services.

Private sector lobby group, the Independent Healthcare Providers Network, which last week cited the specialty as an exemplar of how private providers could be used to boost NHS productivity, has described his comments as a “confused” and “unnecessary attack”.

Professor Burton said a review needed to look at the entire commissioning process and argued “generous” tariff rates for cataracts were resulting in some patients with “very mild cataracts getting surgery at the expense of other patients going blind”, which he said was “just wrong”.

He added: “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.

“If we are going to try and keep it as an NHS service, then we definitely need to change what we’re doing, because the current system is causing chaos, with huge financial loss to the NHS and it’s not in the best interests of patients.”

Professor Burton said the college “recognises the independent sector can help with reducing backlogs” but urged NHSE not to continue with the approach of “unplanned commissioning [which] means the NHS is losing consultants, money and trainees to the private sector”.

He said: “Because of the financial incentives, the number of referrals for cataracts has gone through the roof. We used to do around 450,000 a year and we’re now doing something like 650,000 a year. The number of people with cataracts has not gone up that much.

“Cataracts isn’t even in the top five conditions of causing irreversible blindness, so throwing massive resource and workforce to address this area doesn’t make sense.”

The consultant ophthalmologist argued the profit margin was “too high [and means] companies can pay three times the NHS overtime rate… So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

IHPN chief David Hare told HSJ: “Some of these confused and confusing comments feel like an unfortunate and unnecessary attack on hard-working colleagues, delivering for NHS patients.

“The comparison with dentistry simply doesn’t make sense. These ophthalmology services are NHS services, being delivered to NHS patients, at NHS tariff prices, free at the point of need, delivered by independent providers. This does not amount to NHS ‘privatisation’.”

The debate around the specialty’s provision is of huge significance because ophthalmology cases represent 8 per cent, around 627,000, of the total 7.7 million on the waiting list – the third biggest cohort.

Ophthalmology is one of the few areas not struggling to boost overall activity levels since covid. But, as Mr Hare highlighted in HSJ last week, the overall 15 per cent post-covid uplift in ophthalmology cases has been driven by a huge 160 per cent increase in private sector activity.



Clinical leaders have, however, long argued the volume and type of ophthalmology work being sent to the private sector was hurting the NHS.

Mr Hare added: “Ophthalmology is the only specialty where median waiting times for NHS patients are lower now than in 2019 and any review would confirm that independent providers are a major contributor to that success.

“On training, which does merit further attention, the sector is fully committed to training. It already delivers training and it wants to do more on supporting colleagues in training.”

Responding to Professor Burton’s comments, NHSE said: “The NHS has increased the number of cataract operations to catch up on the inevitable backlogs that built up during the pandemic through a range of measures including using the independent sector to deliver treatments where needed, with prices constantly reviewed to ensure they are at a fair price for taxpayers.”

In a joint statement, the chief medical officers of five private ophthalmology providers – Spamedica, CHEC, Optegra, Newmedica and ACES – said: “We are concerned by the insinuation that patients with cataracts are somehow less important, when we know thousands of patients are suffering, with huge impacts to their quality of life. There are significant clinical benefits, as well as huge operational efficiencies, to the ophthalmology services being delivered successfully across the independent sector, as the safety and quality data clearly shows.”

Source
Interview, statements to HSJ

Source Date
December 2023