The vast majority of eye doctors believe increased outsourcing of cataract operations to private clinics in England in recent years has negatively affected their NHS departments, research has found.
Almost three-quarters of ophthalmologists surveyed said that outsourcing of cataracts to the private sector had a negative impact on their NHS eye care departments, with 54% flagging a large negative impact and 16% a small one.
The survey of 200 eye doctors by the Centre for Health and the Public Interest (CHPI), shared with the Guardian, came after Wes Streeting, the new health secretary, pledged to divert 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 the ophthalmologists polled said outsourcing had a negative impact on NHS staffing, 62% said the same for staff training, and 46% said it harmed the ability of public eye care departments to treat patients with more complex conditions. Issues raised about staffing included the loss of consultants, nurses and optometrists to the private sector.
While eye care budgets have increased by only 15% at 43 NHS trusts over the past five years, ophthalmology spending has gone up by 52%, partly due to a surge in the number of cataract operations, research from the CHPI showed. Hundreds of thousands more 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 everyone else going private” if what had happened to NHS dentistry spread to the whole of the NHS.
A fall in the number of dentists doing NHS work has helped create “dental deserts”, where patients cannot get treatment, and prompted some people to turn to “DIY dentistry”, including pulling out their own teeth.
David Rowland, the director of CHPI, said: “The ‘hollowing out’ of NHS eye care departments due to the loss of income and activity from cataract care has the potential to leave the NHS eye care departments as a ‘poor service for poor people’ and is significantly undermining the training of the ophthalmology workforce.”
The surge in NHS spending on cataracts means there are fewer resources available – money and people – to treat more complex eye conditions that can lead to irreversible sight loss, such as glaucoma and wet macular degeneration, the Royal College of Ophthalmologists has warned.
“The issue to date has been the unplanned and uncontrolled way in which private providers have been commissioned, specifically in England,” said Prof Ben Burton, the college’s president.
“The use of the private sector is draining NHS staff from hospitals and increasing volumes of activity driven by profit margin. We are actively urging policymakers to reform commissioning, tariff and data reporting systems to ensure that independent sector capacity can support rather than subsume sustainable ophthalmology services.”
On average, NHS hospitals are providing about 20% fewer cataract operations than they did five years ago, with some trusts performing more than 40% fewer surgeries, as they outsourced more to private providers, the CHPI said. This has led to an average 21% reduction in income from cataract surgery for 26 out of 50 NHS eye care departments.
When an NHS trust performs fewer cataract operations, it receives less income from commissioning bodies, called integrated care boards (ICBs). As trusts have outsourced nearly 60% of cataract surgery to the private sector, the financial viability of NHS eye care departments has been hit.
These departments also need to run emergency 24-hour services, which is costly and something that is not provided by private eye clinics.
Rowland said: “It’s often thought that using the private sector provides additional capacity to support the NHS, but this research conclusively shows that the mass outsourcing of cataract care has taken money, staff and training opportunities away from the NHS hospitals, leaving them with fewer resources to treat poorer and sicker patients.
“NHS England and the next government needs to quickly get a grip and if necessary reverse eye care outsourcing until it can be shown that patients, training and the depleted NHS workforce are not adversely impacted.”
David Furness, the director of policy at the Independent Healthcare Providers Network industry body, said: “Because independent providers are delivering growing numbers of NHS cataract and other ophthalmic procedures – at prices set by the NHS and to high quality standards – more patients are getting the eye care they need.”
He claimed “good progress” had been made to increase the amount of training delivered by private providers, without providing any figures.
A Department of Health and Social Care spokesperson said: “There are 600,000 patients waiting for eye care, and some are losing their eyesight while they wait.
“The choice is to let patients wait longer, or get them seen faster where extra capacity exists. This government will put patients first, pull every available lever to get them seen on time, while we build capacity so that the NHS can be there for all of us when we need it, once again.”
