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Cataract surgery must be determined on clinical need and not rationed due to funding restrictions

12 August 2016

In response to extensive media coverage during August on restricted access to cataract surgery, the RCOphth issued the following statement.

The Royal College of Ophthalmologists (RCOphth) welcomes Jeremy Hunt’s recognition that patients should receive cataract surgery based on clinical need as recommended by eye doctors. The rationing and postponement of second eye cataract surgery is also a continuing concern of the RCOphth and we stress that the decision to perform second eye cataract surgery should also be based entirely on clinical need.

“Professor Carrie MacEwen, RCOphth president commented, ‘Cataract surgery usually involves a relatively straightforward surgical procedure, performed regularly by ophthalmologists, but can be more challenging in certain circumstances. We make decisions about the suitability of patients for surgery based on their level of vision, the effect on other aspects of their vision and their quality of life.’

The RCOphth 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.

Professor MacEwen continued, ‘Recommendations about first and second eye surgery are made clear in our NICE accredited Commissioning Guide for Cataract Surgery 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.’

Through recent commissioned research, the RCOphth anticipates an increase of around 50% in the number of cataract operations needed over the next 20 years due to an aging population.  However, cataract surgery is a highly cost effective and efficient surgery that has a rapid effect in restoring a patient’s vision and preserving their ability to live an independent life.

It is widely reported that an older person with reduced vision from cataracts is twice as likely to fall.  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.

In February 2015, the RCOphth published a NICE approved Commissioning Guide for Cataract Surgery which outlines recommendations to optimise cataract surgery services and advises commissioners to work in partnership 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.

Commissioning Guidance aims to improve the health and wellbeing of people and communities, and support local service redesign to ensure the provision of high quality, cost effective services that meet the needs of the local population and take into account patient experience.

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.