Over half (53 per cent) of Primary Care Trusts in England are restricting access to cataract surgery. Findings, published today (29 June) by the Royal National Institute of Blind People (RNIB) and the Royal College of Ophthalmologists, show that short term savings are leading to unnecessary sight loss and an inefficient use of NHS resources.
RNIB issued a Freedom of Information request to collect PCTs policies on access to cataract services. 133 PCTs in England responded.
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56 PCTs (42 per cent) were flagged green, meaning clinicians, in discussions with their patients, decide whether an operation is needed or a policy is in place which applies the Department of Health's Action on Cataract criteria* with no visual acuity threshold.
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70 PCTs (53 per cent) were flagged red, meaning they have implemented a visual acuity threshold for surgery on either the first or the second eye. None of the policies received included an impact assessment to ascertain whether the thresholds they established were likely to lead to increased health inequalities.
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7 PCTs (5 per cent) were flagged grey, as either work on a new policy was planned or the current policy was under review.
Dennis Sleigh, a 69-year-old song-writer from Derby, had a cataract successfully removed but now has one in his other eye. He has been told that he cannot have it removed and says: "I need the operation to keep writing and driving and to retain my independence. That's what should count, not an artificial rule. There is all this talk about a patient-centred NHS. For me that means that they should fix my eye so I don't have to rely on other people for transport and I can continue doing what I love most."
Barbara McLaughlan, RNIB Eye Health Campaigns Manager says: "At RNIB we believe that cataract surgery should be performed when consultants believe it is in the patient's best interest, in line with the Department of Health's Action on Cataract good practice guidance and the Royal College of Ophthalmologists' guidelines. But from our research it is clear that some PCTs are forcing patients to live with unnecessary sight loss and a reduced quality of life."
RNIB and the Royal College of Ophthalmologists recognise the financial pressures facing PCTs and the efficiency savings they must make. However, the consistent application of the national cataract guidelines (recently published by the Royal College) combined with a standardised cataract pathway, have the potential to reduce the costs of cataract surgery by five per cent.
Larry Benjamin, Consultant Ophthalmologist and Chair of the Royal College's Cataract Guideline Committee says: "Cataract surgery is safe and has been shown to be both cost and clinically effective. It is also well established that certain types of cataract can leave the vision apparently unaffected according to the measurement chart at the optometrist, but which can dramatically reduce sight whilst driving against sunlight or headlights. Excluding such patients from surgery, because their vision is 'too good' on the sight chart might cause significant danger on the roads and loss of their livelihood. Furthermore, introducing arbitrary thresholds, which delay cataract operations, is a false economy. A patient whose sight is restricted by a cataract will, at some stage, absolutely need surgery. Meanwhile, this short term saving could lead to older people having other accidents, potentially increasing NHS costs in the longer term."
Commissioners should engage with the Royal College of Ophthalmologists and RNIB to make sure all cataract policies are in line with Action on Cataract best practice guidance. Most importantly, PCTs must refrain from trying to solve cash-flow problems by simply cancelling all cataract surgery in the run-up to new financial periods.
The report on access to cataract surgery, 'Don't Turn Back the Clock', is available at: www.rnib.org.uk/campaigns.
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Notes to editors
Action on Cataract
Department of Health "Action on Cataract" best practice guidance establishes some straightforward eligibility criteria, which if implemented fully should prevent situations where people experience a reduction in their quality of life due to operable cataracts. It should also ensure that people do not undergo unnecessary surgery.
Action on Cataract did not establish a visual acuity threshold, but employs three criteria that need to be met for a cataract to be removed:
Department of Health "Action on Cataract" best practice guidance establishes some straightforward eligibility criteria, which if implemented fully should prevent situations where people experience a reduction in their quality of life due to operable cataracts. It should also ensure that people do not undergo unnecessary surgery.Action on Cataract did not establish a visual acuity threshold, but employs three criteria that need to be met for a cataract to be removed:
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the cataract affects the individual's sight
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the reduction in the patient's sight has a negative impact on their quality of life, and
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the patient understands the risks and agrees to having surgery.
The Department of Health guidance, Action on Cataract, did not establish a visual acuity threshold. PCTs introducing arbitrary thresholds to restrict access to cataract surgery do so without a robust evidence base to demonstrate that they will not harm patients or increase inequalities of access across their populations.
Further evidence
'Don't Turn Back the Clock' contains further evidence including a survey of members of the Royal College of Ophthalmologists.
The Royal College conducted an online survey of its consultant ophthalmologist members working in England. From 231 respondents, 38 per cent had encountered situations where a patient has been disadvantaged because of restrictions on cataract surgery. This included situations where patients had been refused surgery, despite the need to drive or operate machinery at work. www.rnib.org.uk/campaigns
About RNIB
Every day around 100 people in the UK start to lose their sight. There are around 2 million people in the UK with sight problems. RNIB is the leading charity working in the UK offering practical support, advice and information for anyone with sight difficulties. If you, or someone you know, has a sight problem RNIB can help. Call the RNIB Helpline on 0303 123 9999 or visit www.rnib.org.uk
About the Royal College of Ophthalmologists
The College is a charity set up by Royal Charter to champion excellence in the practice of ophthalmology for the benefit of patients and the public. We are also the professional association for 4,000 eye doctors. We set the standards for professional practice through clinical guidelines and ophthalmic service guidance. The continuing professional development (CPD) programme is designed to help ophthalmologists maintain and increase their knowledge and expertise.
Supporting the UK Vision Strategy
The UK Vision Strategy is a united cross-sector initiative to improve eye health and sight loss services across the UK. Over 650 individuals and organisations have played a direct role in creating the Strategy. Developed in response to the World Assembly's VISION 2020 resolution, the Strategy aims to reduce avoidable sight loss by the year 2020.