Prevention of avoidable sight loss - a low priority for commissioners?

Posted: 
17 October 2013

The first in a fortnightly series of think pieces, John Slade, Research Officer at RNIB, asks us to consider if prevention of eye health is high enough up the commissioning agenda.

Data published by the Department of Health indicates that for every £10 the NHS spends on problems related to the eye in England, only 1p is spent on prevention and health promotion.

NHS Programme Budgets provide detailed information on how money was spent on healthcare in England in 2011/12. These budgets highlight expenditure on 23 different disease categories across 12 different care settings. This data is a key resource allowing commissioners to see where money is being spent, and it is increasingly being linked to outcome data in order to assess the value for money of outcomes, prioritise and drive reform and quality improvement initiatives.

In 2011/12, the NHS in England spent £2.26 billion on problems of vision:

  • 61 per cent was spent on secondary care, which includes the provision of outpatient appointments and inpatient procedures
  • 31 per cent was spent on primary care, which includes payments made for NHS funded sight tests.
  • 5 per cent was spent in other care settings
  • 2 per cent was spent on urgent or emergency care
  • 0.1 per cent was spent on prevention or health promotion

In other words, for every £10 spent by the NHS in England on eye health and treatment only 1p goes on prevention and health promotion.

It should be noted that other ophthalmic activity may be preventative. NHS sight tests (recorded in primary care) and treatments such as Lucentis injections or cataract surgery (recorded in secondary care) help to prevent people living with avoidable sight loss. More information on the prevention of sight loss in primary care can be found via RNIB's Community Engagement Projects.

The definition of "Prevention and health promotion" in the 2011/12 Programme Budgeting Guidance is as follows:

"Prevention and health promotion Includes primary and secondary prevention, health promotion, family planning, school health services, national screening programmes, public health programmes for communicable and non-communicable disease, epidemiological surveillance and public health administration."

The average amount spent on prevention and health promotion across the NHS in England was 3 per cent. If we compare eye health to other health conditions, many have a higher spend in this area. For example, over six times more was spent on prevention and health promotion of dental problems, and nearly three times more spent on problems of learning disabilities. If we compare the proportionate spend, then six times more of the problems of hearing budget was spent on prevention and health promotion.

Other evidence suggests that spending money on prevention and health promotion to stop avoidable sight loss could be money well spent. Over the last five years, the number of people attending repeat ophthalmology outpatients appointments has increased by one-third. If we prioritise the promotion of eye health, perhaps we can prevent people from needing to come back to the eye clinic?

The Programme budgeting PCT benchmarking tool provides details of PCT spend and ranking. How does your local area compare?