Wirral MP raises alarm about increase in NHS-funded eye care going to private sector

Margaret Greenwood MP has led a debate in parliament on the subject of preventable sight loss in which she argued that we are facing a crisis in eye care provision.

The Wirral West MP called the debate amid concerns that independent, or private, sector providers now deliver almost 60% of NHS-funded cataract procedures – this has more than doubled from around 25% before the coronavirus pandemic.

A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the North West of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers at 61%.

Although use of the sector has helped to bring down cataract waiting lists, the Royal College of Ophthalmologists has found that 67% of NHS ophthalmology departments reported that the impact of independent sector providers on patient care in their area is negative.

They are concerned about its impact on:

  • training opportunities for junior doctors
  • funding for NHS ophthalmology departments
  • the available workforce.

There are concerns that these issues will hamper the long-term ability of NHS departments to deliver sight-saving care for patients.

The Royal National Institute of Blind People (RNIB) has also said that the role of the independent sector has been associated with significant challenges that pose an increasing risk to the sustainability of comprehensive eye care services in the NHS.

The most recent workforce census from the Royal College of Ophthalmologists found that 76% of NHS ophthalmology departments reported not having enough consultants to meet patient need.

There are very serious concerns that the increase in the percentage of the NHS budget being spent on cataract operations, along with NHS staff being drawn away from the NHS to take work which is more lucrative and straightforward in the private sector, is likely to mean that there will be fewer resources available to treat other eye care conditions such as glaucoma and wet macular degeneration, both of which can lead to irreversible sight loss. Age-related macular degeneration is the leading cause of sight loss in adults.

Last December, Professor Ben Burton, President of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with “very mild cataracts getting surgery at the expense of other patients going blind.”

He added that the approach of unplanned commissioning means that “the NHS is losing consultants, money and trainees to the private sector.”

Professor Burton also warned, “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.”

Speaking after the debate, Margaret Greenwood MP said, “The situation regarding eye care in the NHS is an urgent one. I do believe we are facing a national emergency in eye health.

“A survey by the Royal College of Ophthalmologists from this year shows that only around a quarter of NHS ophthalmology departments feel able to meet patient need, and 70% of departments are more concerned about out-patient backlogs compared with 12 months ago. This is a matter of extreme concern.

“There are very real concerns too about the impact of the sharp increase in the percentage of NHS patients being treated in the private sector for cataracts.

“It seems that the increase in the outsourcing of treatment of NHS patients to the private sector is drawing crucial expertise away from NHS departments, leaving NHS ophthalmology departments unable to meet the needs of patients with very serious conditions such as wet macular degeneration and glaucoma.

“There are concerns too that it is also leading to shortages in staff available to work in cancer treatment, urgent care and with newborn babies.

“A number of leading experts have warned that less complex eye conditions are being prioritised for treatment in the private sector, and that as a result there are not the resources in the NHS to effectively deal with more complex conditions.

“Unless the government changes course, there is a real risk that we will be facing eye care deserts in the future – just as we do in dentistry – where people will simply not be able to get treated. That would lead to people losing their sight when it could have been saved. The consequences would be devastating.

“In parliament, I asked the minister how he would feel if he lost his sight, and how he would feel if he then found out it could have been saved. He did not answer on this point, but I hope he subsequently reflects on it.

“Sight is precious, and I will continue to press the government to change course.

“The government has a responsibility to ensure that the NHS is comprehensive in the range of treatments that it provides and that there are sufficient staff to deliver that treatment in all parts of the country.

“Instead, the market is increasingly being allowed to influence what is and what is not getting treated. The independent, or private, sector is cherry-picking the less complex work, leaving a diminished NHS to pick up more difficult, crucial treatments.

“There is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and such a strategy should aim to prevent irreversible sight loss.”

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