NHS surgery rationing on the rise as thousands rejected for cataract surgery, investigation finds

‘Cataract surgery comes out as probably the most cost effective thing in the NHS,’ ophthalmologists say

Alex Matthews-King

Health Correspondent

Thursday 30 May 2019 00:02 BST

Cataract surgery is among the most common and cost effective NHS procedures (Getty/iStock)

Thousands of elderly people losing their vision to cataracts are being left housebound and at risk of galls as NHS bosses try to ration surgery in a bid to cut costs, despite official guidelines warning this is a false economy, an investigation has revealed.

One in five patients now have to undergo a further pre-approval check after being referred for cataract surgery, a rise from 7 per cent of patients who were screened in 2016-17.

Nearly 3,000 patients saw their ophthalmologist’s request for the procedure rejected outright, twice as many as three years ago, the investigation by the British Medical Journal (BMJ) found.

The findings fly in the face of 2017 guidance by the National Institute for Health and Care Excellence (NICE) which concluded that the operation was cost effective and should not be limited to people who had the most severe vision loss.

“What is the point of NICE doing detailed evaluation if CCGs [clinical commissioning groups] are just going to knowingly ignore that advice?” said Mike Burdon, president of the Royal College of Ophthalmologists.

Everyone the Government blames for the NHS crisis – except themselves

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1/6Everyone the Government blames for the NHS crisis – except themselves

Everyone the Government blames for the NHS crisis – except themselves

The elderly

“We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital.

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Everyone the Government blames for the NHS crisis – except themselves

Patients going to A&E instead of seeing their GPs

Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service.

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Everyone the Government blames for the NHS crisis – except themselves

Simon Stevens, head of NHS England

Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required.

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Everyone the Government blames for the NHS crisis – except themselves

Previous health policy, not funding

In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals.

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Everyone the Government blames for the NHS crisis – except themselves

Target to treat all A&E patients within four hours

Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame.

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Everyone the Government blames for the NHS crisis – except themselves

No one

Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in.

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“The health service budget is limited, but you should make those spending decisions on the basis of the clinical evidence. Cataract surgery comes out as probably the most cost effective thing in the NHS.”

Cataract procedures are the most common operation in the NHS and around 400,000 a year are carried out in the UK.

However, after years of below-inflation funding increases, NHS clinical commissioning groups have increasingly looked to restrict non-urgent procedures to free up funds and hospital capacity.

Last year’s severe winter saw 70,000 NHS patients waiting over six months for supposedly non-essential procedures like cataract and hip surgeries and surgeons warned thousands were being made to “beg for treatment”.

Restrictions also vary drastically around the country depending on the financial position and population of each CCG.

The BMJ found Telford and Wrekin CCG in the West Midlands rejected 332 cataract funding requests, one fifth of the total, while 29 out of 30 were rejected by Cambridgeshire and Peterborough CCG.

Rejected patients may have to wait for their vision to get worse and risk falls, fractures and other complications that also end up costing the NHS in the meantime.

“I think it is insulting to our elderly patients that this rationing is going on. It is unjustified,” Mr Burdon said.

Dr Graham Jackson, co-chair of NHS Clinical Commissioners, which represents CCGs, said funding decisions had to be made against a backdrop of “spiralling demand, competing priorities and increasing financial pressure”.

“Cataract surgery specifically is an area that is often subject to prior approval,” he said. “Such clinical decisions are critical in deciding when a patient has reached the stage that an operation will be the best option.”

He added that surgery “is not without risk”.

A Department of Health and Social Care spokesperson said: “Commissioners should take the latest NICE guidelines into account, to ensure fair and consistent access to the best possible treatment for all cataract patients.”

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