In response to the publication of Reforming elective care for patients, Professor Ben Burton, President of The Royal College of Ophthalmologists, commented:
“It is right that the government is refocusing its efforts on tackling backlogs for planned care. This approach must prioritise those waiting for follow-up appointments, not just first appointments with a consultant.
Currently almost 600,000 patients in England are waiting to see an ophthalmologist, with over a third waiting beyond the 18-week target. This figure is dwarfed, however, by the number who are waiting for follow-up appointments for sight threatening conditions – estimated at 10,000 per NHS trust, the most of any specialty.
Previous programmes have overly incentivised a focus on clinical volume rather than clinical need. The upshot in eye care has been a huge uptick in cataract surgeries, with independent sector providers (ISPs) performing over half of these. While this additional capacity has helped to bring down cataract waits, we have serious concerns about the unintended consequences. Investing so much scarce resource into treating cataracts – a reversible, relatively low-risk condition – in the independent sector has led to funding, workforce and infrastructure being diverted here at the expense of resourcing for conditions such as glaucoma that, while being more complicated to treat, can cause irreversible sight loss if not treated swiftly.
While it is helpful that we now have clarity on how NHS England plans to work with the independent sector going forward, lessons must be learned from past experiences if resources are to be used in a sustainable and efficient manner, in line with patient need. We feel an investigation of how independent sector capacity can best be commissioned and an evaluation of how tariff structures can better incentivise the prioritisation of follow-up pathways are urgently needed. England should also follow the example of Wales and require trusts to report on risk rating.
In the meanwhile, we welcome NHS England’s commitment to working with ISPs to ensure that training opportunities are available where needed and we will monitor progress with interest.
To ensure comprehensive, sustainable services that also provide training and world class research, we must invest in the NHS workforce and infrastructure. It is vital that the forthcoming refresh of the Long Term Workforce Plan clarifies the increases to specialty training places that will be delivered to ensure a workforce fit for the future.”