Cataract, which generally affects the eyesight of elderly patients, occurs when the lens of the eye becomes cloudy and results in the patient suffering blurred vision, spots and glare from bright lights. Surgery to replace the affected lens is the most common operation carried out by the NHS, with 300,000 operations performed each year. It is quick and straightforward and associated with low incidences of complication. In a high percentage of cases, it provides patients with improved vision.
Despite its success, there have been consistent reports of patients having to wait months or years, for treatment. In some situations they are denied access to treatment altogether. In 2017 the National Institute for Health and Care Excellence (NICE) investigated those concerns and noted that NHS trusts appeared to be rationing cataract surgery. NICE concluded that cataract surgery was virtually always a good use of NHS resources because patients who struggle to see are more likely to injure themselves and require subsequent assistance from the NHS. Accordingly, the NICE guidance demanded the health service end rationing of cataract surgery.
A recent study by the Medical Technology Group, a forum for patient charities and device manufacturers, found however that 104 of 195 clinical commissioning groups (CCGs) in England have classed cataract surgery as a ‘procedure of low clinical value’ and will not routinely offer funding for treatment. The suggestion from the recent study is that CCGs consider the treatment offers no or little discernible benefit to the patient and funding will only be offered if an exceptional case argument is presented by an individual patient’s GP. This seems to be in direct defiance of the NICE guidelines.
Doctors and ophthalmic specialists have condemned the policies of local CCGs. Helen Lee of the Royal National Institute of Blind People said: "It's shocking that access to this life-changing surgery is being unnecessarily restricted, "while Mike Burdon, president of the Royal College of Ophthalmologists, claimed that there was no justification for the policies. He commented: "CCGs must take notice of the NICE recommendations which reinforce the message that cataract surgery should be delivered at point of clinical need. It is one of the most efficient procedures in the health service."
In response, NHS Clinical Commissioners, which represent the CCGs, contended: "The NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face. They are forced to make difficult decisions that balance the needs of the individual against those of their entire local population. There are tough choices to be made, which we appreciate can be difficult for some patients." Reading between the lines, it seems that CCGs are limiting the procedure on the basis of cost.
Arran Macleod, a solicitor in the clinical negligence team at Penningtons Manches, added: “NICE has previously warned that restricting cataract surgery until people are virtually blind cannot be justified. It is disappointing, therefore, to read that CCGs across the country continue to control access to treatment. The reduction in eyesight caused by cataracts may increase the risk of patients falling or injuring themselves. This is something which NICE has specifically highlighted. The evidence seems clear that earlier treatment will reduce the NHS’s exposure to costs associated with treating patients who have fallen down and suffered bony and soft-tissue injuries.
"While the argument presented by NICE is logical, there is a clear difference in approach between the NICE ideals and the realities of what the CCG will do. Our position is that the NICE guidance should not be deviated from. There are many patients who have experienced a delay in receiving treatment for their condition who may have come to harm because of their poor eyesight.
"If you or a loved one develop cataracts which impact on your daily living, we recommend you get in touch with your GP or optician. We would be happy to speak with anyone who has concerns about the treatment they have received and provide advice on the options that are available."