RCOphth has published an analysis highlighting key trends in cataract surgery in England. This includes changes in the number of procedures performed in each region by NHS and independent sector providers.
Based on data provided by NHS England, The Royal College of Ophthalmologists has published a statistical analysis of trends in NHS-funded cataract surgery in England between 2016-2021.
Cataract surgery is one of the most common procedures performed in the NHS. In 2019/20, there were over 450,000 cataract procedures in England – an 11% jump from three years previously.
This analysis focuses on the changes seen in England because the growing role played by independent sector providers (ISPs) has been a crucial part of this story, and to date, there has been a lack of detailed regional and local level data in the public domain which explains these trends. RCOphth is also working with NHS England and all stakeholders to address the challenges to long-term sustainable patient care created by these shifts in cataract provision.
This analysis will be useful for all those who wish to understand more about how the delivery of NHS cataract services has changed in their area and nationwide over the last five years. We hope too that this information will help those making decisions relating to the commissioning and delivery of cataract services.
We encourage members to contact the eye care lead in their integrated care system (ICS) if they wish to discuss the commissioning of eyecare services in your area. Information on who your ICS eye care lead is and how to contact them has been collated by the College.
- Between 2016-2021, the number of NHS-funded cataract procedures increased by over a fifth (21%), with 44,000 procedures performed a month by late 2021 – almost 1,500 each day.
- The role played by independent sector providers (ISPs) has increased dramatically since 2016. ISP provision increased steadily before the pandemic, but the second COVID-19 wave beginning in Autumn 2020 saw a huge shift when NHS services faced overwhelming pressure. From a third (34%) of NHS-funded cataract procedures delivered by ISPs in December 2020, this jumped to 55% in January 2021 and then a high of 59% in February 2021.
- As hospitals overcame the most severe pandemic pressures from spring 2021, the situation again changed. The proportion of procedures delivered by ISPs fell back under half, settling close to 45% in the six months up to November 2021. This 45% figure nonetheless represents a “new normal” in the delivery of NHS cataract services, given that pre-pandemic ISP provision had never exceeded 30%. The number of cataract procedures delivered by NHS providers was 15% lower in November 2021 than prior to the pandemic, despite the number of NHS-funded procedures increasing by 11% over the same period.
- Significant regional differences exist. The North West, Midlands, South West and North East and Yorkshire were all delivering at least half of their NHS-funded cataract procedures in the independent sector in November 2021. The South East meanwhile was delivering a third (34%) through ISPs, while for London the figure was a quarter (25%).
- At the more local Integrated Care System level, Gloucestershire had the highest ISP provision at 75%. West Yorkshire & Harrogate, Greater Manchester and Cheshire & Merseyside are also notable for being high volume areas with high ISP provision – all three areas are delivering over 60% of their cataract procedures in ISPs, with well over 1,000 procedures per month in ISPs in each area.
- Increasing ISP provision has provided additional capacity for cataract surgery, although there is no evidence they have reduced waiting times for NHS eye care services. This trend has also created challenges that need to be addressed. These include access to training opportunities for ophthalmology trainees and the potential destabilising of NHS eye care units delivering comprehensive care (in terms of available workforce and funding of units).
Commenting on the analysis, Professor Bernie Chang, President of The Royal College of Ophthalmologists, said:
‘It is incredibly important this detailed data on how NHS-funded cataract surgery is delivered is now in the public domain.
‘Especially since the pandemic, we have seen a big jump in the role played by independent sector providers. We all need to better understand this shift so informed decisions are made at a local and national level when services are commissioned. That means ensuring we continue to deliver the highest standards of patient care while not destabilising NHS eye care units delivering comprehensive care.
‘The College is working closely with NHS England and organisations across the eye care sector to address challenges relating to these changes in cataract provision. Access to training opportunities, referral criteria and the post-operative pathway are three areas we are looking particularly closely at’.
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