NHS England restricts patients’ access to cataract removalDr Richard Dune
NHS England restricts patients’ access to cataract removal
RNIB says ‘shocking’ rationing severely affects people’s ability to lead independent lives
An eye test at Moorfields Eye Hospital, London. Photograph: Martin Godwin/The Guardian
Patients who are losing their sight are being forced to wait for months before having eye cataracts removed because of NHS cost-cutting, research has revealed.
The NHS has imposed restrictions on patients’ access to cataract surgery in more than half of England, figures obtained under freedom of information laws show.
The Royal National Institute of Blind People (RNIB) condemned the rationing as shocking. It warned that not treating people with cloudy vision risks them falling and breaking bones, thus costing the NHS more.
Of the 195 NHS clinical commissioning groups (CCGs) in England, 104 now include cataract removal on their list of “procedures of limited clinical value”, according to research by the Medical Technology Group.
Seventy-six CCGS have introduced a “visual acuity threshold”, which means patients must have experienced a set degree of sight loss before they can have surgery. This is despite the National Institute for Health and Care Excellence (Nice), the government’s advisers on what treatments represent good value for the NHS, insisting that CCGs should never resort to such a practice.
Previous research has found that patients can wait for up to 15 months to have a cataract taken out.
“It’s shocking that access to this life-changing surgery is being unnecessarily restricted by so many CCGs,” said Helen Lee, the RNIB’s health policy manager.
“Cataract removal is a crucial procedure. Restrictions or delays can severely impact people’s ability to lead independent lives, making them twice as likely to experience falls and significantly reducing quality of life.”
The 104 CCGs are defying Nice advice that cataract removal is worthwhile because it is “one of the ways in which the NHS can transform our lives” and helps people to function normally and not become isolated.
Ninety-five CCGs also class hernia repair as a procedure that patients can no longer automatically have, while 78 regard hip and knee replacements in the same light, despite evidence that they benefit patients.
A dozen CCGs restrict diabetics’ access to continuous glucose monitoring, while seven others only provide it if the patient’s GP has made an individual funding request for it.
The Patients Association criticised the spread of “crude rationing”. Rachel Power, its chief executive, said: “These restrictions … unfairly and unnecessarily prolong the time patients will spend in pain, possibly immobile and unable to carry out daily tasks or to work and to ask them to wait for longer in discomfort and at risk of further complications is totally unacceptable.”
NHS Clinical Commissioners, which represents CCGs, said they had to make “tough choices” about which treatments to provide because of how much money the NHS receives and the rising demand for care.
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