BMJ  2007;334:222 (3 February), doi:10.1136/bmj.39108.384572.1F

Letters

NHS cataract service

ISTC programme is an expensive option

The improvement report in relation to cataract surgery¹ is further evidence that the independent sector treatment centre (ISTC) programme was an expensive over-reaction to the need to increase rates of cataract surgery.² Many ophthalmology departments had improved cataract surgery pathways, as part of Action on Cataract, an NHS initiative supported by the college,³ before the ISTC programme was proposed.

Modest sums of capital pump-primed increased cataract surgical activity by improved facilities and pathway redesign. As this report confirms,¹ such targeted investment quickly pays for itself. The experience in NHS ophthalmology units elsewhere is similar.

Had the Department of Health followed the advice of clinicians, the royal colleges, and the BMA when the cataract and other ISTC schemes were proposed, improved access to cataract surgery would have been realised with much less expenditure, without adverse effects on surgical training, and without destabilising NHS eye departments. However, an alternative direction was taken.⁴ Despite the paucity of clinical outcome data, a cause of increasing concern,⁵ and the lack of evidence of cost effectiveness of phase 1 of the ISTC programme, further investment in cataract surgical facilities continues in phase 2. Meanwhile, for long term stability of the service, the best option for the public is to support local NHS units, which brought down cataract waiting times, which patients need to call on in an emergency or for chronic eye disease, and which train the next generation of surgeons while meeting waiting time targets. A constructive partnership of clinicians, managers, and commissioners is a surer way to achieve sustained improvements in access and quality of care, rather than centrally imposed initiatives and diktat, such as the needless cataract ISTCs.

¹ Bolton Eye Unit, Bolton Hospitals NHS Trust, Bolton BL4 OJR , ² Royal College of Ophthalmologists, London NW1 4QW, ³ Ophthalmic Group Committee, BMA, London WC1H 9JP

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Competing interests: The Bolton Eye Unit is an NHS Action on Cataract site.

References

1. Tey A, Grant B, Harbison D, Sutherland S, Kearns P, Sanders R. Redesign and modernisation of an NHS cataract service (Fife 1997-2004): multifaceted approach. BMJ 2007;334:148-52. (20 January.)[Abstract/Free Full Text]
2. House of Commons Health Committee. Independent sector treatment centres. Fourth report of session 2005-6. Vol 1. www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/934/934i.pdf
3. Department of Health. Action on cataracts—good practice guidance. NHS Executive. Feb 2000. www.dh.gov.uk/assetRoot/04/01/45/14/04014514.pdf
4. Kelly SP. Cataract care is mobile. Is the direction correct? Br J Ophthalmol 2006;90:7-9.[Free Full Text]
5. Mooney H. Data on ISTCs' clinical quality is "extremely poor," says Healthcare Commission. Health Serv J 2007;117:5.[Medline]

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Related Article

Redesign and modernisation of an NHS cataract service (Fife 1997-2004): multifaceted approach

Adrian Tey, Barbara Grant, Dawn Harbison, Shona Sutherland, Patrick Kearns, and Roshini Sanders
BMJ 2007 334: 148-152. [Abstract] [Full Text] [PDF]