Let me let you into a secret. No one is in charge. No one knows what's going on.

I don't know how it is in your specialty, but in mine there is one man at the Department of Health who is supposed to know what's going on. He is a one man band in charge of “optical services.” That's 7000 optometrists and 1000 consultant ophthalmologists. My 100 colleagues in paediatric ophthalmology rate a few civil service digits.

The government of the day thinks in soundbites and spin. The soundbite for ophthalmology is waiting lists, cataracts, and private practice. That's not to say that cataracts are not important. The reason cataract surgery is the most commonly performed surgical procedure in …