Good quality monitoring is crucial for informed choiceBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7533.118 (Published 12 January 2006) Cite this as: BMJ 2006;332:118
All rapid responses
The survey by Brogan and Simmons (REF 1) revealing little or no
robust monitoring of the quality of cataract care commissioned by most
Primary Care Trusts is important and a worry now that waves of new
providers, including rotating overseas teams (concept known as
‘plurality’) in Independent Sector Treatment Centres (IS-TCs), are
increasingly operational in England. Observers including several of the
medical Royal Colleges and parliamentarians have expressed concern about
the direction of travel of ophthalmic and general care as a result of the
new mantra of competition (concept known as ‘contestability’) possibly
leading to the fragmentation of English NHS healthcare. (REF 2, 3, 4,5).
This survey adds weight to existing concerns and to the recent British
Medical Association survey of NHS clinical directors. (REF 6)
The recent National Centre for Health Outcomes Development’s report of
ISTCs commissioned by the Department of Health did little to allay
clinicians concerns. (REF 7)
Furthermore adverse impacts of the IS-TCs on the training of future
ophthalmic surgeons are now being experienced in some NHS units adjacent
to IS-TCs. (Ref 8)
Do not be surprised to read more on this topic as the evidence
mounts. In the meanwhile, and certainly for long term stability of the
Service, the best option (concept known as ‘patient choice’) for the
public is to support their local NHS units. It is such units that have
brought down cataract waiting times, prior to IS-TC deployment (REF 9),
and it is such units that patients need to call upon in times of accident
1) Paul R Brogden, Ian G Simmons. ‘Good quality monitoring is crucial
for informed choice.’ BMJ 2006;332:118.
2) Kelly SP. ‘Cataract care is mobile. Is the direction correct?’ Br
J Ophthalmol. 2006 Jan;90(1):7-9.
3) Ferris JD. ‘Independent sector treatment centres (ISTCS): early
experience from an ophthalmology perspective’. Eye. 2005 Oct;19(10):1090-
4) Meacher M. ‘Going private can seriously damage your health
service’ The Guardian Newspaper. January 12th, 2006.
5) Denham J, ‘This rigid market model won't survive the real world.’
The Guardian Newspaper. December 21, 2005.
6) British Medical Association. ‘Impact of Treatment Centres on the
Local Health Economy in England.’ Report. December 2005. London. British
7) National Centre for Health Outcomes Development. ‘An overview of
performance under the Independent Sector Treatment Centre programme’ Dec
2005. London. National Centre for Health Outcomes Development
8) Catherine Guly, Richard Sidebottom, Kim Hakin, Keith Bates
‘Challenges of private provision in the NHS: Treatment centres and their
effect on surgical training’. BMJ 2005;331:1338.
9) Kelly SP. Recurring policy errors: blind spots over cataracts.
Lancet. 2005 Nov 12;366(9498):1691.
Council member; The Royal College of Ophthalmologists. These views are my own.
Competing interests: No competing interests