A royal college has reiterated its concerns over the continued rationing of cataract surgery after the NHS medical director told MPs that half of PCTs are restricting access.
Giving evidence to a hearing of the public accounts committee, Sir Bruce Keogh admitted: “We do know that about 50% of PCTs have restricted access to cataract surgery, and we do know that the bulk of policies used by PCTs actually haven’t used the best evidence that’s available in order to ration that care.
“I’ve raised that with our [strategic health authority] medical directors and also with the new medical directors of the [NHS] Commissioning Board.”
Royal College of Ophthalmologists president, Professor Harminder Dua, warned that it is clinically unsound to determine access to cataract surgery on the basis of visual acuity alone.
Patients should be offered treatment for cataract if the cataract is adversely affecting the patient’s daily living; they fully understand the risks and benefits of surgery; and, they want to have, and are fit enough, for surgery.
“We urge commissioners, clinicians and patient groups to work together to implement this advice as a matter of urgency,” he said
Sir Bruce told the committee that in late 2010 he had begun to be “deluged” by complaints about the differing thresholds at which different NHS commissioners would pay for procedures like cataract surgery or hip replacements.
In response, he said, he had tried to “engage” the specialist surgical associations in developing a clinical consensus across the country about the appropriate point at which such treatments should be offered.
This had led to a programme of work with the Royal College of Surgeons called Value Based Commissioning of Elective Surgical Care, to define appropriate access thresholds in a number of areas of treatment.
The College also said it was concerned by reports that patients with cataracts in both eyes are being told their PCT will treat only one, despite substantial evidence in favour of treating both. Unless both eyes are treated, patients lose their ability to judge distances so it is more likely they will suffer accidents.