Eye of the Storm

The waves of strikes by nurses, junior doctors, and ambulance staff are only the most visible problems currently impacting the UK’s National Health Service (NHS). Meanwhile, chronic staff shortages are being exacerbated by difficulties in recruiting from overseas and an increasing brain drain of homegrown talent tempted by better-paying jobs abroad.

In England, waiting lists for consultant-led elective care – standing at 4.43 million on the eve of the pandemic in February 2020 – surged to 7.2 million by early 2023. More than 362,000 of those patients had been waiting more than a year to see a specialist, while an unlucky 1,000 had waited more than two years since their referral (1).

Ophthalmic procedures, particularly cataract surgery, are among the most common operations performed by the NHS. But the Royal College of Ophthalmologists (RCOphth) has repeatedly warned that there are not enough ophthalmic surgeons to cope with the increased demand. As a result, NHS ophthalmic services are facing escalating pressure, with NHS Trusts bracing for a 40 percent increase in demand for eye services over the next 20 years (2).

The risks of such high strain are clear; the RCOphth’s 2018 workforce census suggested that at least 22 patients per month were losing vision from hospital-initiated system delays (2). And that’s why private ophthalmology clinics – rightly seen as a complement rather than a competitor to the NHS – have become increasingly important. By offering patients an alternative path to specialist treatment, they serve as a crucial safety valve.

I’ve seen up close the way the two systems work – and how they can work collaboratively. For the past 17 years, I have worked at Moorfields Eye Hospital in London. Like many ophthalmologists working in the NHS, I also provide privately-funded treatment for some patients. For consultant surgeons, private practice gives us greater control over when and how we work, and greater latitude in the procedures we can offer.

Above all, the goal of private practice is to offer patients a treatment that is precisely tailored to their needs, delivering the best care and optimum outcomes. Achieving this end goal demands more than a simple mission statement; it requires ongoing investment in the most advanced equipment and the best nursing staff, as well as the support of a passionate and committed marketing team to attract patients.

I found all these elements at the independent OCL Vision clinic. OCL’s independence, as well as its freedom to focus on the full range of eye-related surgical procedures, offers a good illustration of how specialist private clinics can – and do – ease the burden on the NHS. Clinics like ours move elective, high-volume surgery away from complex hospital settings to a dedicated outpatient facility. It also makes private care accessible to those who don’t have health insurance, by allowing self-paying patients to spread the cost of their treatment over interest-free instalments.

Thanks to the speed at which it can be carried out, cataract surgery is particularly suited to outpatient day surgery. In addition, as the NHS is unable to offer premium intraocular lens implants, NHS cataract patients who wait many months to be treated may still need prescription glasses even after surgery. Some trusts do offer lenses that correct astigmatism, but often only at higher levels above 2D, even though correcting lower levels of astigmatism would improve vision so that the patient no longer needs distance glasses (3, 4).

The importance of the relationship between community-based optometrists – often the first port of call – and ophthalmology clinics cannot be overstated. Although optometrists’ referrals could put more strain on waiting lists, they are crucial for diagnosing eye conditions early and thus reducing patients’ risk of sight loss.

The NHS is facing funding challenges, but improvements in community eye care could help it become more efficient. OCL Vision has recently adopted a shared care model. This model works with optometrists, encouraging them to refer patients who have private health cover or for whom self-funding is a viable option directly to OCL. Every cataract patient who elects to be treated privately is one less person joining the NHS waiting list. The NHS should continue to expand on community ophthalmology and these types of direct referrals across the UK, which we already see happening in many trusts.

There are other operations where the NHS is suffering serious backlogs, due in large part to a shortage of corneal tissue following years of low donation levels (5). Waiting times are especially long for corneal graft surgery, with half of those referred for treatment on the NHS waiting more than 52 weeks. Moorfields Eye Hospital is the only NHS trust in England able to get round this issue by importing corneal tissue from the USA. With the cost of such imports prohibitively high for other NHS trusts, if you are not at Moorfields and need a corneal graft, private care is the only way to avoid such a lengthy wait.

I am sure every ophthalmologist in the UK shares my desire for the NHS to continue providing surgery that is free at the point of use. But that shared belief should not detract from the work that the private sector is doing to complement the public healthcare system. In reality, there are thousands of people in the UK enduring life-limiting vision problems who are willing – and able – to pay for treatment. If the private sector can step up, it not only improves the quality of life for these patients, but also reduces the burden on the NHS.