The Private Health Impact on NHS Eye Surgery

According to NHS England statistics, the number of cataract treatments has risen by nearly 40 percent from pre-pandemic levels. This translates to an extra 200,000 people a year having the procedure, with close to 60 percent of operations being outsourced to private providers.

Policymakers in England have been increasingly keen to make use of independent sector capacity to alleviate the workforce shortages, rising patient needs, and extreme pressure facing the NHS – and ophthalmology has been at the forefront of this shift. “Well over half of NHS cataract procedures are now performed in the independent sector. While this has helped to bring down cataract waits, we have concerns around the knock-on consequences for the sustainability of comprehensive NHS ophthalmology services,” says Ben Burton, President of the Royal College of Ophthalmologists (RCOphth).

Research published by the Centre for Health and the Public Interest (CHPI) revealed that NHS spending on cataracts has doubled in the last five years. Its analysis of 37 of 42 integrated care boards in England found that the healthcare institution had spent approximately £700m on cataract procedures between 2018-19 to 2022-23. During this time, the proportion of surgeries carried out by the private for-profit sector increased from 24 percent to 55 percent, and the share of the total NHS budget spent on cataracts rose from 27 percent to 36 percent.

“We have spoken to NHS commissioners in England who are very concerned that our commissioning framework means they are unable to properly control their cataract spend and, therefore, effectively resource services that can prevent irreversible sight loss such as glaucoma and AMD,” says Burton. This concern, they found, was echoed amongst a number of clinical leads in ophthalmology departments. “Over two thirds surveyed in 2024 said that the impact of independent sector provision on ophthalmology patient care had been negative,” he adds.

Heavy investment in cataract treatment might lead to a risk of insufficient funding, workforce, and infrastructure for other conditions such as glaucoma, which can cause irreversible sight loss if not diagnosed and treated quickly. “We’ve seen a huge political focus on bringing down waiting lists,” Burton notes. “Cataracts is one of the highest volume procedures in the NHS, and policymakers have identified this as a key area to target.” As it stands, England is the only UK nation delivering more cataract procedures prior to the pandemic – up from 430,000 in 2018/19 to 600,000 in 2024.

The Guardian also reports that, under NHS regulations, optometrists should offer a list of five different providers for cataract surgery that patients can choose from. However, this process has been skewered by  some optometrists that have been indirectly incentivised to refer patients to private clinics because they get a fee – typically around £50 –  for a follow-up appointment, which wouldn’t be possible from an NHS hospital.

While bringing down cataract waiting times is important, this cannot come at the expense of other patients who may suffer permanent irreversible sight loss if not treated promptly, says RCOphth. The College has called on the new government to take a considered approach and provide appropriate direction so that independent sector capacity is commissioned in a planned way where it is most needed. It is their hope that this will ensure patients receive timely care and the NHS and commissioners make best use of limited resources.

This article first appeared in The New Optometrist.