UK ophthalmologists caught up in cataract crunch

BY the end of next year, the UK government wants Britain 's cataract waiting list reduced to three months. Only a year ago, the government said it would reduce the waiting list to three months by 2008.

Helen Seward

The accelerated target date follows the government's determination to reduce waiting lists in the United Kingdom . For example, some 50,000 people 75 years of age or older are waiting at least three months for a cataract operation. Although UK ophthalmologists have long called for the reduction of cataract waiting lists, many believe that the current targets represent a knee-jerk reaction that could endanger the long-term development of ophthalmology in Britain . To reduce the cataract surgery list, the government has deployed a slew of initiatives. Those include: the establishment of public-run and private-run diagnostic treatment centres, the importation of foreign ophthalmologists to perform cataract surgery in NHS hospitals, the exportation of UK patients to foreign hospitals, and the farming out of cataract surgery to existing private-practice ophthalmologists.

Many ophthalmologists complain that the government's focus on cataract surgery is undermining the provision of other, more difficult eye treatments. In particular, they fear that money and staff will be devoted to the targets by squeezing other necessary eye services and teaching. There's also economics: in many hospitals, money allocated to cataract surgery typically ends up subsidising more expensive eye treatments for other conditions.

David Allen , FRCOphth, president of UKISCRS, believes there are a number of reasons behind the government's plan.

"For one, cataracts form the biggest single component of any surgery waiting list, so it is a big number," he says. "Two, it's emotive. Politician's like to pick on something that people can relate to. And people can relate to the idea of waiting for a hip-replacement or cataracts. Cataracts are important because they are stopping people's sight. It is easy for people to understand the benefit in getting these types of operation done quickly. So it's in the politician's interest if the media have made this an issue, then the politicians have to respond to that.

"Thirdly, it is an area where we have demonstrated over the past four or five years that as a group we are actually interested in providing modern services, and we are seen as a group that are willing to modernise." And, Dr. Allen adds, cataract surgery is also an easy target because there is a misconception among policymakers that the surgery is always quick and easy. Against such a backdrop, Dr. Allen told the UKISCRS meeting that ophthalmologists in the NHS should do what they can to perform more cataract surgery.

"Some of you feel these are unrealistic targets," Dr. Allen told his audience. "Regardless of that, however, they are targets set by the elected government and therefore there is a need to explore the best ways of meeting them."Dr. Adrian Beckingsale, a consultant ophthalmologist in Colchester , told the meeting that he and his colleagues had tried to do more surgery, but were told not to. He explained how a scheme set up by the Department of Health was determined to use German doctors whatever the cost.

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"The government paid a team of German ophthalmologists £1.5 million to do 1,000 cataracts," Dr. Beckingsale said. "We told them that we could do much more with the same money, but they were determined to go through with the project. We worked with the team because we couldn't get funding any other way. There's a disappointment that there was enormous amounts of money available to fund a very cost inefficient way of providing resources to fulfil a political need rather than a local clinical need. We couldn't find any resources unless it was in partnership with the German doctors."

Helen Seward, FRCOphth, a consultant ophthalmologist at Croydon Eye Unit in London , believes that poor communication has damaged the relationship between the government and UK ophthalmologists. "I think people are feeling threatened because there are major changes all coming together," she said. "The big problem is that they are not engaged. The issues are not discussed with the ophthalmologists." She added that ophthalmologists should get informed but she cautioned that health authorities have to take on their concerns. "Of course there's a political motivation behind it, but is this going to benefit our patients and benefit our departments? We would be very unwise to not get involved in how this money is spent within our own departments."

Some ophthalmologists said that colleagues should consider the bigger picture of the health services. "Yes, it's important to get the waiting lists down, but I think there are issues of priority," said Paul Rosen FRCOphth. "You will have a situation next year where all cataracts are treated in three months, but what about cancer radiotherapy? There are hip and knee replacement operations that have long waiting lists, and involve real pain, but they are not receiving the same priority. Yes, it's important to return people's sight, but there are other priorities that should not be forgotten in the rush to treat cataracts."

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