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Cataract surgery rationing on the rise

A fifth of patients were screened last year

NHS commissioners are ignoring clinical guidelines by rationing access to cataract surgery, an investigation by The BMJ has found.

NICE’s guidelines state that cataract removal is cost effective and should not be restricted to the more severe cases.

However, in 2018-19 more than a fifth (22%) of patients in England who needed cataract surgery were screened, three times the proportion of 7% in 2016-17.

Among the 185 CCGs that provided data, the investigation found that almost 2,900 prior approval requests or individual funding requests for cataract surgery were rejected last year, more than double the number two years ago.

Although the proportion of prior requests for cataract surgery being rejected has fallen since 2016-17, the absolute number is rising.

The investigation follows research by the Medical Technology Group, a coalition of patients’ groups, research charities and device manufacturers, which found that over half of CCGs in England included cataracts in lists of treatments they deemed to be of “limited clinical value.”

Mike Burdon, president of the Royal College of Ophthalmologists, told The BMJ the findings showed that commissioners were ignoring NICE guidelines.

“Health economists spent 18 months reviewing the evidence for cataract surgery on both first eye and second eye, and they convincingly concluded that there was no justification to ration cataract surgery on the basis of acuity,” he argued.

Graham Jackson, co-chair of NHS Clinical Commissioners, said ensuring patients get the best possible care and outcomes against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“Cataract surgery specifically is an area that is often subject to prior approval,” he stated. “Such clinical decisions are critical in deciding when a patient has reached the stage that an operation will be the best option.”

A Department of Health and Social Care spokesperson added that clinicians were the right people to decide when or whether a patient should have a procedure.”