Out of Sight - understanding the hidden impact of cataract outsourcing on NHS finances
This briefing note forms part of our wider study into the outsourcing of NHS eye care services to the private sector.
Based on data on the outsourcing of NHS cataract provision which has been provided to us by the 42 NHS Integrated Care Boards in England it finds the following:
The percentage of NHS cataracts delivered by the private for-profit sector has increased from 24% in 2018/19 to 55% in 2022/23.
Over this period the NHS has paid the private for profit sector around £700 million.
The overall budget for cataract provision has doubled over this period result of this outsourcing and the percentage of the total NHS budget which is being spent on cataracts has increased from 27% to 36%
This is likely to mean that there are fewer resources available to treat other eye care conditions such as glaucoma and macular degeneration which lead to irreversible sight loss. We have received limited data from 13 NHS Trusts showing that waiting times for some irreversible eye conditions have increased over this period.
The rise in expenditure on cataract services has been accompanied by an increase in the number of private for profit clinics which have been established to deliver NHS cataract services. 78 new private for-profit clinics have been opened over the past 5 years.
Concerns have been expressed to us by some ophthalmologists that the growth in expenditure on NHS cataract provision is not being driven by patient need but by the commercial interests of the companies delivering them– this is known as “supplier induced demand” and is the consequence of the market driven approach to healthcare planning.
The growth in the amount of NHS cataract care which is being delivered by the for-profit private sector has also been accompanied by a large increase in the number of “complex cataracts”.
NHS England have raised concerns that the increase in the number of complex cataracts cannot be explained by changes in patient complexity.
We have identified that the provision of complex cataracts has increased by 144% over 5 years and that the increase is almost entirely due to the provision of these operations in the private for-profit sector.
We estimate that had the private sector been delivering complex cataracts at the same rate as the NHS then the overall cost to the NHS of delivering cataracts would reduce by £29 million.
The report recommends that policy makers from the National Audit Office, the NHS Counter Fraud Authority, NHS England and the Department of Health and Social Care look into the issues raised in this analysis to ensure that public money is being properly spent and to examine the wider impact of this large shift in how NHS cataract care is being provided on patients with other eye care conditions.
