The Outsourcing of NHS Eye Care to the Private Sector
Over the past 5 years the NHS has increasingly outsourced the delivery of cataract surgery to for-profit private companies.
Concerns were raised with us by senior ophthalmologists in England about the impact that this was having on patient care and also on the finances of the NHS.
There were concerns that private companies were taking away both revenue and staff from NHS eye care departments leaving NHS hospitals with fewer resources to treat more complex patients, including those with diseases which lead to irreversible sight loss.
There were also concerns that scarce NHS resources were being wasted and that the training of the ophthalmology workforce was being harmed because of this policy.
In 2024 we carried out two major studies into the impact that the outsourcing of NHS funded cataract surgery had on both the overall finances of the NHS and the availability of funds to treat complex eye care diseases as well as the impact on NHS eye care departments.
Solutions
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.
NHS England should conduct a review of the overall ophthalmology budget to identify whether disproportionate amounts are being spent on cataract care for people with comparatively lower healthcare needs and whether other more complex conditions are being under-funded.
Integrated Care Boards (ICBs) should examine how the use of the private sector to deliver cataract care on NHS eye care is impacting NHS eye care departments in particular their financial viability, their ability to treat more complex patients and the training of the workforce
Key Facts
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 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 eye care budget which is being spent on cataracts has increased from 27% to 36%
the provision of NHS funded “complex cataract” has increased by 144% over 5 years the increase is almost entirely due to the provision of these operations in the private for-profit sector.
Half of NHS Trusts saw a 21% drop in income from cataracts over a 5 year period affecting the financial viability of their eye care departments
37% of opthalmologists said that they had seen a large negative impact of outsourcing on staffing in NHS eye care departments
46% of opthalmologists who said that the outsourcing large or small impact on the ability of the NHS eye care department to treat more complex patients.
62% - the percentage of ophthalmologists in our survey who said that the outsourcing of cataract care had led to a large (56%) or a small (6%) negative impact on staff training.
Reports on The Outsourcing of NHS Eye Care to the Private Sector
