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Cataract Operations

Volume 776: debated on Wednesday 16 November 2016


Asked by

To ask Her Majesty’s Government what plans they have to increase the availability of and capacity to undertake cataract operations.

My Lords, clinical commissioning groups are responsible for commissioning cataract surgery for their local populations. Patients have the right to start consultant-led treatment within 18 weeks of referral for non-urgent conditions. All patients should be treated without unnecessary delay and according to their clinical priority.

My Lords, given the recent dispiriting report from the RNIB of ever-lengthening queues and waiting times for vital cataract operations, will the Government provide more money and stop offloading it—as the Minister has just done—on to CCGs? Will they at the same time embrace innovative and new practices and initiatives by the community optical service and practice?

My Lords, there is evidence of variation around the country, of that there is no doubt, although overall, the waiting times for cataract treatment are no longer than for other procedures. The RNIB has identified two issues of concern: second eye operations and follow-ups. We have asked NICE to bring forward further guidance in 2017 so that there is a proper evidence base for the threshold for cataract operations. As the noble Lord referred to in his Question, we are developing opticians in the high street to help do the follow-up consultations.

My Lords, I declare an interest: I am sure I am one of many in this House who has benefited from cataract operations—I went to the Western Eye Hospital, which is part of the Imperial College system in London. Is the Minister aware of the huge change in life for people who have cataract operations now? My father had to travel from Australia to Vienna in 1938—in fact he was there when Hitler marched in; he got out as quickly as he could after that, but with his eye bandaged it took a bit of time. But that was because one of the only people in the world who could do cataract operations at that time was this surgeon in Vienna. We really do not value what we are getting now, which is done so well.

The cataract operation is remarkable; it can literally give back people’s sight in the course of a 10-minute operation. I think I am right in saying to the noble Baroness that the first cataract operation was done in 1787.

My Lords, the Minister is absolutely right in accepting that there is a huge variation in the availability of cataract surgery. In fact, the variation is fourfold. Nearly 35% of people over 65 will require cataract surgery, and such surgery is the definitive form of treatment for cataracts. Incidence will rise with age and, with ethnicity, it is even higher. As the Minister accepted in part, the variation is caused by variation in commissioning, which is based on clinical judgments, not the scientific evidence that CCGs need. Better guidance will help, as he suggested, but unless the guidance is appropriately monitored and the CCGs follow it, nothing will change—40% of people do not get second eye surgery because CCGs will not commission it.

I mentioned earlier that NICE will bring forward its evidence-based guidelines in 2017. It will be up to CCGs to commission on the basis of those guidelines, and they in turn are monitored by NHS England. Clearly there is variation; there is variation wherever we look in the National Health Service. One of the reasons why Professor Briggs is doing his Getting it right first time work is to try to identify that variation and address it.

My Lords, I declare an interest as a trustee of the Royal College of Ophthalmologists. I understand from the Minister that NICE is preparing guidelines, but in the meantime, will he take this opportunity to condemn CCGs in which there is crude rationing of cataract services? I refer him to the Daily Mail freedom of information survey in July, which showed that under some clinical commissioning groups, a person not only had to have poor eyesight, but had to demonstrate that they had fallen twice in the last year, lived alone and had hearing problems, or that they were caring for a loved one. If that is not crude rationing, I do not know what is.

Clearly the case that the noble Lord mentions is totally unacceptable. Where CCGs are rationing access to cataract operations on such a crude basis, we would all deplore that. But as I said, there is variation around the country, and the new NICE evidence-based guidelines will help to address that.

My Lords, in terms of cost-effectiveness alone, is not the cataract treatment a good one to back? The developments have been remarkable. Years ago one spent two months in a darkened room, but now it is bad luck if one has to spend two hours.

The cataract operation is a remarkable one. There is a huge variation in productivity around England: some surgeons are extremely fast, and in some hospitals the process has been streamlined. Interestingly, in India, where cataract operations are largely done by technicians not doctors, the cost per operation is below $10.

My Lords, does the Minister accept that greater use could be made of laser eye surgery for cataracts, as has been pioneered at Frimley Park Hospital? This could result in better outcomes for patients, reduce the risk of complications and, above all, reduce waiting times, which are unacceptable —up to 15 months—at present.

My Lords, I do not know enough about laser eye surgery to give the noble Lord a proper response, but I will investigate. The average wait time for a cataract operation is 12 weeks, and very few people wait for more than 18 weeks—but of course, that does not alter the fact that there are people who have not been referred for a cataract operation when perhaps they should.