Plunging waiting times reopen dispute over clinical benefits

The audit of more than 55,000 cataract operations from 2001-06 found thresholds for surgery were 'increasingly lenient' - with 60 per cent of patients operated on in the past two years able to see at or better than the cut-off point under the Road Traffic Act 1988. In 1990 less than 9 per cent of patients with sight at that level had surgery.

Eye surgeon Rob Johnston, the lead author of the research, told HSJ: 'Cataracts were prioritised by the government because they were cheap and easy to do, so it was the single easiest way to reduce waiting lists. But they have been over-egged. There is not an equitable distribution of resources and it is not bringing the maximum health benefit.'

The threshold for surgery is now so low that quality of life improvements for patients after the operations - the key indicator used by the National Institute for Health and Clinical Excellence to determine what treatments should be available on the NHS - were questionable, the research, published in the society's journal Eye, suggested.

Mr Johnston said: 'I'm not saying the surgery is clinically inappropriate, but it's a relative issue and from a health economics perspective the money could be better spent. The need for surgery is currently being measured crudely by the size of the waiting list, not on actual health needs.'

King's Fund fellow in health policy Tony Harrison told HSJ the research indicated that the government's policy on waiting lists was bringing limited 'added value' to patients. 'This is a general problem; it occurs in other areas as well. The government has picked out cataracts for particular focus so there has been political pressure to treat as many patients as possible. But there isn't a clear criterion for saying when enough is enough or for measuring the added value at the margin.'

London School of Economics professor of social policy Julian Le Grand, a senior policy adviser to the prime minister from 2003-05, said: 'Certainly there was always a worry that if we got the waiting times down the threshold for referral would fall and people would be referred for less health need - waiting times are a form of rationing after all.'

But there was not much evidence that had happened, he said. 'Ten to 20 years ago [waiting lists were] a massive problem, so it really was a high political priority. I don't accept it was a distortion of priorities. But now waiting times are no longer so long, we can now afford to start looking at other issues.'

The research follows Sir Derek Wanless's review of NHS performance earlier this year. He concluded the cost effectiveness - measured in terms of improved outcomes and benefits for patients - of waiting list reduction was extremely unclear.

In 2000 the average wait for cataract removal was six months. The NHS plan target of three months was achieved by early 2005, due in part to the Department of Health's purchase of more than 13,000 cataract operations from independent sector treatment centres.

The DoH declined to comment.

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