Around half of all primary care trusts have restricted access to cataract surgery, with the majority basing their decisions on inferior clinical evidence, the medical director of the NHS has told MPs.
Giving evidence to a hearing of the public accounts committee yesterday, Sir Bruce Keogh admitted: “We do know that about 50 per cent of PCTs have restricted access to cataract surgery, and we do know that the bulk of policies used by PCTs actually haven’t used the best evidence that’s available in order to ration that care.
“I’ve raised that with our [strategic health authority] medical directors and also with the new medical directors of the [NHS] Commissioning Board.”
Sir Bruce told the committee that in late 2010 he had begun to be “deluged” by complaints about the differing thresholds at which different NHS commissioners would pay for procedures like cataract surgery or hip replacements.
In response, he said, he had tried to “engage” the specialist surgical associations in developing a clinical consensus across the country about the appropriate point at which such treatments should be offered. This had led to a programme of work with the Royal College of Surgeons called Value Based Commissioning of Elective Surgical Care, to define appropriate access thresholds in a number of areas of treatment.
“That process will be overseen by the RCS and quality assured, but the actual work will be done by the specialist associations,” he said.
The programme is now in its “second phase” and by June will have produced 28 pieces of guidance, he added. Sir Bruce has asked that cataract surgery be one of the areas addressed by the programme.
“If we can get this right, if we can get the surgeons and the commissioners into the same place for thresholds of referral I think we’ll not only improve the quality of care but we’ll save a considerable amount of money,” he said.
He also told the committee that there was “probably quite a strong case for us changing the threshold at which we offer bariatric surgery” to treat morbid obesity. It was “clear”, he said, that “almost within hours” of having this surgery patients’ diabetes “disappears”, along with their need for associated drugs and treatment of the disease.