Cataract surgery rationed as PCTs ignore evidence, study finds

Almost half of PCTs unfairly restrict access to cataract surgery and the vast majority of commissioners fail to follow national guidance or clinical evidence, a UK study shows.

Cataract surgery: hit by PCT rationing (photo:SPL)
Cataract surgery: hit by PCT rationing (photo:SPL)

Imperial College London researchers found 47% of 120 PCTs explicitly ration access to the procedure despite clear evidence of clinical and cost effectiveness.

The findings come after a GP survey of 682 GPs found more than a third (35%) said PCTs are ignoring a government order not to ration treatment on the basis of cost alone.

Their study found 92% of 67 rationing policies used criteria that ignored national guidance or clinical evidence.

Researchers said wide variation in these policies has 'the potential for major inequalities in access'.

The study was co-authored by Lord Darzi, who led the influential NHS Next Stage Review.

Cataract surgery is even more cost effective than knee replacements, yet there have been multiple reports of commissioners restricting access.

Lead author Sophie Coronini-Cronberg and colleagues asked 151 PCTs for their cataract surgery policy, of which 80% responded. They found huge variations in the minimum thresholds for vision loss that patients must meet before surgery is granted, set by PCTs.

The authors wrote: 'Only offering surgery to patients with extremely poor vision may exclude patients with a large capacity to benefit, as patients with 50% vision feel very disabled by the loss.'

Guidance states that patients shouldn't wait more than two months for surgery, but only one PCT advised a minimum waiting time.

The researchers believe the study may even have underestimated the number of PCTs rationing care.

Researchers concluded: 'Given readily available evidence is not being used, and the suggestion that cataract surgery should be reduced or even stopped, there is a need for the development of national guidance that outlines which groups could benefit from surgery, and also where local discretion would be appropriate.'

Click here to access the paper

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