Cruel rationing of vital cataract operations has doubled since NHS officials were ordered to stop refusing patients the surgery, a shocking report has revealed.
At least 2,851 people were turned down for a cataract operation in 2018/19 after their doctor had referred them for the procedure, according to figures published in the British Medical Journal.
Astonishingly, the number of refusals have doubled since guidance published by NHS watchdog NICE in October 2017 was supposed to spell an end to people being denied the operations.
In 2017/18 some 1,825 patients were turned down for the procedure and in 2016/17 1,301 were rejected, according to Freedom of Information replies from 185 of England’s 195 clinical commissioning groups (CCGs).
At least 2,851 people were turned down for a cataract operation in 2018/19 after their doctor had referred them for the procedure
Even this is likely to be a significant underestimation of the number of patients missing out on the procedure, because it only takes into account those people referred by their doctor but subsequently turned down.
Many more are likely to be never offered the operation in the first place.
Experts said there was ‘no justification’ of denying patients the procedure and described rationing as ‘a false economy’.
Mike Burdon, president of the Royal College of Ophthalmologists, said: ‘I think is insulting to our elderly patients that this rationing is going on.
‘It is unjustified whatever way you look at it.’
The Daily Mail has been campaigning for three years for the NHS to stop denying patients the operation, which costs just £1,000 and takes just 30 minutes.
A cataract occurs when the lens becomes cloudy with age, causing blurred vision and trouble seeing at night.
The 2017 NICE guidance instructing trusts to offer surgery as soon as a patient’s quality of life is impaired, if their doctor thought they would benefit.
The guidance were ordered by former Health Secretary Jeremy Hunt after the Daily Mail’s Save Our Sight campaign exposed the cruelty of patients being granted the operation on the basis of where they lived.
But because the rules are not legally binding cash-strapped CCGs can decide to ignore them if they want.
WHAT ARE CATARACTS?
The Queen had an eye problem in 2016 that left her right one bloodshot
Cataracts occur when the lens – a small transparent disc inside the eye that helps to focus light – becomes cloudy.
The patches gradually become bigger over time, according to the NHS, and can lead to blurry vision and, in some cases, blindness.
Cataracts affect around half of over-65 in the UK. Some 24 million adults aged over 40 in the US suffer, according to figures.
In children they are much less common, with around one in 3,000 being born with them or developing them in childhood.
The Royal College of Ophthalmologists last year warned that due to a rapidly ageing population, the number of required cataract operations is expected to jump by 50 per cent over the next 20 years.
Yet in his new book ‘The Complete Patient’s Guide to Cataract Surgery’, leading eye surgeon David Allamby claimed there simply will not be enough specialists to cope with the soaring demand.
He said around 1,300 NHS surgeons perform 389,000 operations a year. However, by 2035 more than 2,000 medics will be needed to do around 583,500 procedures annually.
People are more at risk if they have: diabetes, suffered an eye injury, take certain medications or have other eye conditions.
Symptoms normally develop very slowly and include being more sensitive to light and thinking everything looks washed out.
Cataracts can be removed by surgery and replaced with an artificial lens. No other treatment is available.
The Mail has long campaigned against the current unfair system for surgery in the UK, which were a postcode lottery until the health watchdog issued guidelines last August to tackle problem, which had led to many sufferers being denied the straightforward 30-minute operations.
Experts, however, say it is completely unfair to disregard the advice – which is intended to lay out the best options for patients themselves.
Mr Burdon said: ‘What is the point of NICE doing detailed evaluation if CCGs are just going to knowingly ignore that advice?
‘The health service budget is limited, but you should make those spending decisions on the basis of the clinical evidence.
‘Cataract surgery comes out as probably the most cost effective thing in the NHS.’
The BMJ investigation revealed to save money officials are increasingly setting a ‘visual acuity’ threshold – for example considering a patient for the operation only if they score below six out of 12 for their eyesight.
This is also in defiance of the guidelines, which specifically said access to cataract surgery should not be restricted on the basis of how bad someone’s eyesight is, but instead how it is affecting their life.
The report revealed 22 per cent of the total number of cataract operations carried out in England in 2018/19 were screened according to such tests beforehand, three times the number in 2016/17, when only 7 per cent were screened.
The shocking tactic allows CCGs, who decide how to spend NHS budgets in their local areas, to refuse to refer patients for the life-changing operation unless their vision is deemed sufficiently poor.
It comes after the Mail revealed in March that half of CCGs have put cataract operations on a list of ‘procedures of limited clinical value’ – a practice experts said is a gross misuse of the lists which are meant to be used for procedures of dubious worth, such as homeopathy and tattoo removal.
Up to half of over-65s – 4.5million people in England – have some degree of cataract growth.
But the NHS performs only 400,000 corrective operations a year, leaving many to go without.
Nicholas Wilson-Holt, consultant ophthalmologist at Royal Cornwall Hospitals NHS Trust and a former member of the NICE guideline committee, said the prior approval process is ‘acting as a barrier and it’s not in the spirit of the recommendations’.
He added: ‘The evidence clearly was that cataract surgery should not be rationed in this way.
‘A lot of effort was put into producing the guidance, and it is a shame for patients that it is not being followed.
‘It’s such an effective procedure and has the ability to change a patient’s quality of life.’
He added: ‘It makes people question the value of having NICE guidance if we take a ‘pick and mix’ approach to which areas we adopt.’
But Graham Jackson, co-chair of NHS Clinical Commissioners, which represents CCGs, said: ‘Unfortunately the NHS does not have unlimited resources, and ensuring patients get the best possible care and outcomes against a backdrop of spiralling demands, competing priorities, and increasing financial pressures is one of the biggest issues CCGs face.
‘Cataract surgery specifically is an area that is often subject to prior approval.
‘Such clinical decisions are critical in deciding when a patient has reached the stage that an operation will be the best option.’
But a Department of Health spokesman said: ‘Commissioners should take the latest NICE guidelines into account, to ensure fair and consistent access to the best possible treatment for all cataract patients.’
How to protect your vision from cataracts
Get regular eye checks
Blurred vision, halos and light sensitivity may not appear until cataracts are well developed. So have an eye check every two years and annually after the age of 60. If they spot one, your optician can refer to you to an NHS specialist. Private clinics offer surgery for between £2,000 and £4,000 per eye. The NHS does more than 400,000 such operations a year.
Ophthalmologist Professor David Gartry says: ‘Cataract surgery is a safe procedure that can achieve dramatic improvement when cataracts have progressed enough to seriously impair vision and affect quality of life.’
Blurred vision, halos and light sensitivity may not appear until cataracts are well developed. So have an eye check every two years and annually after the age of 60
Tuck into green veg
Eat plenty of dark green leafy vegetables, as they contain antioxidants which may combat stress that damages cells in lens tissue. ‘When symptoms first appear, you may improve your vision for a while with new glasses or stronger lighting but your vision will gradually deteriorate over time,’ says Prof Gartry.
Know the warning signs
One of the most common types of cataract is called nuclear and starts in the centre of the lens. ‘An early sign of one is when a patient becomes more short-sighted after years of a steady prescription,’ says Prof Gartry. ‘That’s because the nucleus of the lens focuses the light more if it has a cataract in it.’