by Eric Barnes
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11 Jan, 2023
Since my last blog 2 years ago we have experienced turbulent times, in the NHS. Once the restrictions were lifted, we found ourselves in a sea of cataracts. Clinics were emotional rollercoasters with several clinics in succession studded with patients so poorly sighted that they could not see the consultation chair. Thankfully, they all managed to leave the RVI with better vision on their return home! Such is the miracle of modern cataract surgery. When the chips are down, the NHS steps up to the mark to help the most needy. I wish I’d managed to record the joy of a patient shouting that he could see,as I was typing up the operating notes! The waiting list for surgery was terrible after the pandemic and all my general clinics were converted to Action for Cataract clinics, which I run with a team of able staff. The waiting list is being whittled down but difficult times lie ahead for the future of cataract surgery locally. With the struggle to bring down the waiting list has come outside competitors, eager to take NHS money for their own profit. Their strategy is simple, encourage the opticians to refer patients to them with a monetary incentive for their referral, cherry pick the straight forward cases that can be turned over quickly, send all the technically difficult cases to the NHS, and send all the complications of their surgery to the Emergency Eye Department! Interestingly, they seem to have a much lower threshold for proceeding with cataract surgery based on the referrals I see. They clearly feel they are doing something reasonable and positive but at the coal face, something difficult to measure is happening. We now have less money for the NHS to invest in the NHS, and fewer technically straight forward cataracts for training the future consultants. In addition, they are taking the hard working nurses and doctors for weekend locum work , which impacts on the hours they can do in the NHS. Sometimes these staff are leaving the NHS altogether to work for the private providers. Reducing the already depleted number of trained nurses for the service. Not a good recipe for a better NHS in a few years time. Almost all the NHS cataract work has now moved to the Newcastle Westgate Cataract Centre, which is opposite the main car park at the old Newcastle General Hospital. We have the capacity to do about 50 cataracts a day. Even if for some reason ,we only staffed it for 40 weeks a year, that would allow us to do 10000 cataracts a year. Pre-pandemic and independent providers, the region would do around 8000- 8500 cataracts a year, with a waiting list of roughly 12-18 weeks from referral. The crux of the problem now is staffing, partly because the independent providers are poaching our trained staff. The NHS seem powerless to defend themselves against this threat. On a brighter note, there are a group of patients who are still getting a decent service from the NHS. The patients with tumours round their eyelids, infected tear drainage systems and patients troubled by misdirected lashes on to the front of their eye will get priority surgery, as their conditions can’t wait without potential permanent detriment to their vision.. Unfortunately, that means if you have a stable non sight threatening problem, you might feel like you are waiting forever for your turn. That is definitely not the case, but the waiting times are painfully long under the current conditions.