Hornby S, Kirkwood G, Pollock AM. Outsourcing NHS cataract surgery in England – a misguided policy? A comparison of waiting times and admissions in England and Scotland 1997/98-2018/19. Abstract. Oxford Ophthalmological Congress 2025

Introduction

This study analyses the impact of commissioning guidance and waiting list policies in England & Scotland on admissions and waiting times for NHS cataract surgery. 

Methods

Hospital episode statistics data for all NHS funded cataract operations in England and Scotland between 1 April 1997 and 31 March 2019 were analysed for admission rate, waiting times and by type of provider (private vs NHS) and by deprivation quintile. Analysis was by provider, socioeconomic deprivation and comorbidity over 3 times periods (pre-2003 prior to privatisation), first phase of privatisation 2003-2008, expanded privatisation (2009 onwards).

Results 

Admission rates more than doubled between 1997 and 2019 and waiting times fell. England has expanded mainly by using the private sector but not in Scotland. Since 2009 age adjusted admission rates have fallen across all deprivation quintiles in the NHS with a divergence between England & Scotland with England becoming less pro-poor and Scotland more pro-poor. Admission rates in England will be pro-rich by 2040. Waiting times were 60.8% higher in England than in Scotland in 1997/98 and 8.7% lower in 2018/19. 

Conclusion

Admissions for cataract surgery in England did not show social inequality but are becoming more unequal in England to the detriment of the poorest patients. With increasing trend towards privatisation in England issues of access as well as possible supplier-induced demand, over treatment of cataracts need to be investigated as does the role of the private sector in destabilising budgets, training and other NHS hospital eye services.