Local funding would reduce waiting lists for cataracts

Editor—In her editorial on recruiting overseas doctors Rosen makes several important points.¹ We have been informed by the strategic health authority for Avon, Gloucestershire, and Wiltshire Strategic Health Authority that many patients with cataracts from Bristol Eye Hospital will have surgery carried out at a local district general hospital by a European team. Our nursing staff were asked to provide information about the number of “straightforward” cataract cases on our waiting list. We expressed a willingness to carry out this work ourselves and were told by the Department of Health that bids to carry out surgery to reduce numbers on the waiting list would be favourably received. Our highly competitive bid was, however, turned down, without having ever been looked at, despite having the obvious advantages of audit, appraisal, and continuity of care.

Bristol Eye Hospital has consistently been at the forefront of innovation in ophthalmology and cataract surgery in particular.²,³ We have met all our “Action on Cataract” targets and increased our annual cataract throughput by 60% in the past 18 months. We have repeatedly applied to do more cataract surgery but have been unable to do so because funding has not been available.

It is difficult to maintain staff morale and motivation when our local surgical teams see funds that we have repeatedly requested being spent on European surgeons carrying out surgery at highly inflated rates, in the knowledge that we shall be expected to look after their complications and maintain our own low complication rates, while operating on the remaining complex cases and teaching junior doctors. A small amount of extra funding to employ optometrists in the outpatient clinics to see suitable patients could free surgeons to go to theatre and carry out surgery to reduce the numbers on the waiting list.⁴ This would cost a fraction of the money that is earmarked for European surgeons, but it lacks the dramatic impact and headline grabbing potential.

Many of the staff working at our hospital are from overseas, and some are from other European countries. Given appropriate funding we could also advertise for medical staff who could work as fully integrated members of a team here at the Bristol Eye Hospital and thereby invest in and develop the local service for years to come and not just the short term.