ISTC programme is an expensive option

The improvement report in relation to cataract surgery¹ is further evidence that the independent sector treatment centre (ISTC) programme was an expensive over-reaction to the need to increase rates of cataract surgery.² Many ophthalmology departments had improved cataract surgery pathways, as part of Action on Cataract, an NHS initiative supported by the college,³ before the ISTC programme was proposed.

Modest sums of capital pump-primed increased cataract surgical activity by improved facilities and pathway redesign. As this report confirms,¹ such targeted investment quickly pays for itself. The experience in NHS ophthalmology units elsewhere is similar.

Had the Department of Health followed the advice of clinicians, the royal colleges, and the BMA when the cataract and other ISTC schemes were proposed, improved access to cataract surgery would have been realised with much less expenditure, without adverse effects on surgical training, and without destabilising NHS eye departments. However, an alternative direction was taken.⁴ Despite the paucity of clinical outcome data, a cause of increasing concern,⁵ and the lack of evidence of cost effectiveness of phase 1 of the ISTC programme, further investment in cataract surgical facilities continues in phase 2. Meanwhile, for long term stability of the service, the best option for the public is to support local NHS units, which brought down cataract waiting times, which patients need to call on in an emergency or for chronic eye disease, and which train the next generation of surgeons while meeting waiting time targets. A constructive partnership of clinicians, managers, and commissioners is a surer way to achieve sustained improvements in access and quality of care, rather than centrally imposed initiatives and diktat, such as the needless cataract ISTCs.