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LETTERS: Paul R Brogden and Ian G Simmons Good quality monitoring is crucial for informed choice BMJ 2006; 332: 118 [Full text]

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Blind spots in cataract commissioning?

Simon P KELLY   (15 January 2006)

Blind spots in cataract commissioning? 15 January 2006
Simon P KELLY, Consultant Ophthalmic Surgeon Bolton Hospital NHS Trust, BL4 OJR Send response to journal: Re: Blind spots in cataract commissioning?	The survey by Brogan and Simmons (REF 1) revealing little or no robust monitoring of the quality of cataract care commissioned by most Primary Care Trusts is important and a worry now that waves of new providers, including rotating overseas teams (concept known as ‘plurality’) in Independent Sector Treatment Centres (IS-TCs), are increasingly operational in England. Observers including several of the medical Royal Colleges and parliamentarians have expressed concern about the direction of travel of ophthalmic and general care as a result of the new mantra of competition (concept known as ‘contestability’) possibly leading to the fragmentation of English NHS healthcare. (REF 2, 3, 4,5). This survey adds weight to existing concerns and to the recent British Medical Association survey of NHS clinical directors. (REF 6) The recent National Centre for Health Outcomes Development’s report of ISTCs commissioned by the Department of Health did little to allay clinicians concerns. (REF 7) Furthermore adverse impacts of the IS-TCs on the training of future ophthalmic surgeons are now being experienced in some NHS units adjacent to IS-TCs. (Ref 8) Do not be surprised to read more on this topic as the evidence mounts. In the meanwhile, and certainly for long term stability of the Service, the best option (concept known as ‘patient choice’) for the public is to support their local NHS units. It is such units that have brought down cataract waiting times, prior to IS-TC deployment (REF 9), and it is such units that patients need to call upon in times of accident and emergency. 1) Paul R Brogden, Ian G Simmons. ‘Good quality monitoring is crucial for informed choice.’ BMJ 2006;332:118. 2) Kelly SP. ‘Cataract care is mobile. Is the direction correct?’ Br J Ophthalmol. 2006 Jan;90(1):7-9. 3) Ferris JD. ‘Independent sector treatment centres (ISTCS): early experience from an ophthalmology perspective’. Eye. 2005 Oct;19(10):1090- 8. 4) Meacher M. ‘Going private can seriously damage your health service’ The Guardian Newspaper. January 12th, 2006. 5) Denham J, ‘This rigid market model won't survive the real world.’ The Guardian Newspaper. December 21, 2005. 6) British Medical Association. ‘Impact of Treatment Centres on the Local Health Economy in England.’ Report. December 2005. London. British Medical Association. 7) National Centre for Health Outcomes Development. ‘An overview of performance under the Independent Sector Treatment Centre programme’ Dec 2005. London. National Centre for Health Outcomes Development 8) Catherine Guly, Richard Sidebottom, Kim Hakin, Keith Bates ‘Challenges of private provision in the NHS: Treatment centres and their effect on surgical training’. BMJ 2005;331:1338. 9) Kelly SP. Recurring policy errors: blind spots over cataracts. Lancet. 2005 Nov 12;366(9498):1691. Competing interests: Council member; The Royal College of Ophthalmologists. These views are my own.