This is part a transcript from 'the tale of two Terrys' and their cataracts that was told on Radio Merseyside on the 25th May 2018. Though I kept my article anonymous, it is easy to access online. The first Terry, an office worker from Kirkdale, visited his opticians to get new glasses only to find out he has a cataract. After receiving a cataract referral from his GP in January 2018 he is still waiting to see a consultant for his initial appointment. Terry’s main frustration is whilst he is ‘on the list’ he is still unsure of the time frame he is expected to wait.
Thankfully although Terry’s vision is limited (unable to see more than 5 yards on a sunny day) he is still able to work, Terry highlights this wouldn’t be the case for everyone, “..if you were a taxi driver, or a bus driver or a train driver you wouldn’t be able to work it’s as simple as that, but my main point is that there must be a lot of people in the Merseyside area in the same situation as me, where basically you’re glad today’s overcast because you can see better, it’s a fact, if you’re in the house you close the blinds you can see better, if you open them it’s difficult to see… all you do every day is wait for a letter to come to say here’s your appointment.”
Terry continues, “… how long you’re going to be waiting I don’t know, and, if say, you had someone who only had their sight in one eye and depended on that other eye and got this cataracts situation – they would really struggle.”
After being advised to go back to his GP if he hadn’t received an appointment by March 26th Terry is still waiting 3 months later, “It is frustrating because if you ever get it, it basically blurs your vision, you get a lot of water in your eye, you get what they call dry eyes where you’ve got to bathe them of a morning – it’s just so frustrating at times you know. Basically, I just feel someone has to speak out for all those people in the Merseyside area who are just waiting for that letter to come through to see the consultant and yet they’re not getting any contact from anyone at all.”
The second Terry, from West Derby, who was referred to an independent high volume specialist cataract provider from his opticians had a very different experience, “…I never heard of any list at all… I actually went to the opticians for an eye test and they discovered that I had cataracts, and within a fortnight I was referred to a local eye unit. And, as I say within 3 weeks I was down I had the left eye done, and basically another 3 weeks and I had the right one done, and I can’t thank these people enough. But with regards to a list no one ever mentioned that I was on any list at all, I just got a letter [to come in for my operation].”
The independent provider's gets patients operated on quickly by concentrating on an efficient cataract patient pathway and perform surgery at a much higher rate than standard NHS units. Their high volume of surgery is associated with improved safety and better measured results compared to the UK average. This makes them popular with patients, who in turn more likely to choose them for their surgery and recommend them to their friends and relatives.
The same principles of efficient patient pathways could potentially be adopted by any eye unit. It is difficult to imagine that any NHS or private ophthalmology department would not aspire to improve their theatre usage and efficiency. It is however difficult to train a cataract surgeon to be consistent, relatively rapid and a good leader of a clinical team that transfers patients in and out of theatre in a safe and efficient manner. It is also difficult to establish a pathway that manages and evaluates the patients before and after surgery, while giving appropriate feedback to the surgeons of their performance. Efficiency improvements as described, would almost certainly mean that the proportion of eye surgeons in the UK performing cataract surgery would reduce, as only the ablest would be selected and trained.
According to the Royal College of Ophthalmologists, cataract surgery accounts for approximately 11% of all operations conducted in the UK. With the recent proposed increases in NHS funding, it would be a major bonus for the NHS to use some of that money to provide cataract operations to all the 'Terrys' of the UK, through improved efficiency and planning from our existing eye units.