Private clinics in England are raking in huge profits from cataract surgery

In England, hundreds of thousands more NHS cataract patients are treated each year in a boom that is driven by private clinics but funded by the taxpayer.

Doctors claim that the trend of outsourcing nearly 60% (up from 24%) of NHS cataract surgeries to private providers is putting pressure on the already stretched NHS budgets and taking away funds for serious conditions which can lead to blindness.

It takes about 10 to 15 minutes to perform the surgery. The procedure is painless and replaces the natural lens of the eye with an artificial lens.

Royal College of Ophthalmologists reports that the number of cataract procedures has increased by almost 40% compared to pre-pandemic numbers. This means an additional 200,000 people per year have the procedure performed on the NHS. The College claims that the increase is due to the outsourcing of services to the private sector.

Ben Burton, president of the college, said that although the independent sector had helped to reduce backlogs following the pandemic it “continued expanding to a point where there is less and less benefit, and more and greater cost”.

The Royal National Institute of Blind People also worries that private eye care providers are having a destabilising impact on NHS services. The Royal National Institute of Blind People said that the use of private providers is having a “destabilising effect on NHS eye care services”.

According to a report published by the Centre for Health and the Public Interest in March, the NHS has spent twice as much on cataracts in the last five years.

The analysis of data collected from 37 out of 42 integrated care boards found that between 2018-19 and 2022-23 the NHS spent about 700 million pounds sterling on private clinics for cataract surgery. This doubled their annual expenditures in NHS hospitals as well as private clinics, from £218m into £437m.

This helped to increase the percentage of NHS eye care budget spent on cataracts from 27% up to 36% over the 5-year period.

The offer is displayed on Google when searching for SpaMedica. SpaMedica is the largest private provider of eye surgery. The offer advises customers to ask their GP or optician to refer them to a hospital of choice. They should receive a response within two to three week.

In the last five years, the top five companies that provide cataract surgery for the NHS opened 101 new eye-clinics in England. This brings the total up to 126. According to data filed with Companies House, the five companies collectively earned more than PS100m in pretax profit by 2022. SpaMedica made £72m.

In Scotland, NHS waiting lists have also increased for eye treatment. This has forced some patients to seek private treatment. Christine McAleer is 76 and a retired nurse from Rutherglen near Glasgow. She decided to go private when an optician’s eye test revealed two signs of glaucoma.

She said, “I am totally against private health care. I worked in the NHS for over 35 years.” “I did not want to lose my sight so I went to a private eye specialist. He told me I did not have glaucoma, but that I needed cataract surgery.

Circle Group, the UK’s largest private healthcare provider, is responsible for Ross Hall Hospital in Glasgow. She spent £6,300 of her savings on cataract surgery in both eyes.

Burton, of the Royal College said that outsourcing was “a good thing right after Covid in order to control cataract waiting lists – but very quickly they have come down to an acceptable level in many parts of England.”

He is concerned that hospitals will lose staff and funding as they turn to private clinics for cataract treatment, which could make it more difficult for the NHS in treating eye conditions like wet macular, the leading cause of preventable blindness and glaucoma.

Burton said, “If you have reduced the waiting list for cataract surgery by a significant amount, then that is great.” “But, if this policy causes more people to become blind due to other conditions, then that’s not desirable.”

The CHPI received data from thirteen NHS trusts that showed waiting times for certain irreversible eye diseases have increased in the past five years, up to April 2023.

Since 2019, NHS clinicians have reported over 200 cases of patients losing their vision due to treatment delays. Hundreds more cases are suspected but not yet reported, according to data from a Freedom of Information request made to NHS England by the Association of Optometristsin march last year.

the thinktank Reformfound that in October last year, there was a backlog for follow-up appointments outpatients not included in government statistics. This included almost 10,000 patients from each trust who were at the highest risk of sight loss.

Burton says that a mild cataract does not require immediate treatment. “A mild cataract in your home is the same as having a dirty glass window. It’s not an emergency for most patients and it won’t make a difference if you wait a few more months.

IHPN, which represents SpaMedica as well as the other companies in the industry, counters by saying that the median waiting time for ophthalmology has now decreased compared to the year before the pandemic.

David Hare, its chief executive, stated: “Over 600,000 NHS Patients are waiting for ophthalmology treatments in England. Independent providers are helping cut NHS waiting time and ensure that as many patients can be treated as possible.”

Colin Hutchinson is a retired consultant and a member of Doctors for the NHS. He is concerned about people having cataract surgery without need and not being informed of the risks of serious complications, such as permanent vision loss, of which they have a 1 in 1,000 chance.

He said that anyone over 60 will have some cataracts, but this does not mean they need a cataract surgery. “There is no benefit to having surgery before you really need it.”

NHS England recently called out private contractors for a significant increase in “complex cataract procedures” for which charges were up to £400 more. The CHPI estimates that complex cases have increased 144% over the past five years, and this has cost NHS an extra £29m in the last two year alone.

A consultation by NHS England raised concerns regarding the increase in December 2022. It said that it couldn’t be explained by changes to patient complexity. In a official response the following month, the Royal College suggested that the increase might be due to a practice called “upcoding”.

All treatments are coded and providers can charge more for the treatment they have performed.

Simon Peck who was head of audit and investigation at Axa Insurance for almost 25 years said that the NHS coding allows providers to request additional payments when a patient’s case is complicated, older, or has comorbidities. This choice is made for good reason, but it can also be abused, especially if there aren’t enough controls or procedures in place.

Hare, of the IHPN, said: “There are robust checks in place, including external audits. Local NHS integrated care systems who commission healthcare activities work closely with providers, to ensure that coding accuracy.”

NHS England has changed its tariffs for cataract treatment in April of this year. There is now only a £30 price difference between a routine cataract operation and a complex one – £868.

NHS England hasn’t yet conducted an analysis on the impact of private eye-clinics on waiting time for cataract surgery or other serious eye conditions. The spokesperson stated: “Thanks for the hard work by staff, the NHS increased the number cataract operations and reduced the backlogs that inevitably built during the pandemic.

The treatment costs are constantly being reviewed and compared to the cost of other treatments.

David Hinchliffe is an ex-Labour Member of Parliament, and former Chair of the Health Select Committee. His GP referred him to a local NHS clinic in the Calderdale & Huddersfield NHS Foundation trust for a cataract surgery.

The trust referred him, “without my knowledge”, to a private firm based in Sheffield called Pioneer Healthcare. This company was sold to Totally in 2022.

Hinchliffe declined the appointment because his GP didn’t know about Pioneer Healthcare, and referred him later to Barnsley Hospital NHS Trust. The report found that Hinchliffe did not require cataract surgery. However, he was being monitored to see if a hole on his retina is causing him to lose vision in his right-hand eye.

Hinchliffe wrote his NHS trust saying: “I don’t want my treatment to come from the private sector. I’m not willing to go there.” I object to the fact that people working part-time for this private company are also employed by the NHS. If they were employed full-time, there would be no reason to use the private service.

Total said: “We don’t provide treatment to patients who pay privately and all of our care is provided on behalf of NHS at no cost to the patient. The waiting lists are growing, so new methods of creating more capacity will be needed.

Independent providers train a much smaller number of people, compared to the NHS. The NHS spends many years training doctors and nurse who then go on to work in private practice. Some even leave their NHS jobs behind.

In the UK, there is a severe shortage of consultant opthalmologists. According to the Royal College, there are only a little under 1,700 consultants. This is about 380 fewer than what’s needed.

According to NHS regulations, optometrists must provide a list of at least five providers who offer cataract surgery. Optometrists are able to advise on the best option, but they may also be indirectly rewarded for referring patients to private clinics. They receive a fee of about £50 per appointment.

Peck, former Axa Audit Chief, warned of the dangers of using private sector services at a recent NHS conference. He is now chief medical advisor at Kirontech. The company provides software that analyzes healthcare billing data in order to detect fraud or poor practices. He believes that the NHS must “protect itself from financial exploitation”.

Peck says that the NHS should also follow the example of insurance companies and create auditing teams to scrutinise billings. These teams would be able to spot any unusual trends, and recover money from private healthcare providers when necessary.

He said: “Both Labour and Conservatives will use private providers, and I don’t believe they are aware of the risks that they are taking.”

SpaMedica is the largest provider. Anil Pitalia founded the eye and skin care centre in Manchester in 2008. It now operates 55 hospitals across England.

Its UK parent company is owned by the Ontario Teachers’ Pension Plan Board and French private equity firm PAI Partners. Pitalia is the head of a private family office with an identical name that has investments in warehouses and Granary office buildings in Leeds, as well as Aeroworks in Manchester.

Newmedica is another leading eye clinic chain. As of March of last year , it provided services to 19 NHS contracts in 28 locations. Darshak, an entrepreneur and Jeremy Diamond are the founders of this eye clinic chain. Diamond is a glaucoma expert who worked as a consultant for the NHS at Bristol Eye Hospital and now works in private practice. In 2020, they sold Newmedica back to Specsavers.

Optegra is a London-based chain of 18 UK clinics owned by MidEuropa, which also operates in Poland and Slovakia. Peter Byloos, the chief executive officer of Optegra since 2018, is in charge.

Community Health and Eyecare Limited, based in Preston, is a hospital chain that includes more than 25 facilities. Imran Rahman is the founder and director of Community Health and Eyecare Limited, which has more than 25 hospitals.

In January 2021, Optical express founder and chief executive David Moulsdale purchased Anglia Community Eye Care Service and was folded into his Glasgow based laser eye surgery company.