NHS Ophthalmic Care: Waiting Lists (Hansard, 17 January 2001)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, cataract operations comprise over 80 per cent of the operations carried out in hospital ophthalmology departments. We have allocated £20 million to modernise cataract services at 60 centres and we have set a target for them to reduce the waiting time from referral to treatment to a maximum of six months by 2003.

§ Baroness Knight of Collingtree
My Lords, by the Government's own admission some of the longest waiting lists in the NHS are for eye care, so why have they not consulted with those most able to advise them on how to deal with this matter, such as the College of Optometrists? Is the Minister aware of the level of expertise and the ready willingness to help in that college? As regards cataract operations, which the Minister has just mentioned, is the sum of £20 million allocated to deal with that problem to be ring-fenced? Concern has been expressed that the money will be allocated to local health authorities, which will spend it as they wish.

§ Lord Hunt of Kings Heath
My Lords, that money is to be spent specifically on cataract services, as it should be. I very much agree with the noble Baroness in her comment on the role of optometrists. I have addressed the annual meeting of the College of Optometrists and I pay tribute to their work. I agree that if they can take on more work, we shall be able to speed up the process and reduce the number of contacts that the patient needs to make with the health service. We shall do all we can to persuade the NHS that optometrists should be used more fully and effectively.

§ Lord Clement-Jones
My Lords, many ophthalmologists recognise the benefits of "Action on Cataracts". However, the bulk of the moneys devoted to that programme are capital moneys. Many ophthalmologists also wish to see revenue funding dedicated to ophthalmic surgery. Can the Minister indicate whether such extra revenue funding will be made available?

§ Lord Hunt of Kings Heath
My Lords, the money is very much capital based. However, the purpose behind injecting this sum of money into the health service is to provide the right incentives and encouragement for local eye services, which will meet the point made by the noble Lord on the role that optometrists can play in providing a much more effective service. The intention is that the outcome of this work will be that treatment is speeded up, waiting times are reduced and optometrists are utilised to the full. We are encouraging other local services beyond the 60 who will receive funding to look at their provision in the same light.

§ Baroness Gardner of Parkes
My Lords, can the Minister say whether there are any other excellent eye surgery centres equivalent to Moorfields Eye Hospital, which we are so fortunate to have here in London? What is the waiting time at those centres? Are they to receive any special funding? The Minister referred several times to local funding. Is there also to be provision for specialist centres in eye treatment?

§ Lord Hunt of Kings Heath
My Lords, as the noble Baroness would expect, there are a number of highly specialist centres throughout the country. In Birmingham we have an extremely good centre that I would commend to the House. Of course, funding for specialised services is dependent on the funding mechanism that we have in place in the health service to ensure that such specialised services do receive the required funding. To that end, we have specialised national and regional commissioning arrangements to enable the appropriate funding to be made. The key issue here relates to local services, because that is where we shall make the best impact in terms of reducing waiting times.

§ Lord Walton of Detchant
My Lords, the initiative to which the Minister has referred is most welcome. However, the problem lies not so much in the length of the waiting list after having seen an ophthalmologist as in the waiting time in many centres of excellenceߞnot only Birmingham, London, Oxford and Newcastle and others—for a consultation with the ophthalmologist. What steps are the Government taking to increase the consultant establishment in this specialty?

§ Lord Hunt of Kings Heath
My Lords, the advice that I have received in relation to consultant specialty is that at present we have enough consultants to meet the demands being placed on the service but we need a much greater emphasis on improving the way in which the service is organised. Improvements can be made. I have mentioned already the role of optometrists. Other improvements can be made in relation to journeys to reduce the number of times a patient has to be seen by the service. With the injection of this 1117 resource and the improved organisation and management of services, we shall be able to achieve the target that we have set.

§ Lord Ezra
My Lords, the Minister referred to a period of six months between referral and surgery in the case of cataract treatment. Does this present a health hazard?

§ Lord Hunt of Kings Heath
My Lords, the question of waiting is the biggest challenge that the service faces. That is why we are right to place a great deal of emphasis on reducing waiting times, not only in relation to cataract operations but in relation to all operative procedures. Clearly we wish to get the figures down as much as possible. If we can achieve a maximum of six months by 2003, we will have done very well. We need to ensure that we get the waiting time down by as much as possible. In most cases, the sooner people are seen and treated the better it is in health terms.

§ Lord McColl of Dulwich
My Lords, £20 million split between 60 centres is one-third of a million pounds each. Can the Minister say how that will be spent? How many operations does he think that will accomplish?

§ Lord Hunt of Kings Heath
My Lords, the point about the £20 million is that it provides a real incentive to those 60 local services to improve the management and operation facilities available to provide treatment for patients. If we are as successful as intended, we shall then be able to achieve a through-put of patients to meet the target that we have set of a maximum of six months. The money will be spent on various facilities to enable us to improve the service that we offer. I stress that it is not only a question of money but about how we organise those services. It is about how we involve optometrists much more in the provision of services. If we can pull that off, I have no doubt that we shall achieve the target.

§ Lord Jenkins of Putney
My Lords, is it the Government's position that the waiting list time is dependent upon the insertion of government money or are there other factors which would entail a certain amount of waiting time, whether or not that money was found? If so, what are the Government doing about it?

§ Lord Hunt of Kings Heath
My Lords, the waiting time issue in the health service is a multi-faceted challenge. Of course resource is extremely important. It is also important that we have enough people to provide the service required. Crucially, we need to ensure that the organisation of the NHS is as effective and efficient as possible. The injection of £20 million into the service will enable us to provide additional facilities and it will act as an incentive to change the way we organise those services. I believe that by 1118 changing the way we organise those services we can achieve a faster through-put of patients and meet the six months' target.