Senior UK ophthalmologists up in arms over ISTC scheme

In a letter to the British Medical Journal (BMJ), senior doctors have accused the independent sector treatment centre (ISTC) scheme for NHS cataract services of being an expensive over-reaction to the need to increase the rate of cataract surgery in the UK.

The letter, co-signed by Simon Kelly (Consultant Ophthalmic Surgeon), the President and Vice President of the Royal College of Ophthalmologists and the Chair of the British Medical Association's Ophthalmic Group Committee, points out that many ophthalmology departments have already improved cataract surgery pathways before the ISTC programme was even proposed.

It goes on to claim that, had the Department of Health listened to the advice of clinicians, colleges and the British Medical Association (BMA), improved access could have been provided with much less expenditure, without causing adverse effects on surgical training and without destabilizing NHS eye departments.

However, despite the lack of clinical outcome data and evidence of cost effectiveness of phase 1 of the ISTC programme, further investment in cataract surgical facilities has continued into a second phase.

According to the complainants, the best option for long-term stability of the UK cataract services is for the public to support local NHS units.

An ISTC is a unit run by an independent sector provider and commissioned by the UK's Primary Care Trust (PCT) to offer ophthalmic treatment and diagnostic services. The UK Government's purpose for these centres was to reduce waiting times and to drive improvements in quality and efficiency.

The authors strongly suggest that constructive partnerships between clinicians, managers and commissioners are a better way to achieve sustained improvements, rather than centrally imposed initiatives, such as the cataract ISTC scheme.