Day case surgery has benefited patients with cataract in North Gwent

EDITOR—According to Boulton, day case cataract surgery is not being done as often as it could be in Scotland.1 In North Gwent such operations have been available for two years. Our local general hospital has no ophthalmic beds; it has only outpatient and day case facilities and an innovative consultant who does no private practice. We used to have the usual long waits for cataract surgery. Day case surgery was the obvious answer, so funds for the necessary equipment were raised by local people and local fundholders. Fundholders bought the service first, and now commissioning groups and total purchasing projects are buying it.

Patients love the service. Contraindications are few: the frailest patients benefit the most because they do not have the disruption of a hospital stay. Social services and our community nurses have been helpful. Assessment is done by optometrists and consultants and the patients' own general practitioner. General practitioners hold the waiting lists.

I am sure that the reasons why this went ahead were that the consultant concerned is motivated to do the best for his NHS patients and that the trust, having no ophthalmic beds, could expand its services and make money. Consultants with a financial interest in private patients often do not push for a better service, and trusts with an investment in inpatient capacity would say that they would lose income, even though in the real world these beds and staffing costs could be transferred to other specialties. One trust with ophthalmology beds has even written a memo to staff asking them to discourage day cases and to promote inpatient care.

In this matter, patients' and taxpayers' interests are best served by the devolution of day cases to smaller local units under the influence of strong general practitioner commissioning groups. This is better than trusts trying to capture patients from each other and still tending to serve certain vested interests under a flawed internal market system.