Health and Social Care Bill

Memorandum submitted by Abbott Medical Optics, Alcon, Rayner and Bausch and Lomb (HS 132)

On behalf of the Ophthalmology Group - Abbott Medical Optics, Alcon, Rayner and Bausch and Lomb – research based ophthalmology companies developing innovative refractive vision therapies in eye care with a particular expertise in cataract treatments.

We welcome the opportunity to answer the call to provide written evidence to the UK Parliament’s Public Bill Committee currently scrutinising the Health and Social Care Bill and hope that it will prove useful in the further development of the proposed Government healthcare reforms.

In the light of the ongoing healthcare r eform debate within the UK Parliament following the initial publication of the Department of Health’s "Liberating the NHS: Commissioning for Patients" proposals, the Ophthalmology Group would like to see improved care for patients with cataract , including prompt diagnosis, the timely provision of patient information on all treatment options, appropriately quick schedul ing of operations, effective after care and to ensur e that second eye operations are not neglected.

The Group feels that a focus during the Public Bill Committee’s discussions on the Health and Social Care Bill on these areas of cataract treatment is important to ensure that cataract patients are able to get access to the best available treatments and, where possible, stay active, mobile and healthy after surgery.  

Summary of the Ophthalmology Group’s written evidence:

· The Bill’s proposals offer both opportunities and challenges for eye care with the proposed new way of commissioning services on behalf of patients and the scope that the Bill provides to extend patient choice.

· The Ophthalmology Group welcomes the possibility that is contained within certain clauses of the Bill to ensure that the provision of eye care treatments and services more accurately reflect patient’s needs and choices in the future.

· The Ophthalmology Group feels that it is vital that eye care patients have access to the widest possible amount of information about the latest advances in cataract treatment before they undergo surgery and when they first see their consultant so that they can make effective decisions in regards to their treatment options, in conjunction with their healthcare provider.

· The Group also feels that it is vital that the representatives on the proposed new structures for the commissioning of healthcare, whether at a local GP Consortia level or those on the proposed Commissioning Board have access to the latest information regarding the most effective cataract treatment options. Ideally, the Commissioning Board would have ophthalmic treatment specialist on it, with a mechanism for either patients or patient advocate groups (or both) to have effective representation at both levels.

· It is vital that in areas where patients develop eye conditions associated with ageing, such as cataract, but at an age which is no longer regarded as ‘old’, that decisions are made with long-term goals in mind, and not simply short-term low cost decisions that do not take into account the patients quality of life or the need for them to stay active and mobile.

How people should have greater choice and control over their eye care in the future and how this can be made as personalised as possible in order to meet their healthcare needs.

1. The development of a more comprehensive healthcare provider approach to improving the choice and quality of care in the UK provides an opportunity for greater patient involvement in regards to their access to the best available treatment options. However, making the most of this opportunity is dependent on how the proposed new healthcare commissioning and decision making system is implemented.

2. As Article 13F and Article 9 of the Bill outlines, patient involvement in improving their access to the best available cataract treatment options would ideally come about when patient representation is implemented at NHS Commissioning Board and GP Consortia level.

3. Patient focused healthcare and informed choice of treatment could be facilitated using these decision making structures and better decisions may be taken because of the involvement of a wider range of expertise.

4. The initiative on greater patient choice and control by the government so early on in its tenure is welcome and we believe it can be delivered upon in this Bill proposal for reform. However, we feel that what should also be pursued is informed choice made by patients in collaboration with their GP and specialist.

5. In order for this to be a reality patients have to be fully informed about their condition and the treatment options that exist. Otherwise patient involvement at Commissioning Board and GP Consortia level would merely be a token gesture and not represent true patient choice.

6. For example, in regards to ophthalmic services, the operation to remove a cataract is the most common surgical procedure undertaken in the UK. It therefore follows that a cataract operation is the most common opportunity for patients to make a decision, along with their GP and specialist, about the preferred treatment option for them.

7. This is especially true as it is a relatively simple treatment to understand and yet the range of options available to patients in terms of eye lens treatments is currently very wide, particularly in the area of implantable refractive lenses.

8. It is clear that in most cases patients are not being informed about additional treatment options and services, such as implantable refractive lenses with additional benefits for cataract (modern implants also treat astigmatism and/or presbyopia) that can improve the patient’s vision to the extent that glasses may not be required. Indeed, such lenses can correct the patient’s vision significantly and this is a treatment option all people should be aware of since genuinely informed patient choice requires a genuinely informed patient.

9. Article 51 outlining the role of Monitor to in promoting the economic, efficient and effective provision of healthcare services could be strengthened here in order to ensure the most effective eye care treatment services are commissioned.

How GP Consortia can work closely with secondary care, community partners and other health and care professionals to design joined-up services that are responsive to patients need for greater choice and control.

10. As stated above, we believe it is important to involve relevant specialist health and care professionals in the decision making by GP Consortia when it is necessary to supplement the knowledge of GPs in order to provide greater choice and control for patients in regards to eye care treatments.

11. A system such as this adds an extra element to the existing commissioning activities currently carried out by Primary Care Trust’s and Strategic Health Authority’s. It will involve healthcare professionals in the process, who have direct contact with patients on a regular basis and whom also often have a greater level of expertise. Such professionals will therefore have a detailed understanding of their health and care needs. The role foreseen for independent advocacy services in Article 170 could help in this commissioning process.

12. Another area of great potential in the greater choice and control agenda within the Bill would be to ensure that local and national healthcare services are linked to a greater extent than they are at present. With members of the GP Consortia being represented on the Commissioning Board such linkage should be easier to foster.

13. Patients with many forms of illness, both short term and chronic, ultimately receive a totality of care from a range of providers e.g. GP surgeries, specialist units in hospitals, home care nursing and social support. However, this treatment is not always co-ordinated. Delivering joined-up services is essential to good patient care and, ultimately, to ensure that money spent is a good investment rather than a cost to the tax payer or private individual. The role of HealthWatch England, outlined in Article 45A, should help in assisting in this process in the future.

14. A notable example of this potential for improvement is in healthcare services for the elderly. A range of disorders commonly experienced by the elderly include Arthritis, Alzheimer’s disease, Parkinson’s disease, Muscular Skeletal Disorders and Cataract.

15. By looking at these conditions together and addressing how healthcare to treat them can be commissioned effectively and linked up with other services patients can be better served by professionals and have wider access to the best available treatments.

16. Indeed, this is especially important considering longer life expectancy in the UK, the economic burden of chronic diseases and the need for people to be healthier and able to work later on in life.

How the NHS Commissioning Board and GP Consortia can best work together to make effective and efficient healthcare choice and control decisions in the future.

17. We strongly believe that specialist expertise must be called upon at all decision making levels in the commissioning of care in order to give patients greater choice and control over their treatment options. This is even more important in order for clinicians to meet the patient outcomes criteria outlined in Article 130 of the Bill, which are effectiveness, safety and quality.

18. Whilst the Bill does focus on how some areas of specialised care will be addressed in the future, we feel that relevant expertise must be involved in all decision making to ensure the best treatment choice and control for patients, as well as secure value for money. In terms of ophthalmic services, this is especially important in order to reflect the link up that exists between GPs and specialist ophthalmologists in the provision of eye care.

 New choices of treatment we would like to see in the NHS following the publication of the Bill.

19. In regards to the question of which new healthcare treatments we would like to see in the NHS, we think that greater choice in the area of eye care would be a priority, particularly amongst elderly patients undergoing cataract surgery.

20. The Coalition Government has recently announced plans to gradually phase out the compulsory retirement age in the UK [1] , suggesting that the elderly population will be working for longer in the near future and that they will therefore require a good level of vision in order to carry out their jobs.

21. This development will require GPs to work closely with secondary care providers, community partners and other health and care professionals who may also have a part to play in terms of the patient’s healthcare needs. Such co-ordination can ensure that they can continue to lead an active and healthy life while staying in employment for as long as possible.

22. This joined-up approach to providing healthcare is particularly important when considering age related visual diseases such as cataract, largely because of the fact that it impedes the passage of light into the eye, having a dramatic impact on a patient’s quality of life.

23. Indeed, as a silently progressing condition, cataract patients often live with a reduced visibility and need frequent prescription changes in spectacles or contact lenses before being appropriately treated by the NHS.

Encouraging people to take more responsibility for their health and treatment choices.

24. In line with Article 178, which refers to Health and WellBeing Boards, we believe that patients should be encouraged to seek more information about their healthcare treatment in the UK and should have access to the widest possible choice of treatment choices.

25. This would result in a stronger relationship between patients and their GPs and clinicians as a better informed patient means that they can gain more responsibility over their treatment. Indeed, with GPs controlling up to 80% of healthcare commissioning budgets in England under the Bill’s proposals, this development will also ensure that they have a clearer understanding of their patients needs.

26. For example, patients undergoing cataract operations should be made aware of the additional treatment options and extra services, such as "multi-function" and "spectacle free" lens treatment options (otherwise known as the intraocular lens with additional functions for cataract) that are currently on the market.

27. This is generally not the case and hence cataract patients do not routinely have access to all the treatment options and as a result many need to wear spectacles for the rest of their lives.

Introducing a right to a personal health budget in discrete and specialised areas of healthcare.

28. We support in principle the idea of introducing personal health budgets. Indeed, we think that such budgets would ideally be introduced on a ‘pilot project’ basis in the area of age related diseases. Such a ‘pilot project’ could be trialled with patients suffering from vision age related diseases such as cataract.

29. This is because UK cataract patients do not always have access to all the latest available treatment options. Indeed, current healthcare commissioning procedures under the Primary Care Trust and Strategic Health Authority decision making structures tend to deny cataract patients the chance to make an informed choice about which treatment might be best for them, especially when it comes to lens implant choice.

March 2011

[1] Information taken from the Department for Business, Innovation and Skills website on the 9 th September, 2010, using the website page on the Government’s current consultation on the phasing out of the compulsory retirement age proposals.