Netcare Opthamic Surgery

MORE CONCERNS OVER NETCARE’S OPHTHALMIC PROJECTS

Network Healthcare UK Ltd, ‘Netcare’, have made substantial inroads into the provision of routine ophthalmic surgery in the United Kingdom. The same organisation that was criticised by an independent report into orthopaedic procedures for its poor recruitment and vetting has been awarded a national contract to provide 44,000 operations. Netcare have invested in mobile treatment units to house this national initiative staffed by surgical teams from South Africa on short-term work permits. They build upon their previous experience in providing Independent Sector Treatment Centres (ISTCs) for the NHS in both the ophthalmic field and beyond.

In October and November 2002 Netcare launched ‘Operation Cataract’. This was a contract to provide 800 cataract procedures for Morecambe Bay Hospitals Trust but in the event 929 procedures were performed. Netcare have heralded the initiative as a great success, citing post-operative visual acuity tests and generous feedback from patients.

With our clients’ interest in the Netcare organisation from the orthopaedic side, we were interested to hear of the success of Operation Cataract in Lancashire. However, we were also surprised to learn of contradictory reports in the media and in medical journals of serious problems during Operation Cataract.

Most recently, Channel 4 News screened a special report on Wednesday 7th December 2005 that focused on Netcare more widely. As far as Operation Cataract is concerned, it included claims from former staff that patients were given drugs contrary to national guidelines to lower their high blood pressure. This was in order that Netcare surgeons could carry out the operations immediately. In addition, the item reported that Netcare doctors were “under pressure to hit high target numbers”. It also featured Laurence Vick of Michelmores describing our involvement in claims on behalf of clients relating to Netcare’s orthopaedic operations at MoD Royal Hospital Haslar in 2003 and 2004.

An article on 13th July 2005 in ‘Eye’, the official journal of the Royal College of Ophthalmologists, commented on higher than average rates of endophthalmitis infection. “The report of three cases of endophthalmitis from the OCT [(Overseas Clinical Team)] deployed in the ‘Operation Cataract’ initiative…in late 2002, at a neighbouring NHS hospital in the north west of England raised our concerns”.

Endophthalmitis is an inflammatory condition that affects the intraocular cavities. It is usually caused by infection and can occur as a result of eye surgery, such as cataract removal. It can lead to decreased vision or, at worst, total blindness. The Royal College of Ophthalmologists views cases of endophthalmitis as “critical incidents” that should be reported through clinical governance channels.

It became apparent during the Lancashire initiative that incidents of endophthalmitis were twice as high as the national average. Indeed, according to Netcare’s own figures, the rate of infection was 0.32%, as opposed to the 0.165% national average as reported in the ‘Eye’ article. By comparison a local NHS ophthalmic unit was reported as having achieved impressively low rates of endophthalmitis infection over a number of years: just 0.055%, or 1 in 1833. Netcare’s rate over the five-week project was 3 in 900.

Channel 4 news reported on August 15th 2005 that in a leaked document Netcare blamed the infection rates on one patient’s throat infection and another’s poor personal hygiene. Later, Netcare explained that it did not intend to pin the blame on its patients and apologised to them, however in its own report it still cites “poor personal hygiene” as one of the aggravating factors.

An investigation was launched in 2003 by the Healthcare Commission into the high infection rates during Operation Cataract. Before this report was published, and before Netcare had published its own audit, they were awarded a much larger contract with the Department of Health to provide 44,000 cataract operations nationwide, under a project called ‘OC123’. Concerns have been expressed by MPs and in the press as to how this contract could have been awarded to Netcare before the final assessment of Operation Cataract had been officially presented.

We agree with the authors of the ‘Eye’ article of 13th July 2005 that basic ways of measuring success in ophthalmic surgery, such as waiting-list reduction or post-operative visual acuity, cannot tell the whole story.

Reduction in waiting time for operations is, of course, desirable. However some commentators consider such reduction to be less attractive when the cost to the NHS is calculated of private healthcare providers’ “cherry-picking” routine procedures (as Dr Jonathan Fielden, deputy chairman of the BMA’s consultants’ committee puts it).

Similarly, statistics that measure the quantity of patients with restored vision are superficial if patients are exposed to higher risks of healthcare-acquired infections through their operations, or if such allegations over drug treatment as those reported on Channel 4 prove to be accurate.

All this suggests that there needs to be comprehensive scrutiny of projects such as Operation Cataract. As Michelmores’ Laurence Vick says, “with all outsourcing initiatives, patients need to have confidence that the standard of care they will receive is as high, if not higher, than that which they could expect from NHS clinicians”. As ophthalmologists writing in ‘Eye’ suggest, figures such as infection rate or complication rate (negative performance indicators) serve to highlight “the net clinical benefit of intervention to patients” and should not be overlooked in a rush to focus on waiting lists or target patient numbers.