Abstract
BackgroundThe number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints.MethodsWe developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams.ResultsFour scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios.ConclusionsUsing new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.
Highlights
The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population
The primary aim of this research is to determine if there are possible changes to the configuration of cataract services, which could improve their efficiency and enable them to cope with increasing demand
The management team made it very clear from the outset that the actions to be evaluated had to be implementable and that any scenario, which is unrealistic should not be considered. This was driven by the management team decision that the scenario associated with the best performance improvement will be implemented in the real world as the services are under huge pressure and running at full capacity
Summary
The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. The total cost for treating people with cataract and providing support and social care for those with partial sight loss or blindness was around £950 Million in 2010 and it is expected to reach a total of around £10 Billion over the current decade [7]
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