Ophthalmologists found themselves in the vanguard of recent government policy to deploy overseas clinical teams (OCTs) in three mobile cataract treatment units touring England. These were announced in the first of two Department of Health (DoH) initiatives in England, titled Wave 1 and Wave 2, to augment clinical capacity. Since 2004 independent sector treatment centres (IS-TCs) have been mostly, but not exclusively, in schemes approved by the National Implementation Team (NIT), which is composed of special advisers to the Commercial Directorate of the DoH. Non-NIT schemes involving OCTs date back to 2002. The Royal College of Ophthalmologists (RCOphth), and others, raised concerns at the outset of the scheme when it was announced that 44 000 cataract operations would be undertaken in the mobile units over 5 years. Clinical and conceptual concerns (box) were mostly ignored. Implementation rather than consideration of policy has been the mantra. Some concerns have been realised.

CATARACT CAPACITY CONSIDERATIONS

Many observers thought that the use of OCTs in mobile IS-TCs undertaking cataract surgery only was not the optimal method of enhancing or increasing ophthalmic services. The RCOphth favoured expansion and upgrading of local National Health Service (NHS) hospital eye service (HES) units. While the underfunding of medical services in England has a deep rooted history, examples of how local HES units have improved following investment, modernisation, and local clinical leadership have been illustrated to ministers. Excellent progress has been made with the commissioning of dedicated day care cataract facilities within Action on Cataracts,¹ an initiative undertaken long before “modernisation” became contemporary. Ophthalmologists in established NHS settings currently carry out more than 300 000 cataract operations per annum in NHS care in England and NHS waiting time targets are being achieved.² Observers suspected that investing in mobile cataract units, staffed by overseas teams, …