Dear NHS South East London Integrated Care Board,

I am writing from the Centre for Health and the Public Interest (https://chpi.org.uk/), a charitable think-tank focused on health and social care. We wrote to you alongside all other ICBs in January with a request for information regarding the expenditure and activity data on cataract surgeries, and again in April to extend this dataset further.

Firstly, we’d like to thank you for the information provided to date. It has been very useful in quantifying the extent to which delivery of cataract surgeries has shifted from NHS Trusts into the independent sector, and further requests to NHS Trusts have explored the impact on their financial position.

To progress this research further, we would like to expand our analysis from the expenditure and activity on just cataract surgeries, to a wider bundle of Ophthalmology services and treatments to see how patterns of delivery in Cataracts map to other eye-care treatments such as for Glaucoma or Macular Degeneration.

Therefore, we would like to request spending and activity data on ophthalmology services broken down by different conditions/treatments. Note that breaking this down further into NHS spending/activity and Independent Sector spending/activity is not necessary for this request.

While we appreciate that such a precise breakdown of spending and activity across a broad range of treatment functions is complex, we hope it would be helpful in analysing and exporting the data to use the tariff codes in use by NHSE as a search and filtering criteria.

By our understanding, ‘Admitted patient care, elective and outpatient procedures’ are covered by Healthcare Resource Group Code (HRG Codes) and the Ophthalmology Services fall under the codes beginning BZ***, in the 93 rows 121-213 of the “1 APC & OPROC” tab in the National Tariff Workbook 2022/23 (https://www.england.nhs.uk/wp-content/up...).

Furthermore, there is additional data on first and follow-up ‘outpatient attendances’ falling under the Treatment Function Codes ‘130 Ophthalmology Service’ and for completion the “216 Paediatric Ophthalmology Service” on the “2 Outpatients” tab.

Although we do not have a firm understanding of the accounting and finance software in use by the ICB, we are hoping that an export of spending and activity broken down by HRG Code and Treatment Function Code would be possible, and not overly burdensome for the ICB. However, we do understand that systems and processes differ and the ICB may have its own internal categorisation which could provide a similar dataset.

We have requested annual data between 2017/18 to 2022/23, but understand that in some cases the merger of CCGs into the ICB makes some financial data difficult to recover. And where tariff income was replaced by COVID block funding we would ask that these figures be provided for the relevant years.

So overall, while we have requested what would be our ideal dataset, if gathering this data proves challenging or impossible then it seems likely there would be an alternative dataset which is more readily available to the ICB and would satisfy our research, so I’d be happy to discuss it.

With that context, could we please request the following:
1. Annual total ICB spending on Ophthalmology services, as defined above, for the years 2017/18 to 2022/23
---This should preferably be broken down by HRG Code and Treatment Function Code

2. Annual ICB Commissioned Activity on Ophthalmology services, as defined above, for the years 2017/18 to 2022/23
---This should preferably be broken down by HRG Code and Treatment Function Code

3. Commissioning and procurement strategy
Could you please provide a digest or summary of information, preferably with attached policy documents, which outline the ICB’s current commissioning strategy with regard to Ophthalmology services.
--- Here I would expect some ICBs to have conducted or inherited an assessment of the local demand for eye care treatments and strategies to meet this demand.
--- In ‘determining whether this information is held’ I would just expect a brief conversation with the responsible officer in case anything came to mind (which it may not) rather than an exhaustive search of the organisation.

4. Independent Provider Information
For each of the five largest Independent Sector Providers, could you provide information for the most recent complete financial year 2022/23:
--- 4.A. Total Cataract Surgery Activity during the year
--- 4.B Total Cataract Surgery payments during the year

I don’t believe any exemptions are in play for this request. While Part 4 of the request could be argued to be commercially sensitive, the prejudice arising from disclosure of these two figures is vanishingly small. Independent sector activity figures are published in the Hospital Episode Statistics, and the Tariff prices per procedure are publically available.

There is in anycase an overwhelming public interest in disclosure, in order to further public interest research and communication of NHS policy challenges to policymakers and the general public.

If there is anything I can clarify or explain regarding this request I would be more than happy to discuss this further via email or on 0791 322 8601 as part of the Section 16 Duty to Advise and assist.

Many thanks, and sincerely,

Sid Ryan
The Centre for Health and the Public Interest

Dear FOI team,

Many thanks to you and the officers for pulling this together, the activity data is perfect. Could I just clarify the the point on being unable to gather spending information?

I've processed the responses from about two thirds of the ICBs now and this is the first of this round that has been unable to provide the information. For example, North East London was able to provide the information in full for all years, so I don't quite understand the issue here.

Yours sincerely,

The Centre for Health and the Public Interest (CHPI)

Dear FOI Team),

Apologies, I meant to provide a link to the NEL ICB response for reference (https://www.whatdotheyknow.com/r/195bc64...)

Yours sincerely,

The Centre for Health and the Public Interest (CHPI)

Dear FOI Team,

My apologies, but further to the above, but could I just clarify something that has come up in the course of our data analysis?

The data you've provided so far is what we've asked for, so no complaints there. But some other ICBs went a bit further in the categorisation of their data by classifying some HRG Code procedures as either 'Inpatient or Outpatient', and that raises the question of how this distinction has been handled by the other ICBs.

As I couldn't see this in/Outpatient breakdown for your ICB's data, I just wanted to double-check whether what you've provided constitutes both Inpatient AND Outpatient Spend/Activity data, or if what has been provided is JUST inpatient data, or JUST outpatients.

If you would be able to clarify this with the officers that would be much appreciated, and we can do the categorisation on our end. We wouldn't ask for a further export from your systems.

Many thanks again for your help,

Best,

Sid