Insights across specialities

National Ophthalmology Database

The Royal College of Ophthalmologists (RCOphth) runs an annual audit to monitor the outcomes of cataract surgery and age-related macular degeneration (AMD) services for the UK – the National Ophthalmology Database (NOD).

There has been considerable growth in the amount of cataract activity in recent years, in part due to direct referral routes which give patients far more control over where they are referred than in other specialties. The mean waiting time for admitted ophthalmology for NHS patients is currently over 19 weeks at NHS providers compared to 10 weeks for independent providers.

This disparity in access is shown in the chart below with many patients waiting far longer than necessary compared to others who live nearby. The size of each dot represents the number of completed admitted pathways in each integrated care board (ICB) area with the y-axis showing the median waiting time at that ICB. Green dots represent patients waiting at independent providers and blue dots show patients waiting at NHS hospitals.

While many patients are clearly choosing to wait for shorter periods, it is important that they also receive high quality care. PROMs data published above illustrates the transformative impact of cataract surgery with the overwhelming majority of patients reporting improved outcomes. The RCOphth publishes hospital-level data from the NOD which provides further reassurance by looking at complication rates.

The 2025 NOD report contains data relating to 275,967 cataract patients treated by independent providers between April 2023 and March 2024. This accounts for 68% of all patients and 71% of eligible operations. The case ascertainment rate for independent providers was 98% compared to 89% for NHS organisations.

The RCOphth applies a risk adjustment methodology to calculate complication rates that reflect the case mix of patients undergoing treatment. All independent hospitals with published complication rates are well within the expected limits calculated by the RCOphth.

The RCOphth states that the ‘expected’ PCR4 rate is 0.89%. The average case-complexity-adjusted PCR rate of independent providers published on the NOD site is 0.46%.

For vision loss, the RCOphth’s expected rate is 0.95%. The average case-complexity-adjusted visual acuity loss rate published for patients treated at independent providers is 0.21%.

While any complication is one too many, the combination of PROMs data, complication data and waiting data shows that the experience of independent ophthalmology is one of rapid access, improved vision and low complications.

National Joint Registry (NJR)

The number of completed procedures submitted to NJR over the past 10 years has more than doubled from just under 74,000 in 2015 to almost 149,000 in 20255. The chart below illustrates that growth and the mix of procedures submitted

High patient consent rates are important because they allow the NJR to link datasets, for example, to link a primary and revision operation to analyse outcomes. The chart below shows that NJR consent rates for orthopaedic procedures carried out by independent providers have been consistently around or above 90% since 2010, except for at the peak of the pandemic period. We are pleased to note that in 2025, the sector achieved its highest consent rates on record at 93.8%

Organisations that submit high quality data are recognised through the NJR Quality Data Provider Awards. In 2025, 296 hospitals received gold awards, 39 received silver and 19 received bronze. 54% of the gold award winners were independent providers.

As of March 2025, data from registries such as the NJR has begun to flow into the Medical Device Outcomes Registry (MDOR), which is part of the Outcomes and Registries Programme (ORP). This means that any patients affected by a future device-related safety issue should be more easily identified regardless of where they received care. We are also working with the central ORP team to ensure that any clinical insights resulting from pooling this data are available to all relevant parties to support future improvements in clinical practice.

Joint Advisory Group on GI Endoscopy

The Joint Advisory Group (JAG) on GI Endoscopy offers accreditation of GI endoscopy services. Accreditation is a supportive process of evaluating the quality of clinical services by guiding services through a quality framework. Accreditation promotes quality improvement through highlighting areas of best practice and areas for change, encouraging the continued development of the clinical service. Accreditation is a voluntary process.

In total, 520 services are currently participating in JAG accreditation, of which 197 have achieved accredited status.

98 independent sector providers are Joint Advisory Group (JAG) accredited (48% of relevant independent providers). By contrast, 32% of relevant NHS providers are JAG accredited. Independent providers make up 50% of all JAG accredited sites in the UK.

Breast and Cosmetic Implant Registry

The NHS Breast and Cosmetic Implant Registry (BCIR) has been collecting data from providers since 2017 with information published for procedures up to the end of 2024. The BCIR records different operation types:

• Augmentation
• Replacement/exchange of implants
• Explant
• Reconstruction
• Exchange of expander to implant.

The 2024 BCIR registry contains information from 350 locations, 53% of which are run by independent sector providers.

17,765 operations undertaken between January and December 2024 were reported to the registry – 16,795 in England, 820 in Scotland and 150 in Northern Ireland. Of these, 73% were performed by independent providers.

Over 70% of operations carried out by independent providers are augmentations (this accounts for 97% of all augmentations). 21% of the sector’s activity are replacements or exchanges of implants.

There has been a steady decrease in the number of augmentations over recent years with 9,400 carried out in total in 2024. This is a similar level to 2017. The only year below that level was 2020, which of course was affected by the Covid pandemic.

In 2024, the BCIR began to collect new information relating to potential risk factors, as part of the transition to outputting data into the Outcomes and Registries Project. This reveals that 20% of patients treated by independent providers had an ASA classification of 2 or above (i.e. a patient with systemic disease), and about 20% had a history of breast cancer. Hypertension and diabetes were the most frequently recorded long-term conditions.

Macmillan Quality Environment Mark

The Macmillan Quality Environment Mark (MQEM) is an award that recognises cancer care environments that prioritise patient wellbeing and patient-friendly spaces. For an organisation to be eligible, at least 80% of its services must focus on cancer care.

The award involves an on-site independent assessment by professionals and patient volunteers, providing feedback and recommendations for improvement. Renewed every three years, the process evaluates design, user journey, service experience and user feedback.

Macmillan describes successful environments as those that:

• Are welcoming and accessible to all
• Are respectful of people’s privacy and dignity
• Are supportive of the users’ comfort and wellbeing
• Give choice and control to people using the service
• Listen to the voice of the user.

72 independent providers currently hold MQEM awards.

Cromwell Hospital case study

Cromwell Hospital is proud to have held the Macmillan Quality Environment Mark since 2022. The environment in which cancer patients undergo treatment is critical to their overall wellbeing and experience and we truly value the opportunity to have expert assessors assess and advise on our set-up.

By ensuring that facilities are welcoming, well-maintained and designed with patients’ comfort in mind, MQEM promotes standards for cleanliness, accessibility and comfort, which are critical in the provision of cancer services.

Implementing the principles of MQEM has helped us drive significant collaboration among the team, allowing every team member to work on the common goal of improving the service. The commitment not only builds long-term relationships but also trust among patients.

The MQEM fosters team work and a patient-centric approach, helping Cromwell Hospital to maintain its reputation as a destination for cancer care.

UK Accreditation Service – Diagnostic Imaging Services

The UK Accreditation Service (UKAS) is the national body responsible for assessing and accrediting organisations, providing certification, testing, inspection and calibration services. It ensures these organisations meet internationally recognised standards, offering confidence in their competence and reliability. UKAS accreditation supports regulatory and market needs, fostering trust in goods and services.

24 organisations are currently accredited for diagnostic imaging services (BS 70000), of which around 60% are independent organisations.

Autism Accreditation Programme

The National Autistic Society’s Autism Accreditation Programme is the UK’s only autism-specific quality assurance programme for organisations providing services to autistic people. Established in the early 1990s, it is the longest-running programme of its kind in the world.

Achieving accreditation requires organisations to complete a structured self-evaluation, develop an action plan, and demonstrate their practice against a rigorous autism-specific framework assessed by National Autistic Society consultants.

In recent years there has been considerable growth in the range of independent providers offering specialist services to patients with autism. Several have used the Autism Accreditation Programme as a framework to drive improvements in care.