{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:42:52Z","timestamp":1785415372492,"version":"3.56.0"},"reference-count":36,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["HEPL"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This paper explores changes in the commissioning, contracting and provision of NHS-funded cataract surgery in England over the last decade, focusing on the growing role of independent sector providers (ISPs). In recent years, there has been a dramatic rise in NHS-funded cataract surgery (from almost 417,000 cases in 2018\/19 to about 650,000 in 2023\/24) with the ISP share increasing from 22 to 57 per cent. A mixed-methods approach was employed, combining quantitative analysis of over 4.6 million NHS-funded hospital admissions for cataract surgery (2013\u20132024) and qualitative interviews with senior NHS and ISP stakeholders. Interviews were analysed using reflexive thematic analysis. The shift to ISPs was largely unplanned, driven by long NHS waiting lists, favourable payment tariffs, and low barriers to entry for new providers. ISPs\u2019 involvement has contributed to reduced waiting times and improved productivity, potentially due to specialised infrastructure and incentive structures. However, concerns exist about contract management, service quality, and value for money. The study highlights the need for improved service commissioning, tariff reform, stronger contractual oversight, and effective monitoring to ensure quality and value. These findings have broader implications for healthcare systems balancing competition, patient choice, and public\u2013private delivery models in elective care.<\/jats:p>","DOI":"10.1017\/s1744133126100486","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:47:10Z","timestamp":1778658430000},"page":"1-19","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Public service and private profit: a mixed methods study of cataract surgery in England"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9325-3362","authenticated-orcid":false,"given":"Gemma","family":"Stringer","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/027m9bs27","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Grigoroglou","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, The University of Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Walshe","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School, The University of Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School, The University of Manchester"},{"name":"Health Services Management Centre, University of Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Allen","sequence":"additional","affiliation":[{"name":"Danish Centre for Health Economics, University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8454-4640","authenticated-orcid":false,"given":"Michael","family":"Anderson","sequence":"additional","affiliation":[{"name":"Centre for Primary Care, The University of Manchester"},{"name":"Health Policy, London School of Economics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Bloor","sequence":"additional","affiliation":[{"name":"University of York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Gee","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School, The University of Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Gutacker","sequence":"additional","affiliation":[{"name":"University of York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"S1744133126100486_ref12","doi-asserted-by":"publisher","DOI":"10.1007\/s10729-008-9069-4"},{"key":"S1744133126100486_ref11","unstructured":"Centre for Health and the Public Interest (2024) Out of Sight - Understanding the Hidden Impact of Cataract Outsourcing on NHS Finances. [Online]. Available at \u2013https:\/\/chpi-fd3a752d575a6d9748da-endpoint.azureedge.net\/wp-content\/uploads\/2024\/03\/PDF-Version-of-Final-Out-of-Sight-Report-Volume-1\u201311032024.pdf (accessed 19 November 2024)."},{"key":"S1744133126100486_ref34","unstructured":"The Royal College of Ophthalmologists (2007) The Way Forward [Online]. Available at https:\/\/www.rcophth.ac.uk\/wp-content\/uploads\/2021\/12\/RCOphth-The-Way-Forward-AMD-300117.pdf (accessed 19 December 2021)."},{"key":"S1744133126100486_ref28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.p71"},{"key":"S1744133126100486_ref22","unstructured":"NHS England (2023c) Patient Choice Guidance. Available at https:\/\/www.england.nhs.uk\/long-read\/patient-choice-guidance\/#for-primary-care-referrers (accessed 9 June 2025)."},{"key":"S1744133126100486_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldq014"},{"key":"S1744133126100486_ref7","first-page":"1","volume-title":"Encyclopedia of Quality of Life and Well-Being Research","author":"Braun","year":"2020"},{"key":"S1744133126100486_ref20","unstructured":"NHS England (2023a) 2023\/24 Priorities and Operational Planning Guidance. Available at https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2022\/12\/PRN00021-23-24-priorities-and-operational-planning-guidance-v1.1.pdf (accessed 19 December 2025)."},{"key":"S1744133126100486_ref15","unstructured":"Holmes, J (2023) Independent Health Care and the NHS London. [Online]. Available at https:\/\/assets.kingsfund.org.uk\/f\/256914\/x\/5e4aed4284\/independent_health_care_and_nhs_2023.pdf (accessed 19 December 2025)."},{"key":"S1744133126100486_ref21","unstructured":"NHS England (2023b) Integrated Care Boards in England. Available at https:\/\/www.england.nhs.uk\/publication\/integrated-care-boards-in-england\/ (accessed 19 December 2025)."},{"key":"S1744133126100486_ref31","doi-asserted-by":"publisher","DOI":"10.1017\/S1744133117000366"},{"key":"S1744133126100486_ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2004.07.003"},{"key":"S1744133126100486_ref23","unstructured":"NHS England and NHS Improvement (2022) National Eye Care Recovery and Transformation Programme Case Study [Online]. Available at https:\/\/primaryeyecare.co.uk\/wp-content\/uploads\/2022\/03\/National-Eye-Care-Recovery-Case-Study_Single-point-of-access-SPoA-Final-Draft.pdf (accessed 9 June 2025)."},{"key":"S1744133126100486_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-7-85"},{"key":"S1744133126100486_ref14","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2014.123"},{"key":"S1744133126100486_ref10","doi-asserted-by":"publisher","DOI":"10.1188\/14.ONF.545-547"},{"key":"S1744133126100486_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002241"},{"key":"S1744133126100486_ref26","first-page":"1189","article-title":"Enhancing the quality and credibility of qualitative analysis","volume":"34","author":"Patton","year":"1999","journal-title":"Health Services Research"},{"key":"S1744133126100486_ref4","unstructured":"Bell, M , Charlesworth, A and Lewis, R (2021) The Future of the NHS Hospital Payment System in England: From Recovery to Transformation. The Health Foundation [Online]. Available at https:\/\/reader.health.org.uk\/nhs-hospital-payment-system (accessed 19 December 2025)."},{"key":"S1744133126100486_ref37","doi-asserted-by":"publisher","DOI":"10.1920\/co.ifs.2023.0082"},{"key":"S1744133126100486_ref19","unstructured":"NHS England (2019) Ophthalmology: Girft Programme National Specialty Report. [Online]. Available at https:\/\/gettingitrightfirsttime.co.uk\/wp-content\/uploads\/2019\/12\/OphthalmologyReportGIRFT19S.pdf (accessed 28 August 2025)."},{"key":"S1744133126100486_ref33","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-008-0119-0"},{"key":"S1744133126100486_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.06.014"},{"key":"S1744133126100486_ref5","unstructured":"Blythe, N and Ross, S (2022) Strategies to Reduce Waiting Times for Elective Care, London, [Online]. Available at https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/reports\/strategies-reduce-waiting-times-elective-care"},{"key":"S1744133126100486_ref6","unstructured":"BMA (2025) NHS Backlog Data Analysis. Available at https:\/\/www.bma.org.uk\/advice-and-support\/nhs-delivery-and-workforce\/pressures\/nhs-backlog-data-analysis (accessed 19 December 2025)."},{"key":"S1744133126100486_ref30","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-086338"},{"key":"S1744133126100486_ref3","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2751"},{"key":"S1744133126100486_ref18","first-page":"1844","article-title":"Using triangulation and crystallization to make qualitative studies trustworthy and rigorous","volume":"29","author":"Morgan","year":"2024","journal-title":"The Qualitative Report"},{"key":"S1744133126100486_ref29","doi-asserted-by":"publisher","DOI":"10.1177\/00207314221114540"},{"key":"S1744133126100486_ref8","doi-asserted-by":"publisher","DOI":"10.1080\/14780887.2020.1769238"},{"key":"S1744133126100486_ref13","doi-asserted-by":"publisher","DOI":"10.1258\/jhsrp.2011.011019"},{"key":"S1744133126100486_ref1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7457.61"},{"key":"S1744133126100486_ref36","doi-asserted-by":"publisher","DOI":"10.1920\/re.ifs.2024.0302"},{"key":"S1744133126100486_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/daae049"},{"key":"S1744133126100486_ref27","unstructured":"PHIN (2025) Our Data. Available at https:\/\/www.phin.org.uk\/data (accessed 9 June 2025)."},{"key":"S1744133126100486_ref24","unstructured":"NICE (2017) Cataracts in Adults: Management. Available at https:\/\/www.nice.org.uk\/guidance\/ng77\/resources\/cataracts-in-adults-management-pdf-1837639266757 (accessed 19 December 2025)."}],"container-title":["Health Economics, Policy and Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1744133126100486","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:47:20Z","timestamp":1778658440000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1744133126100486\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":36,"alternative-id":["S1744133126100486"],"URL":"https:\/\/doi.org\/10.1017\/s1744133126100486","relation":{},"ISSN":["1744-1331","1744-134X"],"issn-type":[{"value":"1744-1331","type":"print"},{"value":"1744-134X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}