A HEALTH board which has restricted referrals for cataracts surgery is earning around £100,000 a year from private patients paying to undergo to eye operation on the NHS.

The health board has come under fire from patients and opticians after it tightened its criteria for cataract surgery during the past year.

At the end of 2017, it introduced a threshold meaning patients' eyesight had to deteriorate substantially before they could qualify, and this summer opticians were told not to refer patients for cataracts surgery on a second eye if they still had vision the first.

Analysis: Private patients can benefit NHS - as long as it does not encourage 'rationing'

This contradicts evidence that delaying the procedure costs the NHS more in the long run, as elderly patients become more vulnerable to falls, fractures or road crashes as their vision fails.

A source at Ayr University Hospital told the Herald that the number of private cataracts patients being seen at the hospital has recently "increased considerably".

They added: "There is a sense that, are patients are turning to private treatment because otherwise they'd be waiting until they're nearly blind? In a roundabout way, the health board could be seen as making money as a result of restricting treatment."

The health board strongly denies the restrictions have contributed to any rise in private activity.

Read more: NHS Ayrshire under fire over restrictions on NHS cataracts referrals

Data obtained by the Herald under freedom of information shows that NHS Ayrshire and Arran earned around £400,000 from providing inpatient, outpatient and day case treatment to private patients between April 2016 and July 2018.

More than half - £228,365 - has come from day case ophthalmology procedures, the vast majority cataracts removal.

With private sector fees ranging from £2000-£4000 for cataracts operations, it is equivalent to around 57 to 114 patients.

The figures also show a steady increase in income from private inpatients - from £10,248 in 2016/17 to £18,266 in 2017/18.

These typically include admissions for routine surgeries such as knee or hip replacements, where patients require a bed and theatre space.

This income is on track to exceed £34,000 this year, with £11,398 raised in first four months from April. Patient numbers will be low, however, as private joint replacements cost around £10,000.

Analysis: Private patients can be a benefit to NHS - as long as it does not encourage 'rationing'

Many NHS consultants double up in private practice and the NHS has long been allowed to boost its revenue by charging the patient or insurance provider if medics carry out private work such consultations, tests or procedures within NHS facilities.

It carries the strict caveat that there should be no adverse effect on NHS patients, such as exacerbating waiting times delays or bed shortages.

However, research earlier this year in England - where around 1% of beds are used by private patients - suggested the impact was not being monitored closely enough, and also found some hospital trusts were being left out of pocket when private patients or providers failed to pay.

Professor Derek Bell, President of the Royal College of Physicians of Edinburgh, said: “We support the fundamental principle that NHS treatment remains free at the point of access, and continues to be based on clinical need rather than the ability to pay.

"Clinical judgement - in consultation with the patient, medical evidence and best practice – is the most appropriate way to decide treatment.

“We would, therefore, be concerned if additional pressure was being placed on NHS services by private referrals, at a time of increasing patient demand.

Any suggestion of such practice should be examined to establish the full facts – including whether the treatment is during routine hours - and fairness in the health system must be a priority.”

A spokeswoman for the health board said: "NHS Ayrshire & Arran carries out a small amount of cataract surgery for private patients each year. The private work undertaken has not increased in recent years.

"Very few of our consultants offer private surgery and, for those who do, the time spent on private patients does not impact on their NHS work and no NHS patients are affected.

"There has been no change in the amount of private cataract surgery undertaken in NHS Ayrshire & Arran since the introduction of the referral criteria.”