Your leading article and editorial (April 13) merits further comment on how the NHS handles fairness and priority. You reported that Mrs Heaven had paid for private treatment of a cataract in one eye and was dismayed to find she would have to wait up to 12 months for NHS treatment of the second eye.

The NHS must be scrupulously fair in spending public money. That means equal waiting times for people with equal clinical need. When someone chooses to accelerate part of their treatment by going privately for an out-patient appointment, for instance, or removal of cataract in the first eye, we cannot allow them a shorter waiting time for the second stage or second cataract without being unfair to everyone else.

However, 12 months is far too long to wait for the first cataract operation to cure serious disability from blindness. Because the numbers of elderly people with cataracts are rising, waiting lists have been growing. Waiting time for the first cataract operation would still be 18 months if our surgical teams had not worked flat out last year, with extra lists out of hours to ensure more people were treated. This year the Government will invest considerably more money to drive down waiting lists in all specialties.

Restoration of perfect vision in the first eye reduces the disability of total blindness by 100 per cent. Restoration of vision in the second eye simply adds binocular vision. The first eye waiting times matter most and will be our priority.

Dr Peter F Kennedy,

Chief Executive,

York Health Services NHS Trust,

Bootham Park,

York.

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