CATARACTS ARE ONE of the most common and treatable causes of sight loss in Ireland – yet thousands of people wait months or even years for the short, straightforward procedure that could restore their vision.

According to the most recent available data, almost 7,500 patients are waiting for cataract surgery, with many more waiting to be assessed. Behind every number is someone struggling to drive, to read or to live independently.

This is not a funding problem. Ireland’s health budget has never been higher, with over €27 billion in Budget 2026. It is, instead, a delivery problem. The reality is the system is constrained by limited public hospital capacity, workforce shortages and outdated models of care that keep high-volume, low-complexity procedures trapped in acute hospital theatres.

Cataract surgery is ideally suited to community-based settings – modern, efficient, high-throughput clinics that can deliver thousands of procedures safely and at lower cost. That shift is entirely consistent with the vision set out in Sláintecare: care that is accessible, affordable and delivered as close to home as possible.

To make that vision real, we need procurement and partnership models that reward efficiency, transparency, and outcomes, and not simply volume or lowest price.

At present, outsourcing is too often a reactive tool, deployed in bursts to clear backlogs.

This stop-start approach creates peaks and troughs in patient access, with no lasting improvement in system capacity. A more sustainable approach would use multi-year, outcome-based agreements that ensure continuity of care, incentivise performance, and allow providers and the HSE to plan together with confidence.

In recent years, thousands of Irish patients have travelled to Northern Ireland for cataract surgery under the EU Cross-Border Healthcare Directive. For many, it has been life-changing – they regain sight within weeks instead of waiting years. But while the directive has offered relief to individuals, it is ultimately a symptom of a system under strain. Its success demonstrates both the demand that exists and the efficiency gains that are possible when capacity is properly organised. Ireland should be embedding that accessibility and efficiency into its own system.

Independent providers can play an important role in that process, working in partnership with the HSE to support capacity rather than competing with it. Properly structured collaboration allows hospitals to focus on complex and emergency cases, while community clinics handle elective work in a way that is transparent, scalable and fully aligned with national standards.

Transparency must be central to that new approach. Ireland has no national audit of cataract surgery outcomes, and no public reporting of complication or success rates.

Patients, decision makers and insurers deserve better. Publishing outcome data should become standard practice across the health system. It is how we build confidence, benchmark quality and ensure value for the taxpayer.

However, tactical fixes alone will not solve a structural issue. Ireland urgently needs a National Eyecare Strategy – a coherent framework that aligns investment, innovation, and service delivery under a single long-term plan for eye health. Ophthalmology is one of the most pressurised specialties in the state, with approximately 54,000 individuals currently on waiting lists. With such a strategy in place, cataract reform could serve as the foundation for wider improvements in ophthalmic care, from prevention to treatment.

Other European healthcare systems have already taken this approach. At Veonet, which operates across multiple national health systems, we have seen first-hand how shifting cataract procedures into community settings relieves pressure on hospitals while accelerating access for patients. Ireland has the opportunity to adapt that model.

Budget 2026’s commitment to reform procurement and outsourcing is therefore welcome. But to deliver meaningful change, reform must go beyond administrative tightening. It must enable smarter, evidence-based collaboration that delivers measurable outcomes for patients and better value for the public purse.

Cataract care is a perfect test case for this new thinking. It is high-volume, predictable and clinically low risk, which is the kind of service where innovation in delivery can make an immediate and visible impact.

With clear standards, open reporting, and performance-linked contracts, Ireland could virtually eliminate long cataract waits within a few years.

Ireland’s cataract crisis isn’t about money but rather about how we organise and deliver care. If we use the tools already available, reward providers for outcomes rather than activity, and deliver more care closer to home, we can restore sight and independence for thousands of people every year.

Our health service will always be publicly led, but it cannot deliver by itself. Procurement reform offers a rare opportunity to build partnerships and transparency that make reform real.

Cataract care can show the way – a proof point for what smarter collaboration can achieve, and a model for how Ireland can build a sustainable, patient-centred eyecare future.

Frank Doheny is CEO of Veonet Ireland, an ophthalmology provider in Ireland.