In the modern National Health Service (NHS), performance outcome is increasingly being compared between surgical units. These quality indices exert a significant influence on the choice of providers offered to the patients by commissioners including patient care advisors in the primary care trusts. Cataract choice initiative gives patients a choice based on performance outcomes that include derived complication rates and waiting times.

One of the key indicators of the performance outcome in relation to cataract surgery is annual complication rates. These are determined currently by CHKS (CASP Healthcare Knowledge Systems, CASP-Clinical Accountability, Service Planning and evaluation), which is an independent national company that is paid by the NHS trusts to analyse the data based on the input by the current coding system. Coding has an established role in standardising the recording of clinical episodes for the purposes of healthcare planning and service delivery. The resulting analysis including complication rates is then forwarded to the Department of Health for subsequent dissemination. In addition, audit and clinical governence issues along with reimbursement via the Payment by Results mechanism in the future depend on the accuracy of coding.

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