My friends and family from around the globe often ask me about the state of the UK. They hear about Brexit, strike action, rapid changes in political leadership and the rising cost of living, and react with natural concern: what exactly is going on there? But my brother who works as an ophthalmologist in the US recently had a question about a lesser-known crisis. “Why are so many people going blind in Britain when treatment is available?”
An article currently circulating among his professional colleagues details the hundreds of people who lost their sight due to treatment delays within the NHS. The backlog for ophthalmology appointments in England is the second-largest in the NHS, with UK eye doctors concerned about the number of patients losing sight unnecessarily. Their shock is palpable.
How this could be happening in a rich country such as Britain? There are treatments for common blindness-causing conditions such as macular degeneration, but to get them patients must be able to access the service. And right now the NHS doesn’t have the capacity to deliver them in a timely way.
As junior doctors’ unions – and possibly those of consultants and nurses – proceed with strike action, it’s easy to attack medical professionals with the question: “How many people are dying because of your actions?” The truth is that the entire system has been struggling, and people have been dying anyway because of system failures. Now add to this people living with disabilities that were preventable, such as going blind.
When Labour was in power, it made a real effort, including with financial allocation, to reduce waiting-list times for non-emergency care. But since the Tories were elected in 2010, years of austerity and public-sector neglect – and the shifting of resources and wealthy patients into a lucrative and growing private sector – has meant that the NHS has been transformed from a robust, preventive healthcare service into an acute one. Its basic offering is now: “If you’re dying, we will save you.”
And now with major staff shortages and limited investment in infrastructure, the NHS is neither an acute healthcare service nor one able to deal with more chronic issues. At the moment, its offering is: “Even if you’re dying, we’re not sure we can get an ambulance to you, or have you seen quickly enough in A&E.” Systems don’t fail overnight. It happens over the course of years. And often deliberately.
You only have to look at the NHS budget compared with other countries. We spend far less on healthcare, resulting in fewer doctors and fewer hospital beds per person than the EU14 countries. The UK would need to spend 21% more to match the per-person spend in France, and 39% more to match the spending in Germany. And looking closer, the UK allocates more to hospital care compared with peer countries, but far less on preventive and residential care.
So, instead of preventing someone becoming sick in the first place through primary and community-based care, the NHS steps in when someone is already ill and needing hospital admission. For example, the UK ranks the highest for rates of hospital admission for asthma within comparable countries, a condition that would be treatable in primary care if it was available.
Where the squeeze is really felt is by the people in the NHS workforce, which is why strikes are happening. Unlike in the private sector, salaries have gone down in real terms for doctors and many other healthcare professionals. And these are highly skilled, motivated people who are actively recruited by countries such as Australia and Canada where they can be paid more and, more importantly, work within a system that actually functions. Healthcare staff are even emigrating to the US, where years of further training are required, but that is still seen as worth it to exit the UK.
The rise in preventable blindness illustrates a few things about modern Britain and the NHS. Years of underinvestment by a Conservative government has resulted in a broken system. And when the public sector is failing, wealthy people simply exit and find another way to use their resources. This likely means paying privately for healthcare services in England, or flying to other countries that offer this type of care.
And that simply is what Britain has become. If you are super-wealthy, your health is protected with money. On the other hand, if you are in a working profession such as a teacher, a bus driver, supermarket staff, a university lecturer, mail delivery or a nurse, you are left in a difficult position of risking going blind while waiting months for treatment, or getting into debt when raising funds to pay for private treatment.
This is exactly the dilemma of uninsured people in the US, and why it is important that reinvestment in the core of the NHS is vital: universal quality healthcare, free at the point of care, regardless of ability to pay. Hopefully this core value of the NHS, which the majority of the public supports, is what the next election will focus on.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
