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.”

Striking NHS junior doctors on a picket line at Southend University
Hospital, Essex, 14 April 2023.
Striking NHS junior doctors on a picket line at Southend University
Hospital, Essex, 14 April 2023. Photograph: Stefan Rousseau/PA
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.

The junior doctors’ strike is not just about pay – this is a
generation that feels betrayed
Gaby Hinsliff
Gaby Hinsliff
Read more
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
https://www.theguardian.com/commentisfree/2023/apr/19/british-people-going-blind-doctors-tory-cuts

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सादर/ Regards

अविनाश शाही/ Avinash Shahi
सहायक/ Assistant
मानव संसाधन प्रबंध विभाग/ Human Resource Management Department
भारतीय रिजर्व बैंक/ Reserve Bank of India
लखनऊ क्षेत्रीय कार्यालय/Lucknow RO
विस्तार/ Extension: 2232

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