“Improving public health is not the same as increasing access to a doctor”

So it was that I opened The Guardian the other morning (or rather clicked on the app) to see reference to an article moving in medical circles showing that increases in hospital waiting lists were leading to patients losing their sight. Naturally, the AOP and its recent #SightWontWait campaign was not namechecked – even though our data and OT’s freedom of information request was the original source of the article. So far, so familiar.

The author of The Guardian piece blamed the problem on “years of under-investment” and saw more money for core NHS staff as the key solution.

To some degree, that was perhaps to be expected from most commentators on health policy. However, this article came not from one of the usual NHS suspects steeped in the traditions of medicine, but was written by a Professor of Public Health, very much an outside voice. Despite that, the analysis they put forward was the same: the problem was a shortage of doctors and the solution was funding for more.

Yes – there was a shortage of ophthalmologists. But remedying that would take decades to achieve and, in any event, much of the work which is currently being done by ophthalmologists can safely, and – from the patient perspective ¬– more quickly and conveniently be done by optometrists

The original AOP story, of course, had argued something very different. Yes – there was a shortage of ophthalmologists. But remedying that would take decades to achieve and, in any event, much of the work which is currently being done by ophthalmologists can safely, and – from the patient perspective – m¬¬ore quickly and conveniently be done by optometrists. What was missing was not money but political will.

Nothing illustrates better the established culture of healthcare policy than a story suggesting that patient care might be better delivered by making better use of other health professionals being spun into an argument for more funding for doctors. Just like solicitors have managed to make the notion of access to justice being synonymous with access to a lawyer, the notions of access to healthcare and access to a doctor have become inextricably interlinked. If patient health is the problem, more doctors is the solution.

But of course, we cannot necessarily equate the two. Back in my Soho drinking days, I used to hang out at the John Snow in Broadwick Street, a pub on the site of the old Broad Street pump, the source for the contaminated water which caused repeated outbreaks of cholera in the mid-1850s. Named to commemorate the doctor who identified the cause of the problem, the pub is a reminder of how much we owe to the skills of doctors.

Nothing illustrates better the established culture of healthcare policy than a story suggesting that patient care might be better delivered by making better use of other health professionals being spun into an argument for more funding for doctors

However, it is worth remembering that John Snow himself spent many wasted years battling the established belief of many of his colleagues that cholera was caused not by contaminated water but by breathing a poisonous miasma in the atmosphere. And while – yes – it was a doctor who identified the source of the problem, it was an engineer – Joseph Bazalgette – who supplied the cure by leading the Herculean task of installing a working sewerage system in London, putting an end – until recent years, it seems – to the practice of pumping raw sewage into the Thames and London’s other waterways (entertainingly, his great-great-grandson was the Peter Bazalgette who was responsible for reality TV show Big Brother; fill in your own sewerage jokes).

Two lessons, then. First, we should not assume that just because the medical establishment believes something, it is necessarily right. It is worth reminding ourselves, particularly at a time when doctors are campaigning for more money “in order to save the NHS,” that in the years before the creation of the NHS, the British Medical Association fought a vigorous campaign against the idea. More money for more doctors is certainly in doctors’ interests, but the interests of doctors and the interests of healthcare are not the same things.

Second, and equally important, improving public health is not the same as increasing access to a doctor. Prevention, monitoring, early diagnosis, routine treatment – all of which can and should be done without any need for a doctor. It is in this space that optometrists are so important. It is true that, in recent years, that work has gone largely unnoticed. That is why we have made it a priority to step up our media efforts and the success of our work on hospital waiting lists has left us hungry for more.