The optics profession should be well used to the tug-of-war between the provision of free health care to all at the point of delivery and the development of services through commercial routes capable of producing a profit.
Indeed, since the formation of the National Health Service, there has existed an uneasy hybrid of private and public provision of eye care. One outcome of this has been the undervaluing of professional services and an over-reliance upon a mark-up on the sale of appliances such as spectacles and contact lenses.
I can think of no other time when news about the balance of public and private funding of essential services has been more prominent. This is both outside the health sector (farewell Carrillion) and within. This week, Stephen Hawking has lent his support to those concerned about proposals for local health provision from GP-led groups to be run as autonomous concerns.
Recent visits to both the QE in Birmingham and the Bristol Royal Infirmary have reminded me of how private enterprise has created some impressive strides forward in infrastructure, with state of the art buildings and artisanal hospitality outlets, while appointments seem all too scarce and staffing levels reach crisis point.
New Labour’s push for public-private finance initiatives perhaps failed to predict the impact of repayments designed to benefit investors and taken from the public purse. This cannot be helped when private suppliers, such as the offshore Virgin Health group which took over a billions’ worth of health service contracts last year, take the NHS to court over lost contracts.
As we, hopefully, move to a more unified system of care and referral pathways in community eye care, the role of private enterprises should be embraced in helping to improve efficiency and quality of service. There should also, however, be a thorough scrutiny of how profits are made and assurance they are reinvested before unhealthy profiteering at the tax payer’s expense raises its head yet again.
