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Eye Health

Volume 724: debated on Thursday 15 December 2022

I beg to move,

That this House has considered a blueprint for eye health in England and the devolved nations.

I thank the Backbench Business Committee for scheduling this debate. The hon. Member for Battersea (Marsha De Cordova) was going to be here, but she has a funeral to attend. As she is the chair of the all-party parliamentary group on eye health and visual impairment, her contribution would be significant. The funeral was at half-past twelve, so it is probably ending about now, and she said she would try to get here. Her contribution to this debate would be of significance to all of us here, particularly the Minister.

I also thank the Eyes Have It partnership, which includes the Royal College of Ophthalmologists, the Macular Society, the Royal National Institute of Blind People, the Association of Optometrists, Fight for Sight and Roche, for its support. The name of the group is my favourite of all the names. The work that the group does is incredible. What could be better for a Westminster Hall debate in the House of Commons than the Eyes Have It? When the ayes have it, that means we are on the right road. I am pleased to see the Minister in his place. My staff have been in touch with him, so he will have a fair idea of what we are trying to achieve.

I am also pleased to see the Labour spokesperson, the hon. Member for Tooting (Dr Allin-Khan), who brings much knowledge from her own personal job to the debate. I look forward to her contribution. I also welcome the hon. Member for Motherwell and Wishaw (Marion Fellows) from the Scots Nats. We speak in all these debates, and it is hard to find a margin of difference between the two of us when it comes to our proposals—indeed, between the three of us.

I thank the Minister for his presence. I know the issues raised will be heard and acted on, which is what we want in these debates—a responsive Minster with a good ear to listen and to grasp the issues, which I know he does, and build on what we say. I am ever mindful that health is a devolved matter, so my contribution to a blueprint for eye health in England and the devolved nations will be from a Northern Ireland perspective. I know the Minister will respond specifically to what we have here on the mainland. The spokesperson for the Scots Nats will add her knowledge from Scotland. I like to hear the contributions from our Scottish colleagues because they have a health system and an eye care system that might be the envy of many of us.

Today’s debate seeks to build on the previous debate, held in January 2022, on eye health and macular disease. It was a Tuesday morning debate, so probably more amenable to those who wanted to attend. Sometimes on a Thursday afternoon, when there are difficulties with trains and suchlike, the people who could be here are not. Since the debate in January 2022, some good things have happened. NHS England has appointed its first national clinical director for eye care. At the same time, England has established integrated care systems, which empower local areas to increasingly shape their healthcare provision. What has been done therefore has a local, community impact.

At present, every nation of the United Kingdom except England has some form of eye care plan, whether it is self-contained or part of a wider strategy. I am sure that the Minister will give us his thoughts on that. However, the content and focus of the plans vary significantly, as I am sure we will hear from the shadow Minister, the hon. Member for Tooting. Additionally, policy progress has often been fragmented, and what planning guidance there is for services in England does not contain longer-term ambitions or measures for improvement. I hope that the debate will perhaps outline another, stronger direction. If we can do that, the debate will have highlighted what we want it to highlight.

A plan for England would empower the NCD by providing a framework that enables effective oversight of ICSs without undermining local autonomy. It would create a shared long-term vision that encompasses primary, secondary and community care, and that future-proofs services. If we can achieve that, we will have done well. At the same time, it could provide a basis for increased alignment between nations, and I hope that the Minister will give us some pointers on how to address this issue better together. The fact that I always make this point does not weaken it: we can learn how to do better from all the regions. By doing better for one—England, for example—we can improve the situation for Northern Ireland, Scotland and Wales. If we can do that, that would be good news.

Over 2 million people in the United Kingdom are living with a condition that can cause sight loss, such as glaucoma, cataracts, macular disease or diabetic retinopathy. Some 340,000 people in the United Kingdom are registered as blind or partially sighted, and 50% of UK sight loss is thought to be preventable. I say this honestly and with deep respect to everyone here, including the Minister: if we can prevent sight loss by doing early checks in opticians and GPs’ surgeries, that would be good. If we cannot, we will leave people with sight loss for the rest of their lives.

I often think that, of all our senses, eyesight would be the hardest to lose. If I did not have the ability to hear, at least I would have vision, which colours everyday life as it goes by; losing eyesight becomes more and more difficult to handle. If 50% of UK sight loss is thought to be preventable, what is being done to prevent it? Members will know that sight loss affects people in many ways, but it is clear to everyone here that the impact of sight loss is profound for individuals, as well as their friends and families.

The Royal National Institute of Blind People once asked me to do a walk around Holywood with guide dogs, which I was more than glad to do. That gave me a better understanding of what it means to have sight loss. I put a black mask over my eyes; I could see no light whatsoever. I had a guide dog that I had never met, and the guide dog did not know me. That guide dog stayed at my right knee, and guided me up the Holywood street, which was full of shoppers, and I got a perspective on having sight loss. The dog took me where it wanted me. It stopped on the footpath before crossing the road. That left an indelible impression of what it means to be blind and what we must do to help. I thank Guide Dogs for all that it does. We all respond to the adverts on TV, and many of us in this debate, and outside of this House, probably contribute to the charity, so that someone else can have a dog as their companion and guide.

Choices made about the provision of eye care can change the trajectory of a person’s life. The experience of sight loss can often be similar to bereavement, inspiring feelings of denial, anger and fear. The impact of sight loss is also felt beyond individuals and their families. In England, the data is most readily available; it is always good to have the data, because it gives us the possibility of establishing a strategy and a way forward. In England, ophthalmology is the single biggest out-patient speciality, with over 7.5 million attendances at ophthalmology out-patient services in 2021.

Recent calculations show that eye conditions cost the UK economy some £25.2 billion per year, a figure expected to rise to £33.5 billion per year by 2050, and 84% of the economic costs of sight loss lie outside the health and social care system. Again, Minister, how best can we draw sight loss within the health and social care system, to ensure that the delivery of treatment for people with sight loss is achieved in a positive fashion?

A range of pressures contribute to what is now a capacity crisis in eye care. Over recent years, demand for eye care services has increased, driven by an ageing population, with people rightly concerned about losing their sight; if we can prevent that, then we will have achieved much. However, such concern can lead to unnecessary referrals, increasing pressure on services. A recent Moorfields study found that 52% of patients referred for specialist assessment did not need specialist treatment.

There are also significant workforce pressures. In 2018, the Royal College of Ophthalmologists identified a shortfall of 230 consultants and 204 staff and associate specialist ophthalmologists. That situation is predicted to get worse, so again I ask the Minister: what can be done to retain the number of staff, and indeed increase their number?

These structural factors have been combined with severe disruption to services due to the pandemic, making it harder for services to implement innovations that could mitigate growing demand. As a result, there are significant ophthalmology backlogs across the United Kingdom and indeed in Northern Ireland as well. Some patients are now waiting six months or longer to access eye care services. With great respect, I believe that situation really needs to improve. Eyesight can be saved if waiting times for appointments are shortened. Back home, I am aware of some people whose appointments were delayed and unfortunately in that short time they lost their sight.

In England, 641,000 people were waiting for specialist eye treatment as of October 2022, accounting for some 9.2% of the NHS waiting list and 1.1% of the entire population of England. In Scotland, ophthalmology accounts for 12.2% of waiting lists; in Wales, the figure is 11.9%; and in Northern Ireland it is 9.9%.

In my constituency of Strangford, the local health and social care trust is the South Eastern Health and Social Care Trust. As of 30 June 2022, 49% of patients waiting for ophthalmology out-patient treatment in the South Eastern HSCT have been waiting longer than 18 weeks. We need to shorten that and I have been in touch with the Minister back home—Robin Swann, who by the way is a very responsive Minister—to see how we can cut down that waiting period of 18 weeks.

According to figures for Northern Ireland from the Office for National Statistics, almost 18,000 patients were waiting for ophthalmology services. Of those, over 9,000 ophthalmology patients—about 55%—were waiting more than 52 weeks for a first consultant-led out-patient appointment. That situation is the reason why people have lost their sight and it really has to be improved. In total, 82% were waiting over nine weeks. Again, it is very clear that something has to be done. It is not the Minister’s responsibility—I know that—but I am just putting the facts on the record in Hansard because I think that there are many issues for us to address, including back home.

Evidence suggests that the mega-clinics are making some progress on cataract surgery waiting times. My own mother is 91 and she has had one of her cataracts done. She was treated on Tuesday and she made the appointment for the second cataract. This treatment will definitely improve my mum’s vision greatly, as well as her participation in life. She may be 91, but she is still a formidable lady. She has a deep interest in all that happens in the world, including in the political things that happen here; no doubt, she will want to watch this debate as well to find out what has been said.

The figures for cataract surgery waiting times are deeply troubling, and the impact on patients’ lives, including their physical, psychological and emotional wellbeing, continues to be significant. It is my belief that the next Assembly or Executive should prioritise addressing waiting times for treatment in Northern Ireland by investing in and expanding the use of timely, targeted interventions, such as mega-clinics and community-based care and support. A greater use should be made of accessible patient communication to address waiting times and treatment delays.

Treatment delays can have a significant impact. Up to 22 people per month experience severe or permanent sight loss due to delays to follow-up care. A national plan for eye care is needed to address the capacity crisis and ensure everybody can access the care they need at the right time and in the right place. Ultimately, that would prevent avoidable sight loss, which would be a massive step forward.

Scotland, Wales and Northern Ireland have some form of eye care plan, but they vary in scope, focus and content. The Eyes Have It identified four key areas that the national plan should address. The workforce should be expanded to ensure the NHS has the skills it needs now and in the future. Ophthalmology training should be expanded, and optometrists and multi-disciplinary eye care teams should be enabled to work at the top of their licences. In other words, there should be a focus on them.

New technologies, such as digital remote monitoring and remote triage, should be used to ensure the care delivered is efficient, prioritises those with the greatest needs and fits around patients’ lives. If we can do that, we will have achieved much.

There should be research into the future of treatment to better understand sight loss, and that should be translated into innovative treatments that enable more people to keep their sight. That has to be a central goal of what we are trying to achieve. The uptake of innovative treatments will improve patient outcomes, prevent the deterioration of sight and reduce the burden of care on the families impacted. We need to address them, too.

The national plan can support systems to ensure that patients access the right care at the right time. That would reduce unnecessary referrals and, ultimately, the pressure on NHS eye care services. A national plan would also help to improve the integration of all levels of community and hospital eye services. It is important that community and hospital eye services are married as one so they can do better. That would enable new integrated care systems to deliver care that is joined up, works for patients and local communities, and supports national oversight. In other words, the strategy starts here and works its way down to communities, councils and all the other systems.

It is of course right that the nations of the United Kingdom of Great Britain and Northern Ireland can develop healthcare services that meet the needs of their own populations. I understand that, but a well-designed plan for one nation can provide a valuable blueprint for others, supporting all nations to improve their eye care services and prevent more avoidable sight loss.

I am my party’s health spokesperson, which is why I am involved in all health debates and why I secured this debate, along with the hon. Member for Battersea. The cancer strategy in England provides a helpful guide for the structure of a well-built, potentially successful national plan. NHS England’s national cancer transformation board publishes an implementation plan for the strategy, and there is a commitment to a £200 million cancer transformation fund.

There are yearly progress updates from NHS England. Alongside its principles, the strategy for cancer details the current landscape in cancer care and sets out ambitions and performance metrics, rather than measuring progress. At the end, it sets out practical recommendations for transformation: improving the experiences of care, treatment and support, improving the efficiency of delivery, and driving implementation and cost savings. Costs are a part of no matter what we do nowadays, and we should make cost savings as long as there is no detriment to the service. Those will be key components of a national eye care plan that tackles the big issues while proposing specific metrics and making recommendations for policymakers.

As highlighted by Professor Kathryn Saunders, the division head of optometry in Ulster University back home, a blueprint for each nation would need to address eye health inequalities, and not just those of a geographical nature. We must ensure that there is more equitable access to eye care among the different communities and populations that are at a significantly increased risk of having a sight problem but may not be accessing NHS sight tests, such as people who are homeless, people with dementia—I make a special plea for them—and children and adults with learning disabilities.

The charity SeeAbility has highlighted the wonderful work of Professor Saunders and the issue of eye care inequality. Some people in the Gallery today are directly involved, and I am pleased to see them here. I am also very pleased that they passed information through to us. Professor Saunders has said:

“I’m sorry to say that not enough action on these inequalities is happening. I’m even sorrier to say that even a service currently offered in special schools appears under threat.”

We need to marry things up better. She continued:

“NHS England will not say what happens after 31 March 2023 to the NHS Special Schools Eye Care Service. It started last year and has reached 83 special schools so far supporting over 9000 children.”

I commend the pilot scheme promoted by the Government and the NHS. It has done much—it is a success story—but I seek assurance that the special schools eye care service will continue beyond March 2023. That evidence-based, inclusive service was celebrated globally last year on World Sight Day, and it was a first for the UK, with Northern Ireland, Wales and Scotland watching closely. It was established by the NHS on the premise that children with learning disabilities are 28 times more likely to have a sight problem but struggle to access sight tests or glasses.

The evidence is compelling. Half of children in special schools have a sight problem, yet only four in 10 have ever had a sight test. What can we do to improve that? I would be pleased if the Minister gave us some indication of what could be done, ever mindful that two Departments probably need to be approached to ensure that it takes place. I am pleased that research from Ulster University has provided evidence to support the benefits of in-school eye care for this vulnerable group. We are moving towards that strategy for Northern Ireland, which is positive, demonstrating that that model of eye care has educational benefits as well as positive impacts on vision.

If the service is to be scaled back or abandoned, what will happen to the 9,000 children in a few months’ time? I do not think that we can ignore the good work that has been achieved. Surely the intention is not for them to return to overstretched hospital clinics. We must do better. If there was ever an example of the need for joined-up strategic thinking on eye care, surely this is it. I ask the Minister the question that Professor Saunders asked me to pose: will he take action to ensure that NHS England does not close the service without proper consultation? There is real good here, and it is important that we have the opportunity to see it continue.

This is a slightly different point, but it is related to eye care in England and the devolved nations. The Older Drivers Task Force sent me some information and was keen to feed into the process, so it is important that we record that. Only the UK uses the ability to read a vehicle number plate at a set distance—20 metres—to assess someone’s visual fitness to drive at their first licence application, with no further requirement for visual assessments. The UK’s reliance on the number plate test has been widely criticised as not fit for purpose. Not only is it a crude measure of visual acuity, but, according to the Driver and Vehicle Licensing Agency in 2021, many motorists are unaware of that requirement for driving.

There have been recent calls for vision checks, such as evidence of a recent sight test, to be introduced at licence application and renewal every 10 years. Those calls are in accordance with the Department for Transport’s “Road Safety Statement 2019”, which stated that consideration was being given to having a mandatory sight test at age 70 and at three-year intervals thereafter, to coincide with licence renewal. The covid pandemic has slowed things up, and we have lost two or three years of progress in the NHS and many spheres of life, but I am keen to hear the Minister’s thoughts on this issue. There is evidence of strong support from older drivers—those aged 60 and over—for compulsory eyesight testing when renewing a licence. The over-60s are entitled to free sight tests, so such a requirement would be at no cost to those drivers. If there is no cost, it seems to be a win-win, so let us do that.

The Older Drivers Task Force recommended the introduction of mandatory eyesight testing, with an optometrist or an ophthalmic or medical practitioner providing an “MOT” of a driver’s eyesight at licence renewal at the age of 70, and at subsequent renewals. Should that be implemented, the NHS contract for free eyesight tests would need to be amended so that drivers aged 70 and above could have a more detailed “MOT” sight test. That is the request of the Older Drivers Task Force, and I believe it would benefit those in that age group who drive and everyone on the road.

The covid pandemic has had a very negative effect on the visual health of the nation. In September 2020, the Eyecare Trust announced that an estimated 5 million routine eye tests had been missed. With subsequent lockdowns and restrictions, the situation has since worsened, which raises serious concerns for road safety, as the UK licensing system relies on drivers being responsible for ensuring that they meet the visual standards for driving. The pandemic has led to long waiting times for patients referred for assessment and treatment of DVLA-notifiable sight conditions. While they wait, they may continue to drive even though their condition may be deteriorating, jeopardising both their safety and that of other road users, so there is a practical reason for this request.

Delays to cataract surgery—my mum, who has been on the waiting list for three years, had her first cataract surgery some three months ago, with the second to come shortly—have been identified as a particular concern. It is difficult to quantify the crash risk of visually impaired drivers, as data is not routinely collected. However, according to the College of Optometrists, a recent analysis of contributing factors recorded in STATS19 showed an association between visual impairment and injury collisions for drivers aged 60 and over. An earlier study by the Road Safety Authority estimated that some 2,000 drivers in the UK were involved in accidents in 2013 due to poor vision, causing nearly 3,000 casualties.

The recommendations made by the Older Drivers Task Force are quite simple, but I believe that they are very practical and helpful. It calls for a change in the way that visual standards for fitness to drive are assessed and monitored for all drivers, but particularly for those aged 60 and over. It recommends that the number plate test should be replaced with a standardised measure of visual acuity plus an assessment of visual fields, contrast sensitivity and twilight vision. In other words, we should test both night and day driving; I think that is important for licence renewals. The Older Drivers Task Force also repeats its recommendation to introduce mandatory eyesight testing and to provide an “MOT” of driver eyesight at licence renewal at the age of 70, and at subsequent renewals.

I will conclude by giving a couple of examples of the importance of people visiting their optician regularly. I know of two people in my constituency who have been affected by this issue. One lady was having headaches and went to see her optician, who checked her and found a growth, which turned out to be a tumour. He sent her to the Ulster Hospital, which is just up the road from Newtownards in my constituency. Ultimately, the lady was hospitalised and had an operation. Opticians, and regular attendance, can save people’s lives.

A good friend of mine had not been feeling well for some time. He came in on a Monday to see me in the office before I came over here for work. He said, “I haven’t been well.” I looked at him and said, “You look very pale and have lost a bit of weight.” He replied, “Jim, I’ve had sore heads for almost three weeks.” He was going to see his optician that day. As a result of the eye test, the optician diagnosed a tumour or growth. My friend was told to go to the Ulster Hospital immediately and, within two days, he had an operation to remove a tumour the size of a tennis ball. It is hard to comprehend such things. I tell those two stories because they are examples of how regular check-ups with opticians save people’s lives.

In conclusion—I have said that already, but I really will conclude with this—eye care services across the whole United Kingdom of Great Britain and Northern Ireland are facing significant pressures, with implications for individuals, the NHS and the wider economy. Developing a national plan for eye care will help tackle the capacity crisis in eye care in England and provide a blueprint to share good practice across the United Kingdom, including Scotland, Wales and Northern Ireland.

I thank you, Mr Sharma, and I thank the Minister for his time. I also thank the two shadow Ministers, who will speak shortly. I have not read their speeches, but I suspect that we will all be on the same page, asking for the same thing. We look to the Minister to respond in a positive fashion.

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Strangford (Jim Shannon) for the nice things he said about me and congratulate him on securing this important debate. He is right: people would have been present if it had been possible, but weather, transport and other emergencies intervened.

Eye problems can affect anyone at any age. It is important that people get their eyes tested regularly. In Scotland, we feel that that should be by having a free NHS-funded eye examination. It is easy for us to neglect our eyes, because often they do not hurt when there is a problem. Having our eyes examined regularly can help to detect early signs of sight-threating conditions and other serious health conditions such as diabetes, cardiovascular disease and high blood pressure, in addition to the conditions that the hon. Member for Strangford told us about a moment ago.

In Scotland, community optometrists are the first contact point for any eye problems. They can diagnose and treat a number of conditions without the patient requiring an appointment with their GP or an ophthalmologist. An increasing number of community optometrists are registered independent prescribers and can issue patients with an NHS prescription to treat their eye problem.

The Scottish Government intend to expand further the range of eye care services delivered in the community by investing in a shared electronic patient record and in accredited practitioner training. That will include the management of stable glaucoma and treated ocular hypertension patients, and a national low vision service for visually impaired people. The Minister should probably have a look at that.

The Scottish Government also have a national ophthalmology workstream on hospital eye services, which sets out how they manage the delivery of hospital eye care services to provide timely care for patients. Patients with ophthalmic conditions are often vulnerable and must be supported by a responsive health service. Their care should primarily be safe and timely.

In Scotland, the Government are committed to improving services for sensory impaired people through their See Hear strategy. Adults and children with a sensory impairment should expect seamless provision of assessment, care and support, and the same access to employment, education, leisure, healthcare and social care as anyone else. In 2017, NHS Education for Scotland carried out an independent review of low vision service provision across Scotland.

In contrast to England and Wales, the Scottish Government provide free, universal, NHS-funded eye examinations, which is really important, especially given the cost of living. Universal access to healthcare is one of the Scottish Government’s key priorities, which is why free eye examinations for all were introduced in Scotland in 2006. Anyone, from any background, is able to access free eye care to help reduce the risk of sight loss. That includes all people in Scotland who are UK resident, refugees, asylum seekers and some eligible overseas visitors. Appointments are available every two years, and people are able to attend an optometrist for an NHS-funded examination of any eye problem that arises between times, including emergencies.

I was a beneficiary of that system. My eye started to fail and I found it very difficult to carry on my work, especially here in Westminster Hall, when I could not read the screens properly unless I was sitting very close to them. I went to my local optometrist. She checked my eyes and discovered cataracts, and immediately put me on a path for treatment, which really helped. When the same thing happened in my other eye, I was able to go back between appointments and say, “Look, I think there’s a problem. Can you help?” Again, I was put on a treatment path. I now have two artificial lenses—one in each eye, as my late father would have said. I have really benefited from that system, as have many people in Scotland.

If someone is unable to travel unaccompanied because of a physical or mental illness or disability, they can arrange to have a home visit quite easily. In fact, I walk from my house to my son’s house every week, and there are posters on railings across the roundabout that I have to go by, telling people that they can have that service. That is hugely important because, often, it is as people get older and more vulnerable—I put myself in that category some days—that they benefit from free eye care.

Those on benefits such as employment and support allowance, jobseeker’s allowance, pension credit, universal credit, working tax credit or child tax credit, and children under 16 years old, are entitled to help with the cost of glasses or contact lenses, and the repair or replacement of glasses or contact lenses, in the form of an NHS optical voucher.

In Scotland, before a child starts primary school, they will be offered a vision screening appointment as part of the See4School programme. That helps children begin school with the best possible vision and helps provide for any long-term visual problems. My daughter only discovered she had eye issues when she was learning to play a musical instrument and could not read the music from where she had to stand. If she had been screened earlier, it is possible that she would not have needed glasses for her whole life, as she does now.

In Scotland, we believe that socioeconomic inequalities drive health inequalities. That is why the Scottish Government are acting to mitigate the impact of austerity and reduce inequality. Where we have public health issues, Scottish Government public health efforts are complemented by wide-ranging cross-Government action. That is where Scotland benefits from being a small country. It is much easier to work in partnership and get cross-governmental things done.

We know that the worst health outcomes are driven to a significant extent by deprivation. That is why the Scottish Government are committed to addressing the underlying causes of health inequalities and to ending poverty; increasing access to fair employment, education and training; and improving our physical and social environments. That whole-systems approach and cross-Government action is needed to improve equity for Scotland’s people and communities. I believe that is true right across the four nations of the United Kingdom. That will be achieved by focusing efforts on the determinants of health inequalities and working more effectively in partnership. Reducing poverty and inequality sits at the heart of the SNP Scottish Government’s investment across all portfolios, and is a key driver of their development of a wellbeing economy that will have the needs of each individual at its core. The wellbeing economy is now becoming a recognised way of improving not just health, but everything around health and the lives of a nation’s people.

We believe that prescription charges are a tax on ill health and a barrier to better health for many. Charging for prescriptions would mean that many people with chronic conditions, or even those receiving treatment for cancer, could be liable. The Scottish Government continue to demonstrate their commitment to the provision of free healthcare advice and treatment when needed, with the introduction of the NHS Pharmacy First service, which is available in all community pharmacies to everyone registered with a GP or ordinarily resident in Scotland.

The Scottish Government are keen to support people to make healthier lifestyle choices that help take care of their eyes. I do not think many people realise that giving up smoking helps, because smokers are much more likely to develop age-related macular degeneration— the most common cause of sight loss in the UK—and cataracts than non-smokers. Given that smoking is more prevalent in the most deprived communities, the Scottish Government have set specific targets for cessation services focused on those communities. They provide £9.1 million a year to health boards to fund smoking cessation services targeted at achieving successful 12-week quits for 1.5% of the adult population in the most deprived areas. Through all of that, the Scottish Government will ensure a “done by communities, for communities” approach, making sure that lived experience is central to their work.

The Scottish Government are also keen that people drink within the recommended limits, because heavy alcohol consumption may increase the risk of developing early age-related macular degeneration. The alcohol framework sets out the priorities for preventing alcohol-related harm. We consulted on potential restrictions on alcohol advertising and promotion in 2022 to protect children and young people. The Scottish Government have twice run their “count 14” campaign work to raise awareness of the UK chief medical officer’s lower-risk drinking guidelines of 14 units per week. It was run for four weeks in March 2019 and over six weeks in January to March 2020. They are exploring the evidence around managed alcohol programmes and are delighted to be able to contribute to the running of the model being piloted in Glasgow by Simon Community Scotland and its evaluation. Of course, making alcohol more expensive in Scotland, especially the kinds of drinks that young people in particular used to drink, has also helped. In the end, it will help their eye health as well.

Will the Minister look at what we are doing in Scotland? I am sure he has a very good idea. It is really important. Will he tell us what he hopes will happen in England?

In conclusion, it is really important that there is a blueprint, as the hon. Member for Strangford said. In Scotland we do things differently, but we want everyone to benefit from our experiences and to have the same chance of good eye health. Will the Minister support a national eye health strategy? As has previously been mentioned, the hon. Member for Battersea (Marsha De Cordova) cannot be here today, but she recently introduced the National Eye Health Strategy Bill. Will the Minister support the Bill on Second Reading on Friday 3 March? Everyone here wants the best for people in their communities. The best way forward—and I would say this—is to look at the Scottish example and put aside the barriers that prevent people from having their eyes tested regularly.

It is a pleasure to serve under your chairmanship, Mr Sharma, and to respond on behalf of the shadow Health and Social Care team. I pay tribute to the hon. Member for Strangford (Jim Shannon) for securing this important debate and for his continued advocacy on this issue. I particularly liked his description of the experience of walking with a guide dog, and how that lived experience has helped him become a campaigner. The hon. Member is a voice for issues that often do not get enough time in this place.

More than 2 million people live with sight loss in the UK, and by 2050 the number will reach 4 million. Ophthalmology is the NHS’s busiest outpatient service, with 7.5 million hospital attendees last year. With demand for eye care services set to soar by 40% over the next 20 years, it is vital that we get this right. The Government must have a plan.

We have all been sharing our personal experiences with eye services, and I am no stranger to them, having something quite unusual called keratoconus—it is particularly bad in my right eye. I understand how worrying it can be when one discovers that they have eye pathology.

I pay tribute to the continued campaigning work of the Association of Optometrists, the Royal National Institute of Blind People and so many others for their work on eye health. I also pay tribute to my hon. Friend the Member for Battersea (Marsha De Cordova), who is a fantastic advocate on this issue. It is very welcome that NHS England has appointed the first ever national clinical director for eye care, a role that aims to put ophthalmology on a par with other major specialties and that will lead to the development of a national strategy.

As we have heard today, NHS eye services are not keeping pace with demand. Waiting lists for ophthalmology treatments have increased by more than 130% over the last 10 years. Over 650,000 patients are stuck on NHS ophthalmology waiting lists in England, with tens of thousands of patients waiting longer than a year. That is unacceptable. Those waiting lists have been longstanding; even pre-pandemic, the system was in trouble.

In 2018, the APPG on eye health and visual impairment found that the current system of eye care was failing patients on a “grand scale”. Waiting lists have increased every year since 2010. For years, there have been calls for the Government to act, but those calls have fallen on deaf ears. It is 12 years of Conservative Government failure that have caused waiting lists to grow and left ophthalmology services in the state they are in now. Patients simply deserve better.

Increased staffing pressures compound the issue. More than three quarters of units in the UK reported unfilled consultant posts, with over two thirds of hospital eye units using locum doctors to fill those vacancies. Many eye units rely, to a large extent, on non-medical clinical staff working in extended roles, or doing work traditionally performed by an ophthalmologist. I ask the Minister, what assessment has the Department made of the impact the current ophthalmologist workforce shortages are having on patient care? Will the upcoming workforce strategy include a commitment to fund the workforce that is identified as being needed to meet patient demand?

I am pleased that the debate as also focused on the devolved nations. In Northern Ireland, at the Western Health and Social Care Trust, the average wait for routine cataract surgery is more than six years. These are grandparents who cannot see their grandchildren properly; these are people who have to give up work because they cannot see. Patients are suffering. The stress and anxiety that long waits such as those have on patients cannot and should not be ignored. There is a huge personal cost. Here is yet another example of Government decisions costing people a full and healthy life.

Along with tackling the workforce challenges, enabling the effective integration of primary and secondary eye care services is key to the plan for eye health. The Labour-run Welsh Government are leading the way in ophthalmology data and referrals and in reform of the general ophthalmic services contract. Wales is ensuring that there is more detailed data on ophthalmology waiting lists. It is also developing a comprehensive, interoperable electronic patient record system, as recommended by the Royal College of Ophthalmologists. When will the Government be serious about eye health and do the same?

The next Labour Government will take eye health seriously. We will pull every available lever to get ophthalmology patients treated sooner. Sticking plasters are not enough. We need a Government that will grasp the root causes of the staffing crisis in the NHS. That is why Labour will end tax breaks for non-doms and use the money raised to expand our NHS workforce. The next Labour Government will train a new generation of doctors, nurses and midwives to treat patients on time again. We will double the number of medical school places to ensure we have the workforce that we need across different specialties, including ophthalmology.

Labour has a plan. I would be grateful if the Minister set out the Government’s position and explained to patients why they continue to wait so long for treatment. They cannot afford to wait any longer.

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this important debate. He has been a strong advocate for eye health for a long time. He speaks from huge knowledge and personal experience, and I listened to his speech with great interest. Given that health is a devolved matter, a lot of my response will focus on England, as he suggested. I understand that the devolved nations are facing similar challenges. We are always interested in sharing ideas and working with our counterparts, in answer to the question asked by the hon. Member for Motherwell and Wishaw (Marion Fellows).

There are 2 million people living with sight loss, and that is predicted to double to 4 million by 2050 as a result of an ageing society. Sight loss is often preventable, and that is why prevention and early detection, along with access to diagnosis and timely treatment, are key. One of the best ways to protect our sight is to have regular sight tests. The hon. Member for Strangford rightly underlined why that is so important with his powerful story about the tennis ball-sized tumour that his constituent had taken out.

When combined with early treatment, sight tests can prevent people from losing their sight. That is why we continue to fund free NHS sight tests for many, including those on income-related benefits, those aged 60 and over, and those at risk of glaucoma and diabetic retinopathy —two of the main causes of preventable sight loss. More than 12 million NHS sight tests were provided to eligible groups in 2021-22. We also provide help with the cost of glasses and contact lenses through NHS optical vouchers. Eligible groups include children and those on income-related benefits. The NHS invests over £500 million annually to provide sight tests and optical vouchers.

The risk factors for sight loss include ageing, medical conditions such as diabetes, and lifestyle factors such as smoking and obesity. We are taking action to reduce obesity and smoking. Smoking rates in England are already the lowest in history, and we remain committed to going further to be smoke free by 2030. We are working to drive down the number of people who take up smoking, and we are supporting those who wish to quit. We are also working with the food industry to ensure that it is easier for people to make healthy choices, and we are supporting adults and children living with obesity to achieve and maintain a healthier weight.

Turning to the medical conditions that lead to sight loss, diabetic retinopathy—a common complication of diabetes—is a potentially sight-threatening condition. The diabetic retinopathy screening programme now provides screening to over 80% of those living with diabetes annually. Between 2010 and 2019-20, the number of adults aged between 16 and 64 who are registered annually as visually impaired due to diabetic retinopathy has fallen by 20%, meaning that it is no longer the main cause of sight loss in adults of working age. The screening programme has played a major role in that.

I thank the Minister for his helpful response. The target of providing retinopathy screening to 80% of those living with diabetes has been achieved. Are there any plans to try to reach the other 20%? I am diabetic. I had my retinopathy test about four weeks ago; I get it every year. I know the encouragement and confidence that testing gives people once they know they are okay. Are there any ideas for how we can get to the other 20%?

Absolutely. As the hon. Gentleman says, we are keen to constantly drive that rate up, and we can talk more offline about the different things that we can potentially do to drive it up even further. The healthy child programme recommends eye examinations at birth, six weeks and age two, and school vision screening is also recommended for reception-age children.

The hon. Member for Strangford raised a question about a special school, which I will address specifically. The NHS long-term plan made a commitment to ensure that children and young people with a learning disability, autism or both who are in special residential schools have access to sight tests. NHS England’s proof of concept programme has been testing an NHS sight-testing model in both day and residential schools, and it is currently evaluating its proof of concept as part of programme development, which we expect to conclude towards the start of 2023. The evaluation will then inform decisions about the scope, funding and delivery of any future sight-testing model. I reassure the hon. Gentleman that, at present, absolutely no decisions have been made; we are waiting for the evidence that that programme is generating.

I turn to secondary care. Once an issue with eye health is detected, it is vital that individuals have access to timely diagnosis and any necessary treatment. The NHS continued to prioritise those with urgent eye care needs throughout covid-19. However, we acknowledge the impact that the pandemic has had on our ophthalmology services, as it has had on other care pathways. Our fantastic NHS eye care teams are working hard to increase capacity and provide care as quickly as possible. We have set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion over the next two years, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund announced last year.

I give way with pleasure to the hon. Lady, who has been hot-footing it from a funeral to attend the debate. I will seamlessly fill in, so she can catch her breath. I congratulate her on making it here.

I honestly thank the Minister for giving way. I have just got here from the funeral of a dear friend, Roger Lewis, who, as a totally blind man, was also a strong advocate for a national plan for eye care in England and the devolved nations. I congratulate my dear and honourable friend, the hon. Member for Strangford (Jim Shannon), on securing this very important debate.

As many Members will know, I currently have a Bill calling for a national strategy for eye health in England. We need to ensure that eye care provision is joined up across England to reduce avoidable sight loss but also, more importantly, to end the fragmentation of services. Is the Minister willing to meet me to discuss some of the provisions in the Bill, to ensure that we can create an eye care pathway that ensures that nobody who is losing their sight—or has already lost it—will go through the pathway without the right support and timely treatment?

I am grateful for the hon. Lady’s intervention, and I will be happy to meet her. It sounds like there is an important connection between where she has just been and this debate. I am extremely happy to meet her to talk about that.

I will continue setting out our strategy. I have already talked about screening in primary care, and I was setting out the sums of money that we are investing—the £8 billion plus the £2 billion—in elective recovery following the pandemic. NHS England has been supporting NHS trusts to increase capacity in surgical hubs, and the independent sector has also been used to increase the delivery of cataract surgery, in particular. In 2021-22, nearly half a million cataract procedures were provided on the NHS, which is actually more than before the pandemic, so that is recovering.

Beyond recovering from the pandemic and looking to the future, hospital eye care services are facing increasing demand. As a number of hon. Members have pointed out, ophthalmology is already the busiest out-patient speciality, and the predictions are that the demand for services will increase by 30% to 40% over the next 20 years as the result of an ageing society.

To help address these challenges, NHS England’s transformation programme is looking at how technology could allow more patients to be managed in the community and supported virtually through image sharing with specialists in NHS trusts. Current pilots for cataracts and glaucoma are allowing primary care practices to care for these patients and refer only those who need to be seen by specialists. The learning from these pilots will feed into any possible future service model. That could allow us to use the primary care workforce to alleviate some of the secondary care pressures.

I am delighted that the NHSE has appointed the first national clinical director for eye care, Louisa Wickham, who will oversee this work programme. I am aware that the APPG on eye health and visual impairment has called for there to be one Minister responsible for primary and secondary care services. I can confirm that my portfolio covers both those areas, so I will be taking an active interest in the development of that transformation programme and strategy.

A number of hon. Members have raised questions about the workforce, and we acknowledge that there are challenges across the system, including in ophthalmology. NHS England is developing a long-term workforce plan that will consider the number of staff and roles required and will set out the actions and reforms needed to improve workforce supply and retention. We have already invested in growing the ophthalmology workforce with more training places in 2022, but there is more to do. We are also improving training for existing staff so that they can work at the top of their licence.

Research is an area that the hon. Member for Strangford is interested in, and I was extremely sorry to hear from the hon. Member for Tooting (Dr Allin-Khan) about her keratoconus. That is one area where, fortunately, research and new treatments are coming online, so research is hugely important. While we have effective treatments, particularly for macular disease, we absolutely cannot rest on our laurels because medicine continues to evolve. We recognise that research and innovation are crucial to driving improvements in clinical care and improved outcomes for people living with sight-threatening conditions. The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing challenges of our time, including sight loss.

Over the past five financial years, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research, and many of the studies focus specifically on sight loss. The NIHR Moorfields Biomedical Research Centre has recently been awarded £20 million from the NIHR for another five years of vision research, allowing it to continue its mission of preserving sight and driving equity through innovation. Through the NIHR, England, Scotland, Wales and Northern Ireland work together on a range of research topics, and the devolved Administrations co-fund several research programmes.

To assess how well interventions are achieving their intended aims, it is important that we track their impact, which hon. Members have mentioned. The public health outcomes framework’s preventable sight loss indicator tracks the rate of sight loss per 100,000 population for three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy.

We are making progress. The indicator shows the impact that the new treatments have had on the rate of sight loss due to age-related macular degeneration. Despite an ageing population, the rate of sight loss in 2019-20 was 105.4 cases per 100,000, down from 114 per 100,000 in 2015-16, so there has been an improvement on macular degeneration. The open availability of this data provides a valuable resource for integrated care boards to draw on in identifying what is needed in their areas and for local democratic accountability for any variation in performance against public health outcomes.

The answers are very helpful. One thing that all three Members referred to was the waiting list, and those who lose their eyesight just because they have been on a waiting list for diagnosis, examination and investigation. I know the pandemic created lots of problems in relation to the waiting list. Does the Department intend to have a strategy that will reduce the number of people on waiting lists to ensure that those waiting for a diagnosis retain their eyesight?

I mentioned earlier that one of the main goals of the huge £8 billion plus £2 billion investment is in elective recovery because, as the hon. Gentleman said, the pandemic has had a huge impact. We have already cleared the number of people waiting for two years. The next milestone is to clear those waiting 18 months and then to work through the plan and bring down the numbers using that additional money over time, reducing those waiting the longest first and then steadily reducing the number of people waiting in total.

I acknowledge the importance of good vision throughout life, and especially as we get older. I hope that what I have outlined today provides some reassurance that we acknowledge the ongoing challenges faced by eye care services and are taking action to address them.

I thank the hon. Members who spoke in the debate. The hon. Member for Motherwell and Wishaw (Marion Fellows) brought a breadth of knowledge to it, and we thank her for that. As I said earlier, I always like to hear what the other devolved nations are doing, and she outlined very well what Scotland is doing. With the See Hear provision, Scotland is expanding its eyesight services, with regular checks and free examinations every two years. She referred to her personal circumstances—it is always good to bring a personal story—of having had cataracts in both eyes. She does not miss too much, so I think we can be pretty sure that her eyesight has greatly improved. She also referred to improving people’s quality of life with eyesight care, and she referred to smoking, drinking and diet and the need to address those three things.

Every one of the things that the hon. Member for Motherwell and Wishaw referred to was also referred to by the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan). She referred to the need for a plan, and to people waiting for six years at the Western Health and Social Care Trust in Northern Ireland. My goodness—that is unbelievable. My mum waited three years for a cataracts operation. She was not desperate for it, so she did not mind waiting for three years, but in the last six months it was coming to the stage where she was unable to drive, which was a problem.

The hon. Member for Tooting said that patients deserve better, and she referred to the staff shortages—I think the Minister heard about that very clearly—and the integration of services. She gave Wales as an example. We hear much about Wales in a negative fashion; today, she introduced a positive. It is evidentially-based as well, which means that it is absolutely on the button. Again, we thank her for that. She also referred to the new IT system in Wales, and the fact that patients cannot wait any longer.

I gave an apology for the circumstances of my friend, the hon. Member for Battersea (Marsha De Cordova), which we understand, and I spoke to you personally beforehand, Mr Sharma, so you know the reason for it. We really missed her contribution to the debate because she brings a wealth and a breadth of knowledge. I commend her for being the chair of the APPG on eye health and visual impairment. She was able to make an intervention that was as good as a speech, so well done to her.

I thank the Minister, as always. He comes with a positive attitude, which we are all very pleased to see. He is committed to sharing ideas with the regions. I want to see that. The hon. Members for Motherwell and Wishaw, for Tooting and for Battersea want to see that as well. The Minister referred to the 12 million eye tests in 2021-22. That is an achievement. We cannot deny the positive things that he referred to. He also referred to ageing, diabetes, childcare and the healthy child programme, learning disabilities and, in answer to my question, the steps that have been taken to address eye tests for children who are disabled and educationally challenged. I think that is good. Those are some of the things that the hon. Member for Battersea and all of us present are very keen to see.

The Minister was also very positive in relation to primary and secondary care combined under his ministership. He confirmed that one of things that we asked for has happened, which is good news. He also referred to the workforce, which we have some concerns about; I think the shadow Minister referred to them, and I know that I did. It is important that we have strategy to fill those vacancies.

Lastly, research has moved on fantastically. I went to an event in Portcullis House yesterday on some of the medical research that has been done. The advances in medicine are incredible. We can never fail to be moved or encouraged by what we see. The investment and research that the Minister referred to is good. On the waiting lists issue for reversible sight loss and elective recovery, the moneys are there to make that happen.

In introducing the debate, I referred to the lovely terminology that we use for all the different groups that come together: The Eyes Have It. Well, today, the ayes have it. The Minister has given us a very positive response, and we thank him for it.

Question put and agreed to.


That this House has considered a blueprint for eye health in England and the devolved nations.

Sitting adjourned.