Preventable Sight Loss

Alex Sobel Excerpts

Tuesday 30th April 2024 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered preventable sight loss.

It is a pleasure to serve under your chairmanship, Sir Mark. I would like to begin this debate by asking Members who have good eye health to consider these questions. How would you feel if you lost your sight? How would it affect your life and your ability to connect with family and friends or earn a living, travel independently, enjoy the place you live in, the hobbies you have or visit new places? If you were to lose your sight, how would it make you feel to subsequently find out that it actually could have been saved?

Sadly, hundreds of our constituents are going through this very experience. In England, over 600,000 patients are currently on NHS waiting lists to begin treatment for ophthalmology—the branch of medicine concerned with the diagnosis and treatment of disorders of the eye. A survey by the Royal College of Ophthalmologists from this year shows that only 25% of NHS ophthalmology departments feel able to meet patient need, and 70% of departments are more concerned about out-patient backlogs compared with 12 months ago. These are incredibly alarming statistics. Alarming, too, is the fact that it was reported last year that, in 551 confirmed instances, patients had lost their sight as a result of delayed appointments since 2019.

Alongside the problems with ophthalmology in the NHS, we have seen the growth of the independent or private sector. I ask Members to consider the impact that the increased use of private sector provision is having on eye care. Independent sector providers now deliver almost 60% of NHS-funded cataract procedures. That has more than doubled from around 25% before the coronavirus pandemic. Although it has helped to bring down cataract waiting lists, the Royal College of Ophthalmology has found that 67% of NHS ophthalmology departments reported that the impact of independent sector providers on patient care in their area is negative. Let us reflect on that: over two thirds of ophthalmology departments in the NHS believe that the impact of independent sector providers on patient care is negative. It is important that we understand why.

The three aspects those departments have said they are most worried about are training opportunities for junior doctors, funding for the NHS ophthalmology department in which they work, and the available workforce. They believe that these will hamper the long-term ability of their departments to deliver sight-saving care for patients. Every Member of this House should be concerned about that.

The Royal National Institute of Blind People has said that the role of the independent sector has been associated with significant challenges that pose an increasing risk to the sustainability of comprehensive eye care services in the NHS. I believe that the impact on many of our constituents could be, and is likely to be, devastating.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Does my hon. Friend agree that the use of the independent sector creates a postcode lottery as well? More affluent areas get to the front of the queue more quickly, and we see regional variations where the independent sector is stronger. That is a real concern for people waiting to have this treatment.

[Margaret Greenwood]

My hon. Friend makes an important point, and I will touch on regional variations later.

A paper published last month by the Centre for Health and the Public Interest reported that in the period 2018-19 to 2022-23, the NHS paid the private sector around £700 million for cataract treatments. While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether the increase in the number of them being delivered comes at the expense of other sight-saving treatments.

We must ensure that the NHS is comprehensive in the range of treatments that it provides. The Centre for Health and the Public Interest warns that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Ophthalmologists have also told me that it is impacting capacity for the treatment of conditions such as cancer care, urgent treatment and the treatment of newborn babies.

Data received by the charity from 13 NHS trusts has shown that waiting times for some irreversible conditions have increased between 2017-18 and 2022-23, including for glaucoma and diabetic retinopathy. Waiting times have also increased for cataract operations. The charity also reports that the rise in expenditure on cataract services has been accompanied by an increase in the number of private, for-profit clinics, which have been established to deliver NHS cataract services. Its paper states that 78 new private, for-profit clinics have opened over the past five years.

It is not surprising that some senior ophthalmologists have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need but by the commercial interests of the companies delivering it. Last December, Professor Ben Burton, president of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with

“very mild cataracts getting surgery at the expense of other patients going blind”.

He added that the approach of unplanned commissioning means that

“the NHS is losing consultants, money and trainees to the private sector”

and that the profit margin is “too high”, meaning that

“companies can pay three times the NHS overtime rate...So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.”

Professor Burton further warned that:

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

That very much chimes with the arguments raised by the Centre for Health and the Public Interest. In other words, the independent sector is cherry-picking the less complex work.

When he responds on behalf of the Government, will the Minister set out what discussions they have had with NHS England about sorting out the perverse outcomes caused by the unplanned commissioning that Professor Burton has highlighted? Unless we see a change of course by policymakers as a matter of urgency, there are real concerns that we will see the breadth of eye care provided within the NHS diminished to the point where some complex sight-saving treatments are no longer available on the NHS. They might be things such as the treatment people need when they are in urgent care after a road traffic accident, the treatment needed for newborn babies or treatment for cancer.

NHS Dentistry

Alex Sobel Excerpts

Tuesday 9th January 2024 Commons Chamber

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Access to dental care in West Yorkshire is a problem that cannot be ignored. Dental care is a fundamental right and its absence has far-reaching consequences for the health of our whole community. Currently, no dentists are accepting new NHS patients in the whole of Leeds, with waiting lists lasting years. Only recently, a dentist in my constituency, in the rural market town of Otley, withdrew from the NHS scheme citing a “chronic lack of investment”; Manor Square has been a reliable provider of NHS dentistry to the local community for many years—intergenerational communities and families have been receiving NHS care at that practice for many decades—but now they cannot receive it there.

The practice’s withdrawal from the scheme has affected 15,000 patients and raises serious questions about the future availability of affordable dental care in the whole area. One constituent was paying around £45 for two annual check-ups at the practice, with their children receiving free dental care. Under the practice’s new private dental plan, the cost will be £640, which is clearly unaffordable for many families in Otley. Such costs are set against rising costs for families across the board.

The decision appears to be yet another symptom of the chronic underfunding and neglect faced by the NHS. Oral health is an integral part of our overall wellbeing and neglecting it can lead to serious health issues down the line. The withdrawal of NHS dental care not only affects individuals, but has a broader impact on the health infrastructure of our communities. The consequences are felt not just by those who currently need dental services, but by all of us who value a robust and comprehensive healthcare system.

We need an urgent reform of dental care. We need to recognise its critical role in maintaining overall health. Our communities deserve access to quality and affordable dental services. The Government have no clear plan, but Labour does. Labour plans to provide 700,000 additional appointments and education on basic life skills in areas where children’s dental health is most affected, through supervised toothbrushing, and to reform the dental contract, which the Government have failed to do over the last 14 years. As many colleagues have said, there are major issues facing the workforce as many NHS dentists have left to practise privately, or have left the UK for countries where dentistry is more highly valued than it is by our Government.

To conclude, the lack of dental care in West Yorkshire is a serious concern that demands immediate attention. It is not just a matter of oral health but a reflection of broader challenges across the NHS. That is why we should support the motion.

[Mr Deputy Speaker (Mr Nigel Evans)]

Members who have taken part in the debate should make their way to the Chamber now, as the wind-ups will begin after Mr Western finishes his speech.

NHS Winter Update

Alex Sobel Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

First of all, I join my hon. Friend in thanking Ms Bullock for her work and public service, and I wish her a speedy recovery.

On the progress made in my hon. Friend’s local area, he is right: there are some really encouraging signs for the future of the NHS. All the work that we have been doing across all the recovery plans—whether it is for urgent and emergency care, primary care or elective recovery plans—is about embedding progress in the future of our NHS in this year of all years, as we celebrate 75 years of its establishment.

On the impact of the junior doctors’ strikes, my hon. Friend is right to refer to the number of new nurses and the progress that has been made locally. In fact, this year we have been able to announce that we have met a manifesto commitment to recruit 50,000 more nurses. We made that promise in 2019. We have met it early, as well as the commitment to have 50 million more GP appointments than in 2019—two manifesto commitments made, and two manifesto commitments kept.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Happy new year, Mr Deputy Speaker.

More and more of my constituents are waiting longer and longer for emergency care. In 2010, the target for emergency care was 95% of patients within four hours. The Government watered down that target to 76%, and are not meeting that. When will they meet their own target, and when can we expect to see 95% of my constituents being seen within four hours?

[Victoria Atkins]

I hope the hon. Gentleman is injecting the same anguish into the conversations that I imagine he is having with his local junior doctors, asking them to come back to work. Of course, having junior doctors not working in hospitals across the NHS has an impact—of course it does; they are a vital part of our NHS. The attention of NHS leaders, medical directors and clinicians over past weeks has had to be diverted towards covering the strike action rather than making the sorts of improvements and progress we all want to see across urgent and emergency care, in line with our recovery plan.

Mental Health Treatment and Support

Alex Sobel Excerpts

Wednesday 7th June 2023 Commons Chamber

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I want to highlight the crisis faced by families dealing with mental health issues, particularly those with children.

The crisis has been brought to my attention by many constituents over the time I have been an MP, but today I would like to raise the issue of my constituent Stephanie, whose son is autistic, non-verbal, and has complex developmental and communication delays. Stephanie knew that her son needed an attention deficit hyperactivity disorder diagnosis from an early age, but was told that he could not be diagnosed until he was seven. When her son did receive a diagnosis, Stephanie was told by the doctor that it was obvious how much he was struggling to cope with his life due to his ADHD. He is suffering from elevated levels of distress and unable to sleep through the night due to his inability to sit still for long.

Sadly, Stephanie was informed that there would be an 18 to 24-month wait for the community service MindMate to sign off the diagnosis and to be referred to child and adolescent mental health services, along with the medication plan. The CAMHS wait would mean a further 18 to 24 months to receive medication, so if they hit the longest waiting times at both services, her son would have been told that he needed medication at the age of seven and only receive his prescription at 11. Long wait times for diagnosis and medication mean that families across the country are turning for help to charities and support groups such as ZigZag, a Leeds autism support group based in my constituency that offers essential advice and support to thousands of families across Leeds. Stephanie has expressed her concerns and garnered support from other families with similar experiences.

The situation is at crisis point and requires immediate attention from the Government. We cannot ignore the struggles faced by families across the country dealing with the complexities of mental health issues. It is the Government’s responsibility to ensure that our most vulnerable citizens have access to prompt and proper care. Those issues are just the start. For instance, Leeds University reports that it has seen an about 60% increase in demand for mental health services and that the issues are a lot more complex than they were before covid. It says that many students are arriving at university with anxiety and mental health issues as the support they needed in their formative years was simply not available. Huge pressure is being built up, like a dam that is going to burst.

Adult ADHD services in Leeds currently have 3,300 people on their diagnostic waiting list—that does not include all the people who cannot be bothered to see their GP because of the length of the waiting list—and they are receiving more than 170 referrals a month, which far exceeds their capacity. The waiting list is currently upwards of three years, with an added wait for medication after having received a diagnosis. Similarly, the adult autism diagnostic service in Leeds currently receives more than 100 referrals a month, but it has the resources to complete only 40 assessments a month.

The current situation is completely unacceptable. We need the Government to create a more effective and efficient mental health care system that is responsive to the needs of communities. We cannot continue to let down families like Stephanie’s at every turn. It is crucial that we invest in the mental health sector and prioritise the wellbeing of all our young people.

NHS Workforce Expansion

Alex Sobel Excerpts

Tuesday 28th February 2023 Commons Chamber

[Wes Streeting]

I am delighted that the hon. Member asks. I had a good meeting with the British Medical Association pensions committee recently. There are a number of ways in which this matter could be resolved, one of which might be a tax-unregistered scheme, which we have seen used successfully in the judiciary. [Interruption.] I am perfectly fine with having a tax-unregistered scheme. I think the difference between the Opposition and the Government is that the Government have an army of civil servants to do the modelling. That is what I would like the Government to do. I say to the hon. Member again that it is no use lobbying the next Government—lobby the current Government.

Turning again to the international picture, the NHS is having to recruit from countries on the World Health Organisation’s red list—countries that desperately need the few doctors and nurses they have—because our Government cannot be bothered to train their own. I think that is unethical, immoral, a disgrace and a kick in the teeth for the UK students who desperately want to be the doctors, nurses, midwives and allied health professionals that our country needs.

The Chancellor is refusing to budge, I believe, on cost grounds, but Labour’s plan before the House today would cost £1.6 billion a year. We have shown how we would pay for it: scrapping non-doms would raise more than £3 billion. If the Chancellor needs any tips about the non-doms system, or if perhaps he is worried that non-doms might flee the country, he need only knock on his next-door neighbour’s door to see a case in point. He will find out how the system works, and that when people are asked politely to pay their taxes here, they do not flee the country.

Inaction also has costs. The NHS spent an eye-watering £3 billion on agency staff last year. One hospital was so desperate that it paid £5,200 for a doctor to work a single shift. Does that not sum up the approach of this Government: penny wise and pound foolish?

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend is making a remarkable speech. My constituent Marjorie Dunn spent seven weeks and a day in Harrogate Hospital last year, and in that time she saw NHS nurses leave the service and she was treated predominantly by agency staff—mistreated, I have to say, by agency staff. It is a disgrace. When she was eventually moved to a recovery hub run by Leeds City Council, she got excellent treatment there. She had broken her pelvis and been told she would never walk again, but it was the council physiotherapist who got her up and walking again. Is it not right that we should be supporting local authorities such as Labour-run Leeds to get such facilities as well as the NHS?

[Wes Streeting]

My hon. Friend is absolutely right. I very much enjoyed my visit to Leeds with the shadow Chancellor to look at the work the acute trust is doing with Leeds City Council to speed up delayed discharges. He is absolutely right about the impact of the churn of staff on a ward—because they are not regular staff on a contract of employment at a particular hospital or medical facility—and it can be quite distressing for patients to see the faces and names change every day and to constantly be explaining once again what their experience in the hospital has been, if indeed the staff have time to stop and talk.

I am really struck by the fact that one of the biggest issues that staff raise with me is the moral injury. The fact is that they are busting a gut and working their socks off, and they go home at the end of the day deeply demoralised, distressed and depressed because they know that, despite their very best efforts, they are not providing the quality of care that patients deserve, through no fault of their own. That is why, even above the issues of pay and of terms and conditions, which I think many of us would understand in and of themselves, I think the straw that is breaking the camel’s back is the moral injury. Unless we address that, we are going to lose the brilliant staff we have, before we even start to think about recruiting the staff we need.

NHS Workforce

Alex Sobel Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House recognises that the National Health Service is facing the worst workforce crisis in its history with a shortage of 9,000 hospital doctors and 50,000 nurses; condemns the Government’s failure to train enough NHS staff to tackle this crisis; regrets that, as a result, patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Government to end the 200-year-old non-domiciled tax status regime which currently costs taxpayers £3.2 billion a year; and further calls on the Government to use part of the funds raised to invest in the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses per year and delivering 5,000 more health visitors to guarantee that the NHS has the staff to ensure every patient can access the care they need.

The NHS is facing the worst crisis in its history. Seven million people are waiting for NHS treatment, and they are waiting longer than ever before; 400,000 patients have been waiting for more than a year. Heart attack and stroke patients are waiting an hour for an ambulance, on average, when every minute matters. “24 Hours in A&E” is not just a TV programme; it is the grim reality facing patients in an emergency. Behind those statistics are people being held back from living their lives: people forced to give up work because they cannot stand the pain; young people, still bearing the scars of lockdown, unable to get the mental health support they need to step into adulthood; families losing loved ones for no other reason than that the NHS was unable to treat them in time.

My friend and colleague the shadow Leader of the House shared with me an email from one of her constituents. A patient with suspected cancer was urgently referred by his GP, which ought to mean being seen by a specialist within a fortnight. Four weeks later he had heard nothing. He phoned the hospital and was told, “two weeks currently means six weeks” and that he would be contacted, not seen, within the next two weeks. He has now had his appointment, during which the doctor identified cancerous cells. He has been told that he will wait up to eight months to have that cancer removed. He said that until waiting lists are down,

“more people will die unnecessarily from cancer. I hope not to be one of them.”

That is not uncommon. That is where we are. That is why Labour is today putting forward our plan to solve this crisis, make the NHS fit for the future, and get patients treated on time again.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Yesterday I spoke to a paramedic who had been with a patient with sepsis, waiting for two and a half hours to be taken in. There were 98 calls at that same Yorkshire hospital waiting to go in. Are we now post-crisis and in complete breakdown, and do we need Labour’s plans to come in now, and not have to wait?

[Wes Streeting]

I strongly agree with my hon. Friend. As the Leader of the Opposition has said, the NHS is not on its knees; it is on the floor. How many times were we told during the pandemic that restrictions were needed to stop the NHS falling over? It has now fallen over, and for the first time in its history people no longer feel certain that, when they phone 999 or arrive at A&E, they will be seen in time. It is the first time in our country’s history that people have not felt confident that emergency medicine will be there for them when they need it.

The Conservatives blame the crisis in the NHS on everything from the weather to the pandemic, and even NHS staff. Of course there is no doubt that the pandemic has made things worse, but the Government—the Conservative party—sent the NHS into the pandemic with 100,000 staff shortages. They spent a decade disarming the NHS, before sending it into the biggest fight it has ever faced. They cannot pretend that the NHS was well prepared. The problem for the Conservative party is that people are not stupid. Their memories are not that short. They know that the NHS was struggling to treat them on time before the pandemic, and they know who is to blame.

Access to GP Services and NHS Dentistry

Alex Sobel Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. This is the problem: they overpromise and underdeliver. If they will not hear it from me, Mr Speaker, let us remind ourselves of what some of the Secretary of State’s colleagues have said. The hon. Member for South West Bedfordshire (Andrew Selous), who is in the Chamber, said in Prime Minister’s questions only last week:

“At one of my surgeries, which has double the recommended number of patients per GP, the bowel cancer diagnosis of a 51-year-old father of four was missed and is now terminal.”—[Official Report, 15 June 2022; Vol. 716, c. 283-4.]

Earlier this month, the hon. Member for Telford (Lucy Allan) read a letter from a constituent to the Health Secretary. It said:

“Trying to get basic healthcare is a joke in Telford. Maybe I would be better off in…a third-world country”.

If the Secretary of State is not going to listen to us, he should at least listen to his own side. Before Conservative Members leap to the defence of their Government’s record, they should probably go back and check the record to make sure that they had not agreed with us in the first place.

As for dentistry, 2,000 dentists quit the NHS last year, around 10% of all dentists employed in England. It is an exodus under the Government’s watch. Four million people cannot access NHS dental care and cannot afford to go private either.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend is making an excellent speech. My constituent, Ellie Cokeley, wrote to me. She works as a receptionist in a local dental practice and gets hundreds of calls a week from upset members of the public who are unable to find an NHS dentist. She said that it feels greatly unjust that the poorest in our society are being forced to pay huge amounts for vital dental care or, worse still, having to continue without any at all. Are the Government not failing people in this country when it comes to the care of their teeth? It is vital that we get more dentists in the system.

[Wes Streeting]

My hon. Friend is absolutely right. Some places, such as Somerset, are dentistry deserts because the remaining NHS dentists are not taking on new patients.

Covid-19 Update

Alex Sobel Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

First, I hope that my hon. Friend will agree with me that one of the reasons for these measures is precisely to avoid a lockdown. We all want to see a lockdown avoided for all the obvious reasons, and taking the right proportionate measures now will certainly help to do that. On the vaccine, I am not proposing reformulation. I think the most important thing right here and now, and more important than even before, is the booster programme—not a reformulation, but getting a third shot to boost everyone’s immunity. On the future, where I see vaccines going is multi-variant vaccines, a number of which are already being developed. Just as we see that with flu, I am sure we will see that with covid.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Mr Speaker, I am sure you, the Health Secretary and everybody in the House would like to thank the South African scientists for their early work and discovery of the omicron variant. If we are to avoid more variants in the future, it is really important that we have a high level of vaccination not just in the UK, but everywhere in the world. Is it not our duty, as a country that produces vaccines, to ensure that countries such as South Africa and others have high levels of vaccine, and that we end the Government policy of vaccine nationalism?

[Sajid Javid]

First, I join the hon. Gentleman in thanking the South Africans for their huge efforts with respect to this variant, recognising how they have worked with the world, including us, on it. I think the way they have reacted to this is nothing but exemplary. However, I would have to disagree with the hon. Gentleman on referring to the Government’s approach as vaccine nationalism. We have already given more than 20 million doses to COVAX and bilateral doses, and there are another 9 million or so ready to go.

Health and Care Bill

Alex Sobel Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Justin Madders]

Let us just say that the more I hear of the right hon. Gentleman, the more I like what he has to say—I will leave it there.

We all accept the urgent need to address the workforce crisis, but I cannot find anyone who thinks that what the Government have put forward in clause 34 is the solution.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

A doctor in my constituency, Dr Tom James, told me that he and his colleagues in the hospital were demoralised, exhausted and at the end of their tether, particularly after the covid crisis, in a building that was falling apart around them. He said there was no more goodwill, and the Government needed to grab hold of this crisis and resolve it. Are new clause 29 and amendment 10 not a minimum, rather than a maximum, for what we should be looking to achieve?

[Justin Madders]

New clause 29 and amendment 10 are the starting point, not the whole answer. They are a framework for getting this right in the future and offering the workforce, which, as the Minister said, has given so much in recent times, some hope that there will be better times along the way. I will refer later to the report by the Health and Social Care Committee on workforce burnout, which brought home just how demoralised the workforce have become and why they need to be given some positive news today.

GP Appointment Availability

Alex Sobel Excerpts

Tuesday 26th October 2021 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve with you in the Chair, Mr Robertson. I thank the hon. Member for Beaconsfield (Joy Morrissey) for calling today’s important debate. Let me set out the challenge, and how Government can make a difference.

York Medical Group has 44,000 patients on its books. In a single calendar month, it received 41,000 calls from people who needed to see a clinician—unprecedented demand, with higher acuity, co-morbidity and complex needs. When patients get through to the call-handling system, they are triaged and, when urgent attention is needed, that is followed up by a clinical conversation. Appointments are allocated, tests are ordered, referrals are made, and prescriptions are issued.

Of course, people are also applying to see a practitioner through the internet or are turning up at the surgery. That is managed by exceptional staff, who are really pulling out all the stops to support their local community. However, this logistical agility to meet the serious demand is outstripped by the pressures placed on it. When spending time embedded in the system—as I did, spending time with call handlers and with GPs—I saw how relentless they were in trying to meet that demand, but that demand is continuing to put pressure on them.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My constituency is only 25 miles from my hon. Friend’s. A constituent came to see me last week; they could not get an appointment with their GP, but were told to go to the accident and emergency department in Leeds. It took two hours at the A&E to be triaged, and they were then told it would be a further six to seven hours to see a doctor. They ended up going home because it was too cold at the hospital to wait. Does this issue not impose pressure right across our health system, to the point that it is near collapse? Winter has not even properly started yet.