Glaucoma and Community Optometry

Andrew Stephenson Excerpts

Tuesday 30th April 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is always a pleasure to see you in the chair, Dame Caroline. Can I start by thanking the hon. Member for Strangford (Jim Shannon) for raising the importance of eye health to the wellbeing of people across our United Kingdom. No Westminster Hall debate is the same without him. I also thank the hon. Member for East Londonderry (Mr Campbell), and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for their contributions.

Losing one’s eyesight can be devastating. I pay tribute to the charities that have done so much to help people living with glaucoma, or which are researching a cure: Glaucoma UK, the Glaucoma Foundation and the Royal National Institute for Blind People to name just a few. This morning, we are focusing on glaucoma and the role that can be played by community optometry. This afternoon, there will be a debate on the broader issue of preventable sight loss. I am responding to both debates on behalf of my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is the Minister responsible for primary and secondary eye care services. She is otherwise engaged, as she is a member of the Tobacco and Vapes Bill Committee. I know she would want me to put it on the record and reassure Members throughout the House that that remains one of her top priorities.

As I am standing in today, I want to reassure Members that this is a subject close to my own heart. Glaucoma affected several people on my father’s side of the family—my great aunt, Emily Stephenson, lost her eyesight in her 60s because of glaucoma. I remember visiting her as a child and seeing the RNIB talking book cassette tapes, which she loved, and I am delighted that that service continues today in more formats and with more titles than ever before. My mother, too, lives with glaucoma, so I take this issue very seriously.

Up and down the country, community optometry plays an essential role in protecting people’s eye health. It also plays a key role in the early detection of glaucoma, as most glaucoma patients are identified through routine sight tests. Glaucoma cannot be felt—it does not cause any symptoms, and the eye pressure does not cause any pain. That is why regular sight tests are essential, so that problems such as glaucoma can be diagnosed and treated as early as possible.

As the hon. Member for Strangford suggested, everyone should have a sight test every two years. The NHS invests over £500 million every year in providing sight tests and optical vouchers. Between 2022 and 2023, we delivered over 12 million NHS sight tests free of charge. The tests are widely available for millions of people and the budget is entirely demand led, meaning that there is no cap on how many we will provide. We understand that some people may not prioritise sight tests compared with other healthcare, or they might not know that eye tests are recommended every two years. That is why we are always looking for opportunities to remind the public to have a test, through social media and other campaigns. Sight-test providers such as Specsavers and others on the high street display information about NHS sight-test eligibility.

We are committed to making greater use of community optometry to help to alleviate pressures in secondary care. Many integrated care boards are already commissioning a greater range of services on the high street, including minor and urgent eye care services, pre and post-cataract checks, and glaucoma referral filtering and glaucoma monitoring.

Glaucoma referral filtering schemes have delivered fantastic results, with additional tests that double-check whether a patient really needs to be referred to secondary care. These are tried-and-tested schemes that can save patients time and worry while freeing up space for those who most need specialist attention in hospital. Devon is a great example of that. An old Nightingale ward has been repurposed with equipment to screen large numbers of glaucoma and medical retina patients. The diagnostics hub has demolished the hospital’s backlog from just under 4,000 in April 2022 to just below 500 in October 2023—almost a 90% decrease. In Milton Keynes, 70% of suspected glaucoma patients were discharged following refinement of initial referrals made on the high street. About 50% of integrated care boards currently have a version of those schemes in place, and we are assessing the potential for encouraging the roll-out of those schemes even further.

It is vital that patients who need secondary care have access to timely diagnosis and any necessary clinical treatment. The hon. Member for Strangford is right to say that those services suffered during the pandemic, just as they have across the NHS. That is why we have set an ambitious target to recover services through the elective recovery plan, supported by more than £8 billion of dedicated funding, and it is why we have expanded surgical hubs and harnessed the capacity of the independent sector, so that more patients can be seen more quickly. That has been particularly successful for cataract surgery.

Our plan is working and it is delivering results, as waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology has been reduced by 96% since its peak, but we know that we have to go further. As well as cutting waiting lists today, we are looking at how we can reform eye care services to meet the demands of tomorrow. NHS England’s transformation programme is running seven projects across each integrated care system area, such as those that test how improving IT links between primary and secondary care could allow patients to be assessed and triaged virtually, saving them time and freeing up more hospital capacity for patients who need specialist face-to-face care the most. NHS England is gathering data and evaluating different interventions, looking to develop a convincing case on what works best and supporting further expansion.

We are going further and faster to free up hospital capacity. Today, many glaucoma patients often have their condition managed in hospital, but in some cases, where clinically appropriate, there is no reason why they cannot be seen somewhere else in their community that is more convenient for them. In England, it is up to ICBs to commission services based on local need, and some ICBs are already trying new ways of working to do just that.

Finally, on research, I want to recognise just how much potential there is for research and innovation to change the lives both of people who suffer from sight loss and of their families. The UK leads the world in research; we could not be more committed to pioneering new treatments and improving our understanding of sight loss. We put our money where our mouth is by awarding the Moorfields Biomedical Research Centre £20 million to carry out another five years of world-leading research in December 2022. Thirteen out of the 100 leaders and innovators in ophthalmology across the world who were included in The Ophthalmologist’s “Power List 2023” were researchers from Moorfields, and we should be proud that that centre of excellence is right here in London.

[Jim Shannon]

I thank the Minister for his very positive and helpful response. The shadow Minister referred to ophthalmology services increasing by 40% over the next 20 years—those figures might not be entirely accurate, but I think that is what he said. That certainly indicates to me that we need to have a progressive and active programme to ensure that people can get tests in partnership with opticians. The Minister mentioned ICBs and how that will be done; I say this respectfully, but can we have some meat on the bones as to how that would work? I am ever mindful that the Minister wants to see that, but we wish to see that as well.

[Andrew Stephenson]

NHS England is looking at a range of different interventions across the country. One of the benefits we have across England, and of course across the United Kingdom, is that we can try different things, such as models of delivery, in different parts of the United Kingdom and learn lessons from one another.

The current strategy pursued by the NHS is to look at different programmes across England and evaluate them to see what delivers the best outcomes for patients. That will help us to improve access for patients and deliver quality treatment. We hope that that evaluation will enable us to suggest best practice. It will still be up to ICBs to commission services—we believe they should be commissioned locally—but we hope that by providing an evidence base for them they can take decisions in the best interests of their local communities. To address the point made by the shadow Minister, that will address the growing demand for services. We recognise the fact that there will be more demand in the years to come. It will also help to address some of the backlogs with which we have struggled since the pandemic.

I hope I have said a few things to convince the hon. Member for Strangford that, while we still have much to learn from Northern Ireland, the Government take glaucoma extremely seriously. Community optometry is helping us manage the flow of glaucoma patients and it is already deployed effectively in many areas across the country to support patients.

We should be under no illusion about how many people watch Parliamentlive.tv. I think it was Stanley Baldwin who once said that the best way to keep a state secret was to announce it on the Floor of the House of Commons. Nevertheless, I wish to end with an appeal to anyone watching this debate at home: remember to take an eye test and please check the NHS website to see whether you are eligible for help. In preparing for today’s debate, I decided to do just that and I will be having my eyes tested tomorrow morning.

[Dame Caroline Dinenage (in the Chair)]

That is good to know; thank you very much. I call Jim Shannon to wind up the debate.