Eye Health: National Strategy

Janet Daby Excerpts

Wednesday 17th May 2023 Westminster Hall

[Marsha De Cordova]

I thank my hon. Friend for his intervention, and he is absolutely spot on. I will come to the workforce plan and the Government’s expectations, but he is absolutely right that it must include this specialism. There must also be an element of training and upskilling.

[Janet Daby (Lewisham East) (Lab)]

I, too, congratulate my hon. Friend on securing such a significant debate. I recently visited Greenvale School in my constituency, which is a school for children with special educational needs and disabilities. It is one of the schools involved in the initial roll-out of the special school eye care service, and I have met the ophthalmologists, who do absolutely brilliant work. Does my hon. Friend agree that if the Government end this service in the summer they will be neglecting children’s eye care, and a huge responsibility and onus will be placed on families?

[Marsha De Cordova]

My hon. Friend makes a really crucial point about special schools and about ensuring there is enough capacity to support children who have complex needs with sight loss. What is really troubling is that, in many instances, sight loss is not always picked up, so having specialist ophthalmologists in schools is crucial. There absolutely should be no way of reducing that provision—in fact, we need to build capacity.

To respond to the current crisis in eye healthcare, the Government must commit to a national eye health strategy for England, as set out in my Bill. The strategy would include measures to improve eye health outcomes, remove the postcode lottery of care, reduce waiting times, improve patient experiences, increase the capacity and skills of the workforce, and make more effective use of data, research and innovation. An eye strategy would ensure that, regardless of where someone lives, they can have access to good-quality eye healthcare, which would address eye health inequalities and ensure that there is more equity of access to eye care among different communities and people who are more at risk of sight problems but who may not be accessing NHS sight tests.

[Marsha De Cordova]

I thank my hon. Friend, who highlights the fantastic eye care department at St Thomas’s Hospital. She is absolutely right: my strategy already sets out how to address the backlogs in eye healthcare, and the Government could just say, “Yes, we are going to take it on, reduce those backlogs and address the workforce issues.”

Ensuring that we have equity of eye health must also include people who are homeless and those with learning disabilities, as my hon. Friend the Member for Lewisham East (Janet Daby) mentioned. A strategy would focus on five areas. The first is the eye health and sight loss pathway, which outlines the care and support for those diagnosed with loss of vision. A pathway would focus on the physical and emotional impact of being diagnosed with sight loss. Research has shown that blind and partially sighted people are likely to experience poor mental health outcomes, such as depression and anxiety, in their lifetimes. As part of the pathway, more emphasis should be placed on the provision of non-clinical community support, which would complement the work of community optometrists, ophthalmologists in hospitals and rehabilitation officers. Where is the plan to improve non-clinical and community support as part of the eye health pathway?

The second area the strategy would aim to improve is collaboration between primary and secondary care, and it would emphasise integrated care systems to ensure timely and accurate referrals. Demand for eye care services is expected to increase by 40% over the next 20 years, so we need to pay more attention to joining up care to meet future demand. Some of the burden on hospitals from that increased demand could be eased through more investment in high street community optometrists and by changing the way services are commissioned, to make more use of resources and infrastructure in our communities.

Two million people attend NHS accident and emergency services each year with an injury to or disease of the eye, and over 65% of those cases could have been treated in primary care optometry, which is not only more accessible but saves money—it costs less. Despite that, only 23 out of the 42 integrated care boards commission a minor eye condition service, or MECS, consistently. Five have no MECS provision at all—patients must attend a hospital eye service either via their GP or A&E. That is unfair and inequitable, and it is a waste of NHS resources to have patients go to A&E when they could access something in the community, which is easier for the patient, improves outcomes and saves us money.

[Janet Daby]

I thank my hon. Friend for giving way. Does she agree that the Government party claim to take care of the public purse, but in this case they are clearly not doing that at all? They are actually doing the opposite—wasting money from the public purse—because they are not making sure that the funds address the right issue.

[Marsha De Cordova]

Again, my hon. Friend makes an intervention that is 100% accurate. We obviously have to ensure that spending is done effectively and properly, and ensuring that resources are allocated in the community and alleviate pressures on hospitals will obviously lead only to better outcomes and savings.

At the most recent meeting of the all-party parliamentary group on eye health and visual impairment, ophthalmologist Dr Seema Verma from St Thomas’s Hospital spoke about the importance of MECS and locally commissioned optometry clinics in south-east London, which prevented 32% of referrals from being sent to hospital eye care services. If my hon. Friend the Member for Vauxhall (Florence Eshalomi) does not mind, I would very much like to invite the Minister to visit the eye department at St Thomas’s and the MECS community service, if he has not already done so.

Better joined-up care requires spending on infrastructure. Improved IT connectivity for two-way transfer of patient and clinical data would enable better patient care, and improved use of clinical skills and facilities in primary care, enabling more patients to be seen and treated closer to home. Everyone can get the theme here: community, community, community.

The eye care sector has been championing a single national electronic eye care referral system or EECR—there are so many acronyms—that would facilitate direct optometry to ophthalmology referrals, without people having to go through their GP. That would reduce the administrative burden on GP services, devolving some of the lower-risk cases to optometry and addressing unwarranted variations in referral and follow-up pathways.

--- Later in debate ---

[Dr Matthew Offord (Hendon) (Con)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Harris. I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing today’s debate. She knows that I feel strongly about eye health and sight-related issues. On one hand, I am pleased to come along to support her. On the other hand, I am disappointed to be having to speak in this debate, because it was not long ago—in fact, it was 11 January last year—that we had the previous debate.

That debate, introduced by the hon. Member for Strangford (Jim Shannon), was on eye health and macular disease. As well as the hon. Gentleman, we heard from the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), my hon. Friend the Member for Sedgefield (Paul Howell), the hon. Member for East Londonderry (Mr Campbell), my hon. Friend the Member for Darlington (Peter Gibson), the hon. Member for West Ham (Ms Brown), the right hon. Member for Hayes and Harlington (John McDonnell), my hon. Friend the Member for Great Grimsby (Lia Nici), the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and the hon. Member for Denton and Reddish (Andrew Gwynne)—and we all came to the same conclusion.

There were a lot of kind words from the Minister in that debate, and a lot of sympathy for our enthusiasm for a national eye strategy. However, I never actually heard the Minister say that she would agree to an eye strategy. That was surprising considering that, during the debate, we learned that over 2 million people currently live with sight loss, and 350,000 people are registered blind or partially sighted. We also learned that age-related macular degradation is a leading cause of blindless. That can be averted with more accessible healthcare provision. We also learned that more people suffer from macular degradation than dementia. Considering the political priority we give dementia, that seems quite shocking.

During that debate, people took the opportunity to talk about sight loss. I do not use the Chamber as a confessional, but I admit that when I first had macular degradation, I had a conversation with my wife to ask whether life would really be worth living if I lost my eyesight. That has always stayed with me. It is an important issue, and not only to me. When I first experienced the problem, I was amazed at how many constituents told me that either they or their families also had sight loss problems. It is a big issue for many people.

During the previous debate, the Minister was keen to stress the additional £2 billion provided through the elective recovery fund. She also mentioned the additional £5.9 billion of capital funding to support elective recovery diagnosis and technology. I was left mystified about how many people would actually be treated for issues relating to their sight, be it cataracts, macular degradation or anything else. A week later, on 18 January last year, I asked the Department how many cataract operations would be performed as a result of the £2 billion allocated to the NHS through the elective recovery fund. The response was:

“This information is not held centrally, as this funding will not be distributed through set allocations.”

So the answer is none.

I have asked several other questions of the Department. I was most disappointed when I realised that the Minister had no intention to introduce a national eye strategy—something that I called for in last year’s debate—so I asked the Secretary of State, straightforwardly,

“if he will introduce a national eye care strategy.”

The response was:

“There are currently no plans to introduce a national eye health strategy. However, NHS England and NHS Improvement are recruiting a National Clinical Director for Eye Care to lead improvements in eye care services.”

That came on 17 January 2022, a week after last year’s debate. If there is a national clinical director for eye care, what are their achievements so far? Will the Minister provide an update on that?

I went back to the Department on 3 March to ask why its policy is that a national eye care strategy is unnecessary. The answer was:

“Regionally based National Health Service commissioners are responsible for commissioning secondary care ophthalmology services, out of hospital services from primary eye care providers and the NHS sight testing service. These services are put in place to meet local identified needs, which vary across the country. It is therefore important to allow local areas to set their own priorities.”

I have to ask the Minister: is it the case that we will not get a national eye strategy following today’s debate?

I attended an event with the hon. Member for Battersea where the person who I thought was the eye Minister, my hon. Friend the Member for Colchester (Will Quince), said that he would think again about a national eye strategy. I thought that this issue was probably important to him, and I asked him some questions in Parliament. I asked him for his assessment of the impact of ophthalmology waiting times on patient outcomes. I did so to try to understand whether he felt that this was an important issue and that we needed to establish a national eye strategy. His response was:

“No formal assessment has been made.”

I asked the Secretary of State yet another question:

“what assessment his Department has made of the potential economic benefits of additional funding in sight loss research.”

For Conservatives, that would be good fiscal policy, because we could ensure that people are not dependent on the state and are not a burden through increased taxation on others, but the answer came back:

“No specific assessment has been made.”

So the answer is that we simply do not know, and we are not going to get any answers by asking the Department.

I ask the Minister to say today that this is an important issue. It is important, especially for people who have gone through the process of thinking that they may lose their sight—they may even question whether it is worth living. As I said, I have certainly been through that. I would like to see greater provision, because the impact of eyesight loss and partial sightedness is huge.

[Janet Daby]

I thank the hon. Gentleman for talking about his personal experience. Among children who have special educational needs and disabilities, sight loss often goes undetected, which is why it is so important to have ophthalmology treatment within SEND schools. Does he agree that if the Government are going to introduce a national eye health strategy, that issue should be one of their priorities?

[Dr Offord]

I certainly do, as the hon. Lady would expect. The implications of having problems at an early age are much longer term, so we will find people without access to education and, ultimately, to employment, and their quality of life will certainly be much reduced if that provision is not implemented. I believe that it should be a major component of a national eye strategy.

In conclusion, I simply say to the Minister that he should make a national eye strategy his legacy, before it is too late.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I must begin by thanking the hon. Member for Battersea (Marsha De Cordova) for bringing forward this very important debate. She is a very strong advocate for improving eye health in England. Likewise, I thank other hon. Members who made important points in the debate, including the hon. Members for Ealing Central and Acton (Dr Huq), for Lewisham East (Janet Daby), for Vauxhall (Florence Eshalomi), for Mitcham and Morden (Siobhain McDonagh) and for Sheffield Central (Paul Blomfield) and my hon. Friend the Member for Hendon (Dr Offord). I will try to address the points that have been made as I go through my speech.

I am haunted by the point made by my hon. Friend the Member for Hendon about wondering whether life would be worth living. To address the question directly: yes, of course. This is a hugely important issue for us, for exactly the reasons he set out. As the Minister for both primary and secondary eye care services, I reassure the whole House that I am working actively on the issue.

Since we last debated the topic in December, I met with the hon. Member for Battersea to discuss how we can make progress on all those things. Although I am unable to say exactly in what form the output of that work will come out, I reassure her that we are looking at pace at absolutely all the different issues she raised, both previously with me directly and in this debate.

I also met with Louisa Wickham, the new national clinical director for eye care—the lady who my hon. Friend the Member for Hendon asked about—to talk about NHS England’s eye care transformation programme. To address another question that was raised, I also met directly with the eye care sector, which talked passionately about how it is ready to deliver more out-of-hospital care to alleviate secondary care pressures. That is an exciting opportunity that we are keen to seize.

Although it is not the main topic of today’s debate, the future of sight testing in special schools is a very important area of concern to a number of hon. Members present, and to me as well. I recently convened a roundtable of experts to discuss the future of sight testing in special schools, and I will continue to engage with NHS England on their proposals for the future. I hope that it will not be too long before I am able to update the House on that.

I am absolutely seized by the arguments I have heard today—and earlier—from the hon. Members for Lewisham East and for Mitcham and Morden, and from the experts and people in special schools who have seen the advantages of the service. I join the hon. Member for Mitcham and Morden in paying tribute to Tina Harvey for her work. Some of the people in those special schools are just totally inspirational.

[Janet Daby]

I thank the Minister for seeking to address special educational needs ophthalmology in schools. Can he say when the outcome of the roundtable on what the future will be like for ophthalmology in schools is expected? It is due to come to an end in July but, in actual fact, in previous years there were promises that it would be a long-term service.