Preventing Avoidable Sight Loss

Jim Shannon Excerpts

Tuesday 28th March 2017 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I have 27 minutes to speak. I jest, by the way; I am not going to speak for 27 minutes.

[Mrs Cheryl Gillan (in the Chair)]

Mr Shannon, you have plenty of time to speak. I feel I should declare an interest as I am wearing glasses to read my papers.

[Jim Shannon]

It is always a pleasure to serve under your chairmanship, Mrs Gillan. I give special thanks to the hon. Member for Wealden (Nusrat Ghani), who very capably set the scene for us all on a subject that is obviously close to her heart; I believe it is close to the hearts of those of us who are here to participate in the debate as well.

As someone who has needed glasses from eight years of age—I am over 50; well over 50, let me tell you—I have never really known any other way; that is the fact of it. I can well remember those first glasses, with those round circles of glass like milk bottle bottoms. Those were the prescription glasses I wore in the ’60s; we have come a long way to the perfection of eyesight and glasses today. In my case, I wear varifocals, and others in this Chamber probably have the same. I look down to read and look up to look away. Varifocals give that better vision, and it is good to have that.

I certainly have compassion for those whose sight is deteriorating or lost completely. I think losing sight is probably one of the worst things that can happen to anyone. How much do we all appreciate seeing things in colour and all around us? There are some who cannot. My dad lost his sight at a late age in life, and I know it is one of the things that he particularly missed. He used to read his Bible in braille in the last few years of his life. To understand that sight loss can be prevented in some cases is something that we must all work towards achieving, and we must play our part in the House.

The Library pack has been quite helpful, and some of the information it gives is particularly applicable. The fact that sight loss costs the UK economy £28 billion is something that cannot be ignored when it comes to adding equations; we understand and appreciate that we have to balance the books, but when balancing the books we should sometimes do the necessary preventive action that the hon. Member for Wealden referred to.

[David Simpson (Upper Bann) (DUP)]

Only yesterday in my surgery some folk came to see me about sight loss, the lack of appointments and the length of time they had to wait. We have been given the figure this morning of 20 people per month losing their sight, which is a precious thing. If there is a drug that can help to prevent that, surely the onus is on the Government to give people the gift of sight? That is worth pursuing.

[Jim Shannon]

It absolutely is. The hon. Member for Wealden referred to England in her introduction, but Scotland, Wales and Northern Ireland have taken some steps in that direction. At the end of the day, we can certainly do this much better.

Sight loss affects people of all ages, but older people are more likely to experience a sight-threatening condition. That is clearly understandable. Having celebrated another birthday on Saturday past—I have stopped counting birthdays, which I think is probably the best idea; I try to forget about it, but the family keep reminding me that I am of a certain age—I certainly feel a deterioration process in action. That old saying that the spirit is willing but the flesh is weak becomes more and more a reality as I mow the lawn at home and carry out maintenance on the farm.

My glasses prescription has changed greatly over the years, and not for the better. That, again, is part of the ageing process. I am also a type 2 diabetic, so I have to be particularly careful with my eyesight. The former health Minister, now the Financial Secretary to the Treasury, replied to a question I asked about diabetes, and I think the hon. Member for Wealden referred to diabetes in her speech. The hon. Member for Erewash (Maggie Throup) also mentioned it in an intervention. We need to be aware of the complications of diabetes. Early diagnosis is very important.

It is critical to have regular appointments with an optician. I am not sure if everybody has one as regularly as they should. In Northern Ireland, I see my optician twice a year—probably because I am a diabetic. Others probably do it at least on a 12-month cycle. It is important to do so, because an optician can spot things in someone’s eyesight and signs affecting other parts of the body. It is important that the role of the optician is encouraged.

One of the lesser-known reasons for sight loss is leber hereditary optic neuropathy. It is an ultra rare and very disabling disease that leads to blindness in approximately 80% of those affected within one year of the onset of symptoms. It affects just one in 50,000 people and is caused by a disorder of the mitochondria; it usually strikes young men aged between 15 and 35. Again, it can be prevented by early diagnosis, but there are no treatment options routinely available to patients with it in the UK. I often look with envy towards Scotland, because Raxone is currently undergoing a review there, whereas in England it was not selected by the National Institute for Health and Care Excellence. That is a bit of a disappointment. If the Minister does not mind me asking, perhaps he could respond to me on that as well when he gets a wee chance. It is most important.

I will give a Northern Ireland perspective, but I will not be taking the time that we talked about at the beginning. In Northern Ireland, the 2011 census reported that, out of a population of 1.8 million, a total of almost 31,000 people self-reported a long-term condition related to blindness or partial sight loss, representing some 1.7% of the population. However, the figure is set to increase dramatically in the future, as the population ages.

I am not sure if anyone has mentioned this yet, but we have an ageing population. We are getting older, and people are living longer, so this issue will become a bigger factor than ever before. Recent population statistics from 2016 reveal how the age structure in Northern Ireland is projected to change. I will give an example. The population aged 65 and over is projected to increase by 74.5% to almost 500,000 people from mid-2014 to mid-2039, with the result that one in four people—24.7%—will be in that age category. The population aged 85 and over is projected to increase by 157.3% to 88,600 people over the same period, which will see that share of the population increase from 1.9% to 4.4%.

The reason for giving those stats is simple: there will be greater demand on the NHS. The increasing prevalence of sight loss over the next decades requires additional planning, a long-term strategy and policy development now in order that the Government best respond to people’s needs and concerns. That is what we are asking of the Minister, for whom we have the utmost respect, and I know he will reply with conviction and a desire to answer our questions.

I wonder whether this could be done better together, through a UK strategy. I am a great believer in the Union of Great Britain and Northern Ireland. I have been told off this morning for saying that once or twice too often, but I continue to say it because it is important, as it is for my colleagues close to me in the Chamber.

In Northern Ireland we face a particular challenge in relation to timely and responsive ophthalmology treatment. In recent years, many new treatments have been developed, saving the sight of thousands of people who previously would have gone blind. One of our universities in Northern Ireland has been involved in perfecting new drugs and systems to prevent sight loss. An enormous amount of work is going on behind the scenes. Those new treatments are an enormous and welcome step forward.

Some conditions, such as dry age-related macular degeneration, can cause permanent sight loss in a matter of weeks or months. That is why early diagnosis and treatment is vital if a person’s sight is to be saved. It is no surprise that delays to treatment can have a severe impact on patient outcomes. Everybody who has spoken so far has said that, as will those who speak after me.

Many new treatments for sight-threatening conditions require frequent follow-up appointments for monitoring and re-treatment. That has caused a rapid increase in demand for services. Northern Ireland faces a waiting list crisis across a number of specialties, including ophthalmology. I know this is a devolved matter, but I want to give some stats. As of 31 December 2016, some 23,000 people were waiting for a first out-patient appointment in ophthalmology, while 14,221 patients—approximately 62%—were waiting longer than 18 weeks. Statistics also show that patient numbers within ophthalmology are increasing year by year. On 31 March 2013, there were more than 8,000 patients waiting for first consultant-led outpatient appointments, compared with 23,000 in December 2016. That is an increase of 184%.

Severe financial constraints on the health service mean that increased demand for eye care services has not been met with increased resources. That has led to some patients losing sight unnecessarily because they are not seen within clinically safe timeframes. That is the core point we are all trying to make. In March 2016, the Royal College of Ophthalmologists released preliminary findings from a national study indicating that at least 20 patients per month suffer severe and unnecessary sight loss due to appointment delays. That is avoidable—if it is avoidable, for goodness’ sake let us try to address that issue.

The situation in Northern Ireland is similar to that in other parts of the United Kingdom; urgent action is needed so that preventable sight loss is avoided and people do not come to harm while waiting to be seen. With more than 14,000 Northern Ireland patients waiting 18 weeks for an initial appointment with a consultant, and more than 30,000 planned appointments missed due to hospital cancellations or the patient’s failure to attend, now is the time to address the provision of eye care services. This is putting an enormous strain on busy hospital eye departments and overworked NHS staff.

To conclude, while the lessons learned in Northern Ireland must be shared and there must be central learning for all the United Kingdom’s devolved Assemblies and the Government’s Developing Eyecare Partnerships strategy, it is important to resource and implement that strategy if effective change is to happen. We are looking for effective change, because without it, this debate will have failed. We are here to be positive, but we need Government assistance to make this happen.

While additional resources are needed, the reconfiguration or development of services does not necessarily need resources; it just needs a more effective way of approaching services. We cannot wait any longer, as each month of waiting for proper funding and implementation is a month in which people are losing their sight unnecessarily. I have said before that I have the greatest respect for the Minister. I look to him for UK-wide action now, and for the Government to work in conjunction with the devolved Administrations.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank the hon. Member for Wealden (Nusrat Ghani) for securing this important debate, which is long overdue. I also pay tribute to the excellent work that she does on the APPG to reduce sight loss; I was privileged to attend a recent meeting, and she is doing sterling work, for which I applaud her.

We are fortunate also to have the expertise of the hon. Member for Twickenham (Dr Mathias); I am sure that we were all interested to hear her expert opinion. We also heard very human stories from hon. Members representing constituents all over the country. They made very powerful cases. As I said, a debate on this subject was long overdue. Given the scale of the problem, to which many hon. Members alluded, the fact that it barely gets a mention in Parliament from one month to the next is quite shocking.

It has been said already, but is worth stressing, that more than 2 million people in the UK are living with sight loss. This is not a problem that affects a small number of people; it is a major problem. One in five people over 75 and one in two people over 90 are living with sight loss. With regard to the impact on the wider NHS, every year there are 2.6 million GP appointments for eye-related conditions and 270,000 accident and emergency visits for acute eye problems. And the problem is not going to go away. We have heard that the number of over-85s will double over the next two decades and that problems with sight loss are also set to double. Research by the Royal College of Ophthalmologists shows that there has been a 37% increase in eye clinic attendances in the UK over the past 10 years, and demand is growing year on year, making it the specialism with the second highest out-patient attendance. New treatments as yet unimagined will inevitably add to that demand.

For me and, I am sure, most Members in the Chamber, the most alarming statistic is that more than 20 people go blind unnecessarily every month in England. That is 20 people who did not need to lose their sight. It is a really shocking statistic. Many Members, including the hon. Member for Motherwell and Wishaw (Marion Fellows) and my hon. Friend the Member for Great Grimsby (Melanie Onn)—I only represent great Burnley—have alluded to the horrors of blindness. Particularly affected are the elderly, people with dementia and people suffering from diabetes.

[Jim Shannon]

I have a very good friend back home in my constituency who has diabetes. He decided to go for laser treatment to correct his short-sightedness and, as a result, he lost sight in both eyes. There can be complications for diabetics who try to improve their sight. For my friend, that became a horror story rather than a good story. People who are diabetic need to take special cognisance of the possibility of complications before they do anything. I apologise, Mrs Gillan, for intervening for a wee bit longer than usual.

[Julie Cooper]

I am grateful to the hon. Gentleman for that important intervention. Diabetes brings its own special problems, which we need to be widely aware of and build into any future strategy.

Some 20 people every month in this country—one of the richest countries in the world—go blind unnecessarily; it is not because we lack the ophthalmic expertise to save sight. On the contrary, we have many leading centres of excellence. Indeed, the Manchester Royal eye hospital that serves my constituency is one of the finest centres in the whole of Europe. People are going blind because capacity in the service is failing to keep pace with demand. For many eye conditions, including glaucoma and macular degeneration, early diagnosis and regular treatment are vital if sight is to be retained. For example, if glaucoma is diagnosed early, good sight can be retained, but in the overstretched and under-resourced system that we have now, 17% of those diagnosed lose their sight.

Currently, fewer than half the patients requiring multiple appointments are seen within the optimum timeframe, and the statistics given by my hon. Friend the Member for Great Grimsby about the effect on her constituents are truly shocking. Research shows that more than half a million appointments in England were cancelled by eye departments in 2015-16. It is therefore not really surprising that the Royal National Institute of Blind People reports that 50% of the incidences of blindness could have been avoided. It is undoubtedly a source of misery for the individuals affected, causing untold suffering, restrictions on lifestyle and a host of missed opportunities. In addition, as has been referred to, it places massive additional pressures on social care services and the wider NHS. I think that we all agree, on both sides of the House, that services need to improve.

There are already many examples of pockets of good practice—deploying mobile units and the multi-skilling of staff—where experts are desperately trying to compensate for a lack of resources to deal with increased demand. Clearly, the knowledge that demand will continue to grow means that there cannot continue to be business as usual. The clinical professionals have identified four areas that need to improve. They have said clearly that there is a need for an overall strategy—a direction from above and from Government. It is significant, as the hon. Member for Wealden pointed out, that in Zimbabwe there is a national strategy to prevent sight loss and retain sight, but in England we do not have such a strategy—I am shocked. The professionals also call for improved access to data to make their job easier and more efficient; to avoid duplication and ensure that they have access to the best possible information about their patients in a timely fashion.

In addition, the professionals call for services to be provided locally. That is particularly important because many of the patients are elderly. The current system of geographically distanced centres seems to be in direct contradiction to the aims of the five year forward view, which asks for treatments to be delivered locally. Current financial constraints must also be reduced to increase capacity. That makes sound economic sense, as we heard from the hon. Member for Motherwell and Wishaw, because it is estimated that the failure to tackle this problem actually costs the UK economy a shocking £28 billion—no wonder the parliamentary researchers got the figure wrong. Like me, they probably could not believe the figure when they saw it; £28 million sounds like a lot, but the cost to the UK economy of failing to act on this issue is actually £28 billion.

I want to pick up on some of the other points made by hon. Members today, most notably on prevention. Early diagnosis and prevention are extremely important, and it is a fact that in many areas across England school eye tests are becoming a thing of the past. Most of us will have had our eyes tested in school as children and had difficulties picked up then, but many areas are choosing not to commission such tests. In deprived communities, such as those in my constituency, many people simply cannot afford eye tests that are charged for and therefore choose not to prioritise them. As eye sight deteriorates with age, many people make do with cheap, over-the-counter spectacles. The point has been powerfully made that people do not just visit their optometrist so that they can read more efficiently; they also need to check and make sure that there are no early signs of other diseases. That is really important.

I totally agree with the point made by the hon. Member for Twickenham about treatment. How can an expert look a patient in the eye knowing that a treatment is potentially being developed but that, for reasons of resources, in one of the richest countries in the world, it is not a priority for us? I ask the Minister to consider all these points. STPs have been mentioned, and they are an exciting opportunity to address some of the issues raised today. Like the hon. Member for Wealden, I have looked at many of the STPs for many reasons; worryingly, even in the ones that do mention sight loss and eye care services, it is a passing mention—a tick-box exercise—and I hope that the Minister will address that. Today we look to the Minister to outline the action that the Government will take to address the many issues that have been raised, and to address what has become a national scandal.