Unpaid Carers

Jim Shannon Excerpts

Tuesday 3rd September 2024 Commons Chamber

[Wendy Chamberlain (North East Fife) (LD)]

Thank you, Madam Deputy Speaker. It is great to be back, and to see you in the Chair. I congratulate you on your new position.

Caring or being cared for is an almost universal experience. Almost everybody will find themselves being an unpaid carer for their loved ones at some point in their life, or being cared for by loved ones. Who among us does not know somebody who is helping an elderly parent, or supporting a family member with a long-term illness? As new MPs will come to learn, almost every week here, we have an opportunity to learn about and mark a national awareness day for a different devastating illness. For every person suffering from those illnesses, there will inevitably be a family member—unseen—supporting and caring for them.

According to the recent census, there are 5.7 million unpaid carers in England and Wales, but those are just the people who recognise themselves as such. In 2022, Carers UK research estimated that there were up to 10.6 million unpaid carers. Whichever figure we use, that is a huge number, and the figure is growing. According to very recent research published by the Joseph Rowntree Foundation, by 2035 there will be an 11% increase in the number of unpaid carers, and as degenerative conditions, including chronic degenerative conditions, become more prevalent, the amount of care that carers do is predicted to go up; it is expected that ever more will provide more than 35 hours of care each week.

The Government should care about carers, not just because that is the right thing to do, and not even because unpaid carers are in homes across every constituency in the UK, but because we need them. Unpaid carers are absolutely vital to our economy and our society.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this debate forward. The House is fuller than usual for this Adjournment debate, which indicates the importance of the issue. Every one of us knows people who are carers. I care for my brother, who had a big accident 20 years ago, and I understand what it means to be a carer and to be available at all times, as others do. Does the hon. Lady agree that respite for carers is an essential component of support, and that inability to access respite care will push many into making the unwanted decision to give up caring and instead institutionalise the people they care for, due to the unbearable pressure on their mental health?

[Wendy Chamberlain]

I am grateful to the hon. Member for that intervention. He is absolutely right, and as he and I know, having served in the last Parliament, during covid the lack of respite care was a critical factor for many carers. It is clear that we all need to do more in that area.

We were talking about how vital carers are to our economy and society. The economic value of unpaid care is £162 billion a year in England and Wales, £13.1 billion in Scotland and £5.8 billion in Northern Ireland. We know the country’s finances have been left in a ruinous state by the last Government, and that the social care system is already stretched to breaking point. We must also know that we cannot take the contribution of unpaid carers for granted, so I hope that the Minister will take tonight as an opportunity to show that the Government do care about unpaid carers.

In a debate shortly before the general election was called, the then shadow Minister for care, who is now a Minister, the hon. Member for Gorton and Denton (Andrew Gwynne), committed Labour to developing a new carers strategy if it formed the next Government:

“There will be a carers strategy under the next Labour Government, because we value the vital work our carers do. It will be a cross-Government strategy with the Department for Work and Pensions, Department for Education and the future of work review all feeding into it along with the Department of Health and Social Care. There is a brighter future for those living with dementia and their families and carers. Labour will deliver it.”

Given that promise, I hope that the Minister can understand why I and many whom I have spoken to in the care third sector were disappointed that unpaid carers were not mentioned at all in the Labour manifesto. At the same point in the speech I just referred to, the then shadow Minister said that unpaid carers

“will be at the heart of Labour’s plans in Government.” —[Official Report, 16 May 2024; Vol. 750, c. 228WH.]

I hope the Minister will take tonight’s debate as an opportunity to make that case.

--- Later in debate ---

[Stephen Kinnock]

I thank my hon. Friend for that intervention. She is absolutely right that many such networks, often informal, play a vital role in the community in providing that support and peer-to-peer support. So often unpaid carers can end up feeling quite isolated. Informal networks like the one she describes are vital and I commend the work of that network in achieving the objectives we all want to see.

[Jim Shannon]

The Minister outlines the need for reform. I think many of us in the Chamber would like compassion and understanding to be key to that. Reforms are okay, but they need compassion and understanding to make them work.

[Stephen Kinnock]

I thank the hon. Member for that intervention. He has reminded the House that caring for friends and family is an important part of what it means to be human. It is at the heart of the desire to support one’s community, as well as one’s friends and family.

We must always approach this issue with compassion. We know that we have certain constraints as a Government in terms of what we are able to do, but I can assure the hon. Member that we are absolutely committed to fixing what is, broadly speaking, a broken system; indeed, my right hon. Friend the Secretary of State for Health and Social Care has described the health and social care system as broken. We have to fix the foundations of that system, and unpaid carers are absolutely part of those foundations. We also have to ensure that unpaid carers have a strong voice in the consensus that we want to build around fixing the system. We know that if we are to build a national care service of which our entire country can be proud, we will need those reforms, but they must truly embody person-centred care and the role played by unpaid carers. To achieve that, I will engage with my counterparts across Government, with unpaid carers and with sector partners such as Carers UK and Carers Trust to ensure that their voices are heard.

I know that many of us were profoundly moved by the experiences of caring shared by the right hon. Member for Kingston and Surbiton (Ed Davey) during the general election campaign. As we have heard this evening, this is a subject of great significance for, and close to the heart of, Members on both sides of the House—including, of course, the hon. Member for North East Fife. I look forward to engaging with colleagues throughout the House on a cross-party basis, because we know that the consensus we need to build transcends narrow party political partisan divides. This is about building a system that is truly fit for the future, and fit for the country in which we live. So let us forge ahead together with the promise of that future in which unpaid carers are visible, valued and supported.

Question put and agreed to.

Healthcare Provision: East of England

Jim Shannon Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis]

On the hon. Gentleman’s first point, yes, successive Governments have presided over the NHS, but with differing intentions. Until the mid-1970s, say, there was a broad consensus—I will come on to this—on what the welfare state was and how it operated. That has changed substantially in the past 60 years. The implementation of different policies by different Governments, including Conservative ones, has not always been in the best interests of the NHS. On enterprise, yes, a secure welfare state, good social security and the ability to give people good health—the NHS has been integral to that—have implications for our economy, as I have already pointed out.

I am sure I am not the first or the last to suspect a direct connection between the rise of angry and anti-democratic right-wing politics and the demise of the NHS’s ability to look after us all effectively. The sheer far-reaching impact of the NHS and its crisis cannot be underestimated. One needs only to look at the US, where free universal healthcare does not exist, as the hon. Member for Mid Norfolk (George Freeman) just mentioned, to see the state of politics, crime, drug addiction and social breakdown there. The free market in healthcare provision and medicines has led to a country with one of the least efficient and most high-cost healthcare systems in the western world, and where millions are hooked on drugs that are as heavily advertised as if they were cans of coke. Let us not indulge too much in English exceptionalism, though. We need only to look at dentistry and adult social care in this country to see what happens to healthcare provision that is, to all intents and purposes, privatised or well on its way to being so—the consequences of which I hope colleagues will discuss later in the debate.

The foresight of the 1945 Labour Government cannot be underestimated. When the NHS was launched in 1948, it was done in tandem with the advent of the welfare state, because Beveridge, Keynes and Bevan understood the three pillars necessary for a healthy nation. The first pillar—the NHS—would be there for people if they became sick, but it was the second and third pillars that meant the NHS would not be overburdened. They would work in tandem with it to prevent sickness.

The second pillar was, of course, the welfare state, providing a network of social institutions that would protect citizens from the market risks associated with unemployment, accidents and old age. The third pillar was an economic system that prioritised full employment in secure, well-paid, unionised jobs—a system that sought to reduce all forms of inequality, from wealth to health.

Over the last 60 years, the three pillars have been systematically smashed. The second and third pillars are in tatters, while the first—the NHS—is wobbling precariously. It is testament to the enduring nature of the national healthcare system that it has managed to survive as an almost solitary pillar for as long as it has. If a Labour Government are truly to fix the foundations of our broken healthcare system, they must acknowledge the nature of the three-pillar foundation, and acknowledge that the NHS cannot be fixed if we do not rebuild and replace the other two pillars as well.

The situation in the east of England—from dentistry deserts to sky-rocketing rates of mental health referrals and some of the worst ambulance waiting times in the country—is beyond one malfunctioning organisation. Norwich and the wider region are experiencing a systemic crisis that is institutional, social and economic. Healthcare reforms such as devolution to the integrated care boards have become about devolving who gets to wield the axe to make savings—known to many people as cuts. I will give an example. Our ICB in the east of England, part of NHS Norfolk and Waveney, has been told by national health bosses to cut its running costs by 30% by 2026. My first question to the Minister is: how will our Government deliver improved healthcare outcomes while simultaneously implementing the previous Government’s frankly destructive cuts?

We know that vast areas such as dentistry and social care are largely privatised, with spiralling costs, and that undermines the NHS’s central commitment to care being free at the point of use. Tendrils of the crisis extend into social care. It is often said that if social care is cut, the NHS bleeds too. Norfolk county council acknowledges a crisis in social care. With soaring demand and struggles to recruit staff, there is a backlog of hundreds of vulnerable people waiting to get their care needs assessed, and care providers fold on a regular basis. My second question to the Minister, then, is: what news can she give us on the last Government’s unimplemented cap on care costs? Is it being implemented, as the Secretary of State implied during the general election campaign, or being dropped? If it is dropped, what plans are there to help those facing ruin given their complex care needs?

One consequence of the situation in Norfolk is that there are regularly hundreds of hospital patients who are medically fit to leave but unable to be discharged. It is clear that our healthcare system is struggling to respond to today’s crisis, but it is also unprepared for the challenges of the future. East Anglia is the UK region most at risk from early climate impacts, and there is clear evidence of the link between climate breakdown and ill health. For example, from 2022 to 2023 the number of flood reports in Norfolk doubled, and stretches of Norwich are predicted to flood year after year. Victims of flooding in the UK are nine times more likely to experience long-term mental health issues, and flooding is linked to a greater instance of respiratory diseases because of dampness.

Prevention is better than cure—it is about treating the causes, not just symptom alleviation. We know that the Prime Minister is keen on the so-called preventive state and we have seen some early policy announcements, so my third question is: will the Minister elaborate on what that will look like? What does healthcare provision that prioritises prevention look like in the east of England?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue forward. I know the debate is about the issues particular to his constituency, but they are ones apparent to all of us across the United Kingdom of Great Britain and Northern Ireland. First, does he understand and perhaps agree that the Minister and Government could look at pharmacies having a bigger role in treating minor ailments? Secondly, there is the issue of how people, particularly elderly people, can access GP appointments regularly. Thirdly, when it comes to cataract surgery there is a postcode lottery across the whole United Kingdom. If people get the surgery early, it stops them losing their sight. Is the hon. Gentleman experiencing issues in his constituency similar to those in mine?

[Clive Lewis]

I thank the hon. Gentleman for his input, and his points were well made. When researching this debate, I probably spent more time working out what I did not have time to say than what I could actually put into the debate, so I have tried to do a broad overview. Many of the issues the hon. Gentleman raised are also of concern in my Norwich South constituency and across the eastern region. I am sure that during the debate many of those issues will be raised and dealt with in more detail.

Our Government have said they are a Government of service, but a legitimate fourth question that I ask the Minister is: in service of whom and to what end? It is clear to many that the interests of big business, of big tech and data companies and of private finance do not always sit well with the public interest, particularly when it comes to health. There are areas where they do, but there are also areas where they do not. We know with whom the last Government sided; whom will ours back when push comes to shove—big business, big tech, the finance industry or Joe public?

I want to briefly provide a snapshot of the scale of the crisis in the eastern region. Ambulance response times in the east of England are significantly worse than those in the rest of England. In 2023, response times for category 1 cases—that is, severe cases—were nearly 12 minutes in East Anglia, while the national target is seven minutes. They were nearly the worst on record. The Care Quality Commission, now under inquiry and investigation itself for its capability to do its job, has described Norwich university hospital as the

“worst in the East of England”

for ambulance handover times.

Referrals to mental health services increased by 18% between 2018 and 2020. Compared with the rest of England, Norwich and Norfolk have higher rates of self-harm, death by suicide and mental health issues among young people, as well as more self-diagnosed mental health issues generally. Our mental health trust—Norfolk and Suffolk NHS foundation trust—is notorious for being the worst in the country, and I do not think that can be said enough.

Norwich is a dental desert. In July, the Secretary of State branded Norwich North the “Sahara of dental deserts”. That is a rather romantic notion, but it is a desert where people pull their own teeth out in this burgeoning phenomenon of a do-it-yourself dentistry industry. Indeed, some of my Ukrainian constituents have told me that they find it preferable to dodge Russian missiles and artillery to use Ukrainian dentists. Ukraine arguably has a better dental system in the middle of a prolonged war. That is unsurprising given that in the east we have one NHS dentist—no, it is not even one NHS dentist; it is one dentist—per 2,600 people. Just picture that in your head: one dentist with their tools with 2,600 people queued up. That is what it feels like to many of my constituents.

For the second year running, no dental practices are accepting NHS patients. Norfolk children under five have some of the worst tooth decay in the entire country. Thousands of people have had to go to hospitals in Norwich and Norfolk for abscesses that should have been prevented. The list goes on and on. I am sure that many of my colleagues from the eastern region will also outline some of the issues and stories that they know are taking place on a daily basis, and that have been for many years now.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Karin Smyth]

My hon. Friend is absolutely right that the separation of babies and their parents at that time is not acceptable, and about the shocking state of the estate, as we have just heard. We will look at the findings of the NHS review very quickly, and I will be happy to get back to her on those specific points.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her answer. This issue is clearly not just about accommodation; it is also about providing physical and emotional help for mothers who have been through traumatic circumstances, emotionally and physically. What will be done along those lines to ensure that mothers and babies have all the help they need?

[Karin Smyth]

The hon. Gentleman makes a really important point about mental health support in that critical period. We will absolutely make sure that is looked at.

Health Services: Rural Areas

Jim Shannon Excerpts

Wednesday 17th July 2024 Commons Chamber

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Let me get my specs on properly, Madam Deputy Speaker. They have a wonky leg that sticks out sideways.

I must say at the outset that I have heard some excellent maiden speeches today. It is a bit worrying to hear such good maiden speeches, because it makes one feel somewhat mundane in comparison. Let me also welcome the Minister to her place: it is a pleasure to see her sitting opposite me.

This Adjournment debate is the first of the new Parliament, and I am grateful to the Speaker for granting it. It concerns a topic that is important not only to my constituents in the highlands, but to constituents in every rural area in the country. I thank the Minister for her attendance, and look forward to hearing what she has to say. I hope that the debate sets the tone for how a Government and an Opposition can work together to meet the needs of every citizen of the United Kingdom, no matter where they live.

I recently had the great honour of being re-elected to represent Caithness, Sutherland and Easter Ross, which is now the largest constituency in the United Kingdom. It measures a staggering 11,798 sq km, more than half the size of Wales. We are here tonight to discuss the adequacy of healthcare services in rural areas, and for fear of being predictable I am afraid to say that the health services in the highlands are not even faintly adequate. I recognise, of course, that health is devolved, but 17 years of centralisation have wreaked havoc on my part of the world. Health services have been stripped back and gutted, leaving my constituents with access to far too few local services.

Let me begin with general practices. In Scotland, we have seen changes in vaccination services because, in an effort to reduce GPs’ workload, GP contract Scotland removed their vaccination capabilities. That is of huge concern to crofters in my constituency who might cut themselves on a piece of barbed wire and need a tetanus vaccination as quickly as possible. The same goes for anyone in need of shingles, flu, covid or travel vaccines. They must travel a staggering 70 miles or more to the nearest A&E, where they will face further waits owing to backlogs resulting from heavy workloads.

[Jim Shannon (Strangford) (DUP)]

I want to keep the tradition alive, Madam Deputy Speaker. This is my first intervention during an Adjournment debate in the new Parliament.

I commend the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for raising an issue that is very important to me and to my constituency. I also congratulate him on his excellent victory in the polls: he has done exceptionally well. I hail from a rural constituency where my own doctor has to service a huge number of people, and the inadequacy of help for rural constituents is abundantly clear to me. Does the hon. Member not agree that the current postcode lottery must end, and that access to GPs, physiotherapists, nutritionists and mental health services for farming and other rural communities must be at least on a par with those in cities and large towns? Why should those in rural communities be second-class citizens in their own country?

[Jamie Stone]

The hon. Member makes his point with his customary charm. It is no wonder that he is so well liked in this place, because he always speaks for his constituents.

I have talked about the delays in vaccinations, which also applies to the lifesaving vaccinations that babies must have. The Scottish Government take a one-size-fits-all approach that, frankly, does not work in remote rural areas such as mine. The retention and recruitment of GPs and other healthcare workers is crucial, but poor wages and terms and conditions, and a lack of proper travel reimbursement, all lead to a general impression that the game is simply not worth the candle. That is why we are missing key workers and doctors, and why we are paying through the nose for locum and temporary staff. Madam Deputy Speaker, can you believe that NHS Highland has spent £21 million on locum staffing in the past year? That is almost 3% of its entire budget—an eye-watering sum. Could that money not have been spent much better, for example on care homes, hospitals or pain clinics that have been forced to close?

--- Later in debate ---

[Karin Smyth]

I am aware of the issues facing the south-west and, when in Opposition, I spoke in the local media about some of the ambulance challenges. I am not aware of those reports, but if the hon. Gentleman writes to me with the details, I will happily look into the issue and get back to him.

We also recognise the additional cost of providing services in rural areas, for example in travel and staff time. That is why the funding formula used by NHS England to allocate funds to integrated care boards includes an element to better reflect needs in some rural, coastal and remote areas.

The NHS faces significant challenges. It needs fundamental reform. The Prime Minister is personally committed to resetting the UK Government’s relationship with devolved Governments in Scotland, Wales and Northern Ireland. I echo the Prime Minister’s words today about our commitment to rural constituencies across the entire country and I hope we can work with hon. Members from across the House, including the hon. Member for Caithness, Sutherland and Easter Ross.

[Jim Shannon]

I welcome the Minister’s clear commitment to England, Scotland, Wales and Northern Ireland—and particularly to Northern Ireland. Let me declare an interest: I am a member of the Ulster Farmers Union. I know that the Ulster Farmers Union back home, in conjunction with the NFU here, has been trying to work with the health service and with all those with responsibility in this area on the issue of suicides. Farmers mostly work on their own and suffer from anxiety and depression. They face pressures from finance and pressures from the bureaucracy that exists in farming. I know the Minister is compassionate and understanding—I mean that honestly. When it comes to addressing that issue, does she think that it must be done in conjunction with the farmers unions? Trying to work together to make things better must be a step in the right direction.

[Karin Smyth]

As ever, the hon. Gentleman makes a valid point. I shall certainly ask my colleagues in the Department for Environment, Food and Rural Affairs about that. His point is extremely well made. I know his constituency in Northern Ireland very well. Let me say that we are very committed to working with hon. Members across the House to share ideas. The hon. Member for Caithness, Sutherland and Easter Ross has put forward more ideas about how that can happen. I do not promise to implement all of those things, but I will certainly look at them. We want to work very closely across all jurisdictions so that we can make progress for all our constituents to improve the health outcomes across the four nations of the United Kingdom.

Question put and agreed to.

NHS

Jim Shannon Excerpts

Thursday 23rd May 2024 Commons Chamber

[Victoria Atkins]

My hon. Friend has devoted her career in this place not only to representing the steelworkers in her constituency, but to her constituents’ healthcare, and it is thanks to her campaigning, and that of other colleagues, that we have a CDC, and facilities like that, in her local area. She has very tactfully described my position. I, of course, acknowledge my awareness of her campaign, and I really look forward to working with her in the future to see whether we can ensure that the residents of Scunthorpe—and the residents of Grimsby—have those services that we all hold so dear.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State very much for her statement. It is clear that the NHS is, in some cases, in need of critical care. While we all prepare for an election, there are ill and vulnerable people unable to prepare for the surgery and treatment that they so desperately need. How will the Secretary of State ensure that, while this Parliament dissolves, the NHS continues to consolidate and grow, and delivers much-needed diagnoses and operations for its patients—our constituents?

[Victoria Atkins]

I thank the hon. Gentleman. One of the joys of this Parliament has been to have him contributing in every statement and debate. On the particular healthcare needs in Northern Ireland, he will appreciate that healthcare is devolved, and that we are all very mindful of recent history, in terms of the devolution of power in that particular set of circumstances. However, I have very much enjoyed working with the Health Minister, Minister Swann.

Clearly, we value our United Kingdom, and we want to do whatever we can to help all corners of the United Kingdom in healthcare—although, of course, we respect that they are devolved matters. That is why I want to work closely with my counterpart in Northern Ireland, and, as I have indicated—or am indicating now— I would be very happy to work with the Health Ministers in Scotland and Wales to help them with their waiting lists.

International Health Regulations

Jim Shannon Excerpts

Tuesday 14th May 2024 Commons Chamber

[Andrew Stephenson]

I happily reassure my hon. Friend that national sovereignty comes first. We will continue to do everything that we can to ensure that we get an accord that is agreeable, but if the accord would undermine our sovereignty and our ability to act domestically in any way, we will simply not sign it.

[Jim Shannon (Strangford) (DUP)]

I have been contacted by a large number of constituents who have voiced grave concerns about the powers and rights requested and required by this unelected body. While we may support some of the work carried out to help developing countries, I will not sign away the sovereignty of this nation. Our participation in the WHO should not come with a prerequisite of signing up to these demands. Further, if that is the case, we should no longer be a participating member of the WHO.

World ME Day

Jim Shannon Excerpts

Wednesday 1st May 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I certainly will do exactly that; I had planned a five-minute contribution.

I congratulate the right hon. Member for Bromsgrove (Sir Sajid Javid) on highlighting World ME Day. I listened to the right hon. Member for Hayes and Harlington (John McDonnell). When I was first introduced as an elected representative, as a Member of the Assembly at Stormont back in 1998, a person with ME came to me one day. I will be honest: I had no idea what it was. But I knew one thing, which was that that lady was ill. I am no wiser or smarter than anybody else, and I am not a doctor, but I can recognise pain. I can recognise a disability that hurts. It was making her life absolutely unworkable.

I helped her with her benefits; incidentally, we won on appeal. We won because if I could see what that lady was going through, the four people on the panel could see it, too. The right hon. Member for Hayes and Harlington referred to the appeals process. I always ask the person, “How many days a week are you ill?” and the person will tell you. Sometimes they are ill for a week, sometimes they are not ill and sometimes they are ill for three of the seven days. The point I am making is that they are ill, and it is a case of proving that.

The article by Hope 4 ME & Fibro Northern Ireland really summarises how the ME community feels:

“In recent times, the landscape of ME has undergone a transformation, with COVID-19 emerging as the most common trigger for this chronic illness. The intersection of these two health challenges has resulted in a significant increase in the number of people affected by ME. An estimated 55+ million individuals worldwide are living with the debilitating effects of this condition.”

It is an epidemic across the world.

“Amidst these escalating numbers, Hope 4 ME & Fibro Northern Ireland proudly stands alongside World ME Alliance members across the globe. We collectively amplify support for initiatives that seek to address the multifaceted impact of ME on individuals and communities alike.”

As an active Member of Parliament, a former Member of the Northern Ireland Assembly and former councillor—I think this is now my 39th year in elected service—I have seen the debilitating effects suffered by those with ME suffer. One of the harsh realities is that there is no cure. Individuals grappling with ME often endure both the physical toll of the illness and the stigmas that accompany it. It is imperative that we as a global community and in this House come together to address these gaps in understanding, treatment and research. That is where we in this place have a part to play. The right hon. Member for Bromsgrove set the scene well, as did others who have spoken; those who follow will tell it again.

I do not believe that we have done more than scratch the surface of fulfilling our obligation to those who are in inexplicable pain daily and who are made to feel as if it is somehow only in their head. It is not. I am not a doctor, but I can see pain; I can see agony; I can see trauma. I can see people who need help. If I can do that, everybody in this room could do the same, because that is what we do every day when we deal with people. They live feeling ashamed of an illness, when most other illnesses are accepted as being out of the victim’s hands. There is work to do in how our health and benefits Departments view ME—there is a big role for them to play—and subsequently treat those who suffer from ME and associated illnesses. Support should be offered not just to them, but also to the families—never forget the families. It is not just that one person suffering; the whole family suffers, because they can see the pain and the agony. Undoubtedly, the burden is often shared with the entire household, emotionally, physically and financially.

On World ME Day, we need to be aware that the people we may see for a brief moment may be fighting a battle with pain that we cannot fully understand. We cannot share that pain, but we can hopefully appreciate what they are saying. It is our job in this place to fight harder for them. For them, this debate is a continuation of that very battle they have fought. We fight today alongside them.

Glaucoma and Community Optometry

Jim Shannon Excerpts

Tuesday 30th April 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered glaucoma and community optometry.

First, a special thanks to the Backbench Business Committee for selecting the debate for this morning. I am my party’s health spokesperson—it is no secret—and am particularly interested in health issues. As such, I secured this debate off the back of a number of people who had contacted me. What I am particularly pushing for—I am sorry for the short notice; I put the request in the Minister’s hand only two minutes ago—is that we do something now so that we can save sight further down the line. If I were pushing for one thing only, that is the one thing I would wish to have.

Optometrists in my Strangford constituency—I will send them a copy of this debate in Hansard afterwards—asked me to secure this debate. A number of bodies here on the mainland asked me the same thing. That is my purpose, but the issue of sight and sight-loss problems affects every constituency equally throughout this great United Kingdom of Great Britain and Northern Ireland. Therefore, the approach to making the system more fit for purpose must also be UK-wide.

I am pleased to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place. We are sparring partners, although when I say that I do not mean that we hurt each other—we fight things together. I am also especially pleased to see the Minister in his place. He has a deep interest in this subject, as well as a deep interest in Northern Ireland, which I much appreciate. He has told me about his times in Northern Ireland in the past month or so, and how much he loves going there. Indeed, every MP who visits Northern Ireland—including you, Dame Caroline—always comes back with the most wonderful memories of the occasion and of the people they meet. Just this morning, a Conservative Whip was telling me that he was in Hillsborough two weeks ago, and about how much he enjoyed it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I want to place on the record the fact that a month ago I made my first visit to Belfast. I had an incredible time meeting Members of the Assembly at Stormont, and going to Harland & Wolff, around Belfast and to an inclusive school. It is a remarkable place, and I just wanted to add, as the hon. Gentleman is putting on the record that everyone else has been to Northern Ireland, that so have I—although I know that is not the subject of our discussion, Dame Caroline.

--- Later in debate ---

[Jim Shannon]

Thank you for bringing me and us all back to focus, Dame Caroline. The reason why I said that is that the Minister has been to Northern Ireland and always has an interest in health issues, and I know that his journey was to Queen’s University to explore such issues. That is the connection. The fact it is a lovely place is just wonderful, but that is not the reason why we are here.

The approach to making the system more fit for purpose must be UK-wide. Whenever we ask for what we are going to ask for at the end of this debate, I know that the Minister and the shadow Minister will have similar ideas to mine. I understand that health is devolved in all the regions, but it is clear that we need joined-up thinking to a joint problem. That is what I wish to highlight this morning.

Visual impairment and sight loss cost the UK economy some £36 billion each year, yet we allow 22 people to lose their vision to preventable causes each week. That is the thrust behind what I am aiming for today: to stop 22 people losing their eyesight this week. We can work alongside the optometrists and the opticians, and have a partnership whereby people can have their eyesight tests done more often. I will give some examples. Maybe people do not think of having their eyesight tested regularly, but they should. Optometrists in my area have told me that they are happy to work with the NHS or the health and personal social services in Northern Ireland to make that happen.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate my hon. Friend on securing the debate. On the frequency of eye testing, does he agree that the issues we are discussing today are symptomatic of other parts of the health service? People ignore eye problems and get to the point where problems could have been solved had there been earlier detection and more frequent eye testing. Even if nothing else transpires from this debate, if we do a little to try to ensure that people have regular eye tests, we can prevent some of the problems we are discussing from getting worse.

[Jim Shannon]

I thank my hon. Friend for his intervention, and say to the Minister: that is the thrust of this debate. If nothing else comes from this debate but the answer was along those lines, I would be more than happy. That does not mean that I will sit down now, Dame Caroline— I want to give a wee bit more background and a couple of examples.

Visual impairment and sight loss cost the UK economy £36 billion. The loss of sight is the loss of independence and confidence, and for many it is the loss of their life as they know it. If it can be prevented, it must be, so it is about prevention, early diagnosis and checks. This morning my focus—excuse the pun—will mainly be on glaucoma, a group of eye diseases that damage the optic nerve, usually due to changes in pressure inside the eye, or ocular hypertension. Data from Specsavers revealed that there have been some 30,000 referrals for glaucoma in people aged 40 to 60 just in the last year. Many more have been missed, accounting for nearly a third—30%—of all glaucoma referrals.

Some years ago I spoke at an event in Cambridge. I was asked to come along as a health spokesperson to an eyesight and visual impairment event that took place at a university in Cambridge—not the University of Cambridge but one of the other ones. They were doing tests and I got my eyes tested for glaucoma. It was rudimentary, but the guy said, “I don’t want to worry you, but I think you need to go and have your eyes tested when you get home.” Whenever I got home I went to my optician right away. I could not understand it, because I had seen the optician a month before and was sure that my eyesight was okay, but the Cambridge guy had given me a wee graph that seemed to show that there were issues relating to glaucoma that needed to be addressed fairly quickly. Why is that important? Because my father had glaucoma, and they say it needs to be checked because it is hereditary and passes from generation to generation.

When I got home I went to see my optician right away and told her what was going on. I explained the circumstances and took her the graph. She said, “Look, Jim, I checked your eyes. I do not see anything wrong with them, but do you want them checked thoroughly?” I said, “Yes, definitely.” So she sent me to the eye clinic in Belfast’s cathedral quarter and I got my eyes checked. Everything is done there, 24/7—all the eye checks that are humanly possible. For ages after, my eyes were stinging. The guy came out after an hour and said to me, “I have done every possible check on your eyes. There is nothing wrong with them.” That was good news after a very thorough check. Since then, my optician has done a thorough check for glaucoma on my eyes, simply because it is hereditary and to ensure my peace of mind. I tell that story because it worked out well for me, but it does not work out well for everyone.

Typically, there are no symptoms to begin with, as glaucoma develops slowly, affecting the periphery of the vision at first. That means that hundreds of thousands of people in the UK currently have glaucoma. Betty in my office gets an annual eye test because her father had glaucoma and she was aware of the issue. When I asked my younger staff when they had last had their eyes tested they said, “Not since school. I don’t need glasses so why should I get an eye test?” I immediately asked them to book a test, and told them that it is like an MOT that needs to take place. The MOT tells us if our car runs okay and what repairs we need; it is the same when we get our eyes tested. The eyes may be known as the window to the soul, but they are also undoubtedly the window to the view of overall health that can be found in an eye test. Eye tests are imperative for finding an early diagnosis of diabetes, for example, and a host of other health concerns.

I remember two occasions when opticians saved the lives of gentlemen who came to see me in my office. One guy I know well came in and he was a terrible colour. I said, “Are you okay?” and he said, “To tell you the truth, I don’t feel at all well. I have been to the doctor who told me to see an optician, and I’m going there now.” I said, “I hope you’re okay.” He was as grey as a badger and it was really quite worrying to see him. He went straight from the optician, who referred him, just up the road to the Ulster Hospital. He had a tumour close to his eye and brain, which was removed in an urgent operation. The other person, who went to a different optician in Newtownards, had the same problem, was also referred to the hospital and also had a tumour removed.

Tests at the optician’s are incredibly important. They can diagnose not only glaucoma but many other things, so it is important to have them. Optometrists have a key role to play because they can spot the early signs of glaucoma during routine tests. For patients with stable glaucoma, optometrists have a role in monitoring eye health and helping them to manage their condition.

Alarmingly, a fifth of the population—some 21%—still do not know how often they should visit the optician for a routine check-up. The same percentage either cannot remember their last eye examination or have never had one. Opticians in my Strangford constituency, and particularly in Newtownards town, have told me they are anxious and keen to ensure that people have regular tests. It is about how to ensure that can happen. I hope the Minister will respond to requests, including from the shadow Minister, and is able to reassure us on how we can encourage a UK-wide method to help.

For those with glaucoma or suspected glaucoma who are referred to hospital, long NHS waiting lists, exacerbated by the pandemic, remain a problem. Alarming figures show that around 650,000 people are waiting for NHS ophthalmology appointments. Will the Minister indicate the steps that can be taken to reduce that number and help those 650,000 people to retain their eyesight? There are steps that we can and must take. I always try to be constructive; it is important to come with a positive attitude on how to do things better. We should be big enough to accept that changes need to be made, and then we can do it.

Although optometry services remained open for urgent care during the covid-19 pandemic, the number of sight tests dropped by 4.3 million in 2020—my goodness—which was a 23% decline compared with tests administered in 2019. In respect of that dramatic drop and the need for improvement, perhaps the Minister could suggest methodologies to address and target those who have fallen out of the system. The drop in the number of eye tests resulted in large reductions in referrals from primary care to hospitals. That is where the fall seems to be, and perhaps where it needs to be addressed. As a result, sight loss has increased hugely since the pandemic.

How can we increase referrals from primary care to hospitals? If we do that, we will have moved a long way. I will give some examples from Northern Ireland—not about how nice it is to visit, Dame Caroline, but about the issues of vision and health. In Northern Ireland there are two glaucoma referral and refinement pathways. By contrast to England, they are available at all community practices, as long as clinicians have the right accreditation in glaucoma care. It is fortunate that my GP service and many others have such access. Through the services, patients have their glaucoma tests completed in the community, and the results are then shared securely with the patient’s ophthalmologist. This joined-up approach helps to streamline the experience for the patient and ensures that optometry practices and ophthalmologists work together for the benefit of the patient. I always try to be constructive in my comments and give examples of what we do, because if we do something well, others need to know, and if the Minister does something well here on the mainland, we need to know about that in Northern Ireland as well.

There is also an ocular hypertension monitoring service in the community across Northern Ireland. The scheme allows optometrists to manage in the community patients who would previously have been seen by the hospital eye services. A significant number of patients—some 2,000 to date—have been discharged to the scheme. That is an example of how it is proactively engaging and working. It has helped to free up the capacity in secondary care to manage more complex cases.

Those successful services show that community optometry, alongside other primary care providers, is responsible for delivering the shift from secondary to community care and is able to do so at almost no cost to the taxpayer, given that it uses existing capacity. What we have is an example of how things can be done—and perhaps spread across all of this great United Kingdom—in a better way. Those working alongside optometrists, who wish to ensure that people have their tests regularly, are keen to assist and to make changes. When the Minister speaks to the Association of Optometrists—as he probably already has—I believe he will find that he is pushing at an open door and that the ideas that he and the Department have are ones that optometrists have too.

Overall, Northern Ireland has shown how a model focusing on glaucoma care in the community can be effective. The challenge in Northern Ireland is that these services sit outside the general ophthalmic services—GOS—contract, which means that they rely on non-recurrent funding and are not subject to a regular uplift in fees; indeed, fees have never been reviewed. Given the success of these services, the push in Northern Ireland is for their funding to be put on a more stable, recurring footing and to be subject to the same process for fee uplifts as GOS. I have another ask to put to the Minister, in a constructive fashion: will he see whether the fees in place can be reviewed and how best the system could be used to improve things?

I know that the shadow Minister will make an incredible speech. By the way, I am not giving him a big head; that is what he always does, because he understands these issues incredibly well and brings forward his own ideas and his party’s ideas to this process.

I want briefly to highlight the difficulties arising with cataract surgery. It is wonderful how cataract surgery can improve people’s eyesight. I am a type 2 diabetic, but some years ago, before I was a diabetic, I went to see about surgery, not for cataracts, but to improve short-sightedness. I did not have the surgery, because I was not entirely confident about it, and shortly after, I became a diabetic. I tell that story because a good friend of mine in Greyabbey—I will not mention his name—was a type 1 diabetic and went for some corrective surgery to his eyes. Unfortunately, he ended up losing his eyesight; that is not the fault of anyone, but the diabetes complicated the issue, and he is now registered blind. Again, there are complications in relation to eye surgery for those who are diabetic, just by the nature of what happens.

Cataract surgery is currently the most common NHS elective surgical procedure, accounting for the majority of the large ophthalmic backlog facing the NHS. My mother has had one of her cataracts removed; she has a second one to remove, but I suspect that, unfortunately, her state of health means that the second procedure will not be done. Between 10% and 15% of those with cataracts suffer from concomitant glaucoma, and I am bringing the issue into the debate because cataracts are often treated separately. I suggest that we consider how we could do the two together—the glaucoma and the cataract surgery.

I have been informed by a company named Clarity that there is an opportunity to treat patients for cataracts and glaucoma at the same time. It is obviously more cost-effective, and although I know we should not always dwell on the cost, we cannot ignore it. If there is a way of doing simpler, easier and cheaper surgery more effectively, let us look at that. I am ever mindful that the Minister has four competent members of staff behind him, who will clearly keep him right, so might they be able to do some research on that?

Treating cataracts and glaucoma together expedites patient backlog reduction and helps save people’s sight by preventing the further progression of glaucoma. The treatment is quite innovative, new and effective, and it is important that we should do it. Micro-scale injectable therapies produced by Glaukos can advance existing glaucoma standards of care and improve patient safety by removing the need for invasive secondary surgery and tackling ophthalmic backlogs. So many people wait for their cataract operations and for improvements to their glaucoma. If we catch things early, we can save the sight, and that is a critical factor. Again, can the Minister look at that and ascertain whether the approach I have just referred to could be a cost-effective way forward? I am sure he knows about it, but if he—and indeed the shadow Minister and others—does not, I would be happy to have a response later. The treatment seems to me to be a win-win, so will the Minister confirm whether the Government will initiate it urgently?

Local optometrist services form a vital part of the eye care patient pathway and of directing patients to vital sight-saving medical technologies. It is incredible to live in an age when 50% of all cancer patients can survive and people’s eyesight can be saved if it is checked and their problems with glaucoma are diagnosed. Are we not fortunate to live in this age? Although I am not the oldest person in the room—I suspect that my colleague on the left-hand side, my hon. Friend the Member for East Londonderry (Mr Campbell), might just be a tad ahead of me by a couple of years—I have seen the great advances we have made in medical technology. We are doing great things, and we could do more. Is it not incredible that all we really need is to check? It is not terribly costly, but if we check, we make the difference.

Optometrists are the ones who are properly trained in the pathway. We must ensure that pathways are clear and that funding is available to ensure that, instead of 22 people a week losing their sight in the United Kingdom of Great Britain and Northern Ireland, no one at all loses their sight and their independent life—something that could have been prevented. I know that the Minister shares my goal and that the shadow Minister definitely shares it, as does my hon. Friend the Member for East Londonderry. As a result of today’s debate, I hope we will have a progressive strategy going forward, and I am anxious to hear what the Minister and the shadow Minister have to say, so that we can feel that they understand the path towards achieving this goal and will focus on and direct it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I start by passing on the apologies of my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), who leads for the shadow health team on the issues we are focusing on today. She is otherwise detained on the Tobacco and Vapes Public Bill Committee, which is taking place at the same time.

I sincerely thank my hon. Friend the Member for Strangford (Jim Shannon)—I know that the custom in this place would be for me to call him “the hon. Gentleman”, because he is not of my party, but he is a friend—for securing this crucial debate and for the positive spirit he always brings to these proceedings. Glaucoma is a common yet serious condition that, if left untreated, can cause real damage. Anyone is at risk of developing glaucoma at any age, but it particularly affects people as they get older.

I declare a bit of an interest here: my grandmother had glaucoma. Because my mum died at the age of 50, they do not if the condition was hereditary, so every time I go to my opticians I have to have the glaucoma test in case it is hereditary. However, it is really important that people are tested routinely, because it is a serious condition that, if left untreated, can cause real damage.

Several factors increase an individual’s risk of glaucoma, including a family history of the condition; being of African, Caribbean or east Asian origin; and having long or short sight, diabetes or blood pressure problems. Glaucoma tends to develop gradually, and it is often entirely symptomless for a long period. As a result, many glaucoma patients are diagnosed only during routine eye tests. The impact of glaucoma can vary greatly, ranging from misty or blurry patches in vision to struggling to complete day-to-day tasks such as reading, and permanent sight loss.

When it comes to accessing basic care, many glaucoma patients face significant challenges. Across eye care, more than 600,000 patients are currently on waiting lists for treatment. Given the risk that glaucoma poses if left untreated, such extensive waiting lists are a serious threat to patient outcomes. Sadly, that statistic shows no sign of changing, and demand for ophthalmology services is set to increase by more than 40% in the next two decades. Given an estimated annual cost to the economy from sight loss of more than £25 billion, the case for action could not be clearer.

I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.

The next Labour Government are committed to reforming the system so that those with glaucoma and other eye health conditions can access care when and where it is needed. We will provide 2 million more operations and appointments on evenings and weekends, paid for by clamping down on tax dodgers, so that patients can be seen on time again. We will have a laser-like focus on prevention, tackling the social determinants of ill health and ensuring that eye conditions such as glaucoma are tackled at source. We will ensure that the NHS shifts from an analogue to a digital service, embracing the latest developments in technology and artificial intelligence to provide the best possible care and deliver the best possible patient outcomes.

Again, I declare an interest: being a bespectacled Member of Parliament, I obviously have routine eye tests. I am short-sighted, although age is catching up with me, and this is the first time that I have had varifocals for reading and for distance. However, my optometrist, Dr Shen of Boots opticians in Denton, has brought in and embraced some of the latest technological advances for testing different eye conditions. At my last eye test, I was amazed at the wizardry and machinery they have brought in, revolutionising the way they can diagnose.

[Jim Shannon]

The hon. Gentleman is speaking very powerfully and I endorse those comments. What I have seen with optometrists in Newtownards in my constituency of Strangford is the amount of money and investment that they have put in. They have not asked for any help from the NHS for those things. They are doing it themselves. I think there is a wonderful opportunity for a partnership with optometrists who are investing money—all they need is the people to come in for testing—and that, I believe, is a role for Government.

[Andrew Gwynne]

I could not agree more with the hon. Gentleman. Boots Opticians in Denton is a franchise, and the owner of that franchise has invested in this remarkable technology. I have now seen parts of my eyes that I never believed it would be possible to be able to see. It is incredible digital technology, and it allows opticians to diagnose eye stroke. That is particularly important for people with diabetes, glaucoma, high blood pressure and cardiovascular disease. The technology can also be used to diagnose diabetic retinopathy, in which people’s retinas are leaky, which can lead to temporary vision loss, and age-related macular degeneration. That detailed eye care allows other eye problems, which ordinarily would have gone unchecked, to be found and the appropriate treatments to be provided. I have seen how transformative the use of modern technology by my own optician can be for testing for a whole range of conditions and eye health.

That is why this debate is relevant and why changes across the system are clearly needed. That is most evident in community optometry. There is a real potential to utilise, as the hon. Member for Strangford has said, the existing capacity on our high streets and in our town centres—crucially, where people are—to get a firm grip on the crisis in eye care. That is why the next Labour Government have committed to seeking negotiations with high street opticians to strike a deal to deliver more NHS outpatient appointments. That partnership, which the hon Gentleman was rightly discussing, will underpin Labour’s eye care policy.

With 6,000 high street opticians serving communities across the country, we cannot afford to sit back and waste their incredible potential. We will work with high street opticians to beat the backlog and to get the system moving again. By utilising community capacity, we can free up specialists in the NHS to support those patients with the greatest need, providing greater accessibility, convenient care and, most importantly for all of us taxpayers, better value for money for the public purse.

This approach is backed up by evidence, proving the tangible impact of community-based eye care and eye health services. A 2014 study of the introduction of minor eye care services in Lewisham and Lambeth showed how significant that impact is. GP referrals to ophthalmology specialists in Lambeth decreased by 30%, with an even greater reduction—75%—in Lewisham. Costs in areas without minor eye care services increased, while there was a drop in costs in Lewisham and Lambeth of 14%.

Given that the sector is in clear need of reform, with patient outcomes continuing to suffer, will the Minister back Labour’s plan to unlock the potential of community optometry? With more than 550 patients suffering sight loss because of delays in the NHS since 2019, does the Minister accept that further inaction is simply not an option? These are people whose lives, and those of their loved ones, have been fundamentally changed through no fault of their own. We owe it to them to fix this system once and for all, working in partnership with the devolved Administrations across the United Kingdom, as the hon. Member for Strangford says, so that there is not a postcode lottery on these services, and we get the best outcomes for all British citizens across the United Kingdom. We owe it to them to ensure patients with glaucoma and other eye health conditions get the care they need, when they need it, and where they need it.

We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.

[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.

--- Later in debate ---

[Jim Shannon]

I thank the Minister. That appeal was a wonderful way to end this debate. I began the debate today by asking that we move towards measures to getting more people tested. The Minister has just done that. He has thrown out a challenge to everyone across this great United Kingdom of Great Britain and Northern Ireland, to do just that.

My hon. Friend the Member for East Londonderry (Mr Campbell) is well aware, as I am, of the merits of what we do in Northern Ireland, of the investment that optometrists are making personally and the need to work together. I am encouraged by the helpful contributions of the Minister, the shadow Minister and my hon. Friend.

The hon. Member for Denton and Reddish (Andrew Gwynne) referred to the fact that routine glaucoma testing can save eyesight. We all know that, and that is the purpose of the debate. We need more people to take the test—that is the purpose of the debate. The response from the Minister outlined a plan. I loved the term the hon. Member for Denton and Reddish used when he referred to turbocharging access to ophthalmology services. Wow! That is exactly what we need: a turbocharger. The Minister, in his response, turbocharged the challenge of eye tests and optometry.

The hon. Member for Denton and Reddish also referred to Labour’s commitment to making eye care a priority, which I welcome. I think that is where we are, and that that will follow hard on what the Minister and the Government are doing. The hon. Gentleman also referred to the 6,000 opticians on the high street with whom we can have a better partnership, and he stated that inaction was not an option—how true that is. He said that it was important to ensure there was not a postcode lottery, and he said that Labour would act.

The Minister always tries to be helpful, positive and proactive in his responses. That is what I like in any Minister, and it is what I particularly like about this Minister. It is helpful to have something to be encouraged by. The Minister has grasped the modus operandi of the debate, and why it is important, even though the subject is not in his portfolio. He referred to the need for people to have an eye test every two years, and said that the Government were working with high street opticians to ensure ICB involvement. He also said that the Government were pushing to increase the number of ICBs engaged with that. He said that the pandemic had created some problems, but also referred to an increase in cataract surgery. I think that is positive. Another positive that is sometimes forgotten, to which the Minister referred, is research. Well done, Minister and well done to the Government.

The Minister referred to £5 million of pioneering technology from the United Kingdom. We lead, across the world, in relation to that. He also referred to a new model within the NHS: proactive, progressive ICB best practices.

Today, we have been encouraged by the Minister. We are very pleased with his response. I can tell people who watch this debate on Parliamentlive.tv or who read Hansard—people will get copies from me in my constituency —and want to know what we are doing that we do not need to do anything really expensive. We just need to be proactive.

I look forward to the implementation of the plan to which the Minister referred, and I very much welcome the turbocharged priority that the shadow Minister and his party are prepared to give to the issue. I thank you, Dame Caroline, as always, for your chairship. You make so much of these debates and we appreciate that.

[Dame Caroline Dinenage (in the Chair)]

Thank you very much.

Question put and agreed to.

Resolved,

That this House has considered glaucoma and community optometry.

Preventable Sight Loss

Jim Shannon Excerpts

Tuesday 30th April 2024 Westminster Hall

[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.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. First, this is a terrific subject. She will know that this morning I had a debate on optometry care, which is a similar topic, and the issue is clear. In that debate, I said that 22 people weekly lose their sight to preventable loss. The hon. Lady knows that. Does she agree that the annual eye test should be pushed as forcibly as a dental check-up, and that the message should start in schools and resound right through the community? I think she will agree that optometrists and opticians want to be part of that move forward. If that is the case, we need the Minister and his Department to work alongside them to push for appointments from an early age.

[Margaret Greenwood]

I thank the hon. Gentleman for his intervention; it was characteristically appropriate. I particularly welcome his call for the message to start when children are in school because it is massively important.

In the not too distant future, we may face eye care deserts in some parts of the country, in much the same way as has happened with dentistry, with some people missing out on crucial treatment. That is exactly what Professor Burton has warned could happen. He said:

“There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”

It is not difficult to see how such a conclusion has been arrived at. The great tragedy we face if that happens is that some people will lose their sight from treatable conditions.

The use of the independent sector for ophthalmology has tended to be more prevalent in some parts of the country than in others, so Members representing constituencies in those areas may be particularly concerned. A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the north-west of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers, at 61%. The midlands, the north-east, Yorkshire and the south-west of England also had figures over 50%. Those figures have increased greatly since 2016. Although there is regional variation, we should be concerned about that right across the United Kingdom.

NHS staffing levels for ophthalmology are also a matter of extreme concern. As I said earlier, NHS ophthalmology departments are worried about training opportunities for junior doctors and the available workforce. In response to a recent written parliamentary question, the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), failed to provide clear information about the Government’s plans for specialty training places for ophthalmology. She said:

“A decision regarding which specialties these places will be allocated to will be made nearer the time that the places are required for the expanded workforce. NHS England will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.”

Will the Minister clarify that? When Under-Secretary of State for Health and Social Care spoke of stakeholders in that context, was she talking about the independent sector as well as the NHS? If so, will the Minister ask NHS England what progress it is making towards meeting its commitment, set out in the 2023 elective recovery taskforce implementation plan, to

“track, monitor and evaluate independent sector’s impact on the long-term NHS capacity landscape”?

That is an incredibly important matter, and if the Minister is not able to reply today, I would welcome it if he can write to me on that point.

How confident is the Minister that the full breadth of ophthalmology expertise will be there in the NHS for any one of us in five or 10 years? Data from the most recent workforce census from the Royal College of Ophthalmologists shows that there is real cause for concern, given that 76% of NHS ophthalmology departments report not having enough consultants to meet patient need. In reality, NHS ophthalmology departments are increasingly relying on costly locums to cover workforce gaps, and nearly two thirds—65%—use locums to fill consultant vacancies.

Typically, UK-trained ophthalmologists will have undertaken the vast majority of their training in the NHS, including those now working for independent sector providers. There are concerns that the increase in NHS staff working in the independent sector on cataract provision is reducing the availability of training opportunities that enable NHS staff to train in more complex areas. That is potentially a time bomb for the future, and could mean that we will not have anywhere near enough staff trained to carry out work on treatment for conditions such as glaucoma and wet macular degeneration.

It is clear that we are facing a sight loss health emergency, and there is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and it should aim to prevent irreversible sight loss.

As the Royal College of Ophthalmologists pointed out, it is imperative that NHS ophthalmology departments across the UK are supported to deliver high-quality and timely care for all patients, regardless of their condition and where they live. Among other things, it is calling on policymakers to support the development of a multi-disciplinary eye care workforce fit for the future. That should include delivering an additional 285 ophthalmology training places in England by 2031 and boosting investment in the ophthalmic practitioner training programme so that more eye care professionals can work to the top of their licence.

The royal college is also calling for better integrated eye care through investment in digital solutions such as interoperable electronic patient records between optometry and ophthalmology, and a further development of integrated pathways for optometry so that patients receive the most appropriate and accessible care and are prioritised based on clinical need. It is calling for the reform of commissioning, tariff and data reporting systems, which it believes will ultimately help the NHS ophthalmology services. All those things should be part of a national eye health strategy.

The strategy must be inclusive and must address the needs of everybody. The charity SeeAbility has pointed out that people with learning difficulties are 10 times more likely to have a serious sight problem than other people, but are far less likely to have a sight test. What is happening to ophthalmology services in the NHS is clearly a matter of extreme concern and is one example of just how damaging the privatisation of NHS services is to the delivery of a universal and comprehensive national health service.

The increasing use of the independent sector to treat NHS patients leaves us vulnerable to the vagaries of the market. Under this Government, the use of private-sector companies in health has increased. Indeed, the Health Service Journal reported last December that the amount spent by NHS trusts on outsourcing activities to other providers has almost doubled from £2.4 billion in 2019-20 to £4.7 billion in 2022-23. The HSJ stated that independent providers are

“likely to make up the bulk of the spend”.

The Minister will say that the Government are not privatising the NHS, but that is smoke and mirrors. The World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

We have seen that in ophthalmology, with the commercial interests of private companies driving the increased expenditure on NHS cataract provision. That is the view of ophthalmologists. No doubt the Minister will say that the Government are providing the national health service with record levels of funding—again, smoke and mirrors. The fact is that, as pointed out in the 2023 report “The Rational Policy-Maker’s Guide to the NHS”, NHS spending has not been enough to keep pace with need when we factor in and combine the effects of inflation, population growth, population ageing and increased morbidity.

I ask Members to think about the questions I raised at the beginning of the debate. How would you feel if you lost your sight, how would it impact your life, and how would you feel if you then found out that the loss of your eyesight could have been prevented? How would you feel if you found that you could not get the treatment you need because less serious conditions were being treated as a priority in the independent sector by specialists who were lured there, away from the NHS, due to how commissioning works and because the market is increasingly influencing what is and is not treated?

RNIB figures show that every day, 250 people in the UK start to lose their sight. We need the national eye health strategy, the goal of which should be to preserve vision and prevent irreversible sight loss. I call on the Government to address those issues as a matter of urgency. The Government must invest in the national health service and strengthen it as a public service to ensure that it is universal and comprehensive. For that, they must build the capacity of expertise within the NHS so that we can be confident that the service is there to treat all eye conditions. In the words of Professor Ben Burton, the chief executive of the Royal College of Ophthalmologists,

“the key to ensuring long term capacity to deliver patient care is to invest in comprehensive NHS services, workforce and infrastructure.”

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Andrew Stephenson]

The GMC and other professional regulators have a statutory duty to investigate any concerns about the fitness to practice of one of their registrants and to take appropriate action to protect the public when that is needed. The regulators are overseen by the Professional Standards Authority for Health and Social Care, which has the power to appeal cases where, in its view, a sanction imposed by a regulator is insufficient to protect the public.

[Jim Shannon (Strangford) (DUP)]

The GMC has seven principles of decision making and consent. How will the Minister ensure that GPs can fulfil their obligations when time constraints on appointments mean that they do not have time to listen to every complaint? People have to book a double appointment to talk about more than one issue. What further support can the Government give GPs to enable them to fulfil their GMC-ordered standards of care?