Eye Health: National Strategy

Marsha De Cordova Excerpts

Wednesday 17th May 2023 Westminster Hall

[Marsha De Cordova (Battersea) (Lab)]

I beg to move,

That this House has considered the potential merits of a national eye health strategy.

It is an absolute pleasure to serve under your chairmanship, Mrs Harris, and I am pleased to have secured today’s debate. Let me begin by placing on the record my thanks to the many organisations that have sent through their briefings and shared their knowledge and expertise, including the Association of Optometrists, the Royal College of Ophthalmologists, Specsavers, SeeAbility and the Royal National Institute of Blind People, which have all supported my National Eye Health Strategy Bill as well.

There is no question but that we need the Government to introduce an eye health strategy in England, because there is an emergency in eye care. Huge backlogs, which were apparent before the pandemic, are leading to people unnecessarily losing their sight. The annual economic cost of sight loss is currently estimated at £37.7 billion. An estimated 2 million people are living with sight loss in the UK, and anyone can be affected by it. As Members, we will all have constituents who have been or are being affected, because 250 people begin to lose their sight every day, with a shocking 21 people a week losing their vision due to a preventable cause. On top of that, we know that 50% of all sight loss is avoidable. We should all be asking why so many people are needlessly losing their sight or going blind.

The backlog for ophthalmology appointments in England is one of the largest in the NHS, with over 630,000 people on waiting lists as of 23 March this year—more than 9% of the total backlog. Ophthalmology has been the busiest NHS out-patient clinic for the last three years, with 7.5 million hospital attendances in England in 2021-22. It is shocking that eye care accounts for only 2.6% of NHS consultants and 1% of the total number of doctors.

[Paul Blomfield (Sheffield Central) (Lab)]

I congratulate my hon. Friend on securing this really important debate. She is making a significant point about capacity. Does she agree that there is a need to ensure that the long-awaited workforce plan the Government have promised pays proper attention to this area of specialism and takes account of the need to train more people as part of the provision being made for additional medical training?

[Marsha De Cordova]

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

[Janet Daby (Lewisham East) (Lab)]

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

[Marsha De Cordova]

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

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

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank my hon. Friend for making such an important speech. I pay tribute to the staff in the eye health department at St Thomas’s Hospital in my constituency. Figures show that 650,000 people are on waiting lists in England and that 37% have waited for more than 18 weeks. If the Government had a strategy, would that not address the postcode lottery my hon. Friend highlighted?

[Marsha De Cordova]

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

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

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

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

[Janet Daby]

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

[Marsha De Cordova]

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

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

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

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

[Paul Blomfield]

I thank my hon. Friend for giving way again, and she really is making a powerful speech. She made the point about the single route of referral in that relationship between primary and secondary care. Does she recognise that that is not only better for patients but—reflecting the comment my hon. Friend the Member for Lewisham East (Janet Daby) made a moment ago—for the NHS, saving it an estimated £2 million a year?

[Marsha De Cordova]

That is exactly the point. Joining up services, which is what my Bill seeks to do, would essentially save the state money, which is crucial.

I have mentioned devolving services and supporting the pathway. When the Minister responds, will he provide an update on where the Government are up to in creating this referral and joined-up pathway system, or EECR, to be specific?

The third area of the strategy would be workforce expansion. There is a significantly uneven distribution of ophthalmology workforces across England, and a quarter of the profession is nearing retirement age. That is extremely concerning, because nearly 80% of eye care units already do not have enough consultants to meet current demand, with over 50% finding it more difficult to recruit for consultant vacancies. In the last year alone, 65% of units had to use locums to fill those consultant vacancies. What do the Government plan to do to respond to this workforce crisis? They say they are bringing forward their plan, but when will it be published?

At the APPG meeting in April, we addressed the challenges of the eye care workforce. Speakers from the Royal College of Ophthalmologists, the College of Optometrists and the Association of Optometrists all made strong recommendations and put forward credible solutions. Again, I would be happy to facilitate a meeting if the Minister is yet to meet those trade bodies. He would hear first hand their strong and credible recommendations, which seek to address some of the workforce challenges.

The Government must make better use of existing workforces while expanding capacity to meet future needs, including by adopting Labour’s call to double medical school places to 15,000 a year. That needs to be complemented with investment in training for wider eye care and multidisciplinary teams and with an expansion in the number of non-medical roles.

The fourth area would be health intelligence and data.  For too long, population data has not been utilised effectively to pinpoint the location of need and the places where opportunities for change can be found. A strategy would solve that by focusing on robust data collection to inform decisions and improve the delivery of service. The UK has no national data to identify people at risk of sight loss. There is potentially a case for looking at how registration for the certificate of vision impairment system works to see whether it could be used to map out an evidence base to show where people with sight loss are living. The lack of data means there is likely to be unmet need in the system, with some people who experience visual impairment not being treated, and some developing conditions that could be avoided if they were treated earlier—as I said earlier, 50% of all sight loss is avoidable.

Without that data, we do not know whether public expenditure on eye health is meeting people’s needs, because that expenditure is not based on any evidence. Where there are still no treatments for certain conditions, the Government should increase spending on eye research, which gets a fraction of the investment it desperately needs. According to UK Research and Innovation, the Government, charities and other public bodies invested £1.4 billion in medical research in 2018, but only 1.5% of that was invested in eye research. To put that in context, only £9.60 was spent on research for each person affected by sight loss in the UK. That is worrying, given that 250 people begin to lose their vision every day.

The fifth area would be improving public awareness. As I said earlier, 2 million people each year turn up to A&E or try to get a GP appointment for a problem that could be dealt with by a community optometrist. A strategy would involve campaigns on the importance of maintaining good eye health, educating the public on the difference between eye screening and eye tests, and improving signposting to where people need to go for help.

England is the only country in the UK without an eye health strategy. Strategies can deliver positive outcomes, as has been the case in Scotland. In England, there are health strategies for other conditions, so why not for eyes? The benefits would transform lives, alleviate pressure on health services and reduce economic costs. Our goal should be to ensure that no one loses their sight unnecessarily. Most people in the Chamber know that I have a condition called nystagmus. I have been living with my sight loss all my life, but those who come to sight loss later in life face even more barriers and challenges.

I would like the Minister to address the following questions. He will get fed up of me saying this, but why will the Government not commit to an eye health strategy for England? Will they appoint a Minister—it could be this Minister—whose sole responsibility is eye healthcare? What are they doing to ensure that every integrated care board has a MECS and that their commissioning is consistent with that of the 23 that already have such services? Five ICBs have no form of MECS provision at all, so what will the Minister do to ensure there is consistency in our communities? When will the Government publish their overdue long-term workforce plan? Will there be a focus on ophthalmology? As I have highlighted, only 1.5% of the £1.4 billion going into medical research involves eyes, so will the Government increase spending on eye health research?

[Carolyn Harris (in the Chair)]

I remind Members that if they wish to speak in the debate, they should bob. I call Dr Rupa Huq.

--- Later in debate ---

[Neil O'Brien]

I expect that to be something we can come back on imminently.

I will come back on to the main topic of today’s debate. While I acknowledge that we must go much further to address the current and future capacity challenges facing eye care services, I highlight some of the excellent work already being done by doctors and nurses across the NHS. Our existing prevention and early detection measures are already playing a key role in preventing avoidable sight loss, and there has been progress over recent years.

One of the most important things we can do in terms of prevention is take action to reduce obesity and smoking, which are both massive risk factors for sight loss. We have made good, long-term progress in reducing smoking rates among adults, which have come down from about 21% in 2010 to 13% now—the lowest on record. Of course, that still means that we have one in seven adults smoking, which is why on 11 April I announced a package of new measures to achieve our ambition to be smoke-free by 2030. We are also working with the food industry to ensure that it is easier for people to make healthier choices, and supporting adults and children living with obesity to achieve and maintain a healthier weight.

In terms of the vital screening services raised by various hon. Members, I have talked previously about the success of the diabetic retinopathy screening programme, which provides screening to over 80% of those living with diabetes annually. Between 2009-10 and 2019-20, the number of adults aged between 60 and 64 registered annually as visually impaired due to diabetic retinopathy fell by 20%. That is real progress. The success of our screening programme has also been recognised by the World Health Organisation as a service that other countries should aspire to achieve.

As Members have heard me say before, one of the best ways to protect our sight is by having regular sight tests. That is why the NHS continues to invest £500 million a year in delivering over 12 million NHS sight tests, and provides optical vouchers to help with the cost of glasses for eligible groups.

As for secondary care services, when an issue with eye health is detected, it is vital that individuals get timely diagnosis and treatment. The pandemic had a huge impact on ophthalmology, as it did right across the NHS. We set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion between 2022 and 2025, in addition to the £2 billion through the elective recovery fund and the £700 million targeted investment fund last year. That will drive up elective activity and get through the backlog more quickly.

We know that NHS eye care teams continue to work hard to provide care as quickly as possible. The average waiting time is reducing; it was down to 11.3 weeks in March, compared with 12.9 weeks in September last year. Progress has also been made in reducing the number of patients waiting the longest for ophthalmology treatment. The number of patients waiting 78 weeks or longer was reduced by more than 85% between September 2022 and March this year.

A large proportion of the patients who are waiting for more than 78 weeks are waiting for corneal grafts. NHS England is working with NHS Blood and Transplant to increase the supply of corneal graft tissue. For patients who are waiting more than 52 weeks, NHS England’s elective recovery team are working hard to support local systems to increase capacity and provide care as quickly as possible. Surgical hubs and the independent sector are also being used to increase delivery, particularly of cataract surgery. In 2021-22, nearly 500,000 cataract procedures were provided on the NHS—more than pre-pandemic.

The hon. Member for Ealing Central and Acton made a point that I felt a bit ambiguous about, in so far as she raised the use of the independent sector. As she knows, Opposition Front Benchers also support the use of the independent sector to try to plough through the elective backlog. On the other hand, there is an important point about ensuring that trainees can get sufficient cataract surgery training and can have a broad range of clinical experiences as they are trained. The NHS has been working with the Royal College of Ophthalmologists to support that, because there is a genuine issue. We are working on that, even though we think it is right to use the independent sector to get through the backlog more quickly and save more people’s sight.

One of the most important points that the hon. Member for Battersea made was about more fundamental reforms to eye care services. She mentioned that ophthalmology is the busiest outpatient speciality and has a number of capacity and workforce challenges that are likely to grow. Predictions from the Royal College of Ophthalmologists say that demand for services will increase by 30% to 40% over the next 20 years, in line with an ageing population. In the light of those predictions, consideration has been given to how we can increase capacity to ensure that we have sustainable eye care services fit for the future. No one should have to face losing their sight due to delays in accessing care.

NHS England’s transformation programme has been considering what services could be safely moved out of hospital. The hon. Member is right to say that image sharing between primary eye care providers and secondary care specialists, through telemedicine hubs, could allow more patients to be seen in the community, which is a very exciting opportunity. A pilot that we are running in north-central London has already shown the potential for that model to improve the triage of patients into secondary care. NHS England plans to support a number of other integrated care systems to adopt the eye care referral model, aligned to their local commissioning arrangements.

[Marsha De Cordova]

On the way in which we can join up primary and secondary care and ensure that MECS are being commissioned across all ICBs, does the Minister agree that that measure should be consistent and must take place, so that across all our ICBs, MECS would be available in the community?

[Neil O'Brien]

The hon. Lady has read my mind, because I was about to come on to MECS. We will produce standard service specifications for MECS to reduce the variation that she rightly raised, as well as driving forward the integration of those new technologies into local ICSs.

As well as making the best use of our clinical capacity, we have to invest in growing the future workforce, as the hon. Member for Sheffield Central (Paul Blomfield) said. That is why we have taken steps to increase the ophthalmology workforce. We increased training places in 2022, and more places are planned for this year. In addition, there will be improved training for existing ophthalmology staff so that they can work at the very top of their clinical licence to further increase capacity and support the flow and delivery of care.

I recognise the important role of research and innovation in understanding sight loss and making available new treatments—a point that several hon. Members raised. That is why we continue to invest significantly in vision research. As I highlighted in a previous debate, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research over the past five years, and the NIHR Moorfields Biomedical Research Centre was awarded £20 million last year for another five years of vision research leadership.

[Marsha De Cordova]

I know that the Minister is coming to the end of his speech, but I do not want to let him sit down without pressing him for a timeline for the workforce plan. Will it cover ophthalmology and eye care? He said that he met Louisa Wickham, the eye care transformation lead, but will he confirm that all the investment in that space will continue and will not come to an abrupt end?

[Neil O'Brien]

I am happy to confirm that the workforce plan should be out pretty shortly, and that it will look across the entirety—

[Marsha De Cordova]

You have been saying “shortly” for a while.

[Neil O'Brien]

Until there is a date, there is no date, but it will be fairly soon.

--- Later in debate ---

[Marsha De Cordova]

I thank all hon. Members for their contributions. This has been a healthy debate, but it is deeply worrying that we continue to debate the need for a national eye care strategy for England.

I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for her fantastic speech and the work she is doing locally. As a campaigner, I learned so much from the incredible work of my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) and her massive support and campaigning for special schools in her constituency. My hon. Friends the Members for Vauxhall (Florence Eshalomi) and for Sheffield Central (Paul Blomfield) are no longer here, but they both made very good contributions, as did my hon. Friend the Member for Lewisham East (Janet Daby).

I want to say a special thank you to the hon. Member for Hendon (Dr Offord) for sharing his experience of macular, and for his tireless campaigning on this issue. I hope that we can continue to champion eye health and raise the need for a national plan to tackle the challenges that people with sight loss face.

I take the Minister’s point; I know he is trying, but we need action. We need to see fundamental changes, particularly on the workforce, the pathway, the joining up of primary and secondary care, research and public awareness. He said that all the areas that we have discussed on a one-to-one basis and that I have raised here are being looked at. Can we have another meeting so he can update me on all the work that is going on? I want to ensure that none of this is in vain and that we actually see some sort of plan—some sort of strategy—that delivers for people living with sight loss and prevents more people from losing their sight.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a national eye health strategy.