Leasehold Reform and New Homes

Debate between Neil O'Brien and Marsha De Cordova

Wednesday 28th February 2024 Westminster Hall

[Neil O’Brien (Harborough) (Con)]

I beg to move,

That this House has considered leasehold reform and new homes.

It is a pleasure to serve under your chairmanship, Mrs Harris. Yesterday, we had an excellent Report stage debate on the Leasehold and Freehold Reform Bill. I was really encouraged to hear from the Minister that the Government are looking at going further on two of the big things that we need to improve in the Bill: ending forfeiture and ending the private estates, or so-called fleecehold estates, model. I once again thank all the different bodies that have worked so hard to get us to this point, the Minister, who managed to get the time for this legislation, the ministerial team that came before him, and all the different bodies that provided useful evidence in Committee, including the Leasehold Knowledge Partnership, the National Leasehold Campaign, Harry Scoffin and Free Leaseholders, HorNet, the HomeOwners Alliance, and many more.

I do not want to just repeat all the points we made yesterday, but I will briefly touch on some, because my speech flows on from them. Yesterday, I quoted my constituent Karen, who said that dealing with FirstPort, her fleecehold company, is

“like having a part time job”,

and who is being charged for, among other things, terrorism insurance for a fence. I quoted my constituent James, who says that he spent

“about 50 days’ work over the first couple of years”

dealing with his unadopted estate and trying to put right some of the mistakes made by developers.

I quoted the residents of Hursley Park, who managed to get control over their residents management company because of a legal mistake by the developer, but years on are still fighting to avoid being lumbered with the cost of botched work by Mulberry Homes. Disappointingly, that developer will not even meet them to discuss it. I also quoted one of the residents of the Farndon Fields estate, who has had a long battle with a faceless fleecehold company called Chamonix that billed people for large sums, did almost no work, repeatedly billed people several times for things they had already paid, and generally behaved appallingly.

I want to bring out how some of those stories show the different ways that we can intervene to get rid of this awful, scamming industry, which sees councils and developers effectively colluding to stiff residents with big bills and poor services. The first step is to look at how homes are sold. Numerous Members in yesterday’s debate talked about constituents who had not realised what they would be liable for. That seems to be particularly the case where people are bribed by the developers to use their lawyers—oddly enough, developers’ lawyers do not always point out the big bills that people will face. That is the first thing we should look at.

The second step is to look at the whole planning process and the fact that permission is often given before there is clarity on adoption. That is a bizarre way of going about things. The residents of Devana Way in my constituency, who I did not mention yesterday, found that out the hard way. They bought beautiful, expensive homes on a nice tree-lined street, but during the process of haggling with the county council over adoption and who was going to look after the trees, the developer concluded that it would be cheaper to simply rip out all the trees—and that is what it did one morning, to the horror of residents. I do not blame councils for wanting funds to look after trees; in fact, I think we should make it a priority in local government finance to make sure that all residential streets come with trees. However, there needs to be clarity about the rules of adoption up front, not after the fact.

Likewise, we need to stop developers wriggling out of planning conditions more generally through variations, as one developer is trying to do at the top of Kettering Road in Market Harborough—it is trying to get rid of a bus service it promised when it was trying to get planning permission. One of the most common abuses is that developers promise that there will be a new GP surgery as part of a new estate, but in fact have no plan, no intention or no way to deliver it. I am afraid I know several colleagues who have had that happen in their constituencies.

The Minister has promised to make progress on forfeiture, one of the most important things we have to deal with. That is important across leasehold and on fleecehold estates, too, because the disproportionate threat that someone might lose their home over a tiny unpaid sum enables the fleecehold cowboys to terrorise people into paying up. People are being conned about what they are buying. As we said yesterday, Margaret Thatcher said that there was no prouder word in our language than “freeholder”. Many of those people believe they are freeholders, but do not realise the threat hanging over them. My constituent Karen said that purchasers on her estate were not told that they would have to pay an annual rent charge:

“the word ‘rent’ wasn’t used by anyone we spoke to. It was referred to as a ‘maintenance charge’—if it was referred to at all. I didn’t fully understand what ‘rent charges’ meant until about four years after we bought.”

That is another way that people are being mugged by the fleecehold estates model.

We need to do two things. First, we need to help the 3 million to 4 million people who are stuck on fleecehold estates. We could do that through something such as a right to manage, or better still we could give them the opportunity to have their estates adopted by the council, which is what many of them want.

Secondly, we need to end this model for the future, which again could be done in numerous ways. We could do what my hon. Friend the Member for North East Bedfordshire (Richard Fuller) suggested and prevent companies from charging for things that are usually provided by councils. Alternatively, we could use guidance to ban the model except in extreme and exceptional circumstances. I do not mind how we go about it, but we have to end the model.

[Marsha De Cordova (Battersea) (Lab)]

The hon. Member is making a fantastic speech—I do not always say that to Government Members—but does he agree that this is about fairness? The current leasehold system is not fair, and it is certainly not just. In 2022, my Battersea constituency was area with the 18th highest number of leasehold transactions. The hon. Gentleman is part of the governing party, and the Government have really missed an opportunity to do away with this outdated system and bring about fairness and justice for leaseholders. Thousands of my constituents, like his, have been calling for that.

[Neil O'Brien]

I got a sense from the Minister yesterday that the legislation will go further. The Leasehold and Freehold Reform Bill is already a great achievement. It is the first time since 2002, I think, that we have legislated on this matter. According to the Opposition, there were some big missed opportunities when we passed that legislation, which has never been commenced—I think everyone across the House agrees with that. The Bill is already good, but I think I detected from the Minister that there are ways we can make it better, and I hope we will collectively be able to do that. To be clear, the people who have been stuffed by the fleecehold estates model do not want a marginal change; they want to end this fundamentally rip-off model.

I asked for this debate to be about new homes as well as leasehold, because sadly fleecehold is just one of the issues affecting buyers of new homes. I have been conducting a survey across Harborough, Oadby and Wigston of buyers of new homes, and I am struck by how widespread the problems are. In two different streets in different places in my constituency, residents have faced sewage in their street and even flowing up into their sinks, dishwashers and showers. There have been occasions when they have been unable to wash because of that.

In the first location, which I visited the other day, the problems have been going on for about four years. The developer plugged the sewage system from a new estate into a sewer for an older estate, causing the older sewage system to overflow with rain water. After four years of denials from the developer, the residents have proved, with the help of Severn Trent, where the problem is coming from. The developer has, in fairness, finally fessed up to causing the problem, and the new person in charge locally seems serious about fixing the problem, so I will not name them for now.

In the second case, Meadow Hill in Wigston, the problem has been going on for about six years. The sewage system in the new estate is simply inadequate. The homes were originally built by Westleigh Homes and were taken over by Countryside Partnerships after completion, which itself has been taken over by Vistry Group. Vistry continues to deny the problem and will not take responsibility, even though I have seen for myself bits of toilet paper in the road that have come spurting up from overflowing sewers. Vistry does not fix the problem. It occasionally sends people to clean up, but mainly it is left to residents to clean up the faeces. I would like to invite Greg Fitzgerald, the chief executive officer of Vistry, to come to see the filth for himself, and I will perhaps ask him how much he would like to have it in his street and coming up into his home. Stephen Teagle, who runs Countryside Partnerships, would also be very welcome to join us to see that disgusting case.

Those are extreme cases, but I am struck by how often British developers sell homes with serious problems, either with the property or with the new estate. For example, a constituent in Wigston has faced a bill of about £10,000 to fix problems caused by his developer, which left his garden at a very steep angle. After two years of fighting, the developer, David Wilson Homes, has agreed to pay about 20% of the cost—a tiny fraction.

A constituent who moved into a new development in Kibworth faced numerous rat infestations due to the pipes in her new home not being fitted correctly. She also experienced mould in the bathroom because the bath was also not fitted correctly.

A constituent who moved into Wellington Place in Market Harborough had more than 200 snags on their property. The toilets did not drain properly, and the downstairs toilet did not work at all for many months, which meant that their disabled daughter had to go upstairs to use the loo. The entire garden needed to be excavated to be fixed and, alarmingly, the fire alarms did not work properly. My constituent found it difficult to get hold of the developer, Davidsons, to get any of those issues addressed, because it had sacked the people responsible for aftercare on the estate.

There are reasons such things happen. On the surface level, some developers are simply more serious about ensuring quality than others. It is not impossible to get it right in the current system, and many do. The Government’s creation of the new homes ombudsman service is a big and very welcome move towards tackling the problems directly. However, some of the problems also reflect wider problems with this country’s model of development: the so-called fast-turn model. In Britain, so much of the profitability of the industry turns on its ability to play our dysfunctional planning system rather than its ability to build in quality.

I was going to make this point today anyway, but as it happens the Competition and Markets Authority’s monumental investigation of the housing market, which was published earlier this week, gives us a huge amount of further evidence that the current model is dysfunctional. Naturally, the sharing of information and cartel-like behaviour between firms was the headline of the report, but many of the other findings are just as explosive. The CMA notes that

“housebuilders don’t have strong incentives to compete on quality and consumers have unclear routes of redress.”

It also notes:

“We see evidence of a statistically significant increase over time in the proportion of homeowners reporting higher numbers of snags, with 35% of respondents…in 2021-22 reporting 16 or more different problems.”

The report brings out what some of those “snags” look like in the real world. One homeowner notes:

“After moving in, my attic hatch fell completely out of the ceiling of its own, because the joiner had only used three screws to fix it instead of sixteen”.

Another says:

“The stairs collapsed while walking up [them] with my son.”

The CMA notes the growing volume of complaints about hidden charges. Among the CMA’s recommendations is

“requiring councils to adopt amenities on all new housing estates.”

That is a very good idea, which takes us back to the issue of leasehold, and I hope that the Government adopt it.

One of the great strengths of the CMA report is the way that it draws the links between the broken planning system and the industry that results from it. Following the conclusions of the Letwin review, the report concludes:

“The evidence shows that private developers produce houses at a rate at which they can be sold without needing to reduce their prices”.

In a paper that I wrote for the think-tank Onward six years ago, I tried to set out some of these dysfunctions. The complexity of the planning system increases market concentration directly and also indirectly, by amplifying the land price cycle, which leads to fewer and fewer developers in each economic cycle, as the small players go bust and are forced out of the market. I am encouraged that the Government are taking great strides towards a better model of development in this country by fixing those deeper, underlying problems.

The vision for more purposive urban regeneration set out in the long-term plan for housing is a good one. The recently passed Levelling-up and Regeneration Act 2023 creates stronger compulsory purchase order powers and requires the dark market in land options to be replaced by a register of land options. I look forward to us cracking on with the secondary legislation needed to bring that about. I also look forward to the Government taking further steps towards creating a more purposive, less passive planning system, in which deliberate, plan-led development becomes a greater share of development and small, speculative development, without the necessary infrastructure, becomes a smaller part of development. The Government are sold on that vision and are making big strides towards it. The current ministerial team—the Secretary of State and our brilliant Housing Minister, who is here today—have that vision and experience these issues in their own constituencies.

I am confident that we are moving in the right direction. I hope that, when the Leasehold and Freehold Reform Bill arrives in the House of Lords, the Government will proactively take steps to improve it to address these issues. If I read the Minister’s body language right, he clearly understands those issues and wants to act on them. I hope that we can agree to act as quickly as possible, because the issues that I have described in my constituency are horrendous. People have worked hard, saved up a lot, done all the right things, and bought a new home, but they are getting mugged by an industry that, although also having some good players, has some real cowboys. As I said yesterday, the people in my constituency want a new sheriff—in the form of our current Housing Minister—to ride into town on his white horse, blow some of those bad guys away, put right what is being done wrongly and address the glaring injustices that my constituents are experiencing.

Mental Health Treatment and Support

Debate between Neil O'Brien and Marsha De Cordova

Wednesday 7th June 2023 Commons Chamber

[Neil O’Brien]

The remaining provisions will be commenced as soon as possible.

We are working with the NHS towards implementing new waiting time standards for people requiring urgent and emergency mental healthcare, in both A&E and the community, to ensure timely access to the most appropriate high-quality support. We also recognise that there is much more to be done to improve people’s experience in in-patient mental health facilities. The Minister with responsibility for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), has spoken to many Members following reports of abuse and care failings at a number of NHS and independent providers. We have been clear that anyone receiving treatment in an in-patient mental health facility deserves to receive safe, high-quality care and to be looked after with dignity and respect.

It is vital that, where care falls short, we learn from any mistakes to improve care across the NHS and to protect patients. That is why we have conducted a rapid review of mental health in-patient settings, with a specific focus on how we use data and evidence, including from complaints, feedback and whistleblowing reports, to identify risks to safety.

[Marsha De Cordova (Battersea) (Lab)]

The Minister wants to talk about data and evidence. We know that, within the mental health crisis, there are huge, long-established racial disparities, with young black men disproportionately being sectioned under the Mental Health Act 1983. The draft mental health Bill is still in train, and I would like to know exactly when the Government will table the Bill, which might stop these racial disparities and stop young black men dispro-portionately being sectioned.

[Neil O’Brien]

We are currently responding to pre-legislative scrutiny, so we are on the case. We are not just waiting, of course, and we are already doing things on these points, including through the culturally appropriate advocacy pilots for those at risk of detention and on the patient and carer race equality framework to avoid and prevent detention in the first place.

The rapid review’s report will be published very shortly. NHS England has also established a three-year quality transformation programme that seeks to tackle the root causes of unsafe, poor-quality in-patient care, including sexual safety, in mental health, learning disability and autism settings.

Our draft mental health Bill, which has been mentioned a few times in this debate, is intended to modernise the Mental Health Act so that it is fit for the 21st century and works better for people with serious mental illness. The draft Bill has completed its pre-legislative scrutiny, and we will respond to the Joint Committee’s recommendations very shortly.

In a world of increasing rates of multiple morbidity and diseases of increasing complexity, it is crucial that we continue our progress towards more person-centred, holistic care that considers a patient’s physical and mental health needs together. That is why we announced in January that we will be producing a major conditions strategy to tackle the conditions that contribute most to morbidity and mortality across the population of England, including mental health. The call for evidence is now open, and I encourage everyone to make their views known before it closes.

Eye Health: National Strategy

Debate between Neil O'Brien and Marsha De Cordova

Wednesday 17th May 2023 Westminster Hall

[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.

Oral Answers to Questions

Debate between Neil O'Brien and Marsha De Cordova

Tuesday 7th March 2023 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

11. What assessment his Department has made of the impact of NHS backlogs on eye healthcare.

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

The elective recovery plan sets out how we are tackling backlogs, including in eye care. As well as having over 4,900 more doctors and 11,000 more nurses than last year, we also have 92 community diagnostic centres operational and 89 surgical hubs, and we are boosting capacity in 180 trusts with expanded wards and modular theatres. Two-year waits have been virtually eliminated, and we now aim to eliminate 18-month waits by April.

[Marsha De Cordova]

The backlogs have meant that the number of patients waiting for ophthalmology treatment has increased by 41% in the last three years, and that is over 630,000 people in England. Average waiting times have increased substantially, and the number of patients starting treatment within 18 weeks of referral has dropped to 62%. We know that delays to treatment can and will lead to avoidable sight loss, and we need a plan to tackle the eye care crisis in the NHS. I recently visited the fantastic eye department at St Thomas’s Hospital, which is doing an incredible job in managing this. Will the Minister back my plan for a Bill and visit the brilliant service that it is delivering?

[Neil O’Brien]

This is exactly why we are investing the extra £8 billion in elective recovery. Ophthalmology 52-week waits are coming down from 42,000 to just under 27,000. But can I pay tribute to the hon. Lady for her passion for this subject? We had a Westminster Hall debate the other day and she had to run to be there—such is her passion—but she made it. I thank her for all her work on this matter.

Eye Health

Debate between Neil O'Brien and Marsha De Cordova

Thursday 15th December 2022 Westminster Hall

[Neil O'Brien]

Absolutely. As the hon. Gentleman says, we are keen to constantly drive that rate up, and we can talk more offline about the different things that we can potentially do to drive it up even further. The healthy child programme recommends eye examinations at birth, six weeks and age two, and school vision screening is also recommended for reception-age children.

The hon. Member for Strangford raised a question about a special school, which I will address specifically. The NHS long-term plan made a commitment to ensure that children and young people with a learning disability, autism or both who are in special residential schools have access to sight tests. NHS England’s proof of concept programme has been testing an NHS sight-testing model in both day and residential schools, and it is currently evaluating its proof of concept as part of programme development, which we expect to conclude towards the start of 2023. The evaluation will then inform decisions about the scope, funding and delivery of any future sight-testing model. I reassure the hon. Gentleman that, at present, absolutely no decisions have been made; we are waiting for the evidence that that programme is generating.

I turn to secondary care. Once an issue with eye health is detected, it is vital that individuals have access to timely diagnosis and any necessary treatment. The NHS continued to prioritise those with urgent eye care needs throughout covid-19. However, we acknowledge the impact that the pandemic has had on our ophthalmology services, as it has had on other care pathways. Our fantastic NHS eye care teams are working hard to increase capacity and provide care as quickly as possible. We have set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion over the next two years, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund announced last year.

[Marsha De Cordova (Battersea) (Lab)]

Will the Minister give way?

[Neil O'Brien]

I give way with pleasure to the hon. Lady, who has been hot-footing it from a funeral to attend the debate. I will seamlessly fill in, so she can catch her breath. I congratulate her on making it here.

--- Later in debate ---

[Marsha De Cordova]

I honestly thank the Minister for giving way. I have just got here from the funeral of a dear friend, Roger Lewis, who, as a totally blind man, was also a strong advocate for a national plan for eye care in England and the devolved nations. I congratulate my dear and honourable friend, the hon. Member for Strangford (Jim Shannon), on securing this very important debate.

As many Members will know, I currently have a Bill calling for a national strategy for eye health in England. We need to ensure that eye care provision is joined up across England to reduce avoidable sight loss but also, more importantly, to end the fragmentation of services. Is the Minister willing to meet me to discuss some of the provisions in the Bill, to ensure that we can create an eye care pathway that ensures that nobody who is losing their sight—or has already lost it—will go through the pathway without the right support and timely treatment?

[Neil O'Brien]

I am grateful for the hon. Lady’s intervention, and I will be happy to meet her. It sounds like there is an important connection between where she has just been and this debate. I am extremely happy to meet her to talk about that.

I will continue setting out our strategy. I have already talked about screening in primary care, and I was setting out the sums of money that we are investing—the £8 billion plus the £2 billion—in elective recovery following the pandemic. NHS England has been supporting NHS trusts to increase capacity in surgical hubs, and the independent sector has also been used to increase the delivery of cataract surgery, in particular. In 2021-22, nearly half a million cataract procedures were provided on the NHS, which is actually more than before the pandemic, so that is recovering.

Beyond recovering from the pandemic and looking to the future, hospital eye care services are facing increasing demand. As a number of hon. Members have pointed out, ophthalmology is already the busiest out-patient speciality, and the predictions are that the demand for services will increase by 30% to 40% over the next 20 years as the result of an ageing society.

To help address these challenges, NHS England’s transformation programme is looking at how technology could allow more patients to be managed in the community and supported virtually through image sharing with specialists in NHS trusts. Current pilots for cataracts and glaucoma are allowing primary care practices to care for these patients and refer only those who need to be seen by specialists. The learning from these pilots will feed into any possible future service model. That could allow us to use the primary care workforce to alleviate some of the secondary care pressures.

I am delighted that the NHSE has appointed the first national clinical director for eye care, Louisa Wickham, who will oversee this work programme. I am aware that the APPG on eye health and visual impairment has called for there to be one Minister responsible for primary and secondary care services. I can confirm that my portfolio covers both those areas, so I will be taking an active interest in the development of that transformation programme and strategy.

A number of hon. Members have raised questions about the workforce, and we acknowledge that there are challenges across the system, including in ophthalmology. NHS England is developing a long-term workforce plan that will consider the number of staff and roles required and will set out the actions and reforms needed to improve workforce supply and retention. We have already invested in growing the ophthalmology workforce with more training places in 2022, but there is more to do. We are also improving training for existing staff so that they can work at the top of their licence.

Research is an area that the hon. Member for Strangford is interested in, and I was extremely sorry to hear from the hon. Member for Tooting (Dr Allin-Khan) about her keratoconus. That is one area where, fortunately, research and new treatments are coming online, so research is hugely important. While we have effective treatments, particularly for macular disease, we absolutely cannot rest on our laurels because medicine continues to evolve. We recognise that research and innovation are crucial to driving improvements in clinical care and improved outcomes for people living with sight-threatening conditions. The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing challenges of our time, including sight loss.

Over the past five financial years, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research, and many of the studies focus specifically on sight loss. The NIHR Moorfields Biomedical Research Centre has recently been awarded £20 million from the NIHR for another five years of vision research, allowing it to continue its mission of preserving sight and driving equity through innovation. Through the NIHR, England, Scotland, Wales and Northern Ireland work together on a range of research topics, and the devolved Administrations co-fund several research programmes.

To assess how well interventions are achieving their intended aims, it is important that we track their impact, which hon. Members have mentioned. The public health outcomes framework’s preventable sight loss indicator tracks the rate of sight loss per 100,000 population for three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy.

We are making progress. The indicator shows the impact that the new treatments have had on the rate of sight loss due to age-related macular degeneration. Despite an ageing population, the rate of sight loss in 2019-20 was 105.4 cases per 100,000, down from 114 per 100,000 in 2015-16, so there has been an improvement on macular degeneration. The open availability of this data provides a valuable resource for integrated care boards to draw on in identifying what is needed in their areas and for local democratic accountability for any variation in performance against public health outcomes.