Preventing Avoidable Sight Loss

Nusrat Ghani Excerpts

Tuesday 28th March 2017 Westminster Hall

[Nusrat Ghani (Wealden) (Con)]

I beg to move,

That this House has considered preventing avoidable sight loss.

I thank the Backbench Business Committee for allocating me this debate, the Chairman of Ways and Means for approving it and you, Mrs Gillan, for being in the Chair. I am also grateful to all the MPs who supported my application and to Lord Low of Dalston, my co-chair on the all-party parliamentary group on eye health and visual impairment, who, with his passion and experience of these issues, is a fantastic source of knowledge and support for the group. I believe that he is with us today in the Gallery.

The latest information from local authorities, which is from 2014, shows that almost 300,000 people in England and many thousands in Northern Ireland, Wales and Scotland are formally registered as blind or partially sighted. Many thousands more suffer from sight difficulties without being registered with their local authority. I thank the Royal National Institute of Blind People for its support as the secretariat of the all-party group, which I have the honour of chairing. The RNIB estimates that almost 2 million people in the UK live with sight loss. It is predicted that that will double to around 4 million by 2050 due to our ageing population and the fact that more people will live with conditions, such as diabetes, that can lead to visual impairment.

[Maggie Throup (Erewash) (Con)]

My hon. Friend talks about sight loss increasing in the future. Does she agree that obesity, which has the knock-on effect of causing type 2 diabetes, is one of the causes of sight loss? Children in their teens are being diagnosed with type 2 diabetes, so we really need to think about how we tackle and prevent that in the long term.

[Nusrat Ghani]

I definitely agree that we need to think about the long term and look at childhood obesity and diabetes, which are on the rise. I would like to put on the record that my application for this debate—I applied for a debate in the main Chamber—was supported by the right hon. Member for Leicester East (Keith Vaz), who chairs the all-party parliamentary group on diabetes.

It is estimated that half of sight loss is potentially avoidable. Glaucoma is the single biggest cause of preventable sight loss. Some 600,000 people in the UK have glaucoma, but half are undiagnosed. If it is detected and treated early, around 90% of people with glaucoma retain useful eyesight for life.

[Mr Jim Cunningham (Coventry South) (Lab)]

Does the hon. Lady agree that one of the most important features of this situation is that at least half a million schoolchildren are affected, one way or another, by sight problems, if I may use that expression? Some 100,000 people in the west midlands, of which my constituency is a part, are probably also affected.

[Nusrat Ghani]

Of course. I will go on to mention children and the fact that it is necessary for them to be tested earlier than we previously believed they should be.

Wet age-related macular degeneration affects the retina and causes changes to central vision. In October last year, Jean Rugg’s eye clinic consultant told her that she needed follow-up treatment. She was told by the receptionist to expect the appointment in the post, but nothing arrived. By December, Jean was continually contacting the booking department and being turned away. She was told that she would not be booked in because the department was just too busy. Time passed. Jean noticed changes in her vision and was extremely worried about permanent damage to her sight. She was getting nowhere, so she contacted her consultant’s secretary and, after much urging, managed to secure an appointment with him to discuss her sight.

By that time, three months had passed. Jean’s consultant was alarmed that she had not received treatment sooner and explained that her vision could well have deteriorated due to the delay, as there had been further leakage of fluid into her eye. Jean needed an urgent course of injections, so the consultant took her to the booking department to try to secure an appointment that same week. They were both told that there were simply no spaces in the injection clinic. After repeatedly explaining the urgency of the matter, the consultant was eventually able to obtain an appointment for Jean the following week.

I am sure that the Minister agrees that that is just not good enough. That delay and lack of responsibility and urgency is just not acceptable. There are many more Jeans across the country. A 2014 survey by the Royal National Institute of Blind People showed that 86.5% of the public were more fearful of losing their sight than any other sense. As I said, 50% of all sight loss is potentially avoidable if treated early, yet NHS England does not give eye health the profile it deserves. There is no overarching NHS England-led strategy to govern it and push for more prevention of avoidable sight loss. There are equivalent strategies for hearing loss and dementia.

[Colleen Fletcher (Coventry North East) (Lab)]

The hon. Lady mentioned dementia, which is a growing problem, especially among elderly people, although not all elderly people. Sight loss can exacerbate or even mask symptoms for people with dementia. Correcting vision loss can help reduce the impact of dementia, at least in the early stages, and improve quality of life. Does she agree that policy makers and commissioners must seek to prioritise addressing sight loss for people who have dementia or are suffering its early onset?

[Nusrat Ghani]

I agree. We most definitely need to prioritise sight loss for all vulnerable people, including older people, who might also have mental health illnesses.

There are eye health strategies in place in Scotland, Wales and Northern Ireland; England is an anomaly. I therefore ask the Government to consider developing and implementing a national strategy for eye health in England. That would not require additional funding, but would be a commitment to improving the efficiency of eye care services and ensuring consistency across the country. It would enable the development of improved clinical leadership at clinical commissioning group level to prevent eye health from slipping down local commissioning agendas, enable closer partnerships between CCGs and local eye health networks, and aid commissioners to identify eye health priorities that respond to the needs of local populations.

The Department of Health and NHS England already do great work to support the voluntary sector-led England Vision strategy, but that is, by definition, limited in its ability to bring together all the relevant organisations in a joined-up way. In response to a written question that I tabled last week, the Department rightly explained that England’s size

“and the diversity of the health needs of different communities”

mean that commissioning is best “owned and managed locally”. I completely agree, but that should not be incompatible with strategic thinking from above by people who see the bigger picture, or establishing principles that local areas can fit to their circumstances.

Local commissioning must be coupled with national leadership. Leaving things to local commissioners is not working as well as it should. There is significant variation in the quality and quantity of services. For example, someone in Luton will wait for 15 days between their first attendance at a hospital out-patient clinic and their cataract surgery, but if they were in Swindon, they would wait not 15, 50 or even 150 days, but 180 days. That is a shocking difference. No doubt the Minister agrees that, again, that is just not good enough.

Small changes to guidelines and legislation would streamline the process for many patients. For example—my hon. Friend the Member for Twickenham (Dr Mathias) may have to help me out with my pronunciation—allowing orthoptists to sign hospital eye service spectacle prescriptions, rather than requiring ophthalmologists to sign them, would allow the delivery of effective patient care and reduce the number of appointments required to access spectacles.

[Mr Jim Cunningham]

rose—

[Nusrat Ghani]

I hope that the hon. Gentleman does not intend to make a quip about my pronunciation.

[Mr Cunningham]

The hon. Lady’s pronunciation is not as bad as mine. I would support a national strategy. More importantly, however, the cost of drugs for treatment is an area that creates difficulties. In 2014-15, the cost of two drugs alone to treat age-related macular degeneration was £287 million. There is room for discussion between the Government and the drug companies on the cost of drugs to treat people with eye problems.

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[Nusrat Ghani]

I thank the hon. Gentleman for his intervention. I hope that the Minister will respond to that and that we can tackle the postcode lottery in treatment and care across the country.

More generally, sustainability and transformation plans are an exciting opportunity to bring different parts of the NHS together, with greater efficiency and greater outcomes. They are designed to ensure that health and social care services in England are built around the needs of local populations. However, of the 44 STPs, only 22 mention ophthalmology. There is a gap in local plans, which could be narrowed by a national strategy. No doubt the Minister will share my disappointment that half of all STPs do not mention ophthalmology.

It is also worth noting that there are national strategies for other health conditions, in which local commissioners play a role alongside national leadership. The cancer strategy for England, for example, was developed by an independent cancer taskforce, including a number of charities. As a result, NHS England’s national cancer transformation board subsequently published an implementation plan. If there was a need for national leadership on cancer, dementia and strokes among other things, why does the same not apply to eye heath? If the Minister needs to look elsewhere for places where there are national eye health strategies, he could even look to Zimbabwe, which has one.

Professor Tim Briggs’s review of ophthalmology services in his capacity as national director for clinical quality and efficiency is warmly welcomed, but his review focused predominantly on secondary care. A national eye care strategy would cover all stages of the patient pathway, from prevention and early diagnosis to effective treatment and management, and high-quality rehabilitation and social care.

Early diagnosis is an important part of prevention, and it hinges on awareness. Eye health must be seen as a public health priority rather than in isolation from wider health and wellbeing issues. For example, too many people see eye tests simply as a way of identifying refractive error, but their purpose is wider: to identify eye conditions that could lead to loss or deterioration of sight at a later date and prevent that before it happens. Anyone entitled to a free eye test must know that they are entitled to it.

Vision defects in children include amblyopia, which can be mild but becomes more serious if left untreated or if the sight in the other eye is lost or damaged. In December 2013, the UK national screening committee recommended that screening should be offered to all children aged 4 to 5 years. However, children’s vision screening in schools has yet to be implemented across all local authorities. Some, where it does not exist, are not commissioning it, and some are decommissioning existing programmes. The national guidelines provide a population-based examination of all children, ensuring that at-risk and vulnerable children in the population are reached. How does the Minister see the future of eye treatment and screening for children, and how does that fit into wider healthcare plans? I know that NHS England is working with CCGs, general practitioners, patients and the public to improve patient choice in all secondary care services by 2020, not least to increase awareness and achieve improvements in patient outcomes and experience. That is extremely welcome, but will the Minister outline how that applies to ophthalmic services in particular?

When early diagnosis is achieved, referral processes must be equally efficient: straight to hospitals, rather than via GPs as happens in some areas, which is inefficient for patients, GPs and hospitals alike. I would be grateful if the Minister provided information on how optometrists and other service providers are encouraged to follow referral guidelines issued by the National Institute for Health and Care Excellence and professional bodies.

Preventing avoidable sight loss relies on timely access to treatment for eye conditions. The latest hospital episode statistics for ophthalmology show a picture of missed and delayed appointments across England. In the High Weald Lewes Havens CCG, which covers my constituency, 6.47% of ophthalmology appointments were cancelled by hospitals in 2015-16. In Sutton, that figure leapt to 26.17%. Cancelled appointments put people at risk of losing their sight unnecessarily, so I would welcome the Minister setting out how his Department works with hospitals and CCGs to ensure that such cancellations are as rare as possible.

As I draw to a close, I will briefly mention the UK’s work on global eye health. In May, the World Health Organisation will discuss how countries are delivering on the avoidable blindness plan. The UK is a signatory to that and also one of the largest supporters of aid to combat the neglected tropical diseases that often cause blindness. Some 90% of blindness is in the developing world, and 80% of cases can be cured or prevented. I pay tribute to the Sussex-based non-governmental organisation Sightsavers, which the Department for International Development supports to deliver British goals for the reduction of blindness abroad. I thank the Government for their international leadership on this important issue.

Back home, I pay tribute to all the work done by Lord Low, the co-chair of the all-party parliamentary group. I asked him what sight loss is like and what obstacles have to be overcome. He said that we cannot underestimate or understand the hurdles, time and energy it takes just to try to live independently and have access to services that the rest of us do to enable us to live a full life. There is also the importance of technology in this area, and how it must be harnessed to support people with sight loss.

Will the Minister explain how much work is being done to harness technology to help people with sight loss and how much work, commitment and finances are put into research? The eye research charity Fight for Sight has done so much commendable work in research. We cannot deal with some sight conditions, but the right amount of investment may help us tackle and stem the rise in sight loss in our ageing population.

Blindness and partial sight in the adult population costs the UK about £28 billion a year—not the £28 million mentioned in the House of Commons Library research paper. However, it costs so much more than that: opportunities are missed and careers stall. While disability employment in general is increasing, the one exception is eye disabilities. Family and relationships are challenged. I know the Government and the Minister are committed to reducing avoidable sight loss, improving the quality of life for people with sight loss and addressing persisting health inequalities. I finish by thanking the Minister for the work he does in this area and encouraging him to keep going.

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[Nusrat Ghani]

I have only a few minutes for my winding-up speech. It has taken a long time to discuss sight loss here in Parliament, but I am pleased that the Minister has responded so positively. Of course the all-party parliamentary group, the RNIB and I look forward to holding a meeting with him. We agree that the lack of local action, accountability and deliverables must be addressed. We are still convinced that it requires a national strategy, but we are more than happy to discuss that with him.

Fundamentally, the population is growing older, and more and more health problems are coming our way. The number of those with sight loss will increase from 2 million to 4 million. We need to do more on screening, research into treatments, prevention and ensuring that, regardless of where in England people live, they are treated equally and with dignity, within a period of time that ensures that preventable sight loss does not happen. Some 50% of current sight loss could have been prevented. That is not a statistic that we want to repeat.

Question put and agreed to.

Resolved,

That this House has considered preventing avoidable sight loss.