Preventing Avoidable Sight Loss — [Mrs Cheryl Gillan in the Chair]

– in Westminster Hall at 9:30 am on 28th March 2017.

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Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden 9:30 am, 28th March 2017

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.

Photo of Maggie Throup Maggie Throup Conservative, Erewash

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.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

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 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.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

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.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

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.

Photo of Colleen Fletcher Colleen Fletcher Labour, Coventry North East

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?

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

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 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.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

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

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

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.

Photo of Dame Cheryl Gillan Dame Cheryl Gillan Conservative, Chesham and Amersham

Order. I gently remind Members that interventions are supposed to be short. We seem to have plenty of time, but we have quite a few speakers, so I would like interventions to be short.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

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.

Photo of Melanie Onn Melanie Onn Labour, Great Grimsby 9:47 am, 28th March 2017

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate Nusrat Ghani on securing the debate. To lose one’s sight partially or wholly, gradually or rapidly, is a life-changing experience. Ordinary, everyday activities that were once straightforward become increasingly complicated, with simple tasks taking longer, and people create their own adaptations in order to cope. The number of people who live with sight loss in the UK is predicted to double to about 4 million by 2050. Due to our ageing population, more people are living with conditions that can lead to visual impairment, such as diabetes.

Loss of sight is more prevalent in my constituency, which is having a dramatic impact on quality of life, particularly among older people, yet we are failing to provide sufficient access to preventive treatment. In October last year, Northern Lincolnshire and Goole NHS Foundation Trust was found to have nearly 22,500 appointments overdue at its three hospitals. More than 12,500 of those were at the Diana, Princess of Wales hospital in Great Grimsby, with hundreds of people at least eight months overdue for appointments. Across all three hospitals, the department most affected was ophthalmology, with 2,200 appointments overdue in Grimsby alone.

By 2030, there are expected to be 7,050 people in north-east Lincolnshire living with sight loss, an increase of 32.5%, and 980 living with severe sight loss, an increase of 38%. That increase is largely because we have an ageing population and, generally, the older someone is, the more likely they are to suffer from loss of sight. That is important, because visual impairment has a considerable impact on our psychological wellbeing, which means that older people are three times more likely to experience depression caused by sight loss, not to mention isolation and loneliness.

Yet as the RNIB and the hon. Member for Wealden have pointed out, nearly half of sight loss is avoidable. Timely access to treatment, including follow-up appointments and the effective monitoring and management of eye conditions, is vital to preventing unnecessary loss of or deterioration in sight. It is important because successful treatment of many conditions is time-dependent. That is why it was so shocking to learn in late October last year that up to 800 patients in the eye department of Northern Lincolnshire and Goole NHS Trust who are potentially at risk of harm were left waiting—many of them for months on end—to be told what treatment they needed. Additional clinics were arranged to deal with the backlog, but patients should never have been left for such an extensive period of time without any check-ups or assessment of their condition.

In that area of the world there is a shortage of clinicians across the board, but particularly in ophthalmology, which adds to the strain on the system. When asked about the backlog of patients, the leadership at Northern Lincolnshire and Goole Trust said that they knew about it and saw it grow, yet they failed to draw up a coherent plan to address it, despite it being a year on from the tragic 2015 case of Brian Critten, a patient at Scunthorpe General Hospital, which is run by the trust. In an investigation that was launched after Mr Critten alleged a failure in duty of care, the hospital acknowledged that there might have been an opportunity to identify his cancer earlier if a cataract operation had not been cancelled and subsequent appointments not repeatedly postponed.

We cannot continue with a situation where preventive treatment is missed. The NHS must work with stakeholders, including the RNIB and other charities, to develop and implement a strategy that ensures adequate eye care services across England. I was contacted by Scartho Eyecare, an optician in my constituency, and informed that we are one of the few areas with no optical enhanced services—services that can ease the burden on GPs and on hospital ophthalmology services. There is apparently capacity to help at a lower cost to the NHS, but it has not been taken up. Perhaps the Minister will reflect on that in his speech.

It seems irresponsible that eye care strategies exist in Scotland, Wales and Northern Ireland, but that England does not have a strategy to meet the future needs that have been highlighted. Surely now is the time to get that right.

Photo of Tania Mathias Tania Mathias Conservative, Twickenham 9:52 am, 28th March 2017

It is a pleasure to serve under your chairmanship, Mrs Gillan. I commend my hon. Friend Nusrat Ghani for securing this important debate; there have already been useful contributions. I want to make a short speech. I declare an interest: before I was a Member of Parliament, I worked in the NHS as an ophthalmologist.

I hope that the Government can achieve their own 20/20 vision for eye care in England. I hope that the Minister will go away with knowledge of what that should mean for the Government. We have heard about delays in the NHS. The figure from the Royal College of Ophthalmologists is that 20 people a month in England experience sight loss because of delays with appointments. I do not know about anyone else, but I have found that the hairdresser and dentist are better at telling me about appointment times than the NHS. It is the 21st century, and I believe that that is negligence—I do not know if lawyers would call it wilful negligence. It is one thing for a doctor in a clinic to have to tell a patient, “I am sorry, there is nothing I can do for you,”—it is the worst part of the job—but it is even worse to have to say, “If you had come to me a month ago, I might have been able to help you.” That is England today. The NHS and Government need to be transparent about where they are letting patients down.

The other 20 in my 20/20 plea to the Government—I have mentioned it to the Minister—concerns the £20 million cap that NHS England is talking about for the annual cost of new NHS drugs. The Minister is aware that for dry macular degeneration—the commonest form of macular degeneration, accounting for 90% of cases—there is currently no treatment. Those are among the sad cases in clinics when people are told, “There may be nothing we can do.” However, a phase 3 trial is being undertaken of a drug that may help with dry macular degeneration. If everyone present were to have an examination, I am sure that there would be people here now with signs of dry macular degeneration—perhaps even the Minister himself. The drug will be an exciting change in medicine. It is not about just preventing sight loss; it is about maintaining independence. I do not believe that the £20 million cap takes into account the cost when someone loses their central vision, through losing independence and depending more on social care or family members who may take time off work to help.

The Government need 20/20 vision. We need to be transparent with patients. We heard about the case of Jean Rugg, who was losing her sight because of delays with appointments. A lady who came to my constituency surgery told me she was getting private treatment for her husband, because she realised that the delay in the monthly appointment for an injection for wet macular degeneration would cost him his sight. She was not angry; she just wanted me to be informed. If there is a £20 million cap, every MP will have people in their surgery saying, “I am trying to sell what I have to save my family member’s sight.” The £20 million cap must not apply to sight-saving treatments. I hope that there will be other speeches—it is a wide field—but that is my plea for the Government to have 20/20 vision.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice) 9:57 am, 28th March 2017

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank Nusrat Ghani, who as always made a thorough and insightful speech. She put on the map what needs to be done about preventable sight loss. Given that that is what it is—preventable or avoidable—it is incumbent on the Government to have policies that ensure that patients get access to treatment. Those patients are our constituents and members of our community. We must support their access to treatment, because it will make a huge difference to their lives.

From my background in psychology, I can say that people with sensory impairment often lack confidence. They may become depressed or, if they have sight difficulties, be isolated because they worry about going outside and tripping or falling over. That has an impact on the whole wellbeing of the individual and therefore also that of family members. We must also consider cost-effectiveness. We have heard today that people who require care sometimes cannot get access to it. I know from other hon. Members that there are anecdotal reports of cataract operations being rationed. Such things are not particularly cost-effective ways of using resources. Obviously people who experience preventable sight loss will have falls and require NHS treatment. They may then require hip surgery as well as surgery for their sight loss. These things tend to exacerbate each other. I would like the Government to look at both the treatment that people should have, and deserve to have, and why preventive care is at the heart of a cost-effective NHS.

My grandmother required a number of cataract operations, and the difference I noticed in her following those operations was remarkable. It was almost as if she had her lease on life back. She was able to get out to the shops. She was an individual who really liked to be out and about because it kept her mood up and her spirits high, which is something I would like for everybody who requires it—particularly older adults. My understanding is that, by 2021, 40% of the Scottish population will be over 50—I actually have to include myself in that figure. A significant proportion of sight loss is related to age, and one in eight over-75s and one in three over-90s will suffer significant sight loss. We have an ageing population and we are going to have to look at this issue extremely seriously, in terms of services right across the UK.

The Scottish Government are committed to keeping NHS services free at the point of delivery, and prescriptions and eye tests are currently free of charge, which has resulted in a 29% increase in the number of tests undertaken. That is important, because my understanding is that one of the barriers to preventing avoidable sight loss is that people are not accessing care, which is particularly linked to areas of deprivation. If the UK Government looked at making eye tests free, people in areas of deprivation in particular might not have to choose between a sight test and a meal on the table at the end of the day. In these times of austerity, those are some of the choices that some families unfortunately have to make.

I understand that the Christie Commission report looked at the future of public spending and estimated that 40% of public service spending could be avoided by using a preventive approach. Once again, I emphasise that it is not only morally right and our absolute responsibility to our constituents to ensure that avoidable and preventable sight loss is avoided and prevented, but that doing so is also cost-effective. International research indicates a fourfold return on investment in early eye care intervention, so this absolutely makes sense. Early diagnosis is key.

Let me end by saying that long-term planning is needed. We have made significant steps in policy in Scotland, but I do not want to see a postcode lottery for the rest of the UK. The Minister should look at making sure the policy is commensurate and gives the very best in evidence-based practice for constituents right across the UK.

Photo of Dame Cheryl Gillan Dame Cheryl Gillan Conservative, Chesham and Amersham

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

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality)

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

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

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

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

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Business, Innovation and Skills), Shadow DUP Spokesperson (Environment, Food and Rural Affairs)

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

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo of Dame Cheryl Gillan Dame Cheryl Gillan Conservative, Chesham and Amersham

Unless anybody else wishes to speak, we will move on to the Front-Bench contributions. I am pleased to call Marion Fellows.

Photo of Marion Fellows Marion Fellows SNP Whip 10:15 am, 28th March 2017

Thank you, Mrs Gillan; it is a great pleasure to serve under your chairmanship. I commend Nusrat Ghani for working so hard to secure this Backbench Business debate.

I must start by declaring a personal interest in this debate: I have been diagnosed with cataracts and also have an issue with the macula in my left eye. I would like to thank the Doorkeepers, who are always present, for writing down the names of all Members for me so that I can refer to them properly in my speech. I simply could not do it without them.

Like a lot of people, no matter how hard I listen at hospital appointments, I cannot always absorb everything that is said to me, so I do not know exactly what is wrong, but I am due another appointment soon. I am fortunate that as a result of visiting my local optician for my regular free eye test, the optometrist saw what was wrong and referred me to a local hospital for further investigation, and then on to a hospital in Glasgow. My husband has also benefited from free eye tests and is receiving treatment. We are really grateful to the Scottish Government that we have free eye tests.

The Cabinet Secretary for Health committed last year to a review, to consider an even more joined-up strategy and ensure that practices already taking place in parts of Scotland are spread across the country. The chair of Optometry Scotland has said that the review, which will look at existing models of good practice, could really change what is happening.

As the hon. Member for Wealden said, almost 2 million people are living in the UK with sight loss, and the number is expected to double to 4 million by 2050 because of the ageing population, which many speakers have referred to. I am one of those older people, so I have a dog in this fight. I do not want people across the UK to wait any longer than necessary for proper treatment. The hon. Lady also referred to glaucoma, which is the most prevalent cause of preventable sight loss. As she pointed out, there is no overarching eye strategy for England, but there are strategies in place for Scotland, Wales and Northern Ireland.

Almost 300,000 people are registered with sight loss in England, and that figure will double. The voluntary sector in England is supported on this, but the Department of Health recognises that local solutions are better. Indeed, the hon. Lady made an impassioned plea for that. She referred to small changes to guidelines. A national strategy is vital to plug local gaps. She called for the screening of all children between four and five, which has been recommended but not yet implemented; I had not recognised that previously, but I do not think anyone in this Chamber would not support that.

The hon. Lady said that early diagnosis is really important and must be followed by speedy treatment, and that missed and cancelled appointments should be minimised. Finally, she looked at the international landscape and the good work done by DFID. She also mentioned that the cost of vision loss in the UK is £28 billion per annum, which could be mitigated by changing the type and speed of treatment that people receive. That was echoed by other speakers.

Melanie Onn—what a wonderful name for a constituency—talked about quality of life, especially for older people. That was echoed by my hon. Friend Dr Cameron, who said that the difficulties experienced by older people lead to things such as falls, which impacts on the national health service across the UK, but especially in England. It also leads to isolation and loneliness, of which my hon. Friend has great professional experience and also family experience with her own grandmother. As the hon. Member for Great Grimsby said, patients should not be left waiting. She referred to problems with Northern Lincolnshire and Goole NHS Foundation Trust, which has been sued as a result of delay in treatment.

Dr Mathias referred to her career as an ophthalmologist. I must say that ophthalmologists do great work, because it was my local ophthalmologist that started my long referral for treatment. The hon. Lady hopes that the Government will achieve their own 20/20 vision for England; indeed, I think we all hope that. Delays are affecting 20 people a month. It gets to the stage where people turn up for appointments but nothing can then be done. No one should be happy with that situation, and no one is. I make a plea to the Minister to ensure that he looks at it.

The hon. Member for Wealden referred to the case of Jean Rugg and the fact that people are now going private across the UK to try to prevent sight loss. I am sorry, Mrs Gillan: I get a bit emotional about this issue because of my own fear. I have not been wearing glasses from such a young age as Jim Shannon—I was 11 when I started—but I think I can safely say that I can give him a good few years, so I have been wearing them for a long time. For someone who already has sight problems, the thought of losing their sight is something that they live with daily, and when it is flagged up that there might be something wrong, that causes great personal distress.

A really important point is that free eye tests, which we have in Scotland, encourage people to attend regularly to have their eyesight checked, which, as I said, leads to better treatment earlier. We really do not want a postcode lottery anywhere in the UK but, as hon. Members said, there is a postcode lottery in England: people need to live in the best place to get the best treatment.

The hon. Member for Strangford talked about the role of the optician. He said that 30,000 people in Northern Ireland—1.7% of the population—are affected at present. However, as is the case for the whole United Kingdom, this will be an ongoing and serious issue as populations age. My hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow painted a vivid picture of how people can be affected psychologically by sight loss—loss of vision. It is awful.

I want to ask the Minister about the cost of drugs and the £20 million cap that NICE has implemented in England. Does he consider the new cap an appropriate measure, given the Conservatives’ manifesto promise to speed up the introduction of new medicines into the NHS? It seems counterintuitive, when we can save the NHS money through early treatment, that we stop treatment that will help to prevent people from suffering falls and psychological illnesses and costing the NHS even more in the long run. Prevention is always better than cure. We really should be looking at that. In Scotland we do our best to do that. There is a different ideological focus. I have talked many times in this Chamber about how we do things better in Scotland. Hon. Members across the Chamber do not always agree with me, so it has been comforting, and indeed pride making, to hear them agree with me on this issue. A national strategy is needed in England as well as in the rest of the UK—in the devolved Assemblies and in the Scottish Parliament. Can the Minister give some comfort this morning to my colleagues who represent English constituencies?

It is a privilege to be able to talk here about the good work that we are doing in Scotland and that has been done in other parts of the UK. I again ask the Minister to look at the £20 million cap and at providing for the NHS in England a strategy that can help prevent avoidable sight loss.

Photo of Julie Cooper Julie Cooper Shadow Minister (Health) (Community Health) 10:25 am, 28th March 2017

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

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

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

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

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality)

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

Photo of Julie Cooper Julie Cooper Shadow Minister (Health) (Community Health)

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

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

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

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

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

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

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

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health 10:36 am, 28th March 2017

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate my hon. Friend Nusrat Ghani not only on leading the charge today but on her work on the APPG more generally. A number of Members have made the point this morning that we have not debated eyes and sight in this place very much over the past few years. It is good that we have the time to put that right today, so I congratulate her on doing so.

I start by acknowledging what a number of Members have said—that 50% of sight loss is preventable. I think my hon. Friend said that 85% of people regard sight as the most precious of all our senses. Frankly, I am surprised that the figure was not higher than that. This is clearly massively important. We can debate numbers—Julie Cooper just talked about £28 billion—but the key figure is the statistic that my hon. Friend Dr Mathias started with. Some 20 people a month are losing their sight, whether due to lack of prevention or lack of early treatment, in ways that are preventable. That is not acceptable, and we need to work collectively to address it—I will try to set out the Government response to it now.

I will talk first about prevention and the need for early detection and improved treatment. We heard about waiting lists in Great Grimsby, which I will come to. I will also talk about the social exclusion that can occur, and the mental health issues that can come from that. As I go through, I will try to address the points raised during the debate by Members on both sides of the House. If I do not, I am sure Members will remind me that I have not; in any event, we will write on any points that are not directly addressed.

The UK vision strategy was produced jointly with the RNIB, which does a lot of extremely good work in this space, for which the Government are grateful. Both the Department of Health and NHS England fully support that strategy, and need to continue to drive it forward. We also support global issues; Members have talked about the WHO global plan, which intends to eliminate preventable sight loss by 2020, and my hon. Friend the Member for Wealden talked about some of the work we do globally. She talked about patient choice and the referral process—whether it is via GPs or direct—which is an interesting point that I will come to. She talked about STPs, as did the hon. Member for Burnley, cancelled appointments and the need for a national strategy in England. I will come back on those points, if I do not get to them during my remarks.

To frame the issue, 2 million people in the UK have sight loss—because sight loss is so related to age, 4 million people will almost certainly be affected by 2050—and 80% of those are over 60 years old. Several Members cited statistics illustrating the demographic changes, including Jim Shannon, who spoke about Northern Ireland. As we debate these things across health and social care, we have to recognise the incredibly significant changes to our demography.

When the national health service was set up in 1948, one person in four lived to be over 65. We have totally fixed that, in the sense of increasing longevity. In the last 10 years, our population has increased by 10% and our population of over-85s has increased by nearly 28%. That trend will continue and accelerate, which gives us all challenges, including resourcing and all that that means. I heard a very apposite phrase recently: “We have done a good job of increasing quantity of life, but we haven’t yet increased quality of life to the same extent.” That is true of sight loss. As we heard, 148,000 people are certified blind in this country, with all that that means in terms of benefits and tax changes. That figure has been fairly stable—indeed, it has gone down slightly in the past three years—but nevertheless, it presents us with a big challenge.

In responding to those changes, we have to look at prevention and understand the risk factors. I have just covered the first risk factor, which is age. We cannot do a great deal about that, other than note that we are all getting older. Like the hon. Member for Strangford, I am over 50—considerably so—and the fact is that the sight loss numbers are driven by age. Smoking and obesity also play a big part in eye health, as they do in other aspects of health. Our tobacco control strategy will be produced imminently. We have done a good job in this country of reducing smoking, but we need to go further and faster, and I hope that the strategy will be a big part of that. There will be specific targets by age group for what we need to achieve. Obesity is equally and possibly more important; it is a risk factor for all sorts of things. I perhaps did not fully understand that obesity affects people’s chances of getting cancer, dementia and suffering from sight loss as much as it does. We need to drive home the potential benefits of the obesity strategy that we published, which aims for a 20% sugar reduction by 2020.

Hon. Members, including Dr Cameron, mentioned cataracts. Obesity doubles the probability of getting a cataract. That is an extraordinary statistic given that it is not intuitive that those are linked, even though they clearly are. I do not want this debate to be about money—what we are talking about is more important than money—but the cost to the country of obesity and diabetes put together means that we now spend more in the NHS on treating them than we do on the police service, the judiciary and the prison service combined. That puts into perspective the magnitude of the cost and what we need to achieve.

On prevention, we have not talked about the screening programme that we have introduced for diabetic eye disease, which was the principal cause of blindness in working-age people until recently. As a result of the programme, which involved offering a digital photograph to all people with diabetes over the age of 12, something like 2 million people were screened last year. For a screening programme, there was a very high uptake—over 80%—and some evidence shows that it has resulted in significant progress in preventing that type of blindness. This is the first year for which we have those figures, and diabetic eye disease is no longer the principal cause of blindness in working-age adults. That has largely been achieved through that very effective screening programme.

Let me talk briefly about the four most common causes of blindness, which are cataracts, age-related macular degeneration, glaucoma—that is the most prevalent, as we have heard—and diabetic eye disease. All of those can be treated most effectively through early diagnosis—frankly, that applies in most areas of health, but it is particularly true of eye health—and the first part of that is timely sight tests. Sight tests are free for children at school, although parents have to arrange them. They are also free for the over-60s, for anybody who is in a high-risk group, including those with diabetes or glaucoma, and for people on various income-supported benefits. There were 13 million eye tests last year, which was an increase of 2%. There is always a case for doing more, and I say to anyone who is listening to this debate, even if they are not of such an advanced age as me or the hon. Member for Strangford, that these things are worthwhile.

Treatment is CCG-led in this country. The principal reason relates to some of the issues that we heard about from Melanie Onn, who spoke well about the large numbers of people on the waiting list of the Northern Lincolnshire and Goole NHS Foundation Trust and the extra clinics that had to be put on. That is a CCG responsibility. With national strategies, there is a choice about whether something should be locally focused, with local commissioners having the resources and money—although resources are a different issue—or whether there should be an overarching national plan.

I was struck by what the hon. Lady said about the actions that were taken. Those were local actions, which were completely appropriate. In England, we produce a public health outcomes framework—I do not think that is the case in Scotland, notwithstanding the excellent speeches by the Scottish National party Members about what is done in Scotland. The framework sets out for every local authority area in the country the extent to which there is glaucoma, diabetic eye disease and age-related macular degeneration, and the total number of people who are certified blind. Those data are tracked over the years and ought to inform local commissioners, and indeed, local health and wellbeing boards in the priority areas. There are striking differences and clusters of different types of blindness and different issues in different areas.

To cite a few of those differences, Barnsley has three times the national average of age-related macular degeneration and twice the national average of people who are certified blind. To me, that suggests that the commissioners in Barnsley should, in particular, be putting effort and resources into treating AMD. London has something like 20% more diabetic eye disease than other parts of the country. That may be to do with the large south Asian population in parts of London and the diabetes that that implies. Those sensible decisions should be taken by local commissioning groups in the knowledge of the facts. I commend the public health outcomes framework to hon. Members, who may not have looked at it for their own constituencies and patches. That should be considered and understood, because for this and other issues, it tells us where the priorities ought to be.

Photo of Melanie Onn Melanie Onn Labour, Great Grimsby

If CCGs are to focus on providing more support for a particular service, it prompts the question, “What will support be taken away from?” The trust in my constituency has now gone into financial special measures. There is only so much give in the system. What does the Minister think is the solution?

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

I did say, when I was making the point, that I was not talking about priorities in terms of total resource there. We must make choices. I will come to the point about the £20 million budget.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned concerns that cataract operations were being rationed. In response, the Secretary of State requested that NICE issue guidelines this year rather than next year, and we will pursue that. However, I make the point that 17% more cataract operations are being done in England now than five years ago. That does not imply rationing to me, but we need to be careful. Operations should not be rationed, and we want NICE guidelines in place to ensure that they are not.

I will address some of the points made by hon. Members. My hon. Friend the hon. Member for Wealden mentioned referral pathways. She is right to say that different CCGs do things differently. Some CCGs will require an optician to refer a patient to a GP, who then refers onward to the hospital or ophthalmologist; around 11% of CCGs do not do so, which is quite odd. I will ask officials to investigate why. The principle is that CCGs are responsible for setting their own pathways. It is not for the Government to tell them what to do, but it is possible—indeed, likely—that some might not have wholly addressed the issue.

There is a general drive right across the health service to do more things in the community and fewer things in hospitals. Part of that involves using opticians in the best way possible, and not just on this issue. Although it has not been mentioned in this debate, I would like to see opticians used much more for glaucoma monitoring and other such things that, at the moment, tend to happen in hospitals, because as we have heard, there is a great deal of strain on a number of hospitals. We will try to make progress on that issue. I am happy to sit down with my hon. Friend and the Royal National Institute of Blind People, as she asked, to talk about it in more detail.

My hon. Friend mentioned shared delivery plans. She said that only 50% of STPs include a coherent eye strategy, and the hon. Member for Burnley said that some of those looked like tick-box exercises. I accept that, and I have two points to make. One is that an STP is not an organisation but a planning document, which must be put in place to begin to establish planning areas across the country where we can marry up prevention, primary care and secondary care. Not all STPs have yet addressed all the issues that they should; they are a process, not an event. I say to the people concerned about that that they should keep lobbying their local STP leadership, who are responsible for addressing it. Frankly, many STPs have a long way to go to become coherent plans, and eye health is just one area on which we need to make more progress.

We heard about the issue of cancelled appointments. They are a particular problem with eye appointments, which can be time-critical; the figure of 20 avoidable sight losses a month was quoted. The principles governing missed appointments across the NHS apply in exactly the same way to eyes as they do to all other things. The NHS constitution sets out an 18-week limit. I have heard speakers in this debate mention clinics where 50% of appointments are not attended. Such numbers are completely unacceptable. What is hard to understand in that context is that in the last five years we have increased the number of consultant ophthalmologists across the patch by around 27%. That does not imply that the problem is staffing, but I will take the issue away and consider it. I reiterate that the same provisions that apply to all aspects of our NHS apply to eyes and to national waiting lists. People who fail to get appointments for which they are clinically ready should be on a national waiting list. We should performance manage it in that way.

My hon. Friend the Member for Wealden mentioned choice, rightly saying that people are entitled to choice in their secondary care. The same principle applies to eye care as to all other types of care, but there is more that we can and must do to build awareness.

I will touch briefly on the issue of an eye strategy. I have asked why NHS England feels that it is better for it to be owned and controlled locally; I made the point previously about the degree of local variation. We heard some instances from Northern Ireland, where there is an eye strategy, that show that it is not a panacea. As a Minister, I have a general view. There are a lot of strategies, but many fewer clear action plans with deliverables and accountabilities. It is rather like what we heard about in Great Grimsby. My preference is to work with NHS England and with Health Education England, if it is a question of getting more people into roles and all that goes with that. Having said that, I am happy, as I said, to talk to my hon. Friend the Member for Wealden and the RNIB more generally, but overall, across the health system, I do not see a lack of strategies. I sometimes see a lack of action plans with accountabilities and clear deliverables. My bias is towards the latter, not the former.

On the point about rationing, the NICE process is an attempt to create, across the whole health system, coherent guidelines and structured ways to evaluate different medicines. Broadly speaking, a cost of £20,000 per quality-adjusted life year is used by NICE to decide whether a drug should be offered or not. However, the point about the £20 million cap is slightly different. The cap is being introduced, potentially, for new drugs; it would not apply to any existing treatment. We are accelerating new drugs coming into the system. The cap would act as a trigger point: after £20 million has been spent, a renegotiation with the manufacturer would take place. On that point, I will sit down and allow my hon. Friend to sum up.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden 10:58 am, 28th March 2017

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.