Eye Health and Macular Disease — [Caroline Nokes in the Chair]

– in Westminster Hall at 9:30 am on 11th January 2022.

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Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee 9:30 am, 11th January 2022

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current Government guidance and that of the House of Commons Commission. I also remind you all that you should have a covid lateral flow test before coming on to the parliamentary estate, and give one another plenty of room when entering and leaving the Chamber. I call Jim Shannon to move the motion.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I beg to move,

That this House
has considered the matter of eye health and macular disease.

Thank you, Ms Nokes. This is a very important issue. I suppose all issues are important, but this one is very important, as I shall illustrate in my speech. I place on the record my thanks to the Backbench Business Committee, as always, for agreeing to schedule this debate, and to the Macular Society, which is working with Fight for Sight and Roche pharmaceuticals in the Eyes Have It campaign group—we say “The Ayes have it” in the House many times, and the eyes have it literally this time—for its support in securing the debate.

I thank all the hon. Members who are here for taking the time to discuss this important issue. I have spoken to some of them, and they will all bring their individual comments and contributions to the debate. I am very pleased, as always, to see the shadow Minister, Andrew Gwynne, in his place, and it is a particular pleasure for me and for all of us to see the Under-Secretary of State for Health and Social Care, Maria Caulfield in her place. We look forward to her response as well.

As someone who had glasses from a young age—eight years old—and who has had diabetes for the last 15 years, I can say that eye health is a matter of great personal import, as well as a constituency issue that affects a huge swathe of my constituents. Every day, 250 people start to lose their sight. At least half of all sight loss is avoidable. That is the key issue in this debate, because if sight loss is avoidable, the question is what steps we take to ensure that people do not lose their sight. With that in mind, I look forward very much to the Minister’s response.

More than 2 million people have sight loss, and 350,000 people are registered blind or partially sighted. Age-related macular degeneration is the leading cause of blindness in adults, leading to 50% of blindness. Lia Nici, when we spoke last night, told me that she herself has this. Therefore the contribution from the hon. Lady, out of everyone in the House, will be particularly poignant and relevant to the debate.

I was shocked to learn that more people in the UK are living with macular disease than with dementia. We hear lots of stories—I am not saying we should not, by the way—about dementia, but just to give an idea of the magnitude of the subject of this debate and its importance, there are more people with macular disease than there are with dementia. Macular disease is a particular risk for the nearly 4 million people in the UK who, like me, are living with diabetes. I have long been instructed that poor control of blood sugar and insulin levels can damage the blood vessels of the eye, causing fluid retention in a condition called diabetic macular oedema. About one in every 14 people with diabetes develops DMO, which will result in a noticeable loss of vision.

Why should this topic be flagged as urgent for every Member of the House? Well, the issue is not just the physical health problems but the financial costs. The cost of eye conditions to the UK economy has been estimated at £25.2 billion per year, and without action, that is forecast to rise to £33.5 billion per year by 2050, so there is clearly a financial equation to this issue. It is about prevention and about reducing the costs for the health service as well. But cost is not the only important factor. The fact is that it is an awful thing to lose one’s sight and—for many people—one’s independence. Members across the House will know—perhaps through their own experiences or those of a loved one, or perhaps through the stories shared by their constituents, which we see in our constituency offices each and every day—the impact that sight loss can have. Loss of vision can have an impact on quality of life by undermining patients’ ability to live and work independently. For example, I recently met a member of the Macular Society, Bryan, who was diagnosed with age-related macular degeneration in 2012 and told me that something as simple as catching a bus can become very challenging.

Sight loss can also have a profound impact on emotional wellbeing. Sight is considered by many people to be the most important sense. Patients with macular disease, who are at risk of losing their sight, report feelings of isolation, shock, anger, anxiety and hopelessness. Those feelings may grow as individual sight deteriorates, with patients increasingly cut off from the world as they had previously experienced it. Losing one’s eyesight makes one particularly lonely; those who lose their eyesight do not know what is happening around them. I often think that, of all the senses that one could lose, eyesight is—with no disrespect to those who have lost other senses—the most important.

At the same time, macular disease can put pressure on the family members, friends or neighbours who act as carers for people with macular disease. This means that, although macular disease is more common among older people, its effects can be felt across the working-age population as well. Such feelings are understandable.

Without treatment, sight loss can be rapid. For example, wet age-related macular degeneration—wet AMD, where blood or fluid from abnormal blood vessels leaks into the macula, causing scarring—can cause significant sight loss within a matter of weeks. That is why this is so urgent. It is vital that patients are diagnosed and treated as quickly as possible. Can the Minister tell us what has been done to achieve the early diagnosis of AMD? It is so important that sight loss is addressed urgently. Other hon. Members in the debate will reiterate what I am saying shortly.

Photo of Margaret Ferrier Margaret Ferrier Independent, Rutherglen and Hamilton West

In 2018, the Royal College of Ophthalmologists found that there was a need for an extra 230 consultants and 204 staff and associate specialists over two years. Does the hon. Gentleman agree that recruiting and retaining staff in the ophthalmology workforce needs to be a primary consideration?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I certainly do, and I thank the hon. Lady for that intervention. That was one of my points; the Minister has heard it said there, and I will not repeat it. The importance of having the staff in place, to which the hon. Lady referred, is one of the asks in this debate. How can we address that? If we have the staff in place, we can address the issue of eyesight loss earlier.

We are all aware of the demand for NHS eye-care services over recent years. Ophthalmology is now the busiest outpatient specialty in the NHS, with some 7.9 million attendances in 2019-20. That gives one an idea of the magnitude of the issue. That is why this debate is important, and why today we need to look to take things forward. Waiting times have been made worse by the covid-19 pandemic—we understand that. The pandemic has meant that some patients faced a waiting time of up to six months to access care. We know that the wait can be a matter of weeks, but if patients have to wait six months for a diagnosis and medical response, their eyesight can deteriorate significantly in that time. Up to 22 people a month may suffer severe or permanent sight loss as a result of delays to follow-up care. Can the Minister tell us what we can do to address those issues, and what has been done to catch up on that in the pandemic?

Photo of Paul Howell Paul Howell Conservative, Sedgefield

Does the hon. Gentleman agree that we have seen massive innovation in the NHS during the covid pandemic? It has been able to deliver huge treatment gains. Does he agree that it is also important that the science of things like macular deterioration is picked up and taken forward? A company called PolyPhotonix, in my constituency, has developed an amazing solution that needs to be driven through to end state. I encourage the Minister to visit the company, because we are very close to making a major difference to treatment both in and out of hospital.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

The hon. Gentleman has, I think, passed on that information to the Minister. It is important that we see where innovation has moved forward. PolyPhotonix, the firm to which the hon. Gentleman referred, can bring beneficial and positive changes to those with eye issues. I thank him for that intervention, and I look forward to the Minister being able to visit the company.

Care for patients with diabetic macular oedema was deprioritised during the pandemic, and delays have led to a doubling in the number of patient with DMO losing between one and three lines of vision. It is very important that that issue is addressed. Margaret Ferrier referred to staff shortages, and again I look to the Minister to see how we can address that issue.

We know that, as with other areas of healthcare, there are inequalities in eye care. Some parts of the population are not accessing regular sight tests, even if they might be eligible for them for free on the NHS. Can the Minister tell us what can be done to ensure that people are accessing that care? I know that the pandemic has changed many lives, but how do we address that? It is about solutions, not about negativity, but we have to say these things in the introduction to the speech so that we can look to the changes that we wish to see.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

I congratulate my hon. Friend on securing the debate. We are coming up to the winter Olympics, and if there was a ski slalom for getting Westminster Hall debates, my hon. Friend would win the gold medal every single year. Given the localised comments that he has very appropriately made about the need for people to get their testing done, it is often the case that when the reminders come through for an ophthalmology appointment, they are overlooked. It is important that people take them up and any problems are identified very early on.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

How pertinent that intervention is. I will give a couple of examples now that I was going to give later because they are pertinent to this. The opticians and ophthalmologists in Strangford and Newtownards town have told me of two occasions in 2021 when people who went for their test were sent straight away to the Ulster hospital in Dundonald because they had a tumour. They had no other ailments, but their ophthalmologist or optician spotted something early on. They say the eyes tell the health of the whole body, and I think they do. In that case, two lives were saved, and there are probably many others.

Photo of Margaret Ferrier Margaret Ferrier Independent, Rutherglen and Hamilton West

Following that point, it is really important to use the available data effectively in understanding the level of serious eye issues experienced across the UK. Does the hon. Gentleman agree that streamlining data sharing across all health care providers should be mandated?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

It is always important to have the data on health issues. The Minister, the shadow Minister and hon. Members will know that. If you have the data, you can respond to where the problems are. The hon. Lady is right; we need to have that data in place.

In 2018, the APPG on eye health and visual impairment took evidence from the charity SeeAbility. People with learning disabilities, including children in special schools, are much more likely to have a sight problem, but much less likely to access NHS sight tests. Last night, in a different debate on the welfare cap, John McDonnell referred to those who will feel the pain of the welfare cap, but those with disabilities will feel it more. That is very real when it comes to health issues and it is why this issue is so important.

With that in mind, the APPG and SeeAbility asked for sight testing and glasses dispensing facilities in all special schools, which has now been taken forward by NHS England. That is excellent news and it shows that sometimes—hopefully all the time—APPGs and their partners can bring about changes. This will reach around 130,000 children and help to address and prevent avoidable sight issues and reduce the need to use hospital eye clinics.

The commitment by NHS England to reform must continue as these children have an equal right to sight. We will all follow matters closely, and I would like to see the rest of the UK following Northern Ireland. The excellent work by the Ulster University Centre for Optometry and Vision Science in special schools has also shown the same need. When we see that issue being addressed, it is good news. Let us all look at the opportunity for reform in England and in the devolved nations and seek to improve sight testing for adults with learning disabilities in the community too.

There are targeted schemes with optical practices in every area. Unfortunately, Minister, at the moment we see a patchwork across the UK. In some areas the service is good and in other areas it is not. We need to act across the board in all postcode areas to see the level of care and attention that we seek in today’s debate.

The health inequalities experienced by people with learning difficulties justify more attention. People with learning disabilities are dying of avoidable health issues at least two decades before their peers. We cannot have people living without good sight and even going avoidably blind because national health services overlook their needs. That cannot happen and should not be allowed to happen.

I have outlined the issues, but I want now to look at the good news; the positive, glass-half-full news about how we make the changes to address those issues, including improving the quality of life for people with macular disease and the pressure on family and friends that inevitably comes with that.

With rapid and appropriate treatments, whether those are pharmaceutical treatments, laser treatments or surgery, we can do the job better, working alongside opticians. They are keen to be involved, and to address these issues. As my hon. Friend Mr Campbell said, when a person gets an appointment from their optician, they should go to it: it is so important that they do so, and we want to make sure that people do that. So many cases of sight loss could be either treatable or preventable.

As the UK builds back from the covid-19 pandemic, there is an opportunity to transform eye care services, increasing capacity to deliver rapid and appropriate treatment for macular disease and other causes of sight loss. NHS planning guidance for 2022 focuses on tackling elective care backlogs. Minister, what has been done to address those backlogs? I understand that there are many backlogs—we know them all too well. We need to deliver 110% of pre-pandemic elective activity, but we must also support the NHS to transform services for the long term, to ensure there is enough capacity to treat patients who start to experience sight loss. Improved integration of eye care services must also be a priority for integrated care systems as they move towards implementation. That should include supporting lower-risk patients to be treated in the community, freeing up specialist service capacity for those patients who need it most. At the same time, as the hon. Member for Rutherglen and Hamilton West said, data sharing needs to be improved, for example through the electronic eye care referral system. That is just one example of what could be done to ensure that everyone has the information they need to improve the quality and timeliness of care.

We must also ensure that the NHS is making use of the most innovative treatments—Paul Howell has referred to one of them—especially those treatments that help people living with sight loss to manage their condition as independently as possible, with less frequent need for hospital visits. If we can reduce hospital visits and improve care, we will reduce costs and improve long-term health. We must invest in the workforce we need to deliver current and future eye care. I am very pleased to note that the Government have already confirmed that the process to appoint a new national clinical director for eye care has begun. I hope that this role will provide much-needed leadership and drive forward a transformation of NHS eye care services, including improved integration, better use of data and expansion of the workforce, which I believe is essential to provide the high-quality care that will, in turn, deliver better outcomes for patients. That national clinical director should therefore be appointed as a matter of urgently, and I look to the Minister and to Government to give us a clear timetable for making that appointment.

To ensure accountability and transparency, the national clinical director for eye care should report to a single Minister with responsibility for eye care services across primary, secondary and community care. The role of that individual is critically important for outlining a strategy and moving forward. Sight loss is widespread, and its implications are significant for the NHS. The cost of sight loss to the public purse cannot be ignored, but it is most important for the patients whose lives will be irrevocably altered by a diagnosis such as macular disease. Timely access to appropriate treatment could quite simply be the difference between someone losing and keeping their sight. We want to ensure that people can keep their sight, so it is vital that we do all we can to ensure that every patient can get the treatment they need, when they need it—the earlier the better. When it comes to sight, every day matters. Every appointment is essential, and that principle must underpin our approach to the necessary changes to macular eye health in this post-covid world.

I thank the Minister again for offering her time. People will say, “Well, that’s her job”, but she comes here with a passion and an interest in this issue. It makes it much more pleasurable for me introducing this debate, and for other Members as well, that we have a Minister who can respond positively. I welcome the opportunity to continue these discussions following today’s debate—I know that the Minister is always agreeable to doing so. In anticipation of their speeches, I also thank all of my colleagues, right hon. and hon. Friends and Members, in this Chamber. Working together, we can and will achieve.

Photo of Peter Gibson Peter Gibson Conservative, Darlington 9:49 am, 11th January 2022

It is a pleasure to serve under your chairmanship this morning, Ms Nokes. I pay tribute to Jim Shannon for leading this morning’s vital debate on eye health and macular disease, which affects many millions up and down the country. Indeed, more than 2 million people in the UK suffer from partial or complete sight loss and the loss of vision is extremely detrimental to someone’s health and wellbeing. Things that many of us take for granted in our daily lives—driving, reading, recognising faces or experiencing colour—are taken away unfairly from those suffering from loss of vision. We know too that loss of vision can lead to further complications, greater care needs and loneliness.

I was pleased to receive reassurance from Ministers in response to my recent written questions that steps are being taken to address waiting lists, including prioritising urgent treatment for sight-threatening eye conditions such as age-related macular degeneration, which affects 23% of those with sight loss. I welcome the steps being taken to reduce the waiting times and backlogs in our health service, including £2 billion committed this financial year through the elective recovery fund to reduce waiting times. I am pleased to learn that the Government have also committed £8 billion between 2022 and 2025 to transform elective services and increase activity. That is joined by a further £5.9 billion in capital funding to support elective recovery, diagnostics and the vital technology that our health service needs to provide accurate diagnosis.

The NHS’s national eye care recovery transformation programme should ensure that existing money will go into improving effectively and efficiently the quality of the service and outcomes for patients. Through the Health and Social Care Bill, integrated care boards will improve patient access and empower primary care providers to tackle eye health and macular disease quicker and without putting further pressure on GPs and hospitals. The forthcoming appointment of a national clinical director for eye services in England, as outlined by the hon. Member for Strangford, is most welcome but long overdue. I know that that appointment will be welcomed by many with an interest in sight loss.

Tackling the issues of poor eye health goes further than just prevention. We must do more to help the sight loss community up and down the country. In my constituency, there are a number of projects and campaigns underway to improve the quality of life for those who are visually impaired. It is right at this point to pay tribute to Darlington’s phenomenal Darlington Action on Disability, led by chairman Gordon Pybus and chief executive Lauren Robinson. The association has been leading the way in campaigning to improve the life of members of Darlington’s visually impaired community. I am proud to support their current campaign to have tactile paving installed on the platforms of Darlington’s Bank Top station and I urge the Minister to lend her support to the push for Network Rail to install such paving when the station undergoes its £105 million refurbishment and expansion.

Yesterday, I spoke to Gordon, who highlighted to me the further problems facing people with sight loss in my town. They include vehicles parked on the pavement, which are both an obstruction and a hazard, with wing mirrors at head height, which cannot be located by someone using a cane or a guide dog. Other members of the community I serve have raised concerns with me about issues such as the rapid increase in the number of e-scooters on our streets, the poor placement of street furniture and other street clutter such as A-boards outside businesses, and the risk posed to those with sight loss from near-silent electric bikes and vehicles. Every Member of the House will have heard the same concerns in their own areas and I urge the Government to continue to listen to those most affected by poor eye health and macular disease to take steps to make our streets safer for them.

I am proud of the work being done by the Government on the matter, tackling waiting lists and investing in preventive measures. However, I urge the Minister to maintain and extend the level of support and investment over the coming years to ensure that we continue to support the visually impaired community in the UK.

Photo of Lyn Brown Lyn Brown Shadow Minister (Foreign, Commonwealth and Development Affairs) 9:54 am, 11th January 2022

It is a genuine pleasure to serve under your chairmanship, Ms Nokes. I wish you, and everybody here, a happy new year.

I thank Jim Shannon for securing the debate on this neglected topic. Not for the first time, my comments will echo those of my right hon. Friend John McDonnell, because today I will focus on the damage that refractive eye surgeries can do to health. In particular, I would like to talk about my constituent, Darren Clixby.

Like many of us, Darren had lived much of his life needing glasses or contact lenses for short sight. As many people have, he heard the messages about laser eye surgery, and its promise to make life easier and better. He also heard the statistics that are bandied about regarding the rarity of serious complications, so he paid his money and went for it in January 2009, but I am sorry to say that the damage immediately after the surgery was awful.

Darren was in tremendous pain. He could not open his eyes at all until the following day and, when he did, his vision was unrecognisable. It was filled with sunbursts coming from light sources, with halos arounds them, with images that overlapped and with many floaters, which are small objects that persistently stay in the vision no matter where someone looks; I have loads of them in my eyes.

Having such damaged vision was distracting, disorientating and very distressing. Darren could not function. He had been told that this was merely a temporary effect and that it would go away after surgery, so he took sick leave and he persevered in that hope. The weeks passed, then the months, and the problems with his vision simply did not go away. Understandably, Darren became increasingly distraught, anxious and depressed. At check-ups, he was told time and again that it was temporary. He was fobbed off with steroid eye drops, which did nothing.

He was then offered another procedure with the same company, using an alternative refractive surgery technique, then another, via a private referral to Moorfields Eye Hospital, and then another. Darren has now had five separate refractive eye surgeries, four of which were to correct the damage of the first. None of these operations have helped. In fact, Darren believes they have just made things worse.

All of this time, Darren’s mental health was deteriorating. He found his work as a solicitor increasingly impossible because of the psychological damage that resulted in a diagnosis of severe depression and anxiety, which remains 13 years on. He resigned from his job and endured 18 months out of work. Even now, after getting a new legal role, he has found it difficult to continue and he had to resign 18 months after starting that job. Eventually, in 2012, Darren had to stop the process of repeated surgeries, and disengage to protect what was left of his mental health. It has taken him many years to come to terms with what has been done.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Lady for sharing what surgery can be like. I have a diabetic constituent who asked a consultant if laser surgery would be appropriate. Unfortunately, as a result of that surgery he lost his eyesight in its entirety. Today, he has no sight in either eye. When it comes to surgery, the hon. Lady is absolutely right and I thank her for the reminder that it does not always work. People need to be careful and aware of that.

Photo of Lyn Brown Lyn Brown Shadow Minister (Foreign, Commonwealth and Development Affairs)

Darren now believes that there is nothing that can be done significantly to repair the damage to his sight. He has uncomfortable, dry eyes every day of his life, which become far worse after reading or concentrating for long periods. He cannot see clearly in low-light conditions or drive after dark. Even crossing the road can be dangerous because it is hard to judge the distance between cars.

Darren believes that he was not fully informed about the risks before his surgery. He has no trust in what little regulation or self-regulation exists via the General Optical Council and the General Medical Council. This was a private, elective procedure that Darren paid for. Surely to heavens, the company that performed the surgery should be responsible for the best possible aftercare, and for making it right. In 2017, Darren again contacted the company responsible for the original surgery. It was made absolutely clear that it would offer him nothing. Effectively, it told him to go away, to stop being a nuisance and to stop getting in the way, frankly, of it making more money.

As always, the NHS has been left to pick up the pieces after poorly regulated private medicine has failed. I ask the Minister how much is this costing the NHS across the country? It would be good to know. Does she have any information to hand on that? We need to create a system where patients are genuinely informed about the real risks; a system where there is proper recourse to a regulator when things go wrong, and where private companies are held responsible for their failings and the cost.

Photo of Matthew Offord Matthew Offord Conservative, Hendon 10:01 am, 11th January 2022

It is a pleasure to serve under your chairmanship, Ms Nokes. I also pay tribute to Jim Shannon for securing the debate.

I first became interested in eye health as a child when I wore glasses and had extreme myopia. That manifested itself in 2011 when I had my first detached retina and experienced the possibility of losing my eyesight. I had a second detached retina that necessitated an operation at Moorfields. That was two detached retinas, and I subsequently required cataract operations on both eyes.

My clinical experience at Moorfields was very good and I had no problem with that. However, when I had subsequent check-ups for glaucoma, there was an excessive number of people per session. On occasion, my consultant was treating up to 100 people in under three hours, which greatly concerned me. This is an issue about which I have always been passionate, more so when constituents came to me and said that they had experienced problems, not only with glaucoma and age-related macular degeneration but with cataracts. I realised that this was a problem across the whole of society.

In 2019, Bambos Charalambous called for a national strategy for eye health, which I support. More recently, in response to a written question, the Government stated that there were no plans to develop a national strategy for eye health and that, given the size and variety of health needs in England, the approach should be managed locally.

That is not a view that I share. As the hon. Member for Strangford said, the number of people waiting for treatment on the NHS for eye-related conditions has increased during the pandemic. We are certainly aware of that, but what is most troubling is that clinical commissioning groups ration the number of operations for conditions, including cataracts. A survey in 2017 of ophthalmic leads shows that some CCGs apply even stricter access to patients needing surgery on a second eye. That means, as has been said, that people are unable to drive and, certainly, unable to read, and have great difficulty accessing normal sight due to the need to wear a single glass lens in a pair of glasses, rather than glasses for one eye.

I have struggled with the possibility of losing my sight, both as a Member of Parliament and as an individual. May I tell the Minister that it is a difficult diagnosis to receive when someone says, “If you do not have this operation, you will lose your sight. If you have it, you will probably save your sight. We have to tell you that, if you do not have it, you will definitely lose your sight”?

I have been keen to campaign for more eye clinic liaison officers. I have repeatedly asked Ministers about the number of eye clinic liaison officers and how we could have more. The response has always been that they are funded by CCGs based on assessment of need. In dealing with the impact of sight loss, the actions of ECLOs in helping people through their support and rehabilitation has always been judged to be of great value. In September 2021, a response that I received to a written question said:

“Eye clinics and their staff, including Eye Clinic Liaison Officers, are commissioned, and funded by individual Clinical Commissioning Groups on the basis of local assessments of need, details of which are not routinely collected centrally.”

Once again, we go back to the point of having the issues decided at local level, with the Department of Health and Social Care not knowing how many officers are in attendance.

The Department is keen to highlight the additional £2 billion that is going into the NHS this year—£8 billion over three years—to increase activity on the elective care backlog caused by the pandemic and other factors. We welcome that, but I have a problem with Ministers never identifying where any of the money will be awarded. Eye health is never identified, so we do not know how many elective operations will occur in the next year or the next three years. The Department also says:

NHS England and NHS Improvement’s National Eye Care Recovery and Transformation programme aims to transform secondary care ophthalmology services by using existing funding more effectively to improve service quality and patient outcomes.”

That seems to counteract an assertion that any of the £2 billion this year, or the £8 billion over three years, will be allocated directly to eye care.

I have two asks of the Minister. The first is to establish, promote and publish a national eye health strategy for England. The second is to identify and allocate resources to ophthalmology so that we can say to our constituents that, when they need the NHS at a moment that could effectively end their productive life through the loss of their sight, we will be there for them.

Photo of John Martin McDonnell John Martin McDonnell Labour, Hayes and Harlington 10:06 am, 11th January 2022

I join others in thanking Jim Shannon for securing the debate. I congratulate him on providing a service to us all by securing so many debates on so many relevant issues. I concur with the previous speaker, Dr Offord, that it is time for a national strategy; we have been calling for one for a while.

Like my hon. Friend Ms Brown, I will talk about refractive surgery. I completely concur with the hon. Member for Strangford, and the general tone of the debate, about the need for longer-term, stable investment, and the worries that we all have about the postcode lottery in access to eyesight assessment, and services to tackle any problems that are identified. Part of the problem of the postcode lottery is that people who have concerns about their eyesight can become desperate and resort to alternative methodologies, one of which has been refractive surgery.

Refractive surgery is often successful, but there is always a risk. We are talking about both laser surgery and lens replacement, in larger numbers every year. It is a growing issue. Thousands upon thousands are receiving refractive surgery, basically from three main companies: Optical Express, Optimax, and Optegra. Tragically, of those thousands, many hundreds are now experiencing serious problems. They have failed to find a solution to their eyesight problems by turning to surgery, but in many instances have been harmed by the surgery itself.

I have been campaigning on this issue for over a decade. I have worked with other MPs and campaigners. We have had private Members’ Bills, ten-minute rule Bills and debates in the House. I pay tribute to the external campaigners. Sasha Rodoy from the My Beautiful Eyes Foundation has brought together literally hundreds of cases, providing people with support and exposing some of the appalling practices. My hon. Friend the Member for West Ham referred to the GMC. There are specific examples of where the GMC guidelines are ignored, resulting in real harm. The guidelines basically say that the surgeon undertaking the surgery should meet the person who is to be operated on. There should be a proper assessment of their suitability for the surgery, and advice should then be provided.

Over the past decade, we are finding too many examples of where the assessment has been given largely by salespeople rather than clinically qualified staff. Often, the person will not see the surgeon until the day of surgery. Owing to the oligopoly of the companies involved, the pressure of meeting sales targets seems to be more important than achieving good outcomes for the clients or patients involved. Inadequate advice then leads to unsuitable judgments and people undergoing surgery that damages their eyesight.

My hon. Friend the Member for West Ham mentioned one tragic case, but there are so many others: paramedics who can no longer pursue their career; police officers who are unable to drive professionally any more; and, as hon. Members may have seen in the media, one health worker who took his own life as a result of the distress.

When things go wrong, the companies often deny responsibility. Sometimes they accept that they need to do something, but they will often delay appointments with the surgeon beyond 12 months and then refuse to accept any responsibility, with people having to be sent off to the NHS for treatment. I want to raise the same issue with the Minister as my hon. Friend the Member for West Ham. It would be really helpful if we ensured that the NHS collated the information about the work it has to undertake and the investment it has to put in to correct the damage and harm caused by those private companies. There was even one company that went into administration and therefore denied all responsibility and liability to patients, only for it to restructure itself and form a new company to continue providing the same services.

On the complaints, I have to say there have been numerous complaints to the GMC and the General Optical Council. Unfortunately, it is often judged that the case does not meet the seriousness threshold and therefore little or no action is taken by those bodies to regulate and monitor companies that are not abiding by basic guidelines. We have discovered that people are operating without being professionally qualified even in cases that are coming up this year. Those shocking examples demand a response now, after all these years.

I am happy to meet with the Minister or, as I know she is busy, with her colleagues and officials to talk through the review that needs to be undertaken into the operation of refractive surgery, as well as what needs to be done to improve regulation and to ensure that the harms caused by the operations largely being carried out by private companies are addressed and that people are supported in the very distressing situations they have found themselves in.

Photo of Lia Nici Lia Nici Conservative, Great Grimsby 10:13 am, 11th January 2022

I thank Jim Shannon for securing the debate. As he alluded to earlier, I have macular disease, and I want to speak about what macular disease is and its effects.

When I was diagnosed 20 years ago, my eye specialist told me that I was going blind. Anybody who does not really understand about going blind might think that one day the lights will switch off, but that is not actually the case. The macula is a particular part of the retina that deals with detail. Over time, it becomes very difficult for people to see in the centre of their vision; there is difficulty reading, recognising faces and writing. It poses a number of challenges, but there is life after a macular disease diagnosis. Hon. Members will notice that I am using my iPad—technology performs a huge service to people with issues such as mine.

I would like to talk about some of the causes. We have talked about diabetes and age-related macular degeneration, but it also happens to younger people. It happened to me when I was young, as secondary to high myopia. Councillor Daniel Westcott, a colleague and constituent of mine, was diagnosed at the age of 17 with Stargardt disease, which is a loss in the macular area of the eye. Despite it ending his career as a plasterer—he could no longer see enough detail—he trained as a teacher and is now working as both a personal trainer and a councillor. Those people who experience the shock and concern of being diagnosed can certainly still have a very positive life that contributes to society.

I want to talk about the importance of going to the optician. We have talked about ophthalmology, but as the hon. Member for Strangford said, it is going to the optician regularly that spots these serious issues. With the retina in particular, speed is of the utmost importance. I went to my optician because when I was reading I noticed that the lines on the page of my book had a dip in them. I went to the optician not thinking anything of it, but it was actually the start of the back of my eye bleeding and causing a bubble. Imagine looking through a window through a raindrop—that is the effect that starts to happen. If anybody hears of someone having that kind of issue, they must go to their optician, who will give them an urgent referral to the hospital. If they cannot get to the optician, they should go to accident and emergency straight away and explain; they will then get straight in to the eye specialist. My constituency is Great Grimsby—that is where I live—and Diana, Princess of Wales Hospital has a fantastic ophthalmology team. Mr Kotta, Mrs Bagga and the whole team are fantastic; the nurse specialists really are specialists, and they are fantastic at care and treatment.

It is incredibly important that we support technology companies being able to continue helping with this. In my case, 20 years ago there was no treatment for my eye condition. However, when it went into my second eye, there had thankfully been a lot of development in technology. I had 11 injections directly into my right eye in order to save my sight. Companies such as Regeneron and Novartis have produced medicines that go directly into the eye. If they had not been available, I would now be registered blind. The effects of those 11 injections meant that my eyes improved five lines on the acuity test. That is quite amazing, and it allowed me to continue to drive. I obviously still have some issues, and colleagues will know that they have to prod me because I do not always recognise them—especially on a dark night. Stem cell research is the real pinnacle, and will hopefully mean that people’s eyes will work better for them in the future.

I want to highlight computer technology, and in particular Apple computers. Twenty years ago Apple had the foresight to ensure that accessibility was built into their operating systems. If it was not for Apple’s technology and foresight, I could not have continued in my previous job of teaching, video production and camera operating. When a camera operator is told that they are no longer going to be able to see, that can be a little bit of a problem. Computer technology allowed me to continue to be able to do what I do, and Members can see that I am working with large text today. It is absolutely vital, and I say to other producers of computer operating systems and programming systems that they should really think about simple things to allow people to zoom in and to magnify. All those things are now on the market and they really do make a difference to people’s independence.

If someone does not lose all of their sight, it is very difficult for people to understand. They do not walk into things, and their peripheral vision is fine. It is the detail that is the problem. For a lot of people, that affects their independence. They can no longer read a telephone bill or look at something on the internet. If they love reading, they can no longer do that either. Writing is also affected because they cannot see what they are doing. There is much hilarity in our household when people say that I should become a professional prescription writer because they cannot read anything that I write any more.

Most important, for me, is the role of employers. When I was first diagnosed, my public sector employer—whom I will not embarrass by naming—was appalling. They were not supportive; in fact, they went into panic mode. I would like to say to employers that when somebody comes to you to say that they are having eye problems, do not go into panic mode, because they can continue to be a positive, important part of the team. It just means that they will need slightly different ways of working. I continued to run a television station, keeping a close eye on my editors and camera operators, who always used to say that I may have eye problems, but I could still see their mistakes.

The Royal National Institute of Blind People in particular was fantastic. Its staff will come and do a free assessment in the workplace and offer advice to the employer. I also thank the people at ACAS because when my employer was being downright dirty, they were fantastic in advising me in what I was able to do. Rather than people with eye or macular disease having issues and becoming vulnerable, they can actually become a positive and important part of the team—even more so than before their eye problems. I send this message out to employers: embrace the team member who has these issues, because they will continue to be a fantastic part of the workplace.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

I thank the Member for that contribution. We now come to the Front-Bench spokespeople.

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member) 10:22 am, 11th January 2022

I commend Jim Shannon for bringing forward this debate on a hugely important subject. Macular disease is the biggest cause of sight loss in the UK, with up to 40,000 people developing wet age-related neovascular macular degeneration every year, with wet macular degeneration being the worst of all known eye diseases.

Age-related macular degeneration is a common condition that affects the middle part of a person’s vision. It usually affects people in their 60s and 70s, rising to a rate of around one in 10 people aged 75 and above. However, it can strike at any age. It can happen in one eye or both and, as we have heard from Lia Nici, it affects the middle part of a person’s eye. AMD can make things such reading, watching television, driving or even facial recognition difficult. Other symptoms can include seeing straight lines as wavy or crooked—which was how the hon. Lady established that she had a problem—objects looking smaller than normal, colours seeming less bright, or seeing things that are not even there.

AMD is not painful and does not affect the appearance of the eye. It does not cause complete or total blindness, but it can make everyday activities incredibly difficult. Without treatment, vision may worsen gradually over several years, which is known as dry AMD, or quickly over a few weeks or months, known as wet AMD. The exact cause is unknown; it has been linked to high blood pressure, being overweight, smoking or having a family history of AMD.

I am sure Members agree that the figures and statistics prove the seriousness of the disease, and why pre-emptive measures should and must be taken. I am proud that that is exactly why we are leading the way in optometry in Scotland. We are currently the only country in the UK to provide free, universal, NHS-funded eye care examinations. Since 2006, adults in Scotland have been able to attend a free eye health check biannually, with children under the age of 16 and adults over the age of 60 entitled to an annual visit. That proves that the Scottish Parliament is committed to delivering a world-leading eye care service for its people.

An NHS eye examination in Scotland is more than just a sight test. It provides a general eye health check that can detect early signs of sight-threatening conditions and other general medical conditions, including diabetes, high blood pressure, cardiovascular disease, tumours, dementia, or even arthritis. Optometrists in Scotland deliver a system of eye care services in which all areas of the ophthalmic workforce are truly at the top tier of their professional competency and expertise. That enables higher quality, safe, effective and person-centred eye care services to be delivered in the community and closer to people’s homes, freeing up hospital services to focus on the most complex eye conditions and urgent patient cases.

Community optometrists are already the first point of contact for any eye problems and they can diagnose and treat a number of conditions without the patient requiring an appointment with their GP or an ophthalmologist, easing pressures on an already burdened health service. An increasing number of community ophthalmologists are also registered independent prescribers and can issue patients with an NHS prescription to treat their eye problem or condition.

I was fortunate enough to be able to visit one of the opticians in my constituency of Coatbridge, Chryston and Bellshill just yesterday. Tuite Opticians in Coatbridge is a family-owned optician currently run by Eamonn Tuite, which has been at the heart of our town since 1973. Tuite understands the needs of the community it serves and always goes the extra mile to ensure the best healthcare and support are provided to all service users. As a result, it not only provides eye examinations in the practice, but also a bespoke service for the housebound, ensuring minimum fuss is required by the patient for such a vital check. I am pleased to be able to place on record my gratitude to the optometrist Stephen Kirley, who took the time to explain to me in great detail the impact of macular degeneration on individuals and why early intervention is so important in treating the disease.

That all lies within and is covered by the free eye test and the fantastic policy of the Scottish Government. By ensuring there are no barriers to accessing eye care, optometrists such as Stephen have a positive impact on patients’ health needs. In return for every eye test carried out, the Scottish Government provide practices such as Tuite with a fee to cover the cost of its work and ensure the business can continue to support as many in the community as possible.

Tuite Opticians was kind enough to carry out my own eye test yesterday and I sure all Members will be happy to learn that I have a clear bill of health—all the better for keeping a beady eye on this Government.

Photo of John Martin McDonnell John Martin McDonnell Labour, Hayes and Harlington

I went for my eye test yesterday. I could not get an appointment in Hayes, my constituency, so I went to Uxbridge. Unfortunately, at the same time the Prime Minister did an official visit to the eye test and disturbed it. How inconsiderate could he be?

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member)

That is so surprising. This Prime Minister is known for his consideration of others.

I put my thanks to Tuite Opticians on the record, not only for having me, but for its tremendous commitment to the wider community of Coatbridge for over 30 years.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Gentleman for his positive contribution to this debate. The other good thing about going to an optician, is that if he has any concerns, he can refer the patient on—it does not necessarily have to go through the GP. I did that when I went to my optician in the Cathedral Quarter in Belfast to get all the tests necessary and ultimately was given the all-clear. An optician can put someone’s mind at ease.

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member)

I thank the hon. Member for his intervention. He is absolutely right. The optician can highlight so many things. We know the burdens across the NHS, particularly on our GPs and this can lighten the load. However, as he correctly outlined, unfortunately, in England, Wales and Northern Ireland, the situation can sometimes be difficult. Optical practices are not so fortunate in that there is no governmental support and provision for free eye tests for the general public.

In England, a typical eye examination costs between £20 and £25 for all, except children, the elderly or people registered as partially sighted or blind. Having a monetary value attached to an eye examination would undoubtedly deter those unable to afford the crucial health test and endanger their long-term health and hamper the early prevention tactics that so evidently work. This in a country where health care should be free at the point of need is unacceptable. I believe it is unacceptable to administer a charge. The rest of the UK should follow suit. We have heard repeated calls for a national strategy—the example set by Edinburgh should be followed. Scottish citizens do not have to pay to have their eyes examined. Seeing is a privilege that so many of us will struggle to appreciate, but ensuring that there is universal access to eye tests means that those who require them do not have to think of any cost ramifications.

Scotland not only leads the way in the universal accessibility of eye tests but is the first country in the UK to enable access to important treatments for macular disease. Treatment depends on the type of AMD. Dry AMD accounts for 80% or 90% of cases. There is no treatment, but vision aids can help reduce the effects on day-to-day life. Wet AMD, which affects 10% to 20% of sufferers, may require regular eye injections and, very occasionally, as we heard from the hon. Member for Great Grimsby, a light treatment called photodynamic therapy, to stop vision getting any worse.

The other nations of the UK are missing a trick not only in determining new treatment methods for macular disease, but when it comes to understanding the importance of addressing such issues in terms of the impact on the wider health and social care system.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

I am very grateful to the hon. Gentleman for all that he is saying with regard to macular degeneration. From speaking to surgeons such as James Neffendorf at King’s College Hospital, I know that treatments are absolutely crucial, but what will help to save people’s eyesight, whether in Scotland, England, Northern Ireland or Wales, is the public awareness of macular degeneration, so that those signs can be picked up earlier across the United Kingdom. Will he agree that the Government should ensure that there is a public campaign across the country to pick up those signs earlier, so that people can know when those symptoms arise and get best treatment early on?

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member)

That is a fantastic idea. Any attention that we can draw to this, we must.

Macular degeneration, both wet and dry, leads to visual impairment, which can in turn lead to depression in many patients. The loss of one’s sight is so catastrophic that it often leads to clinical depression or other mental health issues—up to a 50% increase compared to non-affected patients. Furthermore, sufferers also have a 25% increased risk of developing dementia. The role of optometrists in administering primary care in the community is therefore critical to identifying these conditions at an early stage and minimising the impact on other areas of healthcare. If the protection of the wider health service is not a reason to address the shortcomings in eye care, I am not sure what is.

Eye care and macular health is vital. It is important that we, as a Parliament of the people, address needs in this area and remove any barriers, financial or otherwise, to affording our constituents the ability to access sufficient care on a regular basis. Universal free eye examinations enable optometrists to detect sight-threatening and other medical conditions without depending on how much money a person has or the ability to pay. Let this Parliament follow the example of the Scottish Parliament; let this Parliament put healthcare at the heart of everything that we can achieve. Only by doing so will we fulfil our duties to protect all citizens and communities within our reach.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health and Social Care) 10:33 am, 11th January 2022

It is a pleasure to serve under your chairmanship, Ms Nokes. I commend Jim Shannon for securing this important debate. We have had some powerful contributions. I pay particular tribute to Lia Nici for setting out her personal experiences. It is those experiences that make for such an informed debate, and I thank her for putting those on the record.

The RNIB estimates that there are currently more than 2 million people living with sight loss in the UK. Fight for Sight estimates that by 2050 that number will reach 4 million. Without support, ophthalmology services will be stretched to capacity. As we have heard in the debate, eye health and macular disease are important issues. I am grateful to have been given the opportunity to respond to this debate on behalf of Her Majesty’s Opposition.

As has already been made clear throughout the debate, the demand for ophthalmology services has risen at a rapid rate. Referrals from primary care were up by 12% in December 2019 compared to 2013-14. With an ageing population, it is likely that referrals will increase still further. Around 600,000 people are living with age-related macular degeneration in the United Kingdom. Degenerative sight loss not only is physically traumatising but can have a severe long-term impact on mental health and quality of life. Some 90% of vision impairment is treatable, but treatment must be fast and accessible to limit impairment.

Back in 2018, the all-party parliamentary group on eye health and visual impairment published its report, which found that the current system of eye care is

“failing patients on a grand scale”.

It found that services are delaying and cancelling time-critical appointments, resulting in some patients not receiving sight-saving treatment and care when they need it most. The Government promised to consider the recommendations of the report, yet here in 2022, people are still suffering sight loss on an unprecedented scale.

Nationally, almost 35% of patients—more than 592,000 people—are waiting longer than 18 weeks to start ophthalmology treatment. Shockingly, at the end of October 2021 around 28,000 patients in England and Wales have been waiting a year or longer to begin treatment. It is important to note that there is stark regional inequality in access to eye health services. At the Tameside and Glossop trust, one of two that covers my constituency, over 50% of patients wait more than 18 weeks to begin treatment. That is around 15% higher than the national average. Those figures represent individuals whose eye health is deteriorating rapidly, and who are incredibly anxious and scared about what their future may hold. If they do not receive adequate treatment and care, they will suffer a permanent alteration to their vision and quality of life.

The Government have to tackle this situation, because we know that the figures largely represent the state of the NHS before the pandemic. Waiting lists for treatment have got worse because of the pandemic, but the situation was far from perfect before the covid storm hit these shores. The problem in eye health care is not new; for several years, many organisations and people, including Members of this House, have been calling for the Government to act on it. It is too easy to simply point to the pandemic to excuse lack of action. It will not wash with us or with members of the public, who understandably are frustrated and worried about their own treatments.

I would be grateful to the Minister, whom I respect a lot, if she could outline the Department of Health and Social Care’s current assessment of ophthalmology waiting times and what her Department plans to do to ensure that patient safety and care remains a priority over the next few months, particularly given the acute staffing challenges that the health sector is facing.

In December 2019, the getting it right first time programme’s national specialty report was published. The report was endorsed by the Royal College of Ophthalmologists, and is the product of two years of painstaking work. Over 120 trusts were visited across England and several recommendations were made. I am sure many Members are familiar with the contents of the report, but I want to highlight just a few key points that I believe are instructive to the debate.

The two most common medical retina conditions are diabetic and age-related macular degeneration. Despite how common age-related macular degeneration is, it is important to note that macular disease can affect people at any age, including children. The getting it right first time report recommended that attention be paid to improving the accuracy and efficiency of diabetic retina screening. By utilising cutting-edge 3D imaging techniques, we can generate more detailed images of the retina and thereby increase referrals for diabetic maculopathy. However, the report found that in 2019, only 45% of providers utilised optical coherence tomography to refine referrals.

What we do know—I would be grateful to hear the Minister’s thoughts on the recommendations—is that the Government and her Department need to improve access top treatment and referrals for eye conditions. Specifically, I would be interested to hear what the Department makes of calls to train more staff to deliver specialist AMD injections.

I would also like to draw attention to the proposed Health and Care Bill, and specifically its provisions relating to new integrated care systems. For those to be effective in tackling the crisis in eye health, the Government must ensure that ICSs can co-ordinate community optometry and hospital ophthalmology services, to ensure that patients are seen promptly and at the right time. I would be grateful for any clarity that the Minister could give on how ICSs can be best placed to deliver those important changes.

In conclusion, we cannot continue to overlook the challenges that ophthalmology is facing. It is the busiest outpatient service and was under extreme pressure before coronavirus. The Opposition have repeatedly called on the Government to be straight with the British public about the current strain in the NHS and to urgently set about addressing it. We have time and again urged the Government to undo some of their more damaging policies on the NHS. Waiting times have soared and patients have been let down before covid, yet there is no detailed plan, and patients, staff and people across the country are now looking to the Government to deliver on their promise to improve NHS care and to drive down waiting times and waiting lists. We look forward to seeing the detail, but as has already been mentioned in the debate, there needs to be a real consideration in the plan for eye health and how waiting times can be driven down. I ask that the Minister reflects on the points made during the debate, because people who are suffering poor eye health need to have reassurances from the Government that they are doing everything possible to address the concerns of healthcare leaders, staff and patients.

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care 10:42 am, 11th January 2022

It is a pleasure to serve under your chairmanship, Ms Nokes. I want to start by thanking Jim Shannon for securing this important debate. Before the Christmas recess, the last sitting in Westminster Hall was on surgical fires, and it is a pleasure, so soon after the recess, to be debating with him again.

The prevention, early detection, access to diagnosis and treatment of eye conditions is such an important issue, and we have heard from many Members, including my hon. Friend Peter Gibson, who raised the impact on people’s day-to-day life, on simple steps such as trying to catch a train, and the impact of e-scooters and street pavement furniture. There was also a very moving speech from my hon. Friend Lia Nici. We cannot replace that insight and knowledge of how living with sight problems has an effect on every aspect of life and the simple improvements that can make a big difference.

There are many conditions that affect the eyes, as we have heard about today, and many of them share common risk factors, including some that are unavoidable, such as age and medical conditions such as diabetes, which the hon. Member for Strangford so eloquently described. However, we have not touched on some lifestyle factors that can impact on eye health—for example, obesity and smoking play their part. After age, smoking is the second-most consistent risk factor for age-related macular degeneration, with an increased risk of up to four times. Obesity is also a risk factor for age-related macular degeneration, but also for diabetic retinopathy, retinal vein occlusions and stroke-related vision loss. Morbid obesity is associated with higher eye pressure, which can increase someone’s risk of glaucoma.

When addressing eye health, it is important to tackle some of the low-hanging fruit of what can be preventable in affecting someone’s eye health. The UK is a world leader in tobacco control, and we remain committed to reducing the harm caused by tobacco. Later this year, we will produce a new tobacco plan that will set out how we will support people to give up smoking or to not start in the first place, because there are still 6 million people in England who smoke, which obviously has a knock-on effect on the possibility of eye problems further down the line.

We are also committed to a healthy living and weight loss management programme through our obesity strategy, building on the progress made on nutrition labelling. New rules on products that are high in fat, salt and sugar will come into force from October this year and, from January next year, we will introduce restrictions on the advertising of such products before the 9 pm watershed. We are also delivering a £100 million investment in promoting healthy lifestyles. In the years to come, all of those measures will have a knock-on effect on the number of people presenting with eye conditions.

That said, as we have heard today, there are many unavoidable causes of eye problems. Diabetes is one of the lead causes, and the diabetic retinopathy screening programme offers annual screening to millions of eligible people with diabetes. I place on record my thanks to all the staff of that screening programme who have carried on during the pandemic, because for the first time in 50 years, diabetic retinopathy is no longer the leading cause of certifiable blindness in adults of working age. That is a tremendous achievement.

There are other causes that can affect people of any age. For children, the healthy child programme sets out the schedule of child health reviews from pregnancy through the first five years of life. That includes examining the eyes of the newborn at six weeks and during the two-year review, as well as recommending that children should be screened for visual impairment between the ages of four and five. As we heard from Mr Campbell, we know that at all ages, regular sight testing can lead to early detection of eye conditions. My hon. Friend the Member for Great Grimsby spoke very well about the importance of the appointment with the optician. Combined with early treatment and prevention, we can prevent people from losing their sight, so today’s message of “Attend your eye tests” is very important indeed.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the Minister for her very positive response. This is not just about a person’s visits to their opticians, but their appointments with their GP as well, especially if they are diabetic like me and attend their GP’s clinic twice a year. They should do a retinopathy test as well: the GP’s clinic can do all the things that can indicate whether that person’s sight is going backwards, staying level, or indeed improving. There are lots of things that people can do, and part of that is attending their GP appointments. Do not miss them: they are equally important.

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care

Absolutely: we have heard today about the impact that overall health has on eye health. We know that NHS sight test numbers were impacted at the peak of the pandemic, but there has been a strong recovery, with 9.7 million sight tests carried out between April and December last year. Again, I thank the NHS, and particularly primary eye care providers, for their efforts.

It is vital that once a problem is detected, individuals have access to timely diagnosis and any necessary treatment. Age-related macular degeneration is one of the leading causes of sight loss in the UK, and is a devastating disease that can seriously impact a person’s life. The vast majority of people with age-related macular degeneration suffer from “dry” degeneration, for which there is currently no effective treatment, although vision aids can reduce its impact. For those with “wet” degeneration, this condition can be far more serious and sight-threatening. There are a number of available treatments for that form of AMD, and I point colleagues to the National Institute for Health and Care Excellence’s guidelines: a person should be referred within one day if their condition is considered to be wet active AMD, and offered vascular endothelial growth factor drugs within 14 days of a referral. It is important that patients are able to access that treatment, as indicated by NICE.

Although we do have some effective treatments for macular disease, we do not rest on our laurels. Medicine continues to evolve, and we heard from my hon. Friend Paul Howell about the potential of sleep masks—evidence is still being collected about that treatment. We also heard from my hon. Friend the Member for Great Grimsby, who is the expert in this area, about the exciting developments in stem cell research and the possibilities that they could create in future.

During this time, the NHS has continued to prioritise urgent and life-saving treatments, including for sight-threatening eye conditions. I am pleased that the number of ophthalmology patients seen last October was almost back to a pre-pandemic level.

To help the NHS drive up activity, we have provided £2 billion this year through the elective recovery fund, and a further £5.9 billion of capital funding will support elective recovery, diagnosis and technology. That does include—my hon. Friend Dr Offord asked about this—the ability to expand capacity for new surgical hubs that will drive through high-volume services, such as cataract surgeries, so that they are high on the agenda in tackling the backlog. The NHS has also been running the £160 million accelerator programme, which includes 3D eye scanners and other innovations that are helping to develop a blueprint for elective activity in the NHS.

Ophthalmology is one of the largest out-patient specialties. Change is needed to ensure the NHS can both be sustainable for the future and deal with the growing numbers of people needing eye care services. To address these challenges, NHS England has developed the national eye care recovery and transformation programme to work across all systems and look at everything from workforce to the services provided. It is working with local systems to prevent irreversible sight loss as a result of delayed treatment.

In recognition of this important work, I am delighted that NHS England is recruiting a national clinical director for eye care. That person will oversee services at a national level, which will filter down to tackle the inequalities and disparities we have heard about in certain parts of the country. Much good work is happening, but it is important that the public health outcomes framework is used to identify gaps in services. The framework tracks the rate of sight loss across the population for three of the commonest causes of preventable sight loss—age-related macular degeneration, glaucoma and diabetic retinopathy. The data is openly available and is being used to match areas where services and outcomes need to be improved.

I want to touch on the points raised by Ms Brown about her constituent, Darren, and those raised by John McDonnell. I am concerned about issues around laser surgery and the impact they are having. I am happy to meet the right hon. Gentleman and the hon. Lady, and other colleagues, to discuss that. The Care Quality Commission regulates that area, but I am concerned by the information shared today and I am happy to look at the issue further. It is important that the situation of people with minor eye ailments is not made worse by having surgery that may, or may not, be suitable for their needs.

We have had a good debate today. I hope I have reassured colleagues that eye health procedures, treatment and diagnoses are part of the post-covid recovery process. I take on board the points made by my hon. Friend the Member for Great Grimsby that this is about more than just diagnosing and treating; it is about improving the lives of those with sight loss, to enable them to live the most productive and fulfilling lives they possibly can. I am pleased to hear that the Royal National Institute of Blind People and ACAS were instrumental in helping her and others who are trying to improve the workplace experience. My hon. Friend the Member for Darlington also pointed out that technological changes can have a positive impact but that things such as electric cars can have a negative impact on people with sight loss, as those vehicles are so quiet.

To conclude, maintaining good vision throughout our lives is very important. Some preventable factors, such as smoking and obesity, can help improve eye health, but there are many unavoidable issues that we need to deal with.

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member)

Are there plans in any part of the national strategy to remove the financial impediment, so that English, Welsh or Northern Irish people can get a free eye test?

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care

Many people in England qualify for a free eye test. We are not seeing that issue as a barrier to people coming forward, but I have outlined the many measures we are putting in place to improve the outcomes for people with significant sight loss problems. As we emerge from the pandemic, our priority remains tackling the elective backlog and ensuring that we have high-quality, sustainable eye care services for the future.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 10:55 am, 11th January 2022

First, I thank each and every one of the right hon. and hon. Gentlemen and Ladies who have made a contribution. Paul Howell referred to the innovative company in his constituency, which I think can help. Peter Gibson clearly outlined the issues for those who are blind when it comes to obstacles such as street furniture, e-scooters and so on. He also referred to the strategy in his constituency.

I thank Ms Brown so much for what she said. It was a reminder to us all that corrective surgery, unfortunately, does not always work. She referred to its being regulated. Dr Offord referred to his own personal experience and to how he has better vision today because of the steps that were taken. He also referred to the eye strategy for the United Kingdom. Margaret Ferrier referred to the data. Data is critical to all health issues. My hon. Friend Mr Campbell referred to the fact that people must attend their optician appointment. John McDonnell, in a significant contribution, referred to the longer-term investment that is needed. He also said, “Listen to clinical and medical advice and don’t listen to the salesperson.”

I think every one of us was moved by the contribution from Lia Nici. It was a real step-by-step story of the hon. Lady’s situation, and we thank her for all that she said. She referred to modern technology, buy-in by employers and computer advances.

Steven Bonnar, in a significant contribution, referred to what is done in Scotland. I wish that we in Northern Ireland perhaps had something similar to Scotland. That is something for us to look at as well. Rehman Chishti referred to a public campaign being needed. Andrew Gwynne, in a very good contribution, referred to some people waiting more than a year for treatment. He pointed out that all ages are affected, and it is good to remember that it is not just people of a certain generation; it is younger people as well. Waiting times have soared, and people have been let down.

The Minister, in her response, has been incredibly helpful, as she always is. She understands the issues and understands the concerns of each and every one of us here. We said to the Minister—I think the right hon. Member for Hayes and Harlington also spoke about this—that if we could have a meeting with her, we would certainly do that. In relation to AMD, diabetes and glaucoma, a national eye care director is being put in place. There are certainly significant programmes. The issue is to ensure that those programmes are available across the whole United Kingdom, in every postcode. The Minister is committed and certainly very positive, and we look forward to working with her, all of us together.

Question put and agreed to.

Resolved,

That this House
has considered the matter of eye health and macular disease.