Preventable Sight Loss

– in Westminster Hall at 5:35 pm on 30 April 2024.

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Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West 5:35, 30 April 2024

I beg to move,

That this House
has considered preventable sight loss.

It is a pleasure to serve under your chairmanship, Sir Mark. I would like to begin this debate by asking Members who have good eye health to consider these questions. How would you feel if you lost your sight? How would it affect your life and your ability to connect with family and friends or earn a living, travel independently, enjoy the place you live in, the hobbies you have or visit new places? If you were to lose your sight, how would it make you feel to subsequently find out that it actually could have been saved?

Sadly, hundreds of our constituents are going through this very experience. In England, over 600,000 patients are currently on NHS waiting lists to begin treatment for ophthalmology—the branch of medicine concerned with the diagnosis and treatment of disorders of the eye. A survey by the Royal College of Ophthalmologists from this year shows that only 25% of NHS ophthalmology departments feel able to meet patient need, and 70% of departments are more concerned about out-patient backlogs compared with 12 months ago. These are incredibly alarming statistics. Alarming, too, is the fact that it was reported last year that, in 551 confirmed instances, patients had lost their sight as a result of delayed appointments since 2019.

Alongside the problems with ophthalmology in the NHS, we have seen the growth of the independent or private sector. I ask Members to consider the impact that the increased use of private sector provision is having on eye care. Independent sector providers now deliver almost 60% of NHS-funded cataract procedures. That has more than doubled from around 25% before the coronavirus pandemic. Although it has helped to bring down cataract waiting lists, the Royal College of Ophthalmology has found that 67% of NHS ophthalmology departments reported that the impact of independent sector providers on patient care in their area is negative. Let us reflect on that: over two thirds of ophthalmology departments in the NHS believe that the impact of independent sector providers on patient care is negative. It is important that we understand why.

The three aspects those departments have said they are most worried about are training opportunities for junior doctors, funding for the NHS ophthalmology department in which they work, and the available workforce. They believe that these will hamper the long-term ability of their departments to deliver sight-saving care for patients. Every Member of this House should be concerned about that.

The Royal National Institute of Blind People has said that the role of the independent sector has been associated with significant challenges that pose an increasing risk to the sustainability of comprehensive eye care services in the NHS. I believe that the impact on many of our constituents could be, and is likely to be, devastating.

Photo of Alex Sobel Alex Sobel Labour/Co-operative, Leeds North West

Does my hon. Friend agree that the use of the independent sector creates a postcode lottery as well? More affluent areas get to the front of the queue more quickly, and we see regional variations where the independent sector is stronger. That is a real concern for people waiting to have this treatment.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

My hon. Friend makes an important point, and I will touch on regional variations later.

A paper published last month by the Centre for Health and the Public Interest reported that in the period 2018-19 to 2022-23, the NHS paid the private sector around £700 million for cataract treatments. While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether the increase in the number of them being delivered comes at the expense of other sight-saving treatments.

We must ensure that the NHS is comprehensive in the range of treatments that it provides. The Centre for Health and the Public Interest warns that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Ophthalmologists have also told me that it is impacting capacity for the treatment of conditions such as cancer care, urgent treatment and the treatment of newborn babies.

Data received by the charity from 13 NHS trusts has shown that waiting times for some irreversible conditions have increased between 2017-18 and 2022-23, including for glaucoma and diabetic retinopathy. Waiting times have also increased for cataract operations. The charity also reports that the rise in expenditure on cataract services has been accompanied by an increase in the number of private, for-profit clinics, which have been established to deliver NHS cataract services. Its paper states that 78 new private, for-profit clinics have opened over the past five years.

It is not surprising that some senior ophthalmologists have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need but by the commercial interests of the companies delivering it. Last December, Professor Ben Burton, president of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with

“very mild cataracts getting surgery at the expense of other patients going blind”.

He added that the approach of unplanned commissioning means that

“the NHS is losing consultants, money and trainees to the private sector” and that the profit margin is “too high”, meaning that

“companies can pay three times the NHS overtime rate...So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.”

Professor Burton further warned that:

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

That very much chimes with the arguments raised by the Centre for Health and the Public Interest. In other words, the independent sector is cherry-picking the less complex work.

When he responds on behalf of the Government, will the Minister set out what discussions they have had with NHS England about sorting out the perverse outcomes caused by the unplanned commissioning that Professor Burton has highlighted? Unless we see a change of course by policymakers as a matter of urgency, there are real concerns that we will see the breadth of eye care provided within the NHS diminished to the point where some complex sight-saving treatments are no longer available on the NHS. They might be things such as the treatment people need when they are in urgent care after a road traffic accident, the treatment needed for newborn babies or treatment for cancer.

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

I commend the hon. Lady for bringing forward this debate. First, this is a terrific subject. She will know that this morning I had a debate on optometry care, which is a similar topic, and the issue is clear. In that debate, I said that 22 people weekly lose their sight to preventable loss. The hon. Lady knows that. Does she agree that the annual eye test should be pushed as forcibly as a dental check-up, and that the message should start in schools and resound right through the community? I think she will agree that optometrists and opticians want to be part of that move forward. If that is the case, we need the Minister and his Department to work alongside them to push for appointments from an early age.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

I thank the hon. Gentleman for his intervention; it was characteristically appropriate. I particularly welcome his call for the message to start when children are in school because it is massively important.

In the not too distant future, we may face eye care deserts in some parts of the country, in much the same way as has happened with dentistry, with some people missing out on crucial treatment. That is exactly what Professor Burton has warned could happen. He said:

“There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”

It is not difficult to see how such a conclusion has been arrived at. The great tragedy we face if that happens is that some people will lose their sight from treatable conditions.

The use of the independent sector for ophthalmology has tended to be more prevalent in some parts of the country than in others, so Members representing constituencies in those areas may be particularly concerned. A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the north-west of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers, at 61%. The midlands, the north-east, Yorkshire and the south-west of England also had figures over 50%. Those figures have increased greatly since 2016. Although there is regional variation, we should be concerned about that right across the United Kingdom.

NHS staffing levels for ophthalmology are also a matter of extreme concern. As I said earlier, NHS ophthalmology departments are worried about training opportunities for junior doctors and the available workforce. In response to a recent written parliamentary question, the Under-Secretary of State for Health and Social Care, Dame Andrea Leadsom, failed to provide clear information about the Government’s plans for specialty training places for ophthalmology. She said:

“A decision regarding which specialties these places will be allocated to will be made nearer the time that the places are required for the expanded workforce. NHS England will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.”

Will the Minister clarify that? When Under-Secretary of State for Health and Social Care spoke of stakeholders in that context, was she talking about the independent sector as well as the NHS? If so, will the Minister ask NHS England what progress it is making towards meeting its commitment, set out in the 2023 elective recovery taskforce implementation plan, to

“track, monitor and evaluate independent sector’s impact on the long-term NHS capacity landscape”?

That is an incredibly important matter, and if the Minister is not able to reply today, I would welcome it if he can write to me on that point.

How confident is the Minister that the full breadth of ophthalmology expertise will be there in the NHS for any one of us in five or 10 years? Data from the most recent workforce census from the Royal College of Ophthalmologists shows that there is real cause for concern, given that 76% of NHS ophthalmology departments report not having enough consultants to meet patient need. In reality, NHS ophthalmology departments are increasingly relying on costly locums to cover workforce gaps, and nearly two thirds—65%—use locums to fill consultant vacancies.

Typically, UK-trained ophthalmologists will have undertaken the vast majority of their training in the NHS, including those now working for independent sector providers. There are concerns that the increase in NHS staff working in the independent sector on cataract provision is reducing the availability of training opportunities that enable NHS staff to train in more complex areas. That is potentially a time bomb for the future, and could mean that we will not have anywhere near enough staff trained to carry out work on treatment for conditions such as glaucoma and wet macular degeneration.

It is clear that we are facing a sight loss health emergency, and there is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and it should aim to prevent irreversible sight loss.

As the Royal College of Ophthalmologists pointed out, it is imperative that NHS ophthalmology departments across the UK are supported to deliver high-quality and timely care for all patients, regardless of their condition and where they live. Among other things, it is calling on policymakers to support the development of a multi-disciplinary eye care workforce fit for the future. That should include delivering an additional 285 ophthalmology training places in England by 2031 and boosting investment in the ophthalmic practitioner training programme so that more eye care professionals can work to the top of their licence.

The royal college is also calling for better integrated eye care through investment in digital solutions such as interoperable electronic patient records between optometry and ophthalmology, and a further development of integrated pathways for optometry so that patients receive the most appropriate and accessible care and are prioritised based on clinical need. It is calling for the reform of commissioning, tariff and data reporting systems, which it believes will ultimately help the NHS ophthalmology services. All those things should be part of a national eye health strategy.

The strategy must be inclusive and must address the needs of everybody. The charity SeeAbility has pointed out that people with learning difficulties are 10 times more likely to have a serious sight problem than other people, but are far less likely to have a sight test. What is happening to ophthalmology services in the NHS is clearly a matter of extreme concern and is one example of just how damaging the privatisation of NHS services is to the delivery of a universal and comprehensive national health service.

The increasing use of the independent sector to treat NHS patients leaves us vulnerable to the vagaries of the market. Under this Government, the use of private-sector companies in health has increased. Indeed, the Health Service Journal reported last December that the amount spent by NHS trusts on outsourcing activities to other providers has almost doubled from £2.4 billion in 2019-20 to £4.7 billion in 2022-23. The HSJ stated that independent providers are

“likely to make up the bulk of the spend”.

The Minister will say that the Government are not privatising the NHS, but that is smoke and mirrors. The World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

We have seen that in ophthalmology, with the commercial interests of private companies driving the increased expenditure on NHS cataract provision. That is the view of ophthalmologists. No doubt the Minister will say that the Government are providing the national health service with record levels of funding—again, smoke and mirrors. The fact is that, as pointed out in the 2023 report “The Rational Policy-Maker’s Guide to the NHS”, NHS spending has not been enough to keep pace with need when we factor in and combine the effects of inflation, population growth, population ageing and increased morbidity.

I ask Members to think about the questions I raised at the beginning of the debate. How would you feel if you lost your sight, how would it impact your life, and how would you feel if you then found out that the loss of your eyesight could have been prevented? How would you feel if you found that you could not get the treatment you need because less serious conditions were being treated as a priority in the independent sector by specialists who were lured there, away from the NHS, due to how commissioning works and because the market is increasingly influencing what is and is not treated?

RNIB figures show that every day, 250 people in the UK start to lose their sight. We need the national eye health strategy, the goal of which should be to preserve vision and prevent irreversible sight loss. I call on the Government to address those issues as a matter of urgency. The Government must invest in the national health service and strengthen it as a public service to ensure that it is universal and comprehensive. For that, they must build the capacity of expertise within the NHS so that we can be confident that the service is there to treat all eye conditions. In the words of Professor Ben Burton, the chief executive of the Royal College of Ophthalmologists,

“the key to ensuring long term capacity to deliver patient care is to invest in comprehensive NHS services, workforce and infrastructure.”

Photo of John Martin McDonnell John Martin McDonnell Labour, Hayes and Harlington 5:52, 30 April 2024

I congratulate my hon. Friend Margaret Greenwood on securing this debate. That was a comprehensive and detailed, but succinct, assessment of where we are at. Sometimes, the role of Members of Parliament is to identify an issue before it comes into crisis so that we can advise Government on the action that is needed, and that is exactly what my hon. Friend has done.

When some of my constituents identified this topic as the subject of an Adjournment debate, they approached me to raise an issue I have been dealing with for the last 20 years: people whose eyesight has been damaged as a result of refractive eye surgery, or laser treatment, as some know it. The refractive eye surgery sector is now a huge profit-making industry. Many gain through the use of refractive eye surgery, and their eyesight is benefited, but there are many others—in fact, thousands every year now—whose vision is damaged as a result of the surgery.

Many years ago, a campaign called My Beautiful Eyes was launched by a woman called Sasha Rodoy. Some people will know of her if they have dealt with these laser treatment issues in any way. She is a heroine. Each year, we organise a lobby of Parliament called Bad Eye Day. We bring together individuals whose eyesight has been damaged by refractive eye surgery and their families. When I say “damaged”, for many of them, it is to the point where their eyesight is nearly lost. Many others have heartbreaking stories of losing their employment or being severely disabled.

In 2004, Frank Cook, who was then a Labour MP, introduced a private Member’s Bill to address the issues confronting people whose eyesight had been damaged by refractive eye surgery. I co-sponsored the Bill, which basically called for regulation of the sector. In 2013, I produced a ten-minute rule Bill that reflected many of the proposals that Frank had put forward. We have had debates, meetings with the royal colleges and ministerial meetings. All we have been asking for over the past 20 years is greater regulation—effective regulation—but progress has been limited. Even in the Government’s own inquiry into cosmetic surgery, Sir Bruce Keogh identified laser surgery as something that should be subject to further regulation. To be frank, nothing has followed from all those ministerial meetings and debates, from all the legislation we put forward or from the Government’s own inquiry.

We need effective regulation that runs through every aspect of the process. The first aspect is the marketing and advertising of these treatments. As Sasha Rodoy says, the industry is notorious for making outlandish claims about the effectiveness of surgery. On a few occasions, we have taken companies to the Advertising Standards Authority and they have been found guilty of exaggerating their claims about the treatment.

Secondly, we want regulation of the advice provided to people who commission the surgery. It is about getting appropriate advice, and about whether the individual’s eye is appropriate for the type of surgery. At one stage, we found that advice was being provided by members of staff who were not qualified and were simply selling the product. We want the provision of advice to be regulated, supervised and monitored.

We also want surgical practices and professional standards to be supervised and monitored. I have dealt with several cases in which professional standards have fallen below what we would expect and people have been harmed as a result. When things go wrong, the company will often fail to put things right adequately. It will delay its response and will often try to get beyond the limit when legal action can be taken. Those individuals then have to fall back on the NHS.

Time and again, the NHS has to address complex injuries as a result of laser treatment, yet the financial burden falls not on the companies but on the NHS itself. We have argued that the performance records of those private companies and, if necessary, of the surgeons involved should be published to identify where harm has been caused as a result of action taken. Where NHS involvement is needed to correct or address the concerns that people have been left with, maybe there should be a levy on those private companies so that the cost burden does not fall on the NHS.

We are now 20 years on from that first piece of legislation, which Frank Cook brought forward because—if I recall rightly—he had gone through that experience and was interviewed by the media about it. All of a sudden, he received a flood of correspondence from people saying, “The same thing’s happened to me: I’ve had the same sort of injuries.” When I raised the issue in 2013, I had literally hundreds of emails coming in. We have a national lobby each time, and some of the stories are absolutely heartbreaking.

I know that there are demands on the Minister’s time, but it would be really useful if, like some of his predecessors, he met victims of refractive eye surgery who have become campaigners and the professionals they work with, so that we can address the current situation, get an objective overview of where we are and then agree a programme for reform. All that people are asking for is adequate regulation based on monitoring of professional practices, so that they feel protected. At the moment, as my hon. Friend the Member for Wirral West said, there is a real risk of eyesight loss. It is one of the worst things that can happen to people, because they become completely isolated from the world. It is incredibly distressing.

That request fits with the demand for a national eyesight strategy, which is desperately needed. What my hon. Friend described is happening across the country. There is a fear that if we do not address it now, we could quickly get into a crisis as a result of the loss of professional staff to the NHS in particular. My hon. Friend Alex Sobel also mentioned the postcode lottery of access to those services. I hope that the Minister will agree to meet campaigners on this issue, which is worth addressing, so that at least they can have their say and he can take advice on the programme of reform that we need.

Photo of Mark Hendrick Mark Hendrick Labour/Co-operative, Preston

We now move to the Front-Bench contributions.

Photo of Kirsty Blackman Kirsty Blackman Shadow SNP Spokesperson (Cabinet Office) 6:01, 30 April 2024

Thank you for chairing the debate, Sir Mark. If my voice goes during my speech, I will just sit down, and hon. Members can assume that the rest of it would have been fabulous.

I congratulate Margaret Greenwood on securing this important debate. As John McDonnell said, it is important to highlight these issues before we get to the point of total crisis. I will talk about what has been happening in Scotland on preventable sight loss.

I thank and commend everybody who works in eye care, whether they work as optometrists or in ophthalmology in hospitals, and everybody who provides those incredibly important services to people. We recognise the hard work and dedication that they put in to ensure that as many people as possible continue to have the best possible eyesight.

As the hon. Member for Wirral West said, whether someone can see properly has a significant impact on their life. When I was eight years old, I lost my eyesight completely over a week. I had optic neuritis, which is incredibly unusual for an eight-year-old. For a short period, I genuinely could not see almost anything. Thankfully, I was treated well and helpfully by the team at Aberdeen Royal Infirmary and got my sight back entirely, which does not always happen with optic neuritis. Although I did not have to deal with that situation in the long term, I am aware of how terrifying it is. It has a major impact on people’s lives.

With our public platform, we should do everything we can to encourage people to get their eyes tested regularly and have regular eye examinations. Eyesight is important, but most people probably take it for granted most of the time. Regular checks can ensure that optometrists and community optometrists discover any possible future eye conditions and that people are given treatment as early as possible. Eye checks can also highlight more serious conditions such as cardiovascular issues, high blood pressure or diabetes. In Scotland, we have free universal NHS eye checks in community optometrists. Those check-ups are available for everybody—UK residents, refugees, asylum seekers and some eligible overseas visitors— and people do not have to pay. I encourage people to get their eyes checked regularly: it is important to go along.

I will talk about our strategies and workstreams for ophthalmology. In Scotland we have what is called the national ophthalmology workstream, which has brought together the views of a huge number of people working in ophthalmology, particularly around hospital care, to ensure that the best possible service is provided to everyone. There are workstreams on things like cataract surgery, which the hon. Member for Wirral West has mentioned, to ensure that people are given the best cataract surgery as early as possible. Successful surgery in the first instance also reduces the need for follow-up appointments.

The strategy tries to ensure that, even with Scotland’s fairly unique geography, as many conditions as possible can be treated close to people’s homes and in their communities. If hospital appointments are needed, they should be there, but if the need for hospital appointments can be reduced by providing the same or a similar service closer to home, that is encouraged.

We recently had a pilot of the NHS glaucoma service in communities, which started in Glasgow and has been rolled out across Scotland. It aims specifically to ensure that the number of hospital appointments is reduced. Going to hospital when you do not necessarily need to can be stressful. If someone can be treated in a primary care setting that they are used to, it is easier and better for everybody. It takes some of the stress off NHS services, ensuring that the necessary services are delivered and that capacity matches demand where possible. As I say, it is about providing the best possible services that suit people, as close to home as possible. We cannot get away from the fact that there is a capacity and workforce issue, not just in England but across these islands, but we have been doing what we can to recognise that. The strategy has been in place since 2017 and is leading to real differences and real improvements for people.

We have a couple of other things in place in Scotland. The See Hear strategy is specifically about ensuring that services are improved for sensory-impaired people. Under the See4School system, every pre-school child has their eyesight tested to ensure that they are as ready as possible to learn when they go to primary school and that those conditions can be picked up as early as possible.

Lastly, I encourage everybody to please get their eyes tested. For anyone who has not been for some time, I thoroughly recommend going. It is not just about being able to see incredibly well with 20/20 vision; it is about ensuring that conditions are picked up. I ask everybody to encourage their constituents to go.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (Primary Care and Public Health) 6:08, 30 April 2024

It is a pleasure to serve under your chairship, Sir Mark. I congratulate my hon. Friend Margaret Greenwood on securing the debate. She is a fierce campaigner on bringing down NHS waiting lists, and for an NHS that remains true to the principle on which it was founded: to be a service that is there for everyone when they need it and that is free at the point of use. I also thank my right hon. Friend John McDonnell, who made a powerful speech about how eye care is often a neglected topic.

The RNIB estimates that more than 2 million people in the United Kingdom live with sight loss. Shockingly, at least half of that sight loss might be avoidable. A recent Royal College of Ophthalmologists workforce census found that 63% of eye units estimate that it will take at least a year to clear their backlogs; a quarter of them estimate that it will take more than three years. Across our country, the demand for ophthalmology services has risen rapidly and is set to increase by 40% over the next 20 years. The economic cost of sight loss is estimated to be £25.2 billion a year. Surely that is too big a price not to act.

The current Government have treated eye care as an afterthought. Today in England, 619,000 people are on a waiting list for a hospital eye appointment, and 250 people start to lose their sight every day. Yet this Government have no strategy for eye health in England, unlike every other UK nation.

The next Labour Government will take eye health seriously. We will crack down on the tax dodgers and use the money to bring down waiting lists. We will train a new generation of doctors, nurses and midwives to treat patients on time. We will double medical school places to ensure that we have the workforce we need, including across ophthalmology. We will reform the system, too, so that everyone can access the right care when and where they need it.

Moving more care to the community will help to support those who are suffering sight loss, as will focusing on the provision of non-clinical community support to complement the work of community optometrists, ophthalmologists in hospitals and rehabilitation officers. That is why the next Labour Government will seek to negotiate a deal with high street opticians to deliver NHS out-patient appointments for eye conditions such as glaucoma. There are currently 6,000 high street opticians in England, equipped with specialist staff and kit that can get patients seen faster. We will put them to work to beat the backlog and free up hospital specialists to treat the patients in serious need. That will all mean greater convenience for patients. As these are routine appointments, it will be less expensive to the taxpayer to deliver them on the high street than in hospital.

We know that delivering eye care in the community works. A 2014 study considered the impact of the introduction of minor eye care services in Lewisham and Lambeth on ophthalmology hospital departments. GP referrals to hospital ophthalmology decreased by 75% in Lewisham and by 30% in Lambeth. Costs in areas that did not have a minor eye care service increased, but costs in Lewisham and Lambeth decreased by 14%. A separate dataset from Hereford in 2022 showed that 92% of referrals to eye casualty by GPs could have been seen by an optometrist via the minor eye care services, and 83% of self-referrals could have been seen by MECS.

Perhaps the Minister can say today whether he backs Labour’s plan to try to strike a deal for high street opticians to deliver additional clinical services. Has he made an estimate of how many people now on hospital waiting lists are waiting to be seen for issues that could easily have been seen in community optometric services? According to a report published last year, more than 550 patients have suffered sight loss since 2019 because of NHS delays. That is absolutely tragic.

It is not just patients who stand to benefit from Labour’s plans. GPs stand to benefit from the removal of low-value, time-consuming paperwork that could be dealt with in opticians’ shops by optometrists themselves. Patients can already go directly to sexual health clinics, as well as to physiotherapists in some parts of the country, without seeing a GP; in Greater Manchester, where lung cancer is the biggest killer of people under the age of 75, patients with risk factors can now get walk-in chest X-rays. Opticians who spot a problem should not have to send patients to their GP for referral to an eye specialist instead of referring them directly. Why is direct referral not the case everywhere? Labour’s plans will see best practice adopted everywhere to allow opticians themselves to refer patients to eye specialists, meaning that patients can be seen faster and GPs can get on with more important and meaningful work.

We know how important eye care services are to our communities. Vision loss in older people has been proven to affect their physical and mental health and to increase the speed of cognitive decline. We know that sight loss can be a symptom of serious disease. The Government must set out a plan for these services, with a mix of strengthened community-based care and prevention policies. It is right that we address the gaps in care co-ordination that disproportionately affect those with the greatest need, to give everyone the best opportunities to access education and employment and to live well in older age. Let us give everyone a right to sight.

Photo of Andrew Stephenson Andrew Stephenson Assistant Whip, Minister of State (Department of Health and Social Care) 6:13, 30 April 2024

It is always a pleasure to see a fellow Lancastrian in the Chair, Sir Mark. I thank Margaret Greenwood for bringing forward the debate. This is the second debate today on eye health to which I am responding on behalf of the Under-Secretary of State for Health and Social Care, my right hon. Friend Dame Andrea Leadsom, who has been busy in the Tobacco and Vapes Bill Committee. I also thank those who contributed to the debate—John McDonnell, Kirsty Blackman and the shadow Minister, Preet Kaur Gill—for their thoughtful contributions.

Preventing sight loss remains one of my right hon. Friend’s top priorities, and it is right that we should dedicate parliamentary time to this important issue. Losing one’s eyesight can be devastating, and I want to pay tribute to some of the charities that I did not have time to mention in this morning’s debate—Fight for Sight, the Vision Foundation and Sightsavers, to name just a few more.

About 2 million people live with sight loss in our country. That number is projected to double by 2050, mainly because of our ageing population. We are doing a huge amount to reduce the number, through preventive measures and early detection. One of the best ways to protect eyesight is through regular sight tests. That point was made eloquently by the hon. Member for Aberdeen North, and I am pleased to confirm to her that I am having my next eye test tomorrow morning.

This debate is why the NHS invests more than £500 million every year on free eye tests for people on benefits, people over 60, and people at risk of serious conditions. That investment delivered more than 12 million NHS sight tests to those groups between 2022 and 2023, and extensive discounts on glasses and contact lenses for children and people on income-related benefits, through NHS optical vouchers.

We have also taken great strides in preventing some of the causes of sight loss, including smoking and obesity. As I mentioned at the start, my right hon. Friend the Member for South Northamptonshire is taking our landmark Tobacco and Vapes Bill through the House, and we are backing quit-smoking campaigns with unprecedented funding and support.

On obesity, we have taken a raft of measures on sugar reduction and healthy eating. We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks levy, and almost halved their sugar content between 2015 and 2019. For two years, we have also been restricting the placement of less-healthy products in shops and online, thereby helping consumers to make healthier choices.

Our wider prevention work goes hand in hand with our efforts to catch eye problems early. Glaucoma—which was covered in the debate this morning—and diabetic retinopathy are two of the main causes of preventable sight losses, and both can cause blindness if left untreated. That is why we are offering screening tests to nearly 4 million patients with diabetes at least once every two years. Since 2010, the number of adults between 16 and 64 who became visually impaired from diabetic retinopathy fell by almost a fifth. Our approach has been commended by the World Health Organisation, and we will build on that progress. In October, we begin phasing in optical coherence tomography scans as part of the screening programme, to reduce unnecessary referrals to hospital eye services and improve the quality of the service overall.

It is vital for patients who need to be in secondary care to have access to timely diagnosis and treatment. That is why we have set ambitious targets to recover services that suffered over the pandemic, through our elective recovery plan, which is backed by more than £8 billion of funding, and why we have expanded surgical hubs and harnessed capacity in the independent sector so that more patients can be seen more quickly. Our plan is working and it is delivering results. Waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology treatment has reduced by 96% since its peak. But we know we have much further to go.

While we work to recover from the pandemic, we are reforming eye care services to be fit for the future. NHS England’s transformation programme is currently funding seven projects across each ICS area, testing how improved IT links between primary and secondary care could allow patients to be assessed and triaged virtually. Where appropriate, that would keep patients out of hospital, freeing up hospital eye-service capacity for those who need specialist care the most.

The initiatives have shown promising results. For example, the project in North Central London ICS has improved the flow of information from community optometry to Moorfields Eye Hospital, reducing the triage time from 11 days down to one. The appropriate use of clinics has doubled to more than 70% and reduced the waiting time for first appointments by up to 35 days. NHS England is now using the data from the projects to build the case for a wider roll-out.

Photo of Kirsty Blackman Kirsty Blackman Shadow SNP Spokesperson (Cabinet Office)

I appreciate what the Minister is doing in this policy area. Some of the initiatives he just mentioned, such as electronic assessments and triaging electronically, were put in place in Scotland seven years ago. We decided that they were working and that we would roll them out. Has he spoken to Scottish colleagues and looked at the work done in Scotland in order to ensure that the Government do not have to replicate the same pilots that we have proven do work, so that people can get treatment and things can be put in place more quickly?

Photo of Andrew Stephenson Andrew Stephenson Assistant Whip, Minister of State (Department of Health and Social Care)

As a proud Unionist, I am always happy to learn from different parts of the United Kingdom. After I was appointed to my role, one of the first things I did was to go to Edinburgh and visit various universities and companies across Scotland, and I saw some of the great work going on in Scotland. I also met the then Health Secretary, Michael Matheson, to talk about areas where we can work together, particularly on things such as research. However, we can also trial different things in different parts of the country. Many people in this House talk about regional variations, which can be a concern. Nevertheless, one of the benefits of being able to trial different things in different regions is that we can learn the lessons, learn what works and then build on that best practice.

As well as helping our primary and secondary care sectors to reach their full potential, we have a long-term plan in place to support our workforce and put it on a sustainable footing, which is the first ever long-term workforce plan for the NHS. We have again increased training places for ophthalmologists in 2024 and improved training for existing staff, helping them to deliver for patients while reaching their full potential.

The right hon. Member for Hayes and Harlington raised what sounded like a very important and serious issue. He will forgive me for saying that this area is not my specialist subject, but I am happy to raise his concerns with my right hon. Friend the Member for South Northamptonshire. However, I will say now, in response to his comments on laser eye surgery, that refractive laser eye surgery is not generally available on the NHS. Doctors who perform such surgery must be registered with the General Medical Council and the Care Quality Commission. All locations where refractive eye surgery is carried out should be monitored and are required to report any adverse events. As I say, I will be happy to relay his concerns to my right hon. Friend.

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

I appreciate the Minister’s response; that is really helpful. It would also be useful if a Minister met some of the families who have experienced issues in this area, because over the last 20 years we have had the same ministerial response with regard to regulation, and there have just been too many examples where that regulation and monitoring have not worked and therefore people have been endangered. That is why in the Government’s own report Professor Sir Bruce Keogh recommended further regulation; I think we need to revisit that.

Photo of Andrew Stephenson Andrew Stephenson Assistant Whip, Minister of State (Department of Health and Social Care)

I thank the right hon. Gentleman for making those points. I am not instinctively anti-regulation; indeed, just a few weeks ago I put through this place the statutory instrument on the regulation of physician associates and anaesthetist associates. There are certain parts of the healthcare sector where regulation is very much needed and I would very much advocate for it. As I have said, I will defer to my right hon. Friend the Member for South Northamptonshire. This is her ministerial responsibility, and I am sure she will read the right hon. Gentleman’s comments with interest and may want to take the discussions further.

Finally, on research, the Government are backing scientists and researchers to take strides in understanding sight loss and in making new treatments available. Two years ago, we awarded £20 million to Moorfields Biomedical Research Centre to undertake another five years of vision research, and almost £6.5 million to Moorfields Clinical Research Facility to support cutting-edge treatments for all eye conditions.

Eye care services face challenges and we are taking decisive action to address them, both now and in the long term. The hon. Member for Wirral West and I will never agree on the use of the independent sector. I strongly believe, and think the Labour Front Bench team strongly agrees, that using the independent sector enables us to fully realise our healthcare system’s capacity and to reduce the time that patients spend on waiting lists. I would argue that that does not represent any move to privatise our NHS. As I have said on the record before, the overall proportion of NHS England’s spend on independent sector providers has not increased significantly in recent years. In 2013-14, 6.1% of total health spending was spent on the purchase of healthcare from independent sector providers; in 2022-23, the proportion was 6.5%.

This morning, the shadow Minister in the first Westminster Hall debate, Andrew Gwynne, talked about making better use of the independent sector to help to ensure that we deliver the best outcomes for patients, and the shadow Minister in this debate, the hon. Member for Birmingham, Edgbaston, reiterated that point. On the use of the independent sector, then, I gently say that it is something on which there is broad cross-party support. While recognising that there are always challenges with the use of the independent sector, it is not in any way a privatisation of the NHS.

I firmly believe that through prevention, innovation and investment in our workforce, we will deliver for all our people across the United Kingdom access to the important healthcare services, including ophthalmology services, that they deserve.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West 6:24, 30 April 2024

The Minister said that he is never going to agree with me on the use of the independent sector. Will he look back over this debate and consider the points I have made—and not just my views but those of the Royal College of Ophthalmologists and the RNIB—and the outcomes that are arising as a result of the increased use of the independent sector? He takes an ideological position, but what I am asking him to do is look at the practical outcomes of what is going on.

I thank all Members who contributed to the debate, including my hon. Friend Alex Sobel and Jim Shannon, and in particular my right hon. Friend John McDonnell for his work on behalf of those who have had their eyesight damaged through laser surgery. I hope the Minister will pick up on his call for further regulation and for a meeting with the victims of that treatment. I also thank the many organisations that contacted me in advance of the debate with their thoughts and briefings. It is vital that we do all we can to ensure the provision of comprehensive and universal eye care in the national health service.

The growth of the independent sector in delivering almost 60% of NHS-funded cataract procedures is having a negative impact on patient care, as more than two thirds of NHS ophthalmology departments have said. As a result, treatment for other eye care conditions in the NHS—such as glaucoma and macular degeneration, which are generally considered to be more serious and which lead to irreversible sight loss—are being adversely impacted. We must also consider the potential impact of the availability of treatment for people in urgent care after, for example, a road traffic accident; the treatment needed for newborn babies; and the treatment of cancer both now and importantly for future generations.

Currently, the market is influencing what is and is not treated, and private companies are cherry-picking the treatment that they want to deliver. This is no way to protect and strengthen the national health service. We need a national eye health strategy to preserve vision and prevent sight loss as a matter of urgency. We need a comprehensive and universal national health service that is there for us all when we need it for eye care and all other areas of health. I thank everybody who contributed to the debate.

Question put and agreed to.

Resolved,

That this House
has considered preventable sight loss.

Sitting adjourned.