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.
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, the hon. Member for Denton and Reddish (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, the hon. Member for Lewes (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. The hon. Member for Great Grimsby (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.
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?
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?
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.
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. The hon. Member for Rutherglen and Hamilton West (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.
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.
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.
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?
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, the right hon. Member for Hayes and Harlington (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.
It is a pleasure to serve under your chairmanship this morning, Ms Nokes. I pay tribute to the hon. Member for Strangford (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.
It is a genuine pleasure to serve under your chairmanship, Ms Nokes. I wish you, and everybody here, a happy new year.
I thank the hon. Member for Strangford (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 the Member for Hayes and Harlington (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.
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.
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.
It is a pleasure to serve under your chairmanship, Ms Nokes. I also pay tribute to the hon. Member for Strangford (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, the hon. Member for Enfield, Southgate (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.
20 of 43 shown
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.
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 the Member for East Londonderry (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—the hon. Member for Sedgefield (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.
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.
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.
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.