Glaucoma and Community Optometry

When I got home I went to see my optician right away and told her what was going on. I explained the circumstances and took her the graph. She said, “Look, Jim, I checked your eyes. I do not see anything wrong with them, but do you want them checked thoroughly?” I said, “Yes, definitely.” So she sent me to the eye clinic in Belfast’s cathedral quarter and I got my eyes checked. Everything is done there, 24/7—all the eye checks that are humanly possible. For ages after, my eyes were stinging. The guy came out after an hour and said to me, “I have done every possible check on your eyes. There is nothing wrong with them.” That was good news after a very thorough check. Since then, my optician has done a thorough check for glaucoma on my eyes, simply because it is hereditary and to ensure my peace of mind. I tell that story because it worked out well for me, but it does not work out well for everyone.

Typically, there are no symptoms to begin with, as glaucoma develops slowly, affecting the periphery of the vision at first. That means that hundreds of thousands of people in the UK currently have glaucoma. Betty in my office gets an annual eye test because her father had glaucoma and she was aware of the issue. When I asked my younger staff when they had last had their eyes tested they said, “Not since school. I don’t need glasses so why should I get an eye test?” I immediately asked them to book a test, and told them that it is like an MOT that needs to take place. The MOT tells us if our car runs okay and what repairs we need; it is the same when we get our eyes tested. The eyes may be known as the window to the soul, but they are also undoubtedly the window to the view of overall health that can be found in an eye test. Eye tests are imperative for finding an early diagnosis of diabetes, for example, and a host of other health concerns.

I remember two occasions when opticians saved the lives of gentlemen who came to see me in my office. One guy I know well came in and he was a terrible colour. I said, “Are you okay?” and he said, “To tell you the truth, I don’t feel at all well. I have been to the doctor who told me to see an optician, and I’m going there now.” I said, “I hope you’re okay.” He was as grey as a badger and it was really quite worrying to see him. He went straight from the optician, who referred him, just up the road to the Ulster Hospital. He had a tumour close to his eye and brain, which was removed in an urgent operation. The other person, who went to a different optician in Newtownards, had the same problem, was also referred to the hospital and also had a tumour removed.

Tests at the optician’s are incredibly important. They can diagnose not only glaucoma but many other things, so it is important to have them. Optometrists have a key role to play because they can spot the early signs of glaucoma during routine tests. For patients with stable glaucoma, optometrists have a role in monitoring eye health and helping them to manage their condition.

Alarmingly, a fifth of the population—some 21%—still do not know how often they should visit the optician for a routine check-up. The same percentage either cannot remember their last eye examination or have never had one. Opticians in my Strangford constituency, and particularly in Newtownards town, have told me they are anxious and keen to ensure that people have regular tests. It is about how to ensure that can happen. I hope the Minister will respond to requests, including from the shadow Minister, and is able to reassure us on how we can encourage a UK-wide method to help.

For those with glaucoma or suspected glaucoma who are referred to hospital, long NHS waiting lists, exacerbated by the pandemic, remain a problem. Alarming figures show that around 650,000 people are waiting for NHS ophthalmology appointments. Will the Minister indicate the steps that can be taken to reduce that number and help those 650,000 people to retain their eyesight? There are steps that we can and must take. I always try to be constructive; it is important to come with a positive attitude on how to do things better. We should be big enough to accept that changes need to be made, and then we can do it.

Although optometry services remained open for urgent care during the covid-19 pandemic, the number of sight tests dropped by 4.3 million in 2020—my goodness—which was a 23% decline compared with tests administered in 2019. In respect of that dramatic drop and the need for improvement, perhaps the Minister could suggest methodologies to address and target those who have fallen out of the system. The drop in the number of eye tests resulted in large reductions in referrals from primary care to hospitals. That is where the fall seems to be, and perhaps where it needs to be addressed. As a result, sight loss has increased hugely since the pandemic.

How can we increase referrals from primary care to hospitals? If we do that, we will have moved a long way. I will give some examples from Northern Ireland—not about how nice it is to visit, Dame Caroline, but about the issues of vision and health. In Northern Ireland there are two glaucoma referral and refinement pathways. By contrast to England, they are available at all community practices, as long as clinicians have the right accreditation in glaucoma care. It is fortunate that my GP service and many others have such access. Through the services, patients have their glaucoma tests completed in the community, and the results are then shared securely with the patient’s ophthalmologist. This joined-up approach helps to streamline the experience for the patient and ensures that optometry practices and ophthalmologists work together for the benefit of the patient. I always try to be constructive in my comments and give examples of what we do, because if we do something well, others need to know, and if the Minister does something well here on the mainland, we need to know about that in Northern Ireland as well.

There is also an ocular hypertension monitoring service in the community across Northern Ireland. The scheme allows optometrists to manage in the community patients who would previously have been seen by the hospital eye services. A significant number of patients—some 2,000 to date—have been discharged to the scheme. That is an example of how it is proactively engaging and working. It has helped to free up the capacity in secondary care to manage more complex cases.

Those successful services show that community optometry, alongside other primary care providers, is responsible for delivering the shift from secondary to community care and is able to do so at almost no cost to the taxpayer, given that it uses existing capacity. What we have is an example of how things can be done—and perhaps spread across all of this great United Kingdom—in a better way. Those working alongside optometrists, who wish to ensure that people have their tests regularly, are keen to assist and to make changes. When the Minister speaks to the Association of Optometrists—as he probably already has—I believe he will find that he is pushing at an open door and that the ideas that he and the Department have are ones that optometrists have too.

Overall, Northern Ireland has shown how a model focusing on glaucoma care in the community can be effective. The challenge in Northern Ireland is that these services sit outside the general ophthalmic services—GOS—contract, which means that they rely on non-recurrent funding and are not subject to a regular uplift in fees; indeed, fees have never been reviewed. Given the success of these services, the push in Northern Ireland is for their funding to be put on a more stable, recurring footing and to be subject to the same process for fee uplifts as GOS. I have another ask to put to the Minister, in a constructive fashion: will he see whether the fees in place can be reviewed and how best the system could be used to improve things?

I know that the shadow Minister will make an incredible speech. By the way, I am not giving him a big head; that is what he always does, because he understands these issues incredibly well and brings forward his own ideas and his party’s ideas to this process.

I want briefly to highlight the difficulties arising with cataract surgery. It is wonderful how cataract surgery can improve people’s eyesight. I am a type 2 diabetic, but some years ago, before I was a diabetic, I went to see about surgery, not for cataracts, but to improve short-sightedness. I did not have the surgery, because I was not entirely confident about it, and shortly after, I became a diabetic. I tell that story because a good friend of mine in Greyabbey—I will not mention his name—was a type 1 diabetic and went for some corrective surgery to his eyes. Unfortunately, he ended up losing his eyesight; that is not the fault of anyone, but the diabetes complicated the issue, and he is now registered blind. Again, there are complications in relation to eye surgery for those who are diabetic, just by the nature of what happens.

Cataract surgery is currently the most common NHS elective surgical procedure, accounting for the majority of the large ophthalmic backlog facing the NHS. My mother has had one of her cataracts removed; she has a second one to remove, but I suspect that, unfortunately, her state of health means that the second procedure will not be done. Between 10% and 15% of those with cataracts suffer from concomitant glaucoma, and I am bringing the issue into the debate because cataracts are often treated separately. I suggest that we consider how we could do the two together—the glaucoma and the cataract surgery.

I have been informed by a company named Clarity that there is an opportunity to treat patients for cataracts and glaucoma at the same time. It is obviously more cost-effective, and although I know we should not always dwell on the cost, we cannot ignore it. If there is a way of doing simpler, easier and cheaper surgery more effectively, let us look at that. I am ever mindful that the Minister has four competent members of staff behind him, who will clearly keep him right, so might they be able to do some research on that?

Treating cataracts and glaucoma together expedites patient backlog reduction and helps save people’s sight by preventing the further progression of glaucoma. The treatment is quite innovative, new and effective, and it is important that we should do it. Micro-scale injectable therapies produced by Glaukos can advance existing glaucoma standards of care and improve patient safety by removing the need for invasive secondary surgery and tackling ophthalmic backlogs. So many people wait for their cataract operations and for improvements to their glaucoma. If we catch things early, we can save the sight, and that is a critical factor. Again, can the Minister look at that and ascertain whether the approach I have just referred to could be a cost-effective way forward? I am sure he knows about it, but if he—and indeed the shadow Minister and others—does not, I would be happy to have a response later. The treatment seems to me to be a win-win, so will the Minister confirm whether the Government will initiate it urgently?

Local optometrist services form a vital part of the eye care patient pathway and of directing patients to vital sight-saving medical technologies. It is incredible to live in an age when 50% of all cancer patients can survive and people’s eyesight can be saved if it is checked and their problems with glaucoma are diagnosed. Are we not fortunate to live in this age? Although I am not the oldest person in the room—I suspect that my colleague on the left-hand side, my hon. Friend the Member for East Londonderry (Mr Campbell), might just be a tad ahead of me by a couple of years—I have seen the great advances we have made in medical technology. We are doing great things, and we could do more. Is it not incredible that all we really need is to check? It is not terribly costly, but if we check, we make the difference.

Optometrists are the ones who are properly trained in the pathway. We must ensure that pathways are clear and that funding is available to ensure that, instead of 22 people a week losing their sight in the United Kingdom of Great Britain and Northern Ireland, no one at all loses their sight and their independent life—something that could have been prevented. I know that the Minister shares my goal and that the shadow Minister definitely shares it, as does my hon. Friend the Member for East Londonderry. As a result of today’s debate, I hope we will have a progressive strategy going forward, and I am anxious to hear what the Minister and the shadow Minister have to say, so that we can feel that they understand the path towards achieving this goal and will focus on and direct it.

I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.

The next Labour Government are committed to reforming the system so that those with glaucoma and other eye health conditions can access care when and where it is needed. We will provide 2 million more operations and appointments on evenings and weekends, paid for by clamping down on tax dodgers, so that patients can be seen on time again. We will have a laser-like focus on prevention, tackling the social determinants of ill health and ensuring that eye conditions such as glaucoma are tackled at source. We will ensure that the NHS shifts from an analogue to a digital service, embracing the latest developments in technology and artificial intelligence to provide the best possible care and deliver the best possible patient outcomes.

Again, I declare an interest: being a bespectacled Member of Parliament, I obviously have routine eye tests. I am short-sighted, although age is catching up with me, and this is the first time that I have had varifocals for reading and for distance. However, my optometrist, Dr Shen of Boots opticians in Denton, has brought in and embraced some of the latest technological advances for testing different eye conditions. At my last eye test, I was amazed at the wizardry and machinery they have brought in, revolutionising the way they can diagnose.

This approach is backed up by evidence, proving the tangible impact of community-based eye care and eye health services. A 2014 study of the introduction of minor eye care services in Lewisham and Lambeth showed how significant that impact is. GP referrals to ophthalmology specialists in Lambeth decreased by 30%, with an even greater reduction—75%—in Lewisham. Costs in areas without minor eye care services increased, while there was a drop in costs in Lewisham and Lambeth of 14%.

Given that the sector is in clear need of reform, with patient outcomes continuing to suffer, will the Minister back Labour’s plan to unlock the potential of community optometry? With more than 550 patients suffering sight loss because of delays in the NHS since 2019, does the Minister accept that further inaction is simply not an option? These are people whose lives, and those of their loved ones, have been fundamentally changed through no fault of their own. We owe it to them to fix this system once and for all, working in partnership with the devolved Administrations across the United Kingdom, as the hon. Member for Strangford says, so that there is not a postcode lottery on these services, and we get the best outcomes for all British citizens across the United Kingdom. We owe it to them to ensure patients with glaucoma and other eye health conditions get the care they need, when they need it, and where they need it.

We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.

As the hon. Member for Strangford suggested, everyone should have a sight test every two years. The NHS invests over £500 million every year in providing sight tests and optical vouchers. Between 2022 and 2023, we delivered over 12 million NHS sight tests free of charge. The tests are widely available for millions of people and the budget is entirely demand led, meaning that there is no cap on how many we will provide. We understand that some people may not prioritise sight tests compared with other healthcare, or they might not know that eye tests are recommended every two years. That is why we are always looking for opportunities to remind the public to have a test, through social media and other campaigns. Sight-test providers such as Specsavers and others on the high street display information about NHS sight-test eligibility.

We are committed to making greater use of community optometry to help to alleviate pressures in secondary care. Many integrated care boards are already commissioning a greater range of services on the high street, including minor and urgent eye care services, pre and post-cataract checks, and glaucoma referral filtering and glaucoma monitoring.

Glaucoma referral filtering schemes have delivered fantastic results, with additional tests that double-check whether a patient really needs to be referred to secondary care. These are tried-and-tested schemes that can save patients time and worry while freeing up space for those who most need specialist attention in hospital. Devon is a great example of that. An old Nightingale ward has been repurposed with equipment to screen large numbers of glaucoma and medical retina patients. The diagnostics hub has demolished the hospital’s backlog from just under 4,000 in April 2022 to just below 500 in October 2023—almost a 90% decrease. In Milton Keynes, 70% of suspected glaucoma patients were discharged following refinement of initial referrals made on the high street. About 50% of integrated care boards currently have a version of those schemes in place, and we are assessing the potential for encouraging the roll-out of those schemes even further.

It is vital that patients who need secondary care have access to timely diagnosis and any necessary clinical treatment. The hon. Member for Strangford is right to say that those services suffered during the pandemic, just as they have across the NHS. That is why we have set an ambitious target to recover services through the elective recovery plan, supported by more than £8 billion of dedicated funding, and it is why we have expanded surgical hubs and harnessed the capacity of the independent sector, so that more patients can be seen more quickly. That has been particularly successful for cataract surgery.

Our plan is working and it is delivering results, as waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology has been reduced by 96% since its peak, but we know that we have to go further. As well as cutting waiting lists today, we are looking at how we can reform eye care services to meet the demands of tomorrow. NHS England’s transformation programme is running seven projects across each integrated care system area, such as those that test how improving IT links between primary and secondary care could allow patients to be assessed and triaged virtually, saving them time and freeing up more hospital capacity for patients who need specialist face-to-face care the most. NHS England is gathering data and evaluating different interventions, looking to develop a convincing case on what works best and supporting further expansion.

We are going further and faster to free up hospital capacity. Today, many glaucoma patients often have their condition managed in hospital, but in some cases, where clinically appropriate, there is no reason why they cannot be seen somewhere else in their community that is more convenient for them. In England, it is up to ICBs to commission services based on local need, and some ICBs are already trying new ways of working to do just that.

Finally, on research, I want to recognise just how much potential there is for research and innovation to change the lives both of people who suffer from sight loss and of their families. The UK leads the world in research; we could not be more committed to pioneering new treatments and improving our understanding of sight loss. We put our money where our mouth is by awarding the Moorfields Biomedical Research Centre £20 million to carry out another five years of world-leading research in December 2022. Thirteen out of the 100 leaders and innovators in ophthalmology across the world who were included in The Ophthalmologist’s “Power List 2023” were researchers from Moorfields, and we should be proud that that centre of excellence is right here in London.

The Minister referred to £5 million of pioneering technology from the United Kingdom. We lead, across the world, in relation to that. He also referred to a new model within the NHS: proactive, progressive ICB best practices.

Today, we have been encouraged by the Minister. We are very pleased with his response. I can tell people who watch this debate on Parliamentlive.tv or who read Hansard—people will get copies from me in my constituency —and want to know what we are doing that we do not need to do anything really expensive. We just need to be proactive.

I look forward to the implementation of the plan to which the Minister referred, and I very much welcome the turbocharged priority that the shadow Minister and his party are prepared to give to the issue. I thank you, Dame Caroline, as always, for your chairship. You make so much of these debates and we appreciate that.