Preventing avoidable sight loss

This debate pack is prepared for a Backbench Business Committee debate in Westminster Hall on 28 March 2017 on preventing avoidable sight loss. The debate will be led by Nusrat Ghani MP.

The 2016 Royal National Institute for the Blind (RNIB) report, The State of the Nation, Eye Health 2016 estimates that more than 2 million people in the UK have sight loss that has a significant impact on their daily lives.[1] It predicts that this number will increase by a third between now and 2030. The report also estimates that sight loss is costing over £28 billion to the UK economy, through both direct costs of healthcare, and indirect costs, for example, lower employment levels.

The RNIB website also provides useful general information on eye health, the importance of eye examinations and how to reduce the risk of developing sight loss.

The most common causes of avoidable sight loss are:

• Cataracts;
• Glaucoma;
• Diabetic retinopathy; and,
• Age related macular degeneration.

The Department of Health Public Health Outcomes Framework, Healthy lives, Healthy people: Improving outcomes and supporting transparency sets out a number of outcomes and indicators for the improvement of public health in England. It allows data to be collected and monitored on a number of health indicators across the whole range of public health issues, including visual impairment. A June 2016 Parliamentary Question response provides information about the preventable sight loss indicators, and 2013/14 figures for certifications of visual impairment:

[…]The indicator is made up of four sub-indicators which are measuring the crude rates of Age-Related Macular Degeneration, glaucoma and diabetic retinopathy, and of the rate of sight loss certifications per 100,000 population.

The latest data published by the Public Health Outcomes framework show that there were the following new certifications of visual impairment in 2013/14:

- 11,055 for age related macular degeneration, a decrease of 90 from 2012/13;

- 3,432 for glaucoma, an increase of 141 from 2012/13;

- 1,563 for diabetic eye disease, a decrease of 29 from 2012/13; and

- 22,911 overall new certifications (all causes), an increase of 264 from 2012/13.

Early detection is essential to tackling preventable sight loss. A range of treatment and services are in place in the National Health Service to deal with the key causes of preventable sight loss [2]

1.1 National strategies for eye health

In her application to the Backbench Business Committee, Nusrat Ghani reported that there was no English strategy for eye health, but there were existing strategies on this issue in Scotland, Wales and Northern Ireland. Links to these strategies are included below:

• Scottish Government, Sensory Impairment Strategy, 2014
• Welsh Government, Together for Health: Eye Health Care, Delivery Plan for Wales, 2013–2018
• Northern Ireland Department of Health, Developing Eyecare Partnerships: Improving the Commissioning and Provision of Eyecare Services in Northern Ireland

A March 2017 Parliamentary Question response from the Under-Secretary of State for Health, David Mowat stated that there are no plans to develop a national strategy for eye health, given the size and variety of health needs in England, the approach should be managed locally:

There are no plans to develop a national strategy for eye health. NHS England and the Department contribute to and support the current voluntary sector led England Vision Strategy. Given the size of England, and the diversity of the health needs of different communities, we believe commissioning needs to be owned and managed locally.

Clinical commissioning groups (CCGs) are responsible for commissioning hospital eye services and are also able to commission eye care services in the community which go beyond the standard National Health Service sight test where they judge them to be needed in their areas. CCGs are required, for all services they commission including ophthalmic services, to carry out an assessment of the health needs of their local population using the standard joint strategic needs assessment approach. Improving the commissioning of services is one way that we expect to see improvements for patients and the Clinical Council for Eye Health Commissioning is working with CCGs to develop commissioning guidelines in this area.[3]

1.2 UK Vision Strategy

The UK Vision Strategy 2013-18 is led by health professionals, key charities and stakeholder groups, and is supported by the Government.

The strategy sets six priorities:

1. Detecting eye conditions early, especially in seldom heard groups;
2. Promoting a consistent strategy for eyecare commissioning;
3. Improving the Certification process – making sure people who are eligible actually get certified and registered and that relevant data flows through the whole eye health and sight loss pathway;
4. Early intervention to ensure practical and emotional support post diagnosis (for example, an ECLO available in every eye department);
5. Habilitation and rehabilitation available on a free and timely basis for as long as needed to learn or relearn key life skills including mobility;
6. Development of peer support and self-help groups in every community for adults, children and families to provide voluntary sector support for independent living and to lobby for inclusive local public services.An October 2016 Parliamentary Question response form the Under-Secretary of State for Health, Lord Prior of Brampton stated that the Government supports the aims of the UK Vision Strategy, and also outlines further Government action to tackle preventable sight loss:

Regional groups will be established across all nine England regions with line of sight to every local authority and CCG area in England to support implementation of the strategy. Further information is available in the strategy’s Case for Change.

An October 2016 Parliamentary Question response form the Under-Secretary of State for Health, Lord Prior of Brampton stated that the Government supports the aims of the UK Vision Strategy, and also outlines further Government action to tackle preventable sight loss:

The Government supports the aims of the UK Vision Strategy of improving eye health, preventing avoidable sight loss, improving services for those who do lose sight, and maximising social inclusion and opportunities for blind and partially sighted people.

Improving the commissioning of services is a key priority for the National Health Service and social care services, and this is one way that we expect to see improvements for patients.

The Public Health Outcomes Framework is an online only data tool which examines indicators that help us to understand trends in public health. It includes an indicator on preventable sight loss which will track three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy. The open availability of data provide a resource for commissioners and local health and wellbeing boards to identify what is needed in their areas and for comparisons to be made with other areas. The online data tool is available on the Public Health England website.

Our public health programmes tackling smoking and obesity will also help prevent sight loss by addressing some of the key risk factors in the development of eye disease.[4]

[1] RNIB, The State of the Nation Eye Health 2016

[2]HL Written Question HL2226, 25 October 2016

[3]HC Written Question 68288: Eyesight, 22 March 2017

[4]HL Written question - HL2226, 26 October 2016