Eye Health: National Strategy

Marsha De Cordova Excerpts

Wednesday 17th May 2023 Westminster Hall

[Marsha De Cordova (Battersea) (Lab)]

I beg to move,

That this House has considered the potential merits of a national eye health strategy.

It is an absolute pleasure to serve under your chairmanship, Mrs Harris, and I am pleased to have secured today’s debate. Let me begin by placing on the record my thanks to the many organisations that have sent through their briefings and shared their knowledge and expertise, including the Association of Optometrists, the Royal College of Ophthalmologists, Specsavers, SeeAbility and the Royal National Institute of Blind People, which have all supported my National Eye Health Strategy Bill as well.

There is no question but that we need the Government to introduce an eye health strategy in England, because there is an emergency in eye care. Huge backlogs, which were apparent before the pandemic, are leading to people unnecessarily losing their sight. The annual economic cost of sight loss is currently estimated at £37.7 billion. An estimated 2 million people are living with sight loss in the UK, and anyone can be affected by it. As Members, we will all have constituents who have been or are being affected, because 250 people begin to lose their sight every day, with a shocking 21 people a week losing their vision due to a preventable cause. On top of that, we know that 50% of all sight loss is avoidable. We should all be asking why so many people are needlessly losing their sight or going blind.

The backlog for ophthalmology appointments in England is one of the largest in the NHS, with over 630,000 people on waiting lists as of 23 March this year—more than 9% of the total backlog. Ophthalmology has been the busiest NHS out-patient clinic for the last three years, with 7.5 million hospital attendances in England in 2021-22. It is shocking that eye care accounts for only 2.6% of NHS consultants and 1% of the total number of doctors.

[Paul Blomfield (Sheffield Central) (Lab)]

I congratulate my hon. Friend on securing this really important debate. She is making a significant point about capacity. Does she agree that there is a need to ensure that the long-awaited workforce plan the Government have promised pays proper attention to this area of specialism and takes account of the need to train more people as part of the provision being made for additional medical training?

[Marsha De Cordova]

I thank my hon. Friend for his intervention, and he is absolutely spot on. I will come to the workforce plan and the Government’s expectations, but he is absolutely right that it must include this specialism. There must also be an element of training and upskilling.

[Janet Daby (Lewisham East) (Lab)]

I, too, congratulate my hon. Friend on securing such a significant debate. I recently visited Greenvale School in my constituency, which is a school for children with special educational needs and disabilities. It is one of the schools involved in the initial roll-out of the special school eye care service, and I have met the ophthalmologists, who do absolutely brilliant work. Does my hon. Friend agree that if the Government end this service in the summer they will be neglecting children’s eye care, and a huge responsibility and onus will be placed on families?

[Marsha De Cordova]

My hon. Friend makes a really crucial point about special schools and about ensuring there is enough capacity to support children who have complex needs with sight loss. What is really troubling is that, in many instances, sight loss is not always picked up, so having specialist ophthalmologists in schools is crucial. There absolutely should be no way of reducing that provision—in fact, we need to build capacity.

To respond to the current crisis in eye healthcare, the Government must commit to a national eye health strategy for England, as set out in my Bill. The strategy would include measures to improve eye health outcomes, remove the postcode lottery of care, reduce waiting times, improve patient experiences, increase the capacity and skills of the workforce, and make more effective use of data, research and innovation. An eye strategy would ensure that, regardless of where someone lives, they can have access to good-quality eye healthcare, which would address eye health inequalities and ensure that there is more equity of access to eye care among different communities and people who are more at risk of sight problems but who may not be accessing NHS sight tests.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank my hon. Friend for making such an important speech. I pay tribute to the staff in the eye health department at St Thomas’s Hospital in my constituency. Figures show that 650,000 people are on waiting lists in England and that 37% have waited for more than 18 weeks. If the Government had a strategy, would that not address the postcode lottery my hon. Friend highlighted?

[Marsha De Cordova]

I thank my hon. Friend, who highlights the fantastic eye care department at St Thomas’s Hospital. She is absolutely right: my strategy already sets out how to address the backlogs in eye healthcare, and the Government could just say, “Yes, we are going to take it on, reduce those backlogs and address the workforce issues.”

Ensuring that we have equity of eye health must also include people who are homeless and those with learning disabilities, as my hon. Friend the Member for Lewisham East (Janet Daby) mentioned. A strategy would focus on five areas. The first is the eye health and sight loss pathway, which outlines the care and support for those diagnosed with loss of vision. A pathway would focus on the physical and emotional impact of being diagnosed with sight loss. Research has shown that blind and partially sighted people are likely to experience poor mental health outcomes, such as depression and anxiety, in their lifetimes. As part of the pathway, more emphasis should be placed on the provision of non-clinical community support, which would complement the work of community optometrists, ophthalmologists in hospitals and rehabilitation officers. Where is the plan to improve non-clinical and community support as part of the eye health pathway?

The second area the strategy would aim to improve is collaboration between primary and secondary care, and it would emphasise integrated care systems to ensure timely and accurate referrals. Demand for eye care services is expected to increase by 40% over the next 20 years, so we need to pay more attention to joining up care to meet future demand. Some of the burden on hospitals from that increased demand could be eased through more investment in high street community optometrists and by changing the way services are commissioned, to make more use of resources and infrastructure in our communities.

Two million people attend NHS accident and emergency services each year with an injury to or disease of the eye, and over 65% of those cases could have been treated in primary care optometry, which is not only more accessible but saves money—it costs less. Despite that, only 23 out of the 42 integrated care boards commission a minor eye condition service, or MECS, consistently. Five have no MECS provision at all—patients must attend a hospital eye service either via their GP or A&E. That is unfair and inequitable, and it is a waste of NHS resources to have patients go to A&E when they could access something in the community, which is easier for the patient, improves outcomes and saves us money.

[Janet Daby]

I thank my hon. Friend for giving way. Does she agree that the Government party claim to take care of the public purse, but in this case they are clearly not doing that at all? They are actually doing the opposite—wasting money from the public purse—because they are not making sure that the funds address the right issue.

[Marsha De Cordova]

Again, my hon. Friend makes an intervention that is 100% accurate. We obviously have to ensure that spending is done effectively and properly, and ensuring that resources are allocated in the community and alleviate pressures on hospitals will obviously lead only to better outcomes and savings.

At the most recent meeting of the all-party parliamentary group on eye health and visual impairment, ophthalmologist Dr Seema Verma from St Thomas’s Hospital spoke about the importance of MECS and locally commissioned optometry clinics in south-east London, which prevented 32% of referrals from being sent to hospital eye care services. If my hon. Friend the Member for Vauxhall (Florence Eshalomi) does not mind, I would very much like to invite the Minister to visit the eye department at St Thomas’s and the MECS community service, if he has not already done so.

Better joined-up care requires spending on infrastructure. Improved IT connectivity for two-way transfer of patient and clinical data would enable better patient care, and improved use of clinical skills and facilities in primary care, enabling more patients to be seen and treated closer to home. Everyone can get the theme here: community, community, community.

The eye care sector has been championing a single national electronic eye care referral system or EECR—there are so many acronyms—that would facilitate direct optometry to ophthalmology referrals, without people having to go through their GP. That would reduce the administrative burden on GP services, devolving some of the lower-risk cases to optometry and addressing unwarranted variations in referral and follow-up pathways.

[Paul Blomfield]

I thank my hon. Friend for giving way again, and she really is making a powerful speech. She made the point about the single route of referral in that relationship between primary and secondary care. Does she recognise that that is not only better for patients but—reflecting the comment my hon. Friend the Member for Lewisham East (Janet Daby) made a moment ago—for the NHS, saving it an estimated £2 million a year?

[Marsha De Cordova]

That is exactly the point. Joining up services, which is what my Bill seeks to do, would essentially save the state money, which is crucial.

I have mentioned devolving services and supporting the pathway. When the Minister responds, will he provide an update on where the Government are up to in creating this referral and joined-up pathway system, or EECR, to be specific?

The third area of the strategy would be workforce expansion. There is a significantly uneven distribution of ophthalmology workforces across England, and a quarter of the profession is nearing retirement age. That is extremely concerning, because nearly 80% of eye care units already do not have enough consultants to meet current demand, with over 50% finding it more difficult to recruit for consultant vacancies. In the last year alone, 65% of units had to use locums to fill those consultant vacancies. What do the Government plan to do to respond to this workforce crisis? They say they are bringing forward their plan, but when will it be published?

At the APPG meeting in April, we addressed the challenges of the eye care workforce. Speakers from the Royal College of Ophthalmologists, the College of Optometrists and the Association of Optometrists all made strong recommendations and put forward credible solutions. Again, I would be happy to facilitate a meeting if the Minister is yet to meet those trade bodies. He would hear first hand their strong and credible recommendations, which seek to address some of the workforce challenges.

The Government must make better use of existing workforces while expanding capacity to meet future needs, including by adopting Labour’s call to double medical school places to 15,000 a year. That needs to be complemented with investment in training for wider eye care and multidisciplinary teams and with an expansion in the number of non-medical roles.

The fourth area would be health intelligence and data.  For too long, population data has not been utilised effectively to pinpoint the location of need and the places where opportunities for change can be found. A strategy would solve that by focusing on robust data collection to inform decisions and improve the delivery of service. The UK has no national data to identify people at risk of sight loss. There is potentially a case for looking at how registration for the certificate of vision impairment system works to see whether it could be used to map out an evidence base to show where people with sight loss are living. The lack of data means there is likely to be unmet need in the system, with some people who experience visual impairment not being treated, and some developing conditions that could be avoided if they were treated earlier—as I said earlier, 50% of all sight loss is avoidable.

Without that data, we do not know whether public expenditure on eye health is meeting people’s needs, because that expenditure is not based on any evidence. Where there are still no treatments for certain conditions, the Government should increase spending on eye research, which gets a fraction of the investment it desperately needs. According to UK Research and Innovation, the Government, charities and other public bodies invested £1.4 billion in medical research in 2018, but only 1.5% of that was invested in eye research. To put that in context, only £9.60 was spent on research for each person affected by sight loss in the UK. That is worrying, given that 250 people begin to lose their vision every day.

The fifth area would be improving public awareness. As I said earlier, 2 million people each year turn up to A&E or try to get a GP appointment for a problem that could be dealt with by a community optometrist. A strategy would involve campaigns on the importance of maintaining good eye health, educating the public on the difference between eye screening and eye tests, and improving signposting to where people need to go for help.

England is the only country in the UK without an eye health strategy. Strategies can deliver positive outcomes, as has been the case in Scotland. In England, there are health strategies for other conditions, so why not for eyes? The benefits would transform lives, alleviate pressure on health services and reduce economic costs. Our goal should be to ensure that no one loses their sight unnecessarily. Most people in the Chamber know that I have a condition called nystagmus. I have been living with my sight loss all my life, but those who come to sight loss later in life face even more barriers and challenges.

I would like the Minister to address the following questions. He will get fed up of me saying this, but why will the Government not commit to an eye health strategy for England? Will they appoint a Minister—it could be this Minister—whose sole responsibility is eye healthcare? What are they doing to ensure that every integrated care board has a MECS and that their commissioning is consistent with that of the 23 that already have such services? Five ICBs have no form of MECS provision at all, so what will the Minister do to ensure there is consistency in our communities? When will the Government publish their overdue long-term workforce plan? Will there be a focus on ophthalmology? As I have highlighted, only 1.5% of the £1.4 billion going into medical research involves eyes, so will the Government increase spending on eye health research?

[Carolyn Harris (in the Chair)]

I remind Members that if they wish to speak in the debate, they should bob. I call Dr Rupa Huq.

--- Later in debate ---

[Neil O'Brien]

I expect that to be something we can come back on imminently.

I will come back on to the main topic of today’s debate. While I acknowledge that we must go much further to address the current and future capacity challenges facing eye care services, I highlight some of the excellent work already being done by doctors and nurses across the NHS. Our existing prevention and early detection measures are already playing a key role in preventing avoidable sight loss, and there has been progress over recent years.

One of the most important things we can do in terms of prevention is take action to reduce obesity and smoking, which are both massive risk factors for sight loss. We have made good, long-term progress in reducing smoking rates among adults, which have come down from about 21% in 2010 to 13% now—the lowest on record. Of course, that still means that we have one in seven adults smoking, which is why on 11 April I announced a package of new measures to achieve our ambition to be smoke-free by 2030. We are also working with the food industry to ensure that it is easier for people to make healthier choices, and supporting adults and children living with obesity to achieve and maintain a healthier weight.

In terms of the vital screening services raised by various hon. Members, I have talked previously about the success of the diabetic retinopathy screening programme, which provides screening to over 80% of those living with diabetes annually. Between 2009-10 and 2019-20, the number of adults aged between 60 and 64 registered annually as visually impaired due to diabetic retinopathy fell by 20%. That is real progress. The success of our screening programme has also been recognised by the World Health Organisation as a service that other countries should aspire to achieve.

As Members have heard me say before, one of the best ways to protect our sight is by having regular sight tests. That is why the NHS continues to invest £500 million a year in delivering over 12 million NHS sight tests, and provides optical vouchers to help with the cost of glasses for eligible groups.

As for secondary care services, when an issue with eye health is detected, it is vital that individuals get timely diagnosis and treatment. The pandemic had a huge impact on ophthalmology, as it did right across the NHS. We set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion between 2022 and 2025, in addition to the £2 billion through the elective recovery fund and the £700 million targeted investment fund last year. That will drive up elective activity and get through the backlog more quickly.

We know that NHS eye care teams continue to work hard to provide care as quickly as possible. The average waiting time is reducing; it was down to 11.3 weeks in March, compared with 12.9 weeks in September last year. Progress has also been made in reducing the number of patients waiting the longest for ophthalmology treatment. The number of patients waiting 78 weeks or longer was reduced by more than 85% between September 2022 and March this year.

A large proportion of the patients who are waiting for more than 78 weeks are waiting for corneal grafts. NHS England is working with NHS Blood and Transplant to increase the supply of corneal graft tissue. For patients who are waiting more than 52 weeks, NHS England’s elective recovery team are working hard to support local systems to increase capacity and provide care as quickly as possible. Surgical hubs and the independent sector are also being used to increase delivery, particularly of cataract surgery. In 2021-22, nearly 500,000 cataract procedures were provided on the NHS—more than pre-pandemic.

The hon. Member for Ealing Central and Acton made a point that I felt a bit ambiguous about, in so far as she raised the use of the independent sector. As she knows, Opposition Front Benchers also support the use of the independent sector to try to plough through the elective backlog. On the other hand, there is an important point about ensuring that trainees can get sufficient cataract surgery training and can have a broad range of clinical experiences as they are trained. The NHS has been working with the Royal College of Ophthalmologists to support that, because there is a genuine issue. We are working on that, even though we think it is right to use the independent sector to get through the backlog more quickly and save more people’s sight.

One of the most important points that the hon. Member for Battersea made was about more fundamental reforms to eye care services. She mentioned that ophthalmology is the busiest outpatient speciality and has a number of capacity and workforce challenges that are likely to grow. Predictions from the Royal College of Ophthalmologists say that demand for services will increase by 30% to 40% over the next 20 years, in line with an ageing population. In the light of those predictions, consideration has been given to how we can increase capacity to ensure that we have sustainable eye care services fit for the future. No one should have to face losing their sight due to delays in accessing care.

NHS England’s transformation programme has been considering what services could be safely moved out of hospital. The hon. Member is right to say that image sharing between primary eye care providers and secondary care specialists, through telemedicine hubs, could allow more patients to be seen in the community, which is a very exciting opportunity. A pilot that we are running in north-central London has already shown the potential for that model to improve the triage of patients into secondary care. NHS England plans to support a number of other integrated care systems to adopt the eye care referral model, aligned to their local commissioning arrangements.

[Marsha De Cordova]

On the way in which we can join up primary and secondary care and ensure that MECS are being commissioned across all ICBs, does the Minister agree that that measure should be consistent and must take place, so that across all our ICBs, MECS would be available in the community?

[Neil O'Brien]

The hon. Lady has read my mind, because I was about to come on to MECS. We will produce standard service specifications for MECS to reduce the variation that she rightly raised, as well as driving forward the integration of those new technologies into local ICSs.

As well as making the best use of our clinical capacity, we have to invest in growing the future workforce, as the hon. Member for Sheffield Central (Paul Blomfield) said. That is why we have taken steps to increase the ophthalmology workforce. We increased training places in 2022, and more places are planned for this year. In addition, there will be improved training for existing ophthalmology staff so that they can work at the very top of their clinical licence to further increase capacity and support the flow and delivery of care.

I recognise the important role of research and innovation in understanding sight loss and making available new treatments—a point that several hon. Members raised. That is why we continue to invest significantly in vision research. As I highlighted in a previous debate, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research over the past five years, and the NIHR Moorfields Biomedical Research Centre was awarded £20 million last year for another five years of vision research leadership.

[Marsha De Cordova]

I know that the Minister is coming to the end of his speech, but I do not want to let him sit down without pressing him for a timeline for the workforce plan. Will it cover ophthalmology and eye care? He said that he met Louisa Wickham, the eye care transformation lead, but will he confirm that all the investment in that space will continue and will not come to an abrupt end?

[Neil O'Brien]

I am happy to confirm that the workforce plan should be out pretty shortly, and that it will look across the entirety—

[Marsha De Cordova]

You have been saying “shortly” for a while.

[Neil O'Brien]

Until there is a date, there is no date, but it will be fairly soon.

--- Later in debate ---

[Marsha De Cordova]

I thank all hon. Members for their contributions. This has been a healthy debate, but it is deeply worrying that we continue to debate the need for a national eye care strategy for England.

I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for her fantastic speech and the work she is doing locally. As a campaigner, I learned so much from the incredible work of my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) and her massive support and campaigning for special schools in her constituency. My hon. Friends the Members for Vauxhall (Florence Eshalomi) and for Sheffield Central (Paul Blomfield) are no longer here, but they both made very good contributions, as did my hon. Friend the Member for Lewisham East (Janet Daby).

I want to say a special thank you to the hon. Member for Hendon (Dr Offord) for sharing his experience of macular, and for his tireless campaigning on this issue. I hope that we can continue to champion eye health and raise the need for a national plan to tackle the challenges that people with sight loss face.

I take the Minister’s point; I know he is trying, but we need action. We need to see fundamental changes, particularly on the workforce, the pathway, the joining up of primary and secondary care, research and public awareness. He said that all the areas that we have discussed on a one-to-one basis and that I have raised here are being looked at. Can we have another meeting so he can update me on all the work that is going on? I want to ensure that none of this is in vain and that we actually see some sort of plan—some sort of strategy—that delivers for people living with sight loss and prevents more people from losing their sight.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a national eye health strategy.

NHS: Long-term Strategy

Marsha De Cordova Excerpts

Wednesday 11th January 2023 Commons Chamber

[Wes Streeting]

I have to make progress. I know that Conservative MPs were not interested in speaking in this debate, but many Labour Members were.

We cannot continue pouring money into 20th-century healthcare that is not fit for the future. We do not focus nearly enough on prevention, early intervention and care in the community. Because people cannot see a GP, they end up in A&E, which is worse for them and more expensive for the taxpayer. Because people cannot get the mental health support they need, they reach a crisis point, which is worse for them and more expensive for the taxpayer. Because people cannot get the social care they need, they are left stuck in hospital, which is worse for them and more expensive for the taxpayer. That is why the next Labour Government will agree a 10-year plan with the NHS to shift the focus of healthcare out of the hospital, into the community and closer to patients, which is where it should be.

[Marsha De Cordova (Battersea) (Lab)]

My hon. Friend makes an excellent case, showing that Labour is the only party with a plan to deliver for the NHS. He will know that prevention and early intervention are key for people who are losing their sight. More than 650,000 people are currently on waiting lists. We know that 50% of all sight loss is avoidable, but many people are completely losing their sight because they are not getting early intervention and appointments. Does he agree that the Government need to get on with having a plan to tackle the eye health crisis in our NHS?

[Wes Streeting]

My hon. Friend has campaigned so determinedly on the issue, and she is absolutely right. When I spoke about self-referral in an interview with The Times, it was partly with ophthalmology in mind. In the vast majority of cases and for the vast majority of conditions, self-referral will not be appropriate and it is right that people see a GP before being referred to specialist services. But when people go and see someone who is trained and qualified to investigate their eyes, and that person makes a clinical judgment that they need to see a specialist, how can it be that, rather than being referred straight to the specialist, they are sent off to a GP first? That is absolutely crazy. It is wasting valuable doctors’ appointments and is lengthening waiting times for patients.

Labour is willing to look with an open mind at how we improve the patient journey. It is that fresh thinking that the NHS needs and is so badly missing from this Government. That touches on what I have been saying about the need to fix the front door to the NHS in primary care, with more care in the community. Our plan to recruit more doctors will deliver better access to GPs and ease pressure on accident and emergency departments.

We have to take a look at the GP partnership model, which under this Government is withering on the vine. By 2026, a majority of GPs will be salaried. There are three routes: let it wither on the vine, as the Conservatives are doing; accept that it is in decline and have something better to follow as it phases out over time, which is how we would approach it; or accept that GP partnership is valuable, in which case we should rebuild it. I am open-minded about whether we phase out GP partnerships or whether we rebuild general practice, but what we cannot do is what the Conservatives are doing, which is allowing general practice to wither on the vine. That is exactly what they have done.

Do you know what I found most remarkable today, Mr Deputy Speaker? In advance of this debate, I received a letter from the Minister, no less—the hon. Member for Harborough (Neil O’Brien), who is unfortunately not in his place—telling me that the current system of general practice is working. Bad news for you guys sat opposite, who are facing the patients and the voters at the next general election: your Ministers think that general practice is working. Your Ministers are therefore not looking at plans to fix it. Your Ministers are leaving you hanging out to dry at the next general election, because patients can see that only Labour is thinking about how to fix the front door to the NHS and rebuild general practice.

Our plan to recruit 8,500 mental health workers and provide community mental health clubs in every community—a plan championed by my hon. Friend the Member for Tooting (Dr Allin-Khan)—will deliver faster treatment, supporting schools and easing pressure on hospitals, as well as general practice.

Then there is the exit door of the hospitals to social care. Labour’s commitment to deliver better pay and better terms and conditions for care workers will reduce the 400,000 delayed discharges every month and provide a better quality of care for not just older people but working-age disabled people. There are so many people in hospital who would not need to be there if we could provide quality care in their homes, which is why our commitment to double the number of district nurses qualifying every year is central to our policy. We will also give every child a healthy start to life, with 5,000 more health visitors. [Interruption.]

The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield) has just said, from a sedentary position, “We need more GPs.” I know we need more GPs. Patients know we need more GPs. So why have the Government cut more than 5,000 GPs in the last decade?

Eye Health

Marsha De Cordova Excerpts

Thursday 15th December 2022 Westminster Hall

[Neil O'Brien]

Absolutely. As the hon. Gentleman says, we are keen to constantly drive that rate up, and we can talk more offline about the different things that we can potentially do to drive it up even further. The healthy child programme recommends eye examinations at birth, six weeks and age two, and school vision screening is also recommended for reception-age children.

The hon. Member for Strangford raised a question about a special school, which I will address specifically. The NHS long-term plan made a commitment to ensure that children and young people with a learning disability, autism or both who are in special residential schools have access to sight tests. NHS England’s proof of concept programme has been testing an NHS sight-testing model in both day and residential schools, and it is currently evaluating its proof of concept as part of programme development, which we expect to conclude towards the start of 2023. The evaluation will then inform decisions about the scope, funding and delivery of any future sight-testing model. I reassure the hon. Gentleman that, at present, absolutely no decisions have been made; we are waiting for the evidence that that programme is generating.

I turn to secondary care. Once an issue with eye health is detected, it is vital that individuals have access to timely diagnosis and any necessary treatment. The NHS continued to prioritise those with urgent eye care needs throughout covid-19. However, we acknowledge the impact that the pandemic has had on our ophthalmology services, as it has had on other care pathways. Our fantastic NHS eye care teams are working hard to increase capacity and provide care as quickly as possible. We have set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion over the next two years, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund announced last year.

[Marsha De Cordova (Battersea) (Lab)]

Will the Minister give way?

[Neil O'Brien]

I give way with pleasure to the hon. Lady, who has been hot-footing it from a funeral to attend the debate. I will seamlessly fill in, so she can catch her breath. I congratulate her on making it here.

--- Later in debate ---

[Marsha De Cordova]

I honestly thank the Minister for giving way. I have just got here from the funeral of a dear friend, Roger Lewis, who, as a totally blind man, was also a strong advocate for a national plan for eye care in England and the devolved nations. I congratulate my dear and honourable friend, the hon. Member for Strangford (Jim Shannon), on securing this very important debate.

As many Members will know, I currently have a Bill calling for a national strategy for eye health in England. We need to ensure that eye care provision is joined up across England to reduce avoidable sight loss but also, more importantly, to end the fragmentation of services. Is the Minister willing to meet me to discuss some of the provisions in the Bill, to ensure that we can create an eye care pathway that ensures that nobody who is losing their sight—or has already lost it—will go through the pathway without the right support and timely treatment?

[Neil O'Brien]

I am grateful for the hon. Lady’s intervention, and I will be happy to meet her. It sounds like there is an important connection between where she has just been and this debate. I am extremely happy to meet her to talk about that.

I will continue setting out our strategy. I have already talked about screening in primary care, and I was setting out the sums of money that we are investing—the £8 billion plus the £2 billion—in elective recovery following the pandemic. NHS England has been supporting NHS trusts to increase capacity in surgical hubs, and the independent sector has also been used to increase the delivery of cataract surgery, in particular. In 2021-22, nearly half a million cataract procedures were provided on the NHS, which is actually more than before the pandemic, so that is recovering.

Beyond recovering from the pandemic and looking to the future, hospital eye care services are facing increasing demand. As a number of hon. Members have pointed out, ophthalmology is already the busiest out-patient speciality, and the predictions are that the demand for services will increase by 30% to 40% over the next 20 years as the result of an ageing society.

To help address these challenges, NHS England’s transformation programme is looking at how technology could allow more patients to be managed in the community and supported virtually through image sharing with specialists in NHS trusts. Current pilots for cataracts and glaucoma are allowing primary care practices to care for these patients and refer only those who need to be seen by specialists. The learning from these pilots will feed into any possible future service model. That could allow us to use the primary care workforce to alleviate some of the secondary care pressures.

I am delighted that the NHSE has appointed the first national clinical director for eye care, Louisa Wickham, who will oversee this work programme. I am aware that the APPG on eye health and visual impairment has called for there to be one Minister responsible for primary and secondary care services. I can confirm that my portfolio covers both those areas, so I will be taking an active interest in the development of that transformation programme and strategy.

A number of hon. Members have raised questions about the workforce, and we acknowledge that there are challenges across the system, including in ophthalmology. NHS England is developing a long-term workforce plan that will consider the number of staff and roles required and will set out the actions and reforms needed to improve workforce supply and retention. We have already invested in growing the ophthalmology workforce with more training places in 2022, but there is more to do. We are also improving training for existing staff so that they can work at the top of their licence.

Research is an area that the hon. Member for Strangford is interested in, and I was extremely sorry to hear from the hon. Member for Tooting (Dr Allin-Khan) about her keratoconus. That is one area where, fortunately, research and new treatments are coming online, so research is hugely important. While we have effective treatments, particularly for macular disease, we absolutely cannot rest on our laurels because medicine continues to evolve. We recognise that research and innovation are crucial to driving improvements in clinical care and improved outcomes for people living with sight-threatening conditions. The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing challenges of our time, including sight loss.

Over the past five financial years, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research, and many of the studies focus specifically on sight loss. The NIHR Moorfields Biomedical Research Centre has recently been awarded £20 million from the NIHR for another five years of vision research, allowing it to continue its mission of preserving sight and driving equity through innovation. Through the NIHR, England, Scotland, Wales and Northern Ireland work together on a range of research topics, and the devolved Administrations co-fund several research programmes.

To assess how well interventions are achieving their intended aims, it is important that we track their impact, which hon. Members have mentioned. The public health outcomes framework’s preventable sight loss indicator tracks the rate of sight loss per 100,000 population for three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy.

We are making progress. The indicator shows the impact that the new treatments have had on the rate of sight loss due to age-related macular degeneration. Despite an ageing population, the rate of sight loss in 2019-20 was 105.4 cases per 100,000, down from 114 per 100,000 in 2015-16, so there has been an improvement on macular degeneration. The open availability of this data provides a valuable resource for integrated care boards to draw on in identifying what is needed in their areas and for local democratic accountability for any variation in performance against public health outcomes.

Oral Answers to Questions

Marsha De Cordova Excerpts

Tuesday 19th July 2022 Commons Chamber

[James Morris]

Obviously, given the weather that we are experiencing at the moment, issues to do with melanoma are particularly high on the priority list. I am happy to meet the hon. Lady to discuss the specific issues that she has raised in relation to sunbeds.

[Marsha De Cordova (Battersea) (Lab)]

9. What steps his Department is taking to improve eye health.

[The Parliamentary Under-Secretary of State for Health and Social Care (James Morris)]

We are supporting the prevention of sight loss throughout the NHS sight testing service and diabetic retinopathy screening programmes. Work to reduce smoking and obesity tackles risk factors for sight loss. We are also supporting ophthalmic services to recover from the pandemic and to transform services so that we can meet future demand, including exploring the provision of delivering more services out of hospital, closer to patients where they need them.

[Marsha De Cordova]

Fifty per cent. of all sight loss is avoidable, but currently there is no overarching strategy in England to govern eye care that would help to reduce sight loss. A strategy for England would improve the quality of life for people who are blind or partially sighted, address health inequalities, and link up patient pathways for overall improved health outcomes. Does the Minister therefore agree that England needs its own national eye care strategy, which would include targets for the reduction of avoidable sight loss, and will he agree to meet me to discuss this further?

[James Morris]

Given the size of England and the diversity of the health needs of different communities, we believe that commissioning should be locally led, so there are no current plans for a national eye health strategy. However, I am delighted that NHS England has appointed the first-ever national clinical director for eye care, Louisa Wickham, who will want to set priorities in this area. It is also worth mentioning that we continue to be committed to the national eye care recovery and transformation programme, which is looking to transform secondary care ophthalmology services in order to use existing funding to improve service quality and patient outcomes. That remains a top priority for us.

Draft Mental Health Bill

Marsha De Cordova Excerpts

Monday 27th June 2022 Commons Chamber

[Sajid Javid]

I agree with my hon. Friend. The reforms that we have set out today in this draft Bill mean that, in the absence of a mental health condition, learning disability and autism will no longer be a reason for people to be detained in a mental health hospital after an initial period of assessment. I would be happy to meet him and his APPG.

[Marsha De Cordova (Battersea) (Lab)]

I am disappointed that, yet again, the Department has not produced all the papers for me in large print; it has produced all the papers in standard print. I hope the Secretary of State will take that away and ensure I receive my papers as soon as possible.

I am sure the Secretary of State will share my disappointment that, in England, 24% of all children’s mental health referrals are closed before the child receives any support. In my Adjournment debate last week, I highlighted the importance of children’s mental health services and trauma support and care, so will he reassure the House and me that he will do everything in his power to make sure children receive timely mental health support?

[Sajid Javid]

Of course the hon. Lady should get the Bill and any other documentation she needs in large print, and I am sorry that she has not. I will take that up. I apologise to her, and she makes a very important point.

Support for children, even before the pandemic, was rightly a priority. Funding will increase to record levels by 2023, with an additional £2.3 billion in total so that an additional 345,000 children and young people can be seen. We put in an additional £79 million during the pandemic, and we will set out in our new 10-year mental health strategy exactly how we will do more.

Battersea Funfair Disaster: Child Trauma Support Services

Marsha De Cordova Excerpts

Tuesday 21st June 2022 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

This year is the 50th anniversary of the Battersea funfair disaster. I want to start by remembering the victims, their families, and the survivors. I also want to pay tribute to and thank two of the survivors, Hilary Wynter and Liz Haigh-Reeve, for their tireless campaigning to have the tragedy recognised and remembered.

The Big Dipper rollercoaster was the main attraction of the Battersea Park funfair which opened as part of the festival of Britain. Tragically, on 30 May 1972, a carriage of the rollercoaster broke loose and plummeted backwards through a barrier killing five children—Alison Comerford, Thomas Harmer, Shirley Nash, Debora Robertson and David Sait—and leaving 13 injured. The disaster is one of the deadliest rollercoaster crashes in history. However, it has largely been forgotten and there has been no justice for the victims, their families and the survivors.

To mark the anniversary of the disaster, I attended a special memorial ceremony together with families and survivors in Battersea Park where a plaque was unveiled and a tree was planted. That is the first step to creating a new legacy and a permanent memorial.

There is another silent tragedy associated with the incident, on which I will focus the rest of my speech. It is something that I am determined to change. Survivors have spoken about the devastating impact that childhood mental trauma has had on their lives. As one told me,

“bones are mended, physical injuries fixed, but the dreadful damage to our mental health goes untreated.”

Damage from trauma is not necessarily skin deep: some wounds penetrate through to our minds, leaving lasting damage that can be just as debilitating. Although the funfair and the big dipper are long gone, some of the survivors of the disaster still struggle to go to Battersea Park, and have been unable to shake off their horrific memories of that incident. I am sure many survivors of other tragedies, such as Hillsborough, the Manchester Arena terrorist attack and the Grenfell Tower fire, have been through similar experiences.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on securing this debate on childhood trauma support services. I would mention helpfully to her, and probably to the Minister as well, that we in Northern Ireland have faced 30 years of a terrorism campaign during which many young children, women and men have lost their lives. Such trauma can last way beyond the time that it happened. Does the hon. Lady agree that some discussions with the responsible Minister in Northern Ireland might be helpful when it comes to devising a policy and a strategy to address trauma and child mental issues, which I know she wishes to see?

[Marsha De Cordova]

The hon. Gentleman is right: we can all learn, and it would be useful for the Minister to say whether she would like to meet Ministers in Northern Ireland to look at what works well.

Childhood trauma can have a lifelong effect, and can have lasting consequences for a child or young person’s development, including psychological, behavioural and emotional problems. Those problems can occur into and throughout adulthood, presenting related challenges in many aspects of that person’s life. According to the UK Trauma Council, childhood trauma refers to the ways in which some events and experiences are so extreme that they overwhelm a child’s ability to cope. Many different experiences can lead to such trauma: for example, physical or sexual abuse can be traumatic for children. One-time events like the tragedies I have mentioned can take a psychological toll on children as well. Ongoing stress such as the effects of the pandemic can also be traumatic for a child, even if it just feels like everyday life to an adult.

We know that the pandemic has had a huge negative impact on children and young people’s mental health and wellbeing. The Children’s Commissioner’s Big Ask survey found that one in five children was not happy with their mental health, and that figure rose to two in five for some groups. Childhood trauma does not have to involve experiences that are directly related to the child: for instance, watching a loved one endure major issues can be extremely traumatic, as has been highlighted by the impact of the cost of living crisis on children’s mental health. According to the Childhood Trust’s latest report, 47% of children surveyed felt stressed, 21% of parents said that their children smiled less, and most concerningly, 9% of parents claimed that their children had started self-harming. The results of that report should worry us all, as all those types of trauma will affect children’s development and wellbeing.

The Government need to invest in mental health services to ensure that children who experience trauma today do not face the same painful ordeal that survivors of the Battersea funfair disaster have gone through over the past 50 years. Spending on children’s mental health remains behind investment in adult mental health services. It is worrying that children and young people’s mental health services are among the most under-resourced and that the quality of care varies between different parts of the country. A BBC freedom of information request revealed that 20% of children are waiting more than 12 weeks to be seen for mental health support. That is why I was pleased to secure this debate on better provisions for children’s mental health services and childhood trauma.

The Government need to correct the historical underinvestment in children and young people’s mental health and the postcode lottery of services and support provision. To do that, they must create a comprehensive child mental health strategy, and childhood trauma services must be prioritised as part of that. The UK Trauma Council has called for the Government to invest in the development and delivery of specialist trauma provision so that children and young people have access to the support that they need. It also called on the Government to equip all professionals who work with children and young people with the skills and capacity to support those who have experienced trauma.

Labour has already set out its plan on tackling the mental health crisis, which includes giving adequate funding to mental health services. We have also committed to radically expanding the mental health workforce, including, crucially, investment in children’s mental health that includes putting open-access mental health hubs for children and young people in every community and ensuring that a full-time mental health professional is in every secondary school and a part-time professional is in every primary school.

Labour’s focus on early intervention is so important, because it can prevent the ongoing effects of trauma into adulthood. It would ensure that children are properly supported and resolve problems before they escalate. I will therefore ask the Minister about the Government’s plan for children’s mental health services and, specifically, childhood trauma care. When will her Government introduce a comprehensive child mental health strategy that includes prioritising trauma and investment in the development and delivery of evidence-based trauma service provision? How are they ensuring that children’s mental health services are a high priority in the NHS? That includes increased investment.

The Government have made £139 million available to support children and young people’s mental health in the community, but we need to see more investment. How are the Government working with professionals in contact points including in schools and the third sector so that children can access support when problems emerge?

Much work also needs be done to ensure that every child and young person gets the support that they need for their mental health and wellbeing. We need to step up as a society and be more ambitious in our call for better support for children and young people’s mental health. More funding and resources will be an investment in our children’s future. It is time for the Government to act and listen to the voices of children and young people, especially those suffering from trauma. If we do not act now, when will we?

[The Minister for Care and Mental Health (Gillian Keegan)]

I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing the debate. I must admit that I was not aware of the tragic events that unfolded 50 years ago, on 30 May 1972, and I am sure that others were not, either, so it is fantastic that she secured the debate to remind us all. However, I discussed it with my husband when I got home last night. At the time, he was a 10-year-old boy growing up in London. He was very much aware of what happened and he vividly remembers it. What should have been a happy day in Battersea Park, on the bank of the River Thames, resulted in five children losing their lives and a further 13 being injured, and it shocked many more. I very much hope that the survivors’ campaign for a permanent memorial in Battersea Park is ultimately successful, so that that terrible event is never forgotten—maybe that is the plaque the hon. Lady referred to, or maybe there is something else that they are still campaigning for.

Undoubtedly, many affected by the Battersea funfair disaster will have suffered from what we now call post-traumatic stress disorder, but let us not forget that PTSD was not even added to the International Classification of Diseases until the ’80s, and guidance from the National Institute for Health and Care Excellence was not published until 2005. Events have taught us that people affected by any traumatic incident must be able to access timely mental health support when and if needed, but I am not sure there was the same understanding all those years ago.

Luckily, PTSD can be successfully treated even when it develops many years after a traumatic event. The treatment depends on the severity of symptoms and how soon they occur after the traumatic event. The hon. Lady reports that survivors of the tragedy remain concerned that mental health support for children who have suffered trauma has not changed much since 1972. I too would be very concerned if that was the case, but I must respectfully disagree with that assessment.

If a child has witnessed or experienced a traumatic event, it is quite natural for them to be stressed, upset or frightened. That should not usually last beyond four weeks, but if it does, it may indicate post-traumatic stress disorder and it is then important to seek help via their GP. There are now some really effective treatments, including cognitive behavioural therapy, for children and young people who are experiencing the effects of trauma.

To respond to the hon. Lady’s specific question, NHS England and NHS Improvement have issued guidance on responding to the needs of people affected by incidents and emergencies, which stresses that plans for incidents and emergencies must provide psychosocial and mental health care for people affected, since early intervention for people at risk of developing mental health problems may reduce their severity and chronicity and, ultimately, related costs.

In general, psychological support can be accessed four to six weeks after the event for those who are exhibiting signs of needing professional help, as per NICE guidelines. Those who require urgent support may be referred to services sooner than that, and it is important to ensure that messaging about support services is appropriate. Not all people need psychological support, and many recover over the course of time without specific interventions, but it is still important that such people continue to look after their health and wellbeing after a traumatic incident. That includes getting enough rest, eating well, returning to their routine and staying connected with others.

[Marsha De Cordova]

I just want to ask about the support that is available via NHS England and ensuring that it is available, as the Minister says, within a four to six week period. Can she assure me that that is actually happening? Is there any evidence base to ensure that children who experience trauma or post-traumatic stress disorder are getting that support in a timely fashion?

[Gillian Keegan]

Yes, and of course we always try to ensure that, as the targets we put in are worked throughout the system, those targets are met. That is why we measure those things. Maybe it would be helpful to the hon. Lady if I gave some recent examples. In the wake of the Manchester Arena terrorist attack, which sadly affected many children and young people, the Greater Manchester Resilience Hub was set up to provide a central point for mental health advice for those directly affected, including children and emergency responders. The hub worked with other agencies to develop packages of care.

In response to the tragic fire at Grenfell Tower, more than £10 million has been spent on treating the mental health of those affected. In the year after the fire, 2,674 adults and 463 children were screened for symptoms of post-traumatic stress disorder, and the St Charles Centre for Health and Wellbeing was opened up so that those affected could be treated in dedicated therapy suites. I hope the hon. Lady will recognise that we have seen a dramatic change in both attitudes towards mental health since the days of the Battersea disaster, and the NHS services available to support people with their mental health.

Oral Answers to Questions

Marsha De Cordova Excerpts

Tuesday 14th June 2022 Commons Chamber

[Sajid Javid]

My right hon. Friend is absolutely correct, and that is why that is one of our biggest priorities. As well as asking the NHS to come up for the first time with a 15-year, long-term workforce strategy, we are also recruiting at a record rate, with more doctors and nurses working for the NHS than ever before.

[Marsha De Cordova (Battersea) (Lab)]

Demand for eye care services is at an all-time high, with more than 632,000 people waiting on the NHS waiting lists for ophthalmology treatments. Delays to diagnosis and treatment could lead to a loss of sight, as well as stress and anxiety for patients. Given the stark figures, it is vital that we invest in eye health, such as through the national eye care recovery and transformation programme, which, worryingly, is due to end this year. Does the Secretary of State agree that it is essential that funding for this programme is retained so that he can bring down waiting lists and ensure good-quality eye care?

[Sajid Javid]

The hon. Lady is right to talk about the importance of eye care services. That is why we are putting record investment into dealing with those covid backlogs. As she rightly points out, many of those are in eye care and ophthalmic facilities and surgeries. That record investment is going in, and we will keep it under review to make sure it is leading to the outcome that we all want to see.

Health Inequalities: Office for Health Improvement and Disparities

Marsha De Cordova Excerpts

Wednesday 26th January 2022 Westminster Hall

[Peter Dowd]

I am pleased that my hon. Friend asked that question, because it is one that has been asked many times, and I am sure the Minister will cover it—it is one of the questions I have as well.

The UK vaping industry said:

“It is absolutely critical that the new Office for Health Improvement and Disparities continues the pragmatic approach of Public Health England in recognising the role of vaping in tackling inequalities. It is essential that the institutional knowledge of PHE is not lost in the establishment of the OHID”

It is important that that is factored into these debates.

The House of Commons Library referred to the debate on health inequalities versus disparities. Jabeer Butt of the Race Equalities Foundation has welcomed the institution of the OHID and the possibility of working alongside it, but he said:

“With the establishment of OHID, we can’t help but wonder why the language used by the Health and Social Care Secretary talks about ‘health disparities’, compared to Professor Chris Whitty, who describes ‘health inequalities in the Government announcement.”

This is not just about semantics. It is important that we recognise that it is about not just disparities but health inequalities as well.

[Marsha De Cordova (Battersea) (Lab)]

I commend my hon. Friend on his speech. He touched on a really important point: that the Government talk about disparities when they should talk about inequalities. To truly tackle health inequalities, we need to look at social factors, such as housing, racism and air pollution, and socioeconomic factors. Does he agree that, to tackle all of those inequalities, the OHID will need to look in the round at all those issues and seek a cross-governmental role to deliver on the Department of Health and Social Care’s aims?

[Peter Dowd]

My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.

As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.

Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.

We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.

Before the pandemic, through the pandemic and now as we emerge, we hope, from the worst of the omicron variant—it is clear that there is a deep-rooted inequality in our society that causes huge inequality in health. The gap in life expectancy is startling. People in my constituency live on average 12 years less than people in Southport—just at the other end of the borough. Those are stark differences in healthy life expectancy—how many years a person spends in good health. Before covid, it was estimated that people in the richest communities in England could expect to live in good health for up to two decades more than the poorest. In Bootle, according to Nomis at the Office for National Statistics, 42% of people who are economically inactive are long-term sick, compared to the national average of 24%.

However, statistics get us only so far. A recent paper from the Royal College of Physicians brings to life the reality of health inequalities. One hospital clinician saw a patient who was extremely malnourished and dehydrated. The patient had been regularly missing meals so she could feed her teenage son. When she first became unwell, she did not call the GP, because she was unable to afford to pay someone to look after her son, and was frightened that he would be taken into care if she had to go to hospital for a long time. She was eventually admitted to hospital with sepsis. There are other stories in the paper of people who missed hospital appointments because they could not afford public transport, people who do not have the kitchen facilities to cook food and someone who was hospitalised because their asthma was aggravated by mould in their flat that the landlord refused to fix.

As we all know, 40 years ago, Sir Douglas Black, a former president of the Royal College of Physicians, was asked by the Department of Health and Social Security to lead an expert committee looking into health and inequality. That now famous Black report was unequivocal and said that while overall health had improved since the introduction of the welfare state, there were widespread health inequalities, the main cause of which were economic inequalities.

In his foreword to the report, the then Secretary of State said:

“the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”

That is as true today as it was then. It might seem that health inequality is a matter for the Department of Health and Social Care and the NHS but, as other hon. Members have said, health and social care services can only try to cure the ailments created by the environments people live in.

Research by the University of York linked austerity measures with the deaths of almost 60,000 more people than would be expected in the four years following their introduction. The money a person has will change the decisions they make about their health. It is the difference between having a healthy meal and having a meal at all, or between choosing to pay for the journey to the GP for an ongoing cough or choosing not to.

Housing affects health too. Last year, Shelter found that poor housing was harming the health of a fifth of renters. Our society benefits some people and deprives others, and those structural inequalities drive many of the health inequalities in black, Asian and other minority ethnic groups. We have to address that if we want to tackle this issue.

If we are to prevent ill health in the first place, we need to take action on issues such as how much money people have, poor housing, food quality, communities, place, employment, racism and discrimination, transport, and air pollution. That is why many organisations and coalitions, including the 200 members of the Inequalities in Health Alliance, which is convened by the Royal College of Physicians, have made calls for a cross-Government strategy to reduce health inequalities.

Tackling health inequality requires a considered and co-ordinated approach across myriad factors. Last year, the Government signalled that they recognise the need to look beyond the Department of Health and Social Care and the NHS and to take action on the issues that cause ill health. When the Secretary of State announced the Office for Health Improvement and Disparities in October last year, we were promised a new cross-Government agenda that would look to track the wider determinants of health and reduce disparities. The Health Promotion Taskforce was established.

These are potentially encouraging signs, but I am concerned that we are yet to hear the detail of what the OHID will do to reduce health inequalities. Will the Health Promotion Taskforce have a remit to take action outside the Department of Health and Social Care? When will we see a strategy on reducing health inequalities, so that we know what the Government’s ambition is in this area and we can track progress? Will the Government commit to developing a cross-Government strategy to reduce health inequalities?

Will the Minister set out how the Office for Health Improvement and Disparities will reduce health inequalities? Will he tell us about the work of the Health Promotion Taskforce and how often it meets? What engagement has the OHID had with Government Departments to date, since it was formally established on 1 October 2021? Importantly, will the Minister set out how the OHID will work with integrated care systems and support them to address health inequalities in their areas? I hope he can answer some of those questions.

When the Labour Government first asked Professor Marmot to review health inequalities in 2008, Gordon Brown said:

“The health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health. They also limit the development and the prosperity of communities, whole nations and even continents.”

He was absolutely right.

This Government were elected on a platform of levelling up, but while covid-19 caused a decrease in life expectancies for most countries between 2019 and 2020, the UK’s life expectancy has fallen below where it was in 2010. The UK was one of only two countries where that happened, the other being the United States.

In 1980, the Government responded to the Black report by saying:

“you might be right about the solution, but it’s going to cost too much.”

After two years of living with the pandemic, which, of course, has hit the most deprived the hardest, it is clear that the real cost lies in not supporting those who need that support most. Only Government can create the conditions for better health by improving the factors that lead to ill health in the first place. I hope the Minister can set out what the Office for Health Improvement and Disparities can do to achieve the aim of reducing inequality, and can confirm that the Government intend to tackle the wider determinants of health, which drive so much of the health inequality that we see.

Point of Order

Marsha De Cordova Excerpts

Monday 13th December 2021 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

On a point of order, Mr Deputy Speaker, may I seek your advice? I have been trying to chase my papers for tomorrow’s debate on the statutory instruments, which have not been produced in large print for me. My office and the Vote Office have been chasing the Department of Health and Social Care, and we are not getting a response. I was wondering whether you could advise me on how I can get my papers, so that I can read them in readiness for tomorrow.

[The Secretary of State for Health and Social Care (Sajid Javid)]

Further to that point of order, Mr Deputy Speaker, I would like to reply to the hon. Lady. I have heard very clearly what she has had to say, and I will get back to the Department right now and chase that up immediately.

Sickle Cell Treatment

Marsha De Cordova Excerpts

Wednesday 8th December 2021 Westminster Hall

[Mr McFadden]

I quite agree with my hon. Friend, and our report goes into many recommendations that could improve care. Indeed, it is a call to action; it is a call to arms. Following Evan’s death, the deaths of others and the many near misses involving sickle cell patients, we wanted the report to set out the changes that are needed to stop this story from repeating itself over and over again.

Sickle cell affects about 15,000 people in the UK, with many more carrying a trait. Patients with the condition experience periodic crises—bouts of intense, severe pain that sometimes require hospitalisation. The crises are treated with strong pain relief, and sometimes blood transfusions, and over time they can result in organ damage, an increased risk of stroke, other associated conditions and even early death. It is therefore common among sickle cell patients to have to go to hospital regularly, to present at A&E and to be admitted on to wards. This is an important point. For sickle cell patients, contact with the healthcare system or admission to hospital is not a one-off; it is a lifelong part of living with the condition.

To prepare our report, we took evidence in three oral evidence sessions in June this year. We heard from patients, clinicians and policy makers. We heard from Evan Smith’s parents, Betty and Charles, who spoke with so much dignity about the loss of their son and their determination to make sure that other families do not have to go through what they have been through. We received over 100 written submissions and, taken together, this is the most comprehensive report on sickle cell care that the APPG has ever produced.

[Marsha De Cordova (Battersea) (Lab)]

I congratulate my right hon. Friend on his leadership on and commitment to this issue. The report that his APPG has produced has shone a light on some of the challenges faced by people living with sickle cell—whether it is around some of the negative attitudes, the lack of awareness and understanding, or, most importantly, patient care. Does he agree that tackling this issue and the multiple health inequalities that exist will require significant investment and resource from the Government, and an acknowledgement of the structural racism that exists within the health setting?

[Mr McFadden]

My hon. Friend makes some very strong points, and I will discuss some of them, including the question of race.

Since the report’s publication, I have continued to receive emails from sickle cell patients all around the country that confirm the report’s findings, and I want to put on the record my gratitude to each and every person who has taken the trouble to write to me, whether it was just after the report was published or in advance of today’s debate.

Let me set out the main findings of the report for the House. Let us begin with a positive: we found a good level of trust among sickle cell patients in the specialist haematology departments of hospitals that look after them on a long-term basis. We found clinicians passionately committed to better treatment and honest enough to tell us when that good treatment was not there. We found that where there is a good level of understanding and knowledge, sickle cell patients are generally well treated and well looked after, but we also found a huge gulf between the good level of confidence and trust in the specialist parts of the system, and treatment in the more generalised parts of the system—specifically A&E and general wards.

Our key findings include the unacceptable variability of treatment, depending on where someone lives or who happens to be on duty at the time; patients having to battle for the pain relief to which they are entitled; and protocols on pain relief—for example, that it be administered within 30 minutes of arrival—being regularly and repeatedly ignored or not being implemented. Witnesses told us of waiting for hours in excruciating pain. Some clinicians spoke of adherence to the pain relief guidelines within their hospital being as low as just 20% or 30%. There is a lack of compliance with care plans that have been agreed for individual patients, including with the hospital where a patient has turned up, and people have been told, “That doesn’t apply here.”

We found a dangerous lack of communication between the general and specialist parts of the system. In Evan Smith’s case, he had been in the hospital for over two days before the haematology unit even knew he had been admitted. That finding was described as “shocking” by one haematologist who gave evidence to the group. Such delays can contribute to mistakes, with the most terrible consequences. As well as deaths, we heard about a number of near misses where care had gone badly wrong and the patient had still survived.

There is a lack of awareness of the condition and a lack of understanding about how to respond to a sickle cell crisis among some NHS staff. Everyone in the healthcare system knows the key symptoms of a heart attack or a stroke, and how to respond to them. With sickle cell, however, the patient experience is often one of being caught in a perpetual loop of trying to teach staff about what is happening to them and what treatment they need, often at the time that they are experiencing excruciating pain.