The final item of business is a members’ business debate on motion S4M-08602, in the name of Fiona McLeod, on recognising the value of community optometry. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the value of community optometry and the work of Optometry Scotland; notes that, as a result of an ageing population, the number of people in Scotland, including in Strathkelvin and Bearsden, with sight loss is projected to double in the next 20 years; welcomes what it considers the tremendous strides made in recent years with the development of the Scottish Vision Strategy with its emphasis on prevention, and considers that there is now an opportunity to make Scotland a world leader in integrated eye care.
17:39
I thank members across the parties for supporting my motion so that we could debate it in Parliament, and I welcome to the gallery members of Optometry Scotland and some local opticians in my constituency. I am pretty sure that I can spot that Peter Ivins from Bearsden is here, and can I see Neil Drain from Kirkintilloch? I thank those gentlemen very much for coming.
It was partly a visit to my local optician that made me want to have this debate today. I met representatives of Optometry Scotland at the Scottish National Party conference in October and learned about the amazing amount of extra work that I did not know opticians do. As many of you will know, I used to work in the health service, but I was surprised by what I learned, because I still thought that an optician was someone who dispensed glasses and that was it.
I learned from the Optometry Scotland stall at the conference what is going on, and then I visited both Peter Ivins and Neil Drain in my constituency to find out just how much opticians are moving into eye healthcare, rather than just giving us the pair of glasses that we need in order to read. What I found was inspiring. I learned about optometrists becoming independent prescribers. I have found it quite difficult to get figures, but I understand that from 10 to 25 per cent of optometrists in Scotland are now trained and registered as independent prescribers via Glasgow Caledonian University. Of course, that means that our optometrists are not just dispensing glasses and diagnosing ill health in our eyes but are able to treat the ill health in our local communities.
It was interesting to hear about the teach-and-treat clinic at Stobhill hospital, where local opticians can work with a consultant ophthalmologist to learn the skills that they need to provide treatment in the community. I also found out about the Scottish Government funding for digital fundus cameras, for example, for every practice in Scotland. Another thing that really caught my eye when I was out meeting the optometrists was the Scottish care information gateway electronic referrals. I understand that the electronic patient referral programme was launched in 2010 as part of the integration of eye care services and that it has funding of £6.6 million for 10 years from the Scottish Government.
I know from my years in the health service of the benefits of electronic referral. It means that our independent prescribing optometrists can treat us locally but, when they diagnose something that goes beyond that treatment, they can appropriately refer us on to secondary care. Of course, the biggest benefit in that for any patient is the reduced time from diagnosis to referral to treatment.
It is a great step forward that our optometrists are now an essential part of primary healthcare in our communities. I understand that 20 per cent of out-patient appointments in hospitals are for eye problems. If optometrists are doing a lot more diagnosis and treatment and referring to hospitals only when appropriate, that 20 per cent figure will come down. I have read that, since we introduced the programme in 2010, there has been a 6 per cent increase in referrals to out-patient appointments for eye care in the national health service in Scotland but that the figure in England is 20 per cent. We are therefore seeing the benefits of appropriate referral and treatment being done as locally as possible.
Many members will ask what my interest is in the matter. I am obviously enthusiastic about it. Why am I so enthusiastic? It is great when I find out something new and find out that, yet again, Scotland is world leading in a healthcare area. However, for me, it is part of the preventative agenda whereby those of us with eye problems are being helped in our local communities to prevent them from getting worse. It is about community care and the best patient journey that we can have. It is incredibly important now because one in 30 of us in Scotland suffers from significant sight loss. Because of our ageing population—you will all know that I take a great interest in that issue because of my constituency interests in Strathkelvin and Bearsden—significant sight loss will double in 20 years. The optometrists’ treatment work is part of the preventative agenda that looks to the future by saying to patients, “How well can we care for you? How can we care for you where you want to be cared for?”
Treatment for preventable sight loss in older people is not just about sight loss, because other health problems come with visual impairment. For example, an elderly person with visual impairment is more likely to have falls and end up being hospitalised. Interestingly, they are also more likely to have poor nutrition, because if someone has a visual impairment and they cannot see their food, they do not enjoy it, so they do not eat it, and that has knock-on effects. We should also remember the loss of independence that visual impairment brings, especially for older people, and the social isolation that that can bring.
It was for all those reasons that I wanted to bring this debate to the chamber. I have been so impressed by what I have seen and, through this debate, I wanted to recognise and promote the work that community optometrists do. Perhaps I can best sum up what I want to say by talking again about when I went to see Neil Drain and Peter Ivins. They talked about all the years that they spent training to be optometrists and said that they are now using all their skills in being healthcare professionals and not just people who sell others their specs.
I thank members for their support for this evening’s debate. I look forward to hearing everybody else’s contributions. Thank you.
We move to the open debate. I ask for speeches of four minutes, please.
17:46
I congratulate Fiona McLeod on securing this important debate and I pay tribute to Optometry Scotland and the work that it does to ensure that Scotland provides world-class eye care. It is desperately sad that many people in Scotland still lose their sight through preventable illnesses, so this evening’s debate is welcome in that it highlights people’s need to take their eye health seriously through having regular eye checks and having eye problems treated as a matter of urgency.
The fact that there have been improvements in eye healthcare is a testament to the efforts of Optometry Scotland and other organisations, including the Royal National Institute of Blind People, which have rightly promoted the need for good services in our communities. Opticians in the community now interact with specialists in the acute sector. They are able to send test results and pictures electronically to eye specialists, which cuts costs to the health service and reduces unnecessary appointments for patients. Patients can have their tests done locally at their own optician; should the optician be concerned, they can transfer information electronically to a specialist for them to look at.
On many occasions, no further treatment will be required, so the patient will not need to attend for more eye tests in the acute sector. The approach also reduces the time that patients spend worrying about the outcome of further tests. It is a win-win for patients and the health service, for which the approach reduces costs. There are times when results flag up issues and patients need further treatment, but the approach saves time, and treatment can commence much more quickly if results are sent electronically. The specialist knows the scale of the problem and what needs to be done before they ever see the patient, so treatment can start immediately. That saving of time could also save someone’s sight.
It has been proved that e-health works well in optometry. It saves time and speeds up treatment, it enables better services to be provided to patients and, at the same time, it saves the public purse money. It has huge benefits in my region—the Highlands and Islands—where many people live in remote and rural areas, where it is not easy to access services or to attend multiple appointments that are sometimes huge distances from the patient’s home. As people get older, they often have to depend on public transport, but that is often non-existent in such areas.
The advances that have been made have not happened by accident, but are down to the people who work in the sector at every level. However, we need to ensure that the level of service that we are discussing is available to everyone and that everyone takes their eye health seriously and has regular checks. We know that the people who live in our most deprived communities are less likely to look after their eye health. That pattern recurs in all areas of health, and it sometimes feels almost as if we are unable to tackle those inequalities. I ask the Scottish Government to ensure that people in our most-deprived communities have regular eye tests, which means that services must be made available to them locally and accessibly.
Regular eye health checks can also flag up health issues that are not necessarily to do with eyes. One problem that most people know often shows up in eye health tests is diabetes.
I welcome the debate. Although we have made great strides in eye healthcare since Parliament began, we cannot rest on our laurels. There is much more to be done and I look forward to seeing how that can be brought forward.
17:50
I, too, congratulate my colleague Fiona McLeod on securing this evening’s debate on an important area of health policy. Improving the eye health of people in Scotland, eliminating avoidable sight loss and improving the inclusion, participation and independence of blind and partially sighted people are ambitious aims that have wider benefits for the public health agenda.
Community optometry plays an essential role in delivering the national health service’s 2020 vision by providing diagnosis, prompt referrals and—increasingly—treatment in the community. It is difficult to conceive of a clearer example of effective early intervention than being able to prevent a person’s losing their sight—not least given all the dramatic impacts on health and wellbeing, as well as on NHS and social care services, that sight loss can have. Community optometrists and Optometry Scotland are absolutely essential in delivering a service that has grown by 25 per cent since free NHS eye examinations were introduced in 2006. Without them we would not have made the progress that is already being made in improving Scotland’s eye health.
That is not to say that there is not more to do. For example, studies suggest lower uptake of free eye examinations among low-income households remains. To an extent, that reflects wider concerns about the persistence of health inequalities, which remain a significant problem for Scotland and should concern us, as my colleague Rhoda Grant highlighted.
We know, for example, that the incidence of type 2 diabetes has a direct relationship with deprivation; Audit Scotland’s 2012 report on health inequalities found that the incidence of type 2 diabetes increases significantly with deprivation. In 2008, the incidence of type 2 diabetes was around 2.5 per cent for the least-deprived areas, but was more than 4 per cent in the most-deprived areas. With diabetes comes the risk of diabetic retinopathy, which can have severe consequences for patients’ sight. Increasing the uptake of the universal eye examination, particularly among low-income households, is an important measure in helping to address at least the symptoms of health inequalities.
The situation also emphasises, in my view, the importance of taking a universal approach to providing health services, which is a crucial underpinning to the ambition to be the
“world leader in integrated eye care”
that Fiona McLeod’s motion refers to. As elected members, we could all assist in making sure that our constituents know that they are entitled to a free sight check, the benefits of taking up that entitlement and the kind of fantastic eye care services that are being delivered in our high street opticians.
Also, the flexible easy access to services that community optometrists provide, coupled with the direct electronic referral system to improve the patient route from primary to secondary care, will deliver lasting improvements and benefits by detecting conditions early when people are examined, and by making prompt and appropriate referrals.
As Fiona McLeod mentioned, local optometrists who have completed the necessary Optometry Scotland training are now able to issue prescriptions to treat eye conditions. The streamlining and improving of eye care services are clearly set to continue. In my view those are very welcome developments, especially in some of the more rural and remote parts of the region that I represent—South Scotland—in Dumfries and Galloway and the Borders.
We have high ambitions to eliminate avoidable sight loss—which is a bold statement, but one that is absolutely right. Community optometrists have an absolutely vital role to play in delivering that objective so I am very pleased that tonight’s debate has offered an opportunity to highlight their vital contribution and the ongoing innovative work to integrate eye care nationally with other NHS services and optometry professionals across Scotland, which I hope will have a positive impact on levels of sight loss and, ultimately, will improve the eye health of all the people in Scotland as locally as possible.
17:54
I, too, congratulate Fiona McLeod on bringing the debate before us to highlight the sometimes unsung heroes of the health profession—community optometrists.
As Fiona McLeod said, most people do not realise that when they visit an optician for a sight test they are in fact being examined by an optometrist who has undergone advanced professional training and is qualified to recognise and diagnose eye problems within the community and recommend the appropriate treatment or, if the patient’s condition requires it, refer on to a specialist hospital-based ophthalmologist. The prescribed treatment may simply be the required strength of lens to correct their vision, either within spectacles or as contact lenses.
However, optometrists also check eye health by measuring intraocular pressure to pick up on glaucoma, which can soon cause blindness if it goes untreated, and by carrying out examination of the retina, which can disclose complications of high blood pressure and diabetes and, again, the possibility of glaucoma. All those conditions can lead to impaired vision, or to macular degeneration, which is a common cause of blindness in elderly people. Macular degeneration may or may not be treatable, depending on its type, but it can be treated only if it is diagnosed early in its development. As the first port of call for eye problems, optometrists are therefore at the front line of that area of medical care. We are all well advised to attend regular eye checks so that problems can be picked up early and treated before our vision is permanently impaired.
I, too, pay tribute to the work of Optometry Scotland, which provides an invaluable service in promoting the work of optometrists north of the border and expressing the views and concerns of its members. “Lobbying” is often seen as a dirty word these days, but I have to say that Optometry Scotland is very successful at engaging with MSPs, the Scottish Government and other key stakeholders. On its aims and ambitions, it is commendable that at its heart is the raising of awareness of the importance of regular eye examinations, and encouragement of optometrists to train continually to reach the highest standards of their profession. Considering that Optometry Scotland was set up less than a decade ago, its achievements have been very impressive.
I have no doubt, for example, that Optometry Scotland played a significant role in the introduction of legislation, under the Scottish Government’s health and social care integration directorate, that permits independent prescribing rights to optometrists. That initiative means that, following rigorous training, optometrists can prescribe licensed eye-related medicines to patients under the NHS without the patient’s having to visit their general practitioner or an ophthalmologist.
Although concerns have been raised with me by hospital specialists in Grampian, following closure of the eye emergency clinic in Aberdeen, that optometrists do not have sufficient training to deal appropriately with a number of problems that present for emergency care, the new system generally appears to work well and will create efficiency savings in the NHS, which I am sure all members will welcome.
The motion refers to the Scottish vision strategy, which is an offshoot of the UK vision strategy. That strategy complements vision 2020, which is the global initiative to eradicate avoidable blindness by 2020. The refreshed Scottish vision strategy aims to maintain good eye health and ensure that people who suffer sight loss receive the appropriate services. That builds on other recent advances in Scotland. Although I was not convinced of how practical it would be to introduce free eye tests for all when they were legislated for nearly a decade ago, I have to admit that my concerns were misplaced. Before anyone else takes the credit, I add that those free eye tests were introduced in 2006 by the previous Administration.
Fiona McLeod’s motion refers to the worrying statistic that in the next 20 years, the number of people in Scotland with sight loss could double, which will mostly be the result of an ageing population and the increasing incidence of long-term conditions, including diabetes. I would be interested to hear the minister’s thoughts on that in his summing up.
I end by, once again, thanking Fiona McLeod for leading the debate, and by paying tribute to Optometry Scotland for its efforts to promote and develop community optometry throughout Scotland.
17:58
I am pleased to have the chance to speak in the debate. I, too, congratulate my colleague Fiona McLeod on securing it. I encourage her to go along to the next meeting of the cross-party group on visual impairment, of which I am convener. The important topic of community optometry has been discussed many times by the group, both while I have been convener and, previously, when I was an ordinary member. It is only right that we should give credit where it is due. That is certainly the case with those providing such a valuable service to local communities.
According to the latest figures, more than 180,000 people throughout Scotland have significant sight loss. That equates to about one in 30 people. As the motion states, that is set to increase, mainly due to the ageing population in Scotland. However, more than 50 per cent of sight loss can be avoided, and many older people are needlessly living with sight loss. Almost two thirds of sight loss in older people is caused by refractive error and cataract.
Eye health checks provide quick and convenient access to an expert, allowing for rapid diagnosis and timely intervention for treatment and management of any condition. As with other conditions, most eye disorders respond better when detected early, resulting in shorter recovery time, less patient distress and a reduction in the overall care costs. Early diagnosis and intervention, and the provision of information to people and their carers at the point of diagnosis, is critical. That is why regular eye checks and the work of community optometrists are important.
I believe that the service is also highly valued by the public. Community optometry plays a key role in primary care. Eye health checks reduce the burden on secondary care, retain people with minor problems in the community and improve the quality of referrals. The service has led to a 4.5 per cent reduction in referrals across Scotland, compared with an increase in England of approximately 23 per cent over the same period.
It is also worth highlighting in this debate the role of the Scottish vision strategy, which we have heard about from one or two previous speakers. It sets out a blueprint for improvements in eye care services in Scotland, giving direction to the work in this sector. Key strategy outcomes include: awareness and understanding of sight loss; early intervention, timely treatment and access to early and appropriate services and support; and the full participation in society of those with sight loss.
The Scottish vision strategy continues to enjoy the endorsement of a wide alliance of statutory, health and social care bodies, voluntary organisations, eye health professionals and individuals. [Interruption.]
I ask members to check whether they have any mobile devices next to the broadcasting equipment, because our sound system is experiencing a degree of interference.
I am sorry, Presiding Officer.
The issue of electronic referral has come up more than once in the discussions of the cross-party group. People have come to the cross-party group to talk about how electronic referral has saved their sight. It is a huge step forward in eye healthcare in Scotland.
It is true that free eye tests were introduced in 2006. I absolutely congratulate the previous Labour and Liberal Democrat Executive on implementing that universal policy, and I congratulate the current Scottish Government on maintaining it. It has been a huge boost to eye healthcare in Scotland.
The value of community optometry can be seen in the enhanced role that it provides in communities across Scotland, providing much-needed early intervention and detection of eye disorders. I am happy to support the motion and to recognise the value of community optometry and the work of Optometry Scotland.
18:03
I thank my colleague, Fiona McLeod, for bringing this debate to the chamber.
I have a long-established relationship with Optometry Scotland and, prior to that, with the Scottish Committee of Optometrists and the Scottish Contact Lens Society. I mention that because, many years ago, when I was with the Guide Dogs for the Blind Association, I used to speak at its conferences and spoke to colleagues in Northern Ireland when we held joint conferences. The idea that we discussed was that it was important to go beyond the eye and to understand that, behind the eye, there is a person—a person who has feelings and who is, quite often, anxious about and dismayed by what is happening with their sight.
I was also fortunate to have been invited to present lectures at Glasgow Caledonian University to optometry students in their final year. Again, I took the opportunity to emphasis the fact of the person behind the eye. I want optometrists to realise that, when they are explaining a condition to a patient, they must do so in terms that are understandable to the patient.
When we are talking about a cataract and, perhaps, its removal, that is fine. However, in the past, people often used to believe that, when they had their operation, they would get their sight back. I am not blaming optometrists and perhaps not even ophthalmologists for that, but they failed to tell patients that they would get only their remaining sight back. For example, if a patient had macular degeneration and a cataract, they would still have macular degeneration, so they would not get their full vision back. We need to encourage our optometrists to convey that sort of information to the patients when they see them.
I talked to one or two optometrists who were at the SNP conference. They understand and realise that they can do more as a signposting agency. I go back to the mid-1980s, when I worked with Sudi Patel. Some optometrists might cringe when they hear that name, but he was probably a forerunner of the low vision service in Glasgow. At that time, Glasgow was providing a one-stop shop and bringing the low vision service to the patient group through the social work service. That was a forerunner of the services that we have now. The RNIB has taken that forward through the years and continues to do so.
We continue to see the benefits of eye care health and the new strategy for vision in Scotland, because early intervention saves sight. If somebody has wet macular degeneration, we have only a small window of opportunity to save that person’s sight. If it goes undetected, the person will lose their sight. Various other conditions such as glaucoma or retinitis pigmentosa can be detected early, and optometrists can give advice and provide understanding to the patient group.
The fact that community optometrists are now doing much more than they have done in the past means that people do not have to go to their general practitioners. They can go and see their optometrist and not take up valuable time with a GP who, I am sorry to say, might not have the expertise to diagnose what is wrong with the person’s sight in the first place.
Over the years, the partnership working between optometry, ophthalmology and social services has shifted. That partnership was well overdue, but it has been driven by Optometry Scotland. Ophthalmology has now embraced it and realised that the community optometry service does an excellent and valuable job because it sees patients who then no longer have to go to the eye clinics and take up valuable time in hospital.
I congratulate Optometry Scotland on the work that it continues to do and the work that it will probably embrace in the future. My message to it is to remember the patient beyond the eye. The eye is the window to that patient, but the patient needs understanding of their condition, which needs to be explained to them in words that they can understand.
18:08
I congratulate Fiona McLeod on securing time for the debate. I listened with great interest to all the speeches. I will use the debate to recognise on the Scottish Government’s behalf the valuable work that high street optometrists do and the role of Optometry Scotland.
The Government has a commitment to community-based eye care services because there is a strong and compelling case for continuing to deliver services in that way for some of the reasons that members highlighted in their speeches. It can be convenient for people. It provides flexible access to eye care services, with the real prospect that conditions will be identified at an early stage.
Community-based eye care also reduces the burden on hospital care by ensuring that patients with conditions that could be dealt with outside a hospital setting are treated appropriately within the primary care setting. Also, appropriate care can be delivered much more cost effectively in the community than in the hospital environment, without any detrimental impact on the quality of care that an individual patient receives.
A number of members have highlighted the free NHS eye examination. That policy, which the previous Executive introduced, is an exemplar of the benefits of preventative healthcare. That comprehensive examination of eye health affords the best prospect of identifying treatable eye conditions at an early stage in their development, which is important, for the reason that Dennis Robertson outlined.
The examination is provided in our communities—on the high street—by optometrists and is universally available. Members will be aware that the policy has proved to be extremely popular with the public and that take-up continues to grow. In the year ended 31 March 2013, there were more than 1.9 million examinations, which equates to 36 per cent of Scotland’s population. That demonstrates that the people of Scotland are taking on board the message about the importance of maintaining good eye health and making good use of the services that are in place. That is to be welcomed.
It is important to say something about the financial commitment to community-based eye care services. In the last financial year, 2012-13, NHS Scotland spent £70.8 million on the provision of free NHS eye exams. I am sure that members will recognise that that represents a significant financial commitment, particularly when it is contrasted with the expenditure of just over £20 million in 2005-06 on the universal examination’s predecessor, the NHS eye test.
That is just part of the Scottish Government’s commitment to eye care. In addition, through NHS Education for Scotland, the Government provides £1 million per annum for optical education and training to support the free NHS eye examination. We made funding available to optical practices to purchase digital cameras and other associated equipment to facilitate examinations and take photographs of the eyes in order to monitor a patient’s condition. That builds on further improvements in the overall service.
I am sure that members all recognise that prevention is a key part of our eye healthcare policy. We know that the universal free NHS eye examination has delivered benefits to the people of Scotland. One study estimated that between 2,000 and 5,500 patients have received treatment for preventable sight loss that they would not otherwise have received.
We can begin to see the substantial benefits when we consider that the RNIB estimates that sight loss has an associated cost of more than £17,500 per person per year. Of course, the personal cost of blindness is impossible to determine. A partial or full loss of sight results in a loss of confidence and can result in a loss of income and in dependence on others.
Members will be aware of the significant impact that the change in Scotland’s demography is having on our healthcare system. As we grow older, increased funding for care costs needs to be provided, and the prevalence of conditions such as diabetes and glaucoma increases with age.
The age profile of Scotland’s population is set to change dramatically in a comparatively short time. I will give members some figures to illustrate that. The proportion of the population that is aged under 15 is to fall from 32 to 16 per cent, while the proportion that is aged 65 and over is to increase from 5 to 17 per cent. That trend is set to continue and our health services, including our eye care services, will need to meet that challenge.
However, I believe that we have a very strong base to work from. I acknowledge the important role that has been played by Optometry Scotland in helping to bring in, and successfully deliver, the free eye examination. That would simply not have been possible without strong partnership working.
To extend that theme of partnership working, it is fair to say that, as a result of the work done by Optometry Scotland, NHS boards, RNIB Scotland, the Scottish Eyecare Group, and NHS National Services Scotland, we are now generally acknowledged as the world leader in the provision of eye healthcare services.
However, we want to build on that good progress. For example, we are well advanced in implementing the electronic referral system between optometrists and hospital eye healthcare services that patients can benefit from—several members have referred to that system. Those are real benefits that I believe will continue to allow us to build on the progress that we have made and to ensure that we speed up the process for patients being referred into the appropriate system as and when they require further care.
As a Government, we recognise the value of community optometry in the success of eye care services in Scotland, and the particular role of Optometry Scotland in bringing that about. Of course, we need to remain vigilant to the challenges of an ageing population but, equally, we need to acknowledge the strengths of the current service and the fact that we are well placed to build on those achievements in the years to come.
Meeting closed at 18:16.Previous
Decision Time