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Chamber and committees

Meeting date: Wednesday, September 22, 2021

Meeting of the Parliament (Hybrid) 22 September 2021

Agenda: Portfolio Question Time, Diversion from Prosecution, ScotRail, Scottish Ambulance Service, Business Motion, Parliamentary Bureau Motions, Decision Time, Point of Order, National Eye Health Week 2021


Contents


National Eye Health Week 2021

I remind members of the Covid-related measures that are in place and that face coverings should be worn when moving around the chamber and across the Holyrood campus.

The final item of business is a members’ business debate on motion S6M-00792, the name of Stuart McMillan, on national eye health week 2021. The debate will be concluded without any question being put. Members who wish to speak in the debate should press their request-to-speak buttons now.

Motion debated,

That the Parliament notes National Eye Health Week, which it considers does great work in promoting the importance of maintaining good eye health and, in 2021, runs from 20 to 26 September; believes that it continues to be vital for people in Scotland to book their free eye health check every two years in order to pick up changes to the eyes before they affect the vision; understands that 50% of sight loss is avoidable; notes the measures put in place in optometry practices across Scotland by healthcare professionals to make attending an eye health check safe during the COVID-19 pandemic; commends the work of Optometry Scotland and RNIB Scotland to encourage people to return to practices and check their eye health; emphasises what it considers the need to not forget eye health checks, and notes the call for people in Greenock and Inverclyde, and across Scotland, to book their free eye health check if they have not attended an examination in the last two years.

18:22  

I am delighted to have secured this debate and I thank members from across the parties who have signed the motion. I also thank all the organisations that provided briefings for the debate: the Royal National Institute of Blind People Scotland, Sight Scotland, Optometry Scotland and the RPP Group.

As convener of the cross-party group on visual impairment, I seek to highlight national eye health week every year to raise awareness of the importance of looking after our eye health. I do that not only in one week each year; I talk to constituents and raise the issue throughout the year.

Since 2006, people in Scotland have been able to attend a free eye health check every two years. It is vital that we all make use of that service, even if we think that our eyesight is fine. That is because eye examinations not only help to detect changes to the eyes before they affect vision but can pick up other health conditions such as high blood pressure, raised cholesterol, diabetes and an increased risk of stroke. Going for a free eye examination every two years is important not only for eye health but for overall health.

Covid-19 has made us all pay more attention to our physical and mental health but, worryingly, there were 4.3 million fewer eye appointments during the pandemic. That is both understandable and concerning.

Covid-19 has also resulted in increased waiting times for appointments, with many postponed due to lockdown. The longer patients wait to receive treatment, the more serious their eye condition is likely to become, which can result in further deterioration of vision. Vital eye care has been available throughout the pandemic at emergency eye care treatment centres and through virtual appointments. After the easing of restrictions, optometrists have offered routine eye health checks, with measures in place to minimise the risk of spreading Covid-19.

At present, there are around 178,000 people in Scotland with sight loss, including almost 3,000 people in my constituency. That national figure is expected to double in the next 20 years.

The most common cause of sight loss is age-related macular degeneration, but people of all ages can experience sight loss, with the most common cause of sight loss among working-age people being diabetic retinopathy.

According to the RPP Group, in Scotland, glaucoma affects approximately 10 per cent of those over the age of 75, or around 47,000 Scots, and it only becomes more common and severe with increasing age. Glaucoma is also responsible for approximately 10 per cent of United Kingdom blindness registrations.

Considering that 50 per cent of sight loss is avoidable, I cannot stress enough the importance of getting a free eye examination. I got an examination again this summer, and the experience was excellent. My message to Scotland is simple: now that restrictions have eased greatly and optometrists are open for business, please pay that visit.

Another way in which we can reduce our chance of developing sight loss and improve our overall health is to quit smoking. I have never smoked, but I know people who have successfully quit and others who have struggled to do so. Research shows that smokers are twice as likely to become visually impaired compared with non-smokers, because the chemicals in cigarettes can affect the lenses and blood vessels in the eyes.

Wearing sunglasses is also important in protecting vision. Although we might joke about the Scottish weather and Scottish summers, it does not need to be scorching hot and sunny for ultraviolet light to harm a person’s cornea, retina and lenses.

Eating a well-balanced diet is also important, because a diet that is rich in vitamins can preserve eye health for longer.

National eye health week is also about recognising the issues that are faced by people who are already living with sight loss. For them, the past 18 months have been additionally challenging. Sight Scotland asked more than 400 people for their views on how they were impacted by coronavirus restrictions. Its findings show that 70 per cent said that their sight loss had made lockdown an even harder experience, and 43 per cent said that they were still not confident about going back into society with social distancing requirements in place.

In thinking about how we emerge from the pandemic and what our recovery looks like, we have to be mindful of people who are living with sight loss. Additional outdoor seating and the reconfiguration of public spaces and pavements are welcome, but we have to consider how they affect visually impaired people. Such adaptations should seek to improve accessibility for everyone, and they should not make navigating pavements, paths or parks more difficult for people who are visually impaired. As Miles Briggs will be aware, that issue has come up in the cross-party group on visual impairment.

It is also important that we improve the support and services that are available to people living with sight loss. In the latest research carried out by Sight Scotland, 55 per cent of participants said that they did not have enough information about where they could find support after their diagnosis; 83 per cent said that it was important to provide more support for family members and carers; and 58 per cent said that they had not been made aware of the financial support that is available to them.

I therefore welcome Sight Scotland’s new national support line for visually impaired people, which the minister launched today. Its purpose is to enable visually impaired people to access advice and talk through concerns. The number is 0800 024 8973. The support line is part of Sight Scotland’s new family wellbeing service, which aims to reach everyone in Scotland who is living with sight loss. It is free and is open from 9 am to 5pm, Monday to Friday. A person can get in touch by telephone or email, or by requesting a call back from an adviser.

RNIB Scotland also offers advice and support to people who phone its helpline on 030 123 9999. People can even ask Alexa to call the helpline without needing to touch their phone. RNIB Scotland also has services and resources to help people rebuild any lost confidence.

I am sorry that I cannot attend tomorrow’s Optometry Scotland webinar, which is on the future of community eye care in Scotland, as I will be attending the funeral of a former MSP, Bruce McFee. However, I encourage MSPs and their staff to log on and engage in the webinar. I know that Optometry Scotland works well with the Scottish Government, and I encourage the continuation of that engagement.

Most people say that sight is the sense that they fear losing most, and ensuring that people take care of their vision is key to prevention.

I again thank the members who signed the motion to allow us to have the debate, and I look forward to hearing colleagues’ speeches.

18:19  

I welcome the opportunity to speak in the national eye health debate, and I congratulate my friend and colleague Stuart McMillan on securing it.

Eyesight is one of our most important senses—80 per cent of what we perceive comes through our sense of sight.

This week is national eye health week, which has been established to communicate the importance of good eye health. It rightly encourages people from every walk of life to take better care of their eyes and have regular sight tests.

There are five key areas to protecting and promoting good eye health, which Stuart McMillan has covered in more detail than I perhaps will in the time available to me.

It is worth reiterating that a healthy diet is really important. Studies show that what we eat can affect our vision. Antioxidants can help to prevent retinal damage, and one antioxidant that is hugely beneficial is lutein. Exercise is also important. Lack of exercise contributes significantly to several eye conditions, particularly among people aged 60 and over. Reduced alcohol intake is an interesting area—excessive alcohol consumption can lead to serious health conditions that can have a detrimental effect on eye health. Stopping smoking is another area. After ageing, smoking is the biggest risk factor in the development of macular degeneration.

My younger sister, Buffy, is an ophthalmic nurse specialist who specialises in glaucoma care. She keeps me and her patients right with her expert knowledge. It will be interesting to hear what she thinks of the debate, because I know that she is watching.

Optometrists play a crucial role in our community. However, as with all health professionals, they have been particularly hard hit by the pandemic. Over the course of the pandemic, I engaged with Optometry Scotland on the negative impact that the pandemic has had on optometry, with eight months of no face-to-face appointments.

Sight Scotland has carried out research since lockdown that involved speaking to people in Scotland with visual impairment and those close to them. I thank Sight Scotland for its briefing ahead of the debate. Its report highlighted that 70 per cent of respondents said that their sight loss made lockdown a worse experience; 50 per cent said that they would not be confident about offering support to someone with visual impairment; and a large number of people said that they were unable to attend their optometrist and therefore attended hospital instead.

I recognise the impact that Covid has had on optometry services and encourage the Scottish Government to ensure that they are supported in the upcoming budget. We have heard that optometrists are potentially looking for a 3 per cent fee increase—that is the request from Optometry Scotland.

In 2016-17 alone, community eye care in Scotland saved the national health service £71 million through carrying out 1.8 million primary eye examinations. Importantly, in 2016-17 community optometry services preventing more than 370,000 people from having to attend hospital for eye issues.

In 2019, I saw for myself the very positive impact that community optometry can have when I visited Stranraer Specsavers, where I met the chair of Optometry Scotland, David Quigley, prescribing optometrist, Elaine Hawthorne, and communications officer, Ross Stevens. During the visit, I heard that, as well as identifying any specific issues with sight, an eye check—which is free in Scotland—can help to identify conditions such as diabetes, high blood pressure, arthritis and even signs of dementia. I also heard about the benefits of having a 3D eye scan, which can give the optometrist a better picture of the eye and enable them to pick up any developing issues early, preventing late diagnosis and the need for secondary or acute care.

An issue that was highlighted was that optometrists are not recognised as allied health professionals. I was told that such recognition would help optometrists to be better at working in partnership with the national health service. I therefore ask the minister to consider whether optometry personnel could be added to the list of allied health professionals.

I realise that my time is up. I again welcome the debate. I thank Optometry Scotland for all that it does and encourage everyone to have their sight checked regularly.

18:34  

I, too, thank Stuart McMillan for bringing this important members’ business debate to the chamber and, more importantly, for all his work in the Parliament campaigning on eye health issues. It is important that we recognise that as well.

National eye health week is an excellent opportunity to highlight the importance of good eye health. I pay tribute to Sight Scotland and the RNIB, as other members have, for their useful briefings ahead of the debate. Both charities do exceptional work in supporting blind and partially sighted people across Scotland.

In today’s Edinburgh Evening News, Edinburgh old-age pensioner Charlie Burns, who is 83, and his daughter Gail Burns, praise Sight Scotland for its new national support line. Charlie has been diagnosed with macular degeneration, which is the most common cause of sight loss. Gail got in touch with Sight Scotland to ask what support would be available to both Charlie and herself. She said:

“It would have made a huge difference to have had support at an earlier stage after Dad’s diagnosis.”

The experience of Charlie and Gail reinforces Sight Scotland’s recent findings. It found that 83 per cent of participants said that it was important to provide more support to family members and carers, and 87 per cent said that support with the emotional impact of sight loss was important.

We face huge challenges in preventing sight loss across Scotland. There are currently 178,000 people in Scotland with sight loss, and that number is expected to double over the next 20 years. The pandemic has clearly had a negative impact on eye health, with fewer eye checks being carried out over the past year and a half. In my own region of Edinburgh and the Lothians, patients are experiencing extremely long waits for ophthalmology services. All of that combined presents a number of concerns, which I hope the debate will bring to ministers’ attention.

I noticed ahead of the debate that there has been a significant call to ministers by the sector to consider a proper long-term funding settlement. Optometry Scotland has asked for

“a minimum budget increase of 3% annually in real terms on fees.”

It also called on the Scottish Government to agree to an annual process for reviewing and negotiating eye-care examination fees. I hope that, in closing the debate, the minister can touch on how we can ensure that services recover post pandemic and that as many people as possible are able to access eye-health services across Scotland.

On a separate note, at the end of the previous session, Scottish National Party ministers announced that they were withdrawing funding for a replacement for the Princess Alexandra eye pavilion. Throughout the past year, I and other colleagues—I see that Sarah Boyack is in the chamber—have campaigned to ensure a U-turn from ministers on that.

This is an important opportunity to highlight the need in Edinburgh and the Lothians for information on when that hospital replacement—a long-term proposal—will take place. I would appreciate it if ministers could outline a timetable or timescale for that replacement hospital. Have ministers specifically considered the need for maintenance at the old eye pavilion in the capital? It is no longer fit for purpose—there are already significant challenges, such as old lifts that are often out of use.

I put on record, as others have already done, my huge thanks to opticians and healthcare professionals across Scotland, who continued to provide eye-health checks during the pandemic. Most importantly, I fully support the call by Stuart McMillan, Optometry Scotland and RNIB Scotland to encourage people who have not had an examination over the past two years to return to practices to get their eye health checked.

18:38  

I, too, start by thanking Stuart McMillan for his work, and I congratulate him on securing tonight’s excellent debate. I agree with the praise that he has rightly given to RNIB Scotland and Optometry Scotland, and I, too, thank Sight Scotland for the fantastic work that it is doing across the country.

I am very keen to support eye health for my constituents in the Lothians, whether at a very local level or in getting access to emergency services. Over the past year, as Miles Briggs has said, the situation has been brought to the forefront, first by the cancellation of the new eye pavilion and then by the very welcome U-turn, with a commitment that we will get that new eye pavilion. As Miles Briggs has said, however, it is five years off, even though a huge amount of work has been done on it by NHS Lothian.

Stuart McMillan’s motion rightly highlights how vital it is for people to book their eye check every two years—and it is free. The impact of the pandemic has made many people not do that, and it is understandable that people are nervous about going back to clinical settings. The briefing that we received from RNIB Scotland outlined just some of the fantastic steps that clinicians are taking to ensure that the service is safe, so that people do not need to be worried and can get their eyes checked.

Emma Harper and Miles Briggs highlighted the work that is being done by optometrists, which was very important during the pandemic and will be crucial going forward. I hope, therefore, that the minister will tell us what her response will be to Optometry Scotland’s request not only for a fee increase this year, but for an agreement on reviewing fees so that optometrists can plan ahead.

As Miles Briggs has said, the announcement of the new eye pavilion in Edinburgh really lifted people’s spirits. It was a welcome U-turn, although it took a lot of campaigning to get there, and the issue certainly came up at a lot of hustings before the election. I was also struck by the series of Edinburgh Evening News articles about people’s real-life experiences, highlighting the importance of all our eye services. In that respect, I am talking not just about services at community level and at the eye pavilion, but the clinical expertise and excellence that is needed in those emergency situations when there is only a matter of minutes to save someone’s eyes. I know from personal experience the very long hours that those clinical staff work and the 24-hour service that they provide and, indeed, have provided even through the pandemic. They have been fantastic, and we need to thank them.

I hope that progress on the new eye hospital will be rapid. As has been said, NHS Lothian has already done a lot of work on the project. We also need to think about the community services that should sit alongside that kind of emergency treatment to ensure not only that people get their eyes checked but that any diagnosis is followed up. I want to thank the NHS and third sector organisations for the awareness-raising work that they are carrying out to improve eye health outcomes for people across Scotland. Indeed, that is what this debate is all about.

I urge everyone to book an eye health check—and then book another two years from now, because it should not be a one-off. The service is accessible and free, and it is vital to everyone’s health and wellbeing, so let us get on with it.

I thank the Presiding Officer for her understanding about the fact that I will not be able to stay for the whole debate, but it has been great to be present and to see everyone’s energy and enthusiasm for this service. It is certainly important that we agree on this issue.

18:42  

I thank Stuart McMillan for lodging a motion on national eye health week. I have the pleasure of being a member of the cross-party group on visual impairment, of which Stuart is the long-standing convener, and after attending the group’s annual general meeting earlier this month, I am pleased that it will continue to have a large active membership in this new parliamentary session.

I want to take this opportunity to thank all those who look after our eye health—our optometrists, our opticians and everyone else who helps us take care of our vision. Key to such care are the eye health checks that are carried out at local optometry practices. Since Labour introduced free checks in 2006, everyone in Scotland has been able to book a two-yearly check-up at no expense, and I strongly encourage everyone to do so. After all, we could have an eye condition without knowing it; indeed, glaucoma and diabetic retinopathy affect the eyes before they affect vision. Although the initial changes caused by such conditions are not always noticeable, they can be picked up by an optometrist at an eye health check and can be treated and have their progression slowed before they affect someone’s sight.

Eye health checks can also be crucial in picking up conditions before they get worse. I will briefly share my own experience in that respect. Some time ago, I noticed what appeared to be a few floating objects and little flashes of light in my vision, so I popped into my local Specsavers—other brands are, of course, available—to describe my condition and ask for advice. I was seen straight away and was very quickly diagnosed with a torn retina; I was then referred to the hospital that very day to see the on-call ophthalmologist, and the next morning, I received laser treatment to repair the tear. Had I not had such prompt service, the tear could very easily and quickly have led to a detached retina, which could have permanently affected my vision.

As Stuart McMillan pointed out, eye health checks not only pick up such conditions but can detect general health conditions such as diabetes, high blood pressure and heart disease. Indeed, that ability to pick up eye and more general conditions makes such checks one of the most vital forms of preventative medicine.

As with all health services, optometry practices have had to adapt to the pandemic to create a Covid-secure environment and minimise the risk of transmitting infection. They have done so superbly, and constituents can be assured that it is safe to attend their local optometry practice. However, even though the environment has been made safe, I have been worried to hear in the debate about the significant reduction in the number of people choosing to attend eye health checks over the past 18 months. As a result, fewer eye conditions will have been picked up in their early stages, which means that more people will be diagnosed with more advanced eye conditions. We need to keep highlighting the importance of those routine eye health checks.

If someone is diagnosed with a more advanced condition, it is vital that they do not face that diagnosis without support. Being diagnosed with an eye condition can leave people feeling shocked, saddened and scared about their future. They have worries about whether they will retain employment, be able to pay their bills and continue to take part in the things that they love. That can be deeply overwhelming. It does not have to be like that. We know that, with proper support, people with even the most complex eye conditions can often continue in their jobs, maintain financial stability and be eligible for payments to cover the increased costs of living independently, and they can continue to do the things that they love.

A key group that provides support to help people do that is eye clinic liaison officers. Based in eye clinics, they can discuss the impact that an eye condition is having on a patient’s life, listen to any fears or worries that a patient has and answer questions that they might not have had when they were given a diagnosis. They can also advise on services, covering everything from rehabilitation to financial support, and on the benefits of registering as sight impaired or severely sight impaired. Their support can be both emotional and practical, making it easier for people to get used to how they are going to live with sight loss.

In this national eye health week, I want to thank all our ECLOs, ophthalmologists and optometrists who have continued to work through the pandemic to detect, treat and help people with eye conditions—in fact, I thank every one of our health workers who have done so. I also thank all those charities and groups that support people who are living with visual impairments, from RNIB to Sight Scotland, for the extraordinary work that they do. They really have made a difference to so many people’s lives.

I call the minister to wind up the debate.

18:46  

I have listened with great interest to the debate, and I add my thanks to Stuart McMillan for giving us the opportunity to mark national eye health week and discuss eye health and eye care services in Scotland.

I also thank Goskirk Pettinger Optometrists, whose Dingwall practice I had the pleasure of visiting on Monday, and Sight Scotland, which I visited this morning to help launch its new national support line for visually impaired people and their families. It was also a pleasure to hear my colleague Miles Briggs mention Charlie and his daughter Gail, who I met this morning. Gail spoke so eloquently about the support that Sight Scotland gave them when Charlie first developed visual impairment. She talked about telephoning the helpline and it being like a “warm blanket” wrapped around her. It was wonderful to hear such a glowing report of a service.

I am sure that we can all agree that general ophthalmic services are one of the many NHS success stories in Scotland. I assure members that remuneration for the service and a system for reviewing remuneration are under active consideration. I am absolutely confident that we will reach a mutually agreeable solution on that.

In 2006, the introduction of free universal NHS-funded eye examinations set Scotland apart from the rest of the UK, and the Government is committed to maintaining the policy. That year was the first time everyone in Scotland, regardless of their personal situation, had access to an eye examination free of charge.

A regular eye examination in Scotland provides a full health check of the patient’s eyes, as well as a normal sight test. As others have said, that examination helps to detect early signs of sight-threatening conditions, as well as other serious health conditions. Also, unlike in the rest of the UK, patients in Scotland can be seen by an optometrist for free, as often as it is considered clinically necessary, between regular eye examinations. That supports the on-going care of patients, as it allows referrals to the hospital eye service to be refined and patients to be monitored. It also allows emergency eye problems to be seen and treated in the community or appropriately referred, as Colin Smyth outlined.

Optometrists in Scotland are the first port of call for any eye problem, and the majority of general practitioners and other health care professionals signpost patients to their local optometrist. That has helped reduce the burden on GPs and hospital services; before Covid, Scotland had nearly 50 per cent fewer new hospital eye service out-patient appointments than England.

The service is enhanced by the increasing number of optometrists who have undergone further training to become independent prescribers, and are thus able to issue NHS prescriptions for eye problems. More than 350 community optometrists are now fully trained independent prescribers—that is a quarter of the optometrist workforce in Scotland and more than one third of all IP optometrists in the UK. I believe that we should continue to grow that number.

Despite those successes, it is important that we do more to promote eye health and regular eye examinations, and the Scottish Government will continue to work with others to do that in many different ways.

First, we recently launched Eyes.Scot—Scotland’s new national website for information about eye health and eye care services. Eyes.Scot is the first website of its kind in the UK and it supports the public and professionals by providing easy access to information about how best to look after our eyes and vision.

Secondly, we will ensure that national initiatives such as the right care right place winter campaign continue to promote the importance of regular eye examinations and that of contacting an optometrist as the first port of call for eye problems.

Thirdly, we will work with the national Scottish Eyecare for Everyone—SEE—group to run targeted awareness-raising campaigns among specific patient groups in which take-up of eye examinations is lower, including people who live in more disadvantaged communities.

The Scottish Government remains committed to ensuring that Scotland’s eye care services remain world class, which is why we have set out ambitious but achievable plans in our NHS recovery plan and programme for government to manage more patients in the community and closer to their homes. I want to take this opportunity to set out some of those plans in more detail. First, from April 2023, we will begin to roll out a national low vision service for visually impaired people, which accredited community optometrists and dispensing opticians will provide in the community. That national service will standardise low vision services across Scotland, improve access and reduce waiting times, particularly in areas where the service is currently provided in hospitals. The physical and mental wellbeing of visually impaired people will be improved, which will help them maintain their independence and reduce both isolation and the need for other support services.

Secondly, we will pilot a new community glaucoma service this year. When fully rolled out, approximately 20,000 lower-risk glaucoma patients will be discharged from hospital and accredited IP community optometrists will manage their care in the community. Thirdly, from next summer, we will support IP optometrists to manage more anterior or front eye conditions in the community, which, again, will help reduce the burden on GPs and hospitals.

As well as those new services, the Scottish Government will continue to provide significant investment in new digital technology such as tele-ophthalmology equipment, and a once for Scotland electronic patient record to support two-way communication between community optometrists and hospital ophthalmologists. The EPR in particular is a game changer, which will ensure regional and national working across Scotland. It will make certain that a patient’s optical record is shared across the primary and secondary care interface, which will prevent duplication of effort, provide robust outcome data, ensure that ophthalmologists can provide meaningful feedback to optometrists and support the management of more patients in the community.

On the matter of the replacement Princess Alexandra eye pavilion, which Miles Briggs raised, construction is due to be complete in 2026.

I finish by putting on record the Government’s sincere thanks to our eye care professionals and third sector organisations. Their outstanding dedication, commitment and professionalism has ensured that patients have continued to be safely managed and supported through the pandemic and will ensure that we continue to be able to deliver for the people of Scotland.

That concludes the debate.

Meeting closed at 18:53.