In an exclusive interview with NB, Health minister Lord Howe discusses health service cuts and a commitment to improving eyecare.
What are you doing to ensure that eye health remains a priority for the Government?
I am extremely pleased that the Royal College of General Practitioners have made eye health one of their clinical priorities for the next three years. This has underlined the vital importance of eye health and will see a renewed focus on driving improvements in this area - something this Government is committed to.
Research by RNIB suggests that blindness and serious sight loss could be prevented in 50 per cent of cases if detected and treated early. Figures also show that almost two million people in the UK are living with sight loss. Our priority is making sure that everyone has access to the very best care available.
GPs are the cornerstone of the NHS and under the changes we are making to the NHS, they will have more power to make decisions. They know what their patients needs better than anyone and will make sure that local services are designed in the best way to meet the needs of their local communities.
Last year, we also saw an eye health indicator included in the public health outcomes framework for the first time. This will help drive improvements and make sure people across the country are getting the services they need to protect their sight.
What is the Government doing to prevent sight loss or is it content to leave issues to major charities to resolve?
Let me just reiterate, the Government is committed to improving eye health. I have already outlined that for the first time tackling preventable sight loss will be used as a measure of improving the public's health and wellbeing. There are also other programmes, introduced by the Department of Health, which focus on this area.
General Ophthalmic Services (GOS) are at the centre of our work to prevent sight loss. They provide free sight tests and issue optical vouchers to millions of people each year to help meet the costs of glasses. This service has been an important part of the NHS right from the very beginning.
From April 2013, the NHS Commissioning Board will directly commission this service, making sure its place at the centre of efforts to prevent sight loss is secure.
Regular eye screening for people with diabetes is another important area for safeguarding eyesight. The national diabetic retinopathy screening service plays an important role in tackling sight loss and is now reaching a very high proportion of those diagnosed with diabetes. From April 2013, Public Health England will take on responsibility for all screening services, ensuring they will be consistently and effectively promoted across the NHS.
A library of more than 180 National Institute for Health and Clinical Excellence (NICE) quality standards will support the delivery of the NHS Outcomes Framework. These will set out what high quality care looks like across specific pathways of care. Glaucoma was the first of these quality standards and cataract and age-related macular degeneration are both on the agenda for quality standard development in the next few years.
Of course it goes without saying that charities make an extremely valuable contribution to tackling eye health issues and preventing sight loss and I am keen to see their excellent work continue.
Some PCTs are going against the Government's guidance in determining who qualifies for cataract surgery. How can you stop this in the wake of Government cuts?
First of all, the NHS budget has not been cut. It is in fact going up by £12.5 billion over the course of this Parliament.
We have made it very clear that rationing on the basis of cost alone is unacceptable. Clinicians must make decisions about treatment required based on the individual needs of that patient.
Primary care trusts (PCTs) are currently responsible for planning and funding services that meet the needs of their patients. They must take clinical effectiveness and individual circumstances into account and make sure resources are used effectively to maximise health outcomes for all.
It is very clear that any decisions on funding drugs and treatments must be made following a proper consideration of the evidence. This is required under the NHS Constitution. PCTs also have a legal duty to give reasons for refusing to fund healthcare interventions.
The changes we are making to the NHS will improve the way local services are planned and designed. In the future, decisions of this kind will be taken by doctors, nurses and other health professionals who best know what their patients need.
The RNIB's engagement with commissioners both now and in the future is welcome and I am keen to see this continue.
How do you think the Government could cut waiting lists, for example for cataracts?
The NHS Constitution makes it very clear that patients have the right to consultant-led treatment within 18 weeks of referral. If this is not possible, patients have the right to request an offer of alternative providers - and the NHS must take all reasonable steps to meet patients' requests.
According to current figures, average waiting times are low and the number of patients waiting longer than 18 weeks is at the lowest level since records began.
We have made it very clear that local NHS organisations must ensure that patients should not experience any undue delay at any stage of their treatment. Treatment should be given when clinically appropriate and the healthcare needs of individual patients taken into account. Patients should also be treated in order of clinical priority and then patients who have waited the longest treated first.
What do you think you have done to improve eye health since you have been in post?
Having the right framework in place is crucial if we are to see real improvements in eye health. My primary focus has been on making sure this happens and I believe that the changes we are making to the NHS will create a much better landscape for this.
The needs of the patients will be at the heart of the NHS as never before. Their doctors and other health professionals - working together in clinical commissioning groups - will have the power to plan and design local services. This new way of planning and buying health services will mean that local eye health services can be better tailored to local needs.
What would you like to achieve this year?
I want to see real improvements in eye health and I believe that we have the platform in place to address this - from tackling preventable sight loss through the public health outcomes framework to doctors and other health professionals being able to ensure that services meet the needs of their local communities.
Would you urge more hospitals to employ eye clinic liaison officers ECLOs?
Making sure information is available for people newly diagnosed with sight loss is crucial. NHS organisations must make sure people are getting the information they need and make improvements where they are needed.
For the number of ECLOs to increase, there needs to be evidence of their success and the benefits for patients. Clinical commissioning groups (CCGs) will be responsible for making sure services meet the needs of their local communities. We would expect them to draw on evidence about effective ways of supporting patients.
Why is the first-ever public health indicator for preventable sight loss so important?
I was delighted that an indicator on eye health and preventing sight loss had been included in the public health outcomes framework. All our senses are precious, but sight is probably the one people fear losing the most.
Sight loss reduces autonomy and mobility and also our ability to enjoy and participate in the world around us. Ensuring that people can live longer, healthier and more independent lives is one of this Government's key priorities. We want a health system which is as good at keeping people in good health as it is at treating those who suffer ill health. This is why we want to focus on the results that the health system achieves for local communities in improving public health.
An increased emphasis on eye health is overdue and our move to a more outcomes focused approach provided the natural opportunity to include an indicator on eye health. Our public health programmes tackling smoking and obesity will also help prevent sight loss by addressing some of the key risk factors in the development of eye disease.
It has been said that it's difficult to find anyone with a bad word to say about you. What do you think about that?
This is really for others to say! However, the world of healthcare is full of people with the most fantastic values and commitment. It is therefore difficult for a job like mine not to be a source of inspiration and enjoyment.
Article published in NB magazine March 2013.