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Lord Roberts of Conwy moved Amendment No. 84:
- Page 28, line 30, at end insert ", and indicate which authority is to take the lead in the formulation of such strategies"
The noble Lord said: Amendment No. 84 relates to Clause 22 and deals with health and well-being strategies. The concept of such strategies drawn up by local authorities and local health boards is attractive. We are all aware of the relationship between people's health and their physical and mental environment, and of the inevitable overlap between the health sphere and the sphere of local government.
There are some areas—I am thinking particularly of social services—where there is a close relationship which is to be found in all parts of Wales. The relationship may be particularly important where there is a high proportion of elderly people in the population, as in the retirement areas of North Wales. There are other areas, such as the valleys of South Wales, where the working environment and its legacy may still be an important determinant of people's health. I am sure that there are other areas where housing conditions are a primary concern. We still have a great deal of pre-1918 housing.
Health and well-being strategies are therefore likely to vary in their priorities in different parts of Wales. Obviously, they will also have much in common, such as health promotion, but my main concern is to establish through the amendment which body is to take the lead in drawing up such strategies.
The clause opens by laying a duty on both types of authority—local government and health authority—to act jointly in formulating and implementing strategies. But, as I am sure the noble Baroness will realise, the danger is that neither will get far without one or other taking the lead, depending on what is perceived to be the major problem of the area and whether it is clearly in the health field or a local government responsibility. The clause is silent on that point. I shall be interested to hear what the noble Baroness has to say. I beg to move.
Baroness Farrington of Ribbleton: The noble Lord, Lord Roberts of Conwy, has raised an important aspect of the Bill in terms of the way in which the formulation of policies will occur within the local
health boards. The effect of the amendment would undermine the principle of joint ownership of each health and well-being strategy and the partnership principles which underpin the NHS Plan in Wales.The National Assembly will give advice in guidance about how the responsible bodies should work jointly to formulate and implement the strategy. In doing so, the National Assembly intends to leave as much as possible to local determination. Local partners, therefore, will determine the local arrangements.
It is the wish of those involved in developing the proposals in Wales that these partnerships will be across local government and the voluntary sector and, as the noble Lord recognised, develop in line with the circumstances prevailing in particular health board areas.
However, I am able to reassure the noble Lord, Lord Roberts of Conwy, that should any problem arise where a particular health and well-being strategy was not being progressed under the joint requirements, the National Assembly would seek to work with the relevant authorities to find a solution. It could ultimately use direction-making powers were they to be necessary. In the light of those assurances, I hope that the noble Lord will not press his amendment.
Baroness Carnegy of Lour: Before the noble Baroness sits down, perhaps she will try to imagine the situation that will arise when this part of the Bill is implemented. I am sure that she is well placed to do so. Would it not be helpful to the Assembly if it was required to decide who was the lead authority? There could be a problem in this area, and all that my noble friend is suggesting is that the Assembly should be required to do that—naturally in consultation. To leave it out would be asking for trouble for the Assembly.
Baroness Farrington of Ribbleton: I have failed to make clear the position which is being taken by the Assembly following detailed consultation. It is taking the view that it is not for the Assembly to direct who the lead authority should be but that that should develop at local level. The local partnership should bring in all parties to consider how best to develop the health and well-being strategy. The view that one authority must be the lead authority imposed by the Assembly is in conflict with the whole ethos of the development of the health service strategy in Wales.
Lord Roberts of Conwy: I am grateful to the Minister for her reply. I made the point simply to highlight the possibility that there could be difficulties so far as leadership was concerned in formulating these health and well-being strategies. She has reassured me. Indeed, I am reassured by the contents of the Bill because Clause 22(6)(b) refers to the fact that,
- "The regulations may, in particular, make provision as to ... steps which the responsible bodies must take before formulating the strategy".
I heard what the noble Baroness said about the fact that if there is difficulty the Assembly can step in, but it is quite clear—I do not think that she will dissent from
what I said earlier—that the primary concerns of these strategies will vary as between different areas. It is important that that point is taken on board and that the Assembly, if necessary, can give guidance as to who should take the lead. Having been reassured by the noble Baroness, I beg leave to withdraw the amendment.Amendment, by leave, withdrawn.
6 p.m.
Lord Clement-Jones moved Amendment No. 85:
- Page 28, line 46, at end insert—
The noble Lord said: In moving Amendment No. 85, I shall speak also to Amendments Nos. 87 and 159. The Minister will note that this is my one foray into Welsh health matters. I do so only because of the importance of the issue of visual impairment. The amendments cover both England and Wales in different ways.
Clause 22 imposes a duty on local authorities and local health boards in Wales to formulate and implement a health and well-being strategy for their area. Amendment No. 85 would help to ensure that regulations made by the National Assembly for Wales could include provision for a duty to be imposed on both to include steps to improve the eye health of, and the provision of eye care to, the public in each area.
Amendment No. 87 is designed to ensure that any health improvement plan drawn up under the Health Act—I apologise if I have confused the Minister. There is a misprint in the amendment. The reference should be to the Health Act 1999, not the Health and Social Care Act 2001. The Bill should include a strategy,
Why are the amendments necessary? Eye health is accorded low priority at primary care level and has not been a major feature of health improvement plans. Despite the prevalence figures, eye health has been accorded woefully little importance by primary care planners.
One of the reasons for this is that there is a mistaken assumption that visual impairment is a low incidence disability. That is not correct. Two million people in the UK are affected by uncorrectable sight loss; two-thirds of these have another disability or a serious health problem such as deafness, arthritis or diabetes. Currently, 90 per cent of blind or partially sighted people are aged 60 and over. One in five people over 75 has a sight problem. Within the next 30 years, about 40 per cent of the UK population will be aged 60 and over, which means that 2.5 million people will be living
There is strong evidence that adults in the UK are at risk of developing eye disease and other sight problems because they are not regularly having check-ups. Services have failed to pick up at least 1 million people with an eye condition which is either treatable or remediable, or which could be compensated for in some measure by rehabilitative services and equipment. Eight-five per cent of people over 65 who have cataracts and 75 per cent who have glaucoma have no contact with eye specialists. The number of overall sight tests since the extension of free eye tests to the over-60s has risen by only a small amount. People from certain ethnic backgrounds—for example, Afro-Caribbean and South Asian— are at greatly increased risk of glaucoma and diabetic retinopathy. One in five school-age children have undetected poor sight. People on low incomes are unaware of the exemption categories and low-income concession scheme and are not having sufficient eye tests. Further evidence can be obtained from a recent report from the Patients Association which demonstrates the inadequate information and access to treatments for major causes of blindness and visual impairment.
The detection of eye disease and low vision happens at primary care level—critically, through the NHS sight test, which is also an eye health examination. But unless and until this matter is re-prioritised in local health strategies, and proper monitoring and targets are put in place for addressing under-identification and low take-up of services by at-risk groups, people will continue to lose their sight unnecessarily.
The cost to the NHS of failing to re-prioritise eye health at primary care level will be huge. The risk of hip fracture is doubled in people with poor and moderately impaired vision. The cost to the National Health Service of treating sight-related falls and injuries among older people is estimated at £221 million, as against £25 million for rehabilitation and prevention.
Amendment No. 159 seeks to insert a new clause setting up low vision committees. It would require,
The purpose of the amendment is to ensure that low vision services become more uniformly available and are better co-ordinated across England and Wales. Low vision affects nearly 2 million people. Low vision services are crucial for rehabilitation, the prevention of accidents and the amelioration of general health. They depend on effective, patient-centred, inter-disciplinary working.
There is a nationally agreed framework in England and Wales respectively for the way in which the disciplines can work together to provide effective care for people who lose their sight. However, without statutory provision for low vision committees, services will remain extremely patchy and unco-ordinated.
What is a low vision service? It is a rehabilitative process which provides a range of services for people with low vision to enable them to make use of their eyesight to achieve maximum potential. It involves assessing the person's visual function. It involves providing aid, such as hand and stand magnifiers, telescopes, spectacle mounted aids, task lights and so on. It involves addressing psychological and emotional needs and facilitating modification to the home, school or work environments.
Who provides these services? There are a huge range of practitioners involved in delivering them. Ophthalmologists undertake the clinical diagnosis; optometrists will be involved in low vision assessment, and often the provision of low vision aids. GPs need to be able to refer patients quickly. Rehabilitation workers and local societies for blind and partially sighted people provide advice, information, low vision aids and training. Other specialist practitioners need to be involved; for example, to deliver an effective children's low vision service. I could continue. There are a number of other professionals involved in the process.
Research by the RNIB has found that more than half of the low vision teams contain only one type of professional group. One team in 10 has no link with any other agency. The amendment specifies that the membership of low vision committees must include a range of professionals such as the ones I have mentioned.
Why is the amendment necessary? A lack of low vision services will mean more residential care and attendance costs for local authorities. Such a core rehabilitation service should be uniformly provided in the UK; but two out of every five potential service providers do not deliver any low vision services whatever, with some areas of the country left out altogether.
Challenging AMD in Europe, a report from the AMD Alliance UK published in September, indicated that the UK was among the worst of the countries surveyed in providing rehabilitation services to people with age-related macular degeneration—the leading cause of sight loss in the UK.
Current government initiatives relating to community equipment, pooling budgets and joint assessments—valuable though they are—will not make sufficient impact in this area because they are too generic and do not give a strong steer to PCTs and social services departments to prioritise low vision services. The National Assembly for Wales has begun to address the need for a low vision framework in Wales; but again, without any statutory requirement, services may be slow to develop.
Three years ago, a report was published by the Low Vision Services Consensus Group, chaired by the noble Lord, Lord Jenkin of Roding. I am delighted to see the noble Lord in his place. It involved all the voluntary and professional interests engaged in these issues. Its central recommendation was for low vision committees to be established in every local area. A similar report was subsequently issued in Wales.
The then Health Secretary commended the report to primary care groups, hospital eye departments, social services and voluntary agencies. If the Government still agree with every agency in the visual impairment field that low vision committees provide the best means of ensuring an integrated model of service, they should accept the amendment and insist that such a provision is written into the legislation. I beg to move.
"( ) the imposition of a duty on the responsible bodies to include steps to improve the eye health of, and the provision of eye care to, the public in the area."
"to improve the eye health of, and the provision of eye care to, the public in the area",
and, of course, that applies to England. These two amendments are promoted by the Improving Lives Coalition, which is composed of over 100 organisations in the field of visual impairment.
"each local authority in England and Wales; and ... each Primary Care Trust in England and local health board in Wales, jointly to establish and support a Low Vision Committee ... for the purpose of co-ordinating multi-disciplinary low vision services for persons with low vision".
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