I now move to the short debate, and I call on Nick Ramsay to speak on the topic he has chosen. Nick Ramsay.

Diolch. Thank you, Deputy Presiding Officer. I’ve agreed to give a minute of my time to Mark Isherwood. There is a brief opening presentation with a difference at the start of this short debate. So, can I firstly ask you all to close your eyes for a minute or so?

A sound recording was played.

Thank you; you can open your eyes now. The sounds you’ve just heard are sounds that blind and partially sighted people hear on a daily basis. Without sight, as you can imagine, these noises can be very disconcerting. I recently undertook a blindfolded walk with Monmouth Visually Impaired Club, and my experiences were nothing short of profound. The walk from the Monnow bridge to the top of town is normally straightforward, but, with a blindfold, everything was different. After a short space of time, I was disorientated and completely dependent on the people around me for support. The traffic noise was bewildering, and retailers’ A-boards compounded the dangerous complexity of this new obstacle course, as did the plethora of mismatched pavement and road surfaces. In short, it was one hell of an eye-opener, if that’s the right expression. Of course, I was able to remove my blindfold once we’d reached the relative safety of the Punch House tavern at the end of my journey, but it left me thinking, ‘What about my new friends who don’t have this luxury?’

The reason for this debate is that this week is National Eye Health Week. Lots of events are taking place across the country to raise awareness of the importance of eye health and having an eye test. I believe the Minister for Social Services and Public Health had her own eyes tested recently, but still one in 10 people do not get their eyes tested on a regular basis. Many people do not realise that their long-term sight can be affected, and that 50 per cent of sight loss is avoidable with early detection and treatment. Everyone should have their eyes tested every two years. If you have diabetes or a family history of glaucoma, you should have a test every year.

Losing your sight impacts on every area of your life. It is the sense that the majority of people are most afraid of losing. I’m now going to speak a little about the different things that blind and partially sighted people experience in their day-to-day lives, and how policymakers can make this better for those living with sight loss.

If you’re unable to drive, your only choice is to use public transport, something that can be difficult for many reasons, not least because information at bus stops is often not provided in the most accessible formats. In 2015, the Royal National Institute of Blind People Cymru and Guide Dogs research for ‘Get on board’ found there were many issues blind and partially sighted people faced when accessing public transport: incidents such as rudeness to partially sighted passengers who mistakenly pulled over the wrong bus, because it was too difficult to make out the number in time. Often, a blind or partially sighted person will learn a route to enable them to live independently. If they’re not helped to find their stop, or if audio announcements are turned off, people can very easily end up in the wrong place and may no longer be able to travel independently at all. In rural areas, information at bus stops is often out of date or too small or weather-beaten. Rural bus services are integral to blind and partially sighted people who cannot drive. Funding for these services must be protected.

New developments are not always sympathetic to the needs of people with sight loss. A building with lovely glass ceilings may be in vogue at the time, but this can cause problems for people with sight impairment as the light can cause difficulties for the eyes understanding the route to take through the building. This is a very scary and also unsafe situation for someone with a visual impairment. The redevelopment of Aberystwyth bus station a couple of years ago meant you had to cross the path of a potentially oncoming bus to enter the station, with no helpful tactile paving, and it was incredibly unsafe. This has now, thankfully, been rectified, but there must be more understanding at the outset of the principles of safe design in the upcoming planning and policy developments.

Many people associate going blind with old age, but the reality is that many people are born with sight impairment. Of the 106,000 people in Wales living with sight loss, there are an estimated 1,935 children and young people aged between 0 and 25 years. Children with a visual impairment are at risk of poor outcomes, as 80 per cent of learning is visual for children who have full sight, which is why children born with any sight impairment need understanding of the additional support and adjustments needed to ensure that they have the same access to education as their sighted peers.

As children with a visual impairment learn differently, it’s vital that specialist teachers who understand this are able to support teachers and learners. Research undertaken by RNIB Cymru has shown that the number of teachers holding the teaching qualification for this speciality has been decreasing as teachers get closer to retirement age and are not replaced. The qualification for teaching children with a visual impairment has been made mandatory in England. The only university that currently provides the course in the UK is in England and is oversubscribed, so Welsh teachers are not given priority to access that course. It’s also vital that school inspection regimes monitor the provision of specialist support across Wales.

We’re about to enter an important time in the development of additional learning needs policy in Wales, and this is the time when we can really make a difference to visually impaired learners. The additional learning needs Bill must ensure mandatory specialist learning training for staff teaching blind and partially sighted young people.

If I can turn to health, as most sight loss conditions are degenerative but also treatable, and in some cases blindness is preventable, it’s important that ophthalmic patients are reviewed within the NHS within a clinically-led timeframe that doesn’t just focus on the first appointment but that the patient’s full treatment is monitored, with follow-up treatments built in. At present, the referral-to-treatment time target only focuses on the initial diagnosis and first treatment. There’s no target for follow-up eye appointments and therefore the risk to the patient cannot be adequately managed. This is why an RTT target that does not focus on the clinical time frame is potentially damaging, as it drives attention and resources away from ensuring timely follow-up appointments.

The fact is, improved outcomes in ophthalmology will lead to better health outcomes overall and achieve savings. For example, almost half of all falls experienced by blind and partially sighted people were found to be attributable to their sight loss. Blind and partially sighted people also need timely access to rehabilitation services. If the Social Services and Well-being (Wales) Act 2014’s primary aims are to be realised, then blind and partially sighted people must be assessed by trained and experienced professionals. A specialist assessment will also mean that blind and partially sighted people will know what support they need.

Charities in the sight loss sector are increasingly concerned about the provision of rehabilitation for visually impaired people. They believe the commissioning process should guarantee qualified rehabilitation officers are employed in local authorities. The minimum coverage recommended is at least one rehabilitation officer per 70,000 of the population. Now, I’m not saying that that’s not being achieved, but, currently, local authorities, whilst being asked to do more with less increasingly, are attempting to provide the minimum service for their population and not carrying out sufficient equality impact assessments to ensure that the more complex needs of someone who is losing their sight are met.

Eye clinic liaison officers are also in each health board across Wales, offering support to people with sight loss at the point of need. They’re recognised by the Royal College of Ophthalmologists as an integral part of a minimum service team within the eye clinic. Without the right support, the impact of sight loss can have a major effect on other areas of a person’s life, such as falls, isolation, and on the ability to stay in work. In an RNIB published study carried out at Singleton Hospital in Swansea, it was found, using social-return-on-investment methodology, that an investment of £1 in the early intervention service brings a return of £10.57 to health and social care budgets in Wales, so there are real savings to be made.

Finally, England has only just launched standards for accessible information for people with sensory loss in the NHS. This is over two years behind Wales, so we’ve really made progress here. However, with people with sight loss in Wales still facing major barriers to their healthcare, more needs to be done. They’re still leaving hospital every day unsure of how much medication they are meant to take, or unsure of what advice they have been given. In the hospital setting, simple actions such as a change in the colour of materials so that there’s a greater contrast between food and plates, or beds and wards, toilets and floors—the list goes on—would stop patients from going hungry, losing their way or taking a fall; simple changes, but changes that can have a real effect. The standard in England contains penalties for services that do not ensure that people with sensory loss receive information in the format they need. Is it time that we in Wales think about applying this sort of regulation to our standards? Perhaps the Welsh Government’s annual report on the public sector equality duty should focus more on these types of duties.

So, in closing, Deputy Presiding Officer, I would ask you all to think about the issues affecting people with sight loss in Wales during this National Eye Health Week. Attend one of the events if you can, and let’s all of us do our bit to raise awareness of this issue and to try and improve the standard of living of visually impaired people living in Wales today and tomorrow.

Shared space or shared services remain a significant issue for people living with vision loss in Wales, where no kerbs, no safe crossing points, pavement obstacles and a reliance on eye contact turns high streets into no-go zones for blind and partially sighted people and guide dogs. A Flintshire constituent told me, ‘Both of my children and I have vision loss, and if we want to access the village shops and facilities, we have to cross the road unassisted by a pedestrian crossing, or walk in the road itself’. This, she said, is risky and scary. She added, ‘I’ve visited the Senedd, and the lack of marking of the steps and slopes outside the building makes it very difficult for someone with vision loss to navigate safely.’ As the RNIB states, local authorities should work with blind and partially sighted people under their public sector equality duty to assess existing shared spaces and involve them when new schemes are put forward. Of course, the same goes for the Assembly.

Thank you. I now call on the leader of the house, Jane Hutt, to reply to the debate.

Can I begin by thanking the Member for Monmouth, Nick Ramsay, for raising this important matter and using the short debate during National Eye Health Week? I’m very grateful to him for highlighting the significant impact that low vision and sight loss has on people. Improving access to services for this group in all aspects of Welsh life is so important, as you so adequately have demonstrated in your short debate.

The Well-being of Future Generations (Wales) Act 2015 places a responsibility on specified public bodies to set and work towards well-being objectives, which contribute towards each of the well-being goals. One of the goals, of course, is to create a more equal Wales with a society that enables people to fulfil their potential no matter what their background or circumstances. As a Government, there’s work going on in many areas that supports this goal of creating a more equal Wales. One example is our disability equality forum, which allows us to engage directly with disabled people and hear from them how Welsh Government legislation policies are affecting their lives, and how things might be improved. Our framework for action on independent living sets out the action we’re taking as a Government to promote the rights of disabled people in Wales to live independently and exercise the same rights as other citizens. I recall, as many Members from previous Assemblies will, that we did actually take forward this framework for action as a result of a petition that then led to Government responding and developing this framework.

Many issues raised by disabled people are about local service access and delivery, which is, of course, so important to people living with sight loss. We know that local disabled people’s groups and organisations, where they exist, can be very effective in keeping up the pressure for improvement at local level. And it’s important that this continues. As a Government, we’re funding Action on Hearing Loss Cymru, working with RNIB Cymru, to train and support people with sensory loss to share their personal experiences with service providers in the health, social services and housing sectors. As part of this work, a best practice guide for housing providers has been published and similar guides are planned for social services and GP services.

Our digital technology can have a key role in improving access to services for disabled people, including those with sight loss, and this is another area of work that can help reduce isolation and enhance the capacity for independent living by giving disabled people the same choice and control over their lives as everyone else. So, Welsh Government’s digital inclusion programme, Digital Communities Wales, works with disabled people’s organisations so that these organisations can deliver digital skills support to the disabled people they work with. But we also recognise that e-accessibility can be a barrier to more people benefiting fully from the numerous opportunities presented by the internet. I’m aware of research that shows that disabled people are more likely to be digitally excluded, so it’s particularly important that we fully understand the issues, because arguably disabled people have even more to gain from digital technologies that are progressing all the time, as technology can open up opportunities that were previously out of reach. If we look at Digital Communities Wales, for example, it’s supported RNIB Cymru to deliver its lottery-funded Online Today digital inclusion project, which helps people with sensory loss to get more out of computers, tablets, smartphones and the internet.

If we move on to the area of employment, disabled people have told us how important accessing and remaining in work is to them. We also know that, sometimes, negative and inflexible attitudes by employers and managers can adversely affect disabled people. It’s vital that we tackle this, because disabled people have told us that being in employment promotes independence, confidence, health and well-being, as well as providing a route out of poverty and enabling participation in society. As a result of hearing these ongoing concerns, Welsh Government officials are working with the Department for Work and Pensions to raise awareness amongst employers and disabled people of the support that is available through the Access to Work schemes.

Nick Ramsay, you raised the important issue of public transport, which is an area of real concern. There are a number of examples where we in Wales have taken a lead in advocating improvements in our public transport system to improve accessibility. You raised the important issue of access to bus services. Since 2013, it has been our policy that public service vehicles operating local scheduled bus services should have next-stop audiovisual announcements on board. These systems do enable people who are blind or living with sight loss to use our public transport system with confidence, and they reduce the risk of passengers being left at the wrong bus stop in an unfamiliar area that can be a significant distance away from their final destination. In March, we published our voluntary Welsh bus quality standard, which, for the first time, directly linked the payment of grant funding made available from our bus services support grant to the delivery of Talking Bus and other quality expectations. It’s for this reason that we’ve welcomed the Secretary of State for Transport’s decision to introduce an amendment to the Bus Services Bill that will improve the availability of accessible information on buses as a requirement of the Equality Act 2010.

The award of the next Wales and borders franchise and the development of the north Wales and south-east Wales metro systems will provide a transformational change to public transport in these areas that’s long overdue. We’re determined that improving accessibility of the rail network to improve the passenger experience should be at the heart of the work that we’re doing with the rail industry.

Moving on to the crucial area of health, in December 2013, the Welsh Government introduced the all-Wales standards for accessible communication and information for people with sensory loss. The aim is to set up standards of service delivery that people with sensory loss should expect to be met when they access healthcare. Every patient or service user who requires communication support should have this need met. In implementing the standards, Action on Hearing Loss Cymru and RNIB Cymru have worked closely with the NHS Centre for Equality and Human Rights to develop training for NHS staff specifically around the needs of people with sensory loss. ‘Treat Me Fairly’ is an e-learning package that has been developed and accepted by all local health boards as statutory mandatory training at induction. It is about fair and equal treatment for everyone accessing healthcare and is very much centred on communication.

Access will increasingly improve as primary care is organised better. For example, there is a need for more options on how to get help and advice on a wider range of self-care services and professionals to respond. We are managing more people in primary care, including direct access for many conditions, rather than needing a GP referral. Our Wales eye care service leads the way in the UK, and I was very proud to be part of that development many years ago as health Minister. And I recall Dr Dai Lloyd and others—still one or two from then—and David Melding, who were involved at that time, I think in the first Assembly session. It is actually recognised as a significant advance in the provision of primary eye care services. There are two key aims: to preserve sight through the early detection of eye disease and to provide support to those who have low vision and whose sight is unlikely to improve.

Thank you for recognising, Nick, how Wales is ahead in terms of the NHS, but we mustn’t be complacent. There is more to learn, clearly, as you say, and we look to that evidence. The Wales eye care service’s prudent pathways benefit the patient by making their care more accessible and closer to where they live. They also ensure that optometrists in primary care and ophthalmologists in secondary care work at the top of their licence.

The social care provided by local authorities in Wales is a major component of the care offered in the community, and we’re driving improvements for the implementation of the Social Services and Well-being (Wales) Act 2014. So, we must be assured that the prevention of avoidable sight loss is a key priority. It certainly is a key priority of this Welsh Government, and this drives our policies. The challenges we face in eye care are well known. The number of people with eye disease is predicted to increase dramatically, and the burden on eye care services will continue to increase, but it’s good news—

Thank you, leader of the house, I should say, for giving way on that. Just for the record, I did identify one area where the Welsh health service was ahead of that across the border in England, but there are also other areas where we are falling behind a little bit, and we need to make sure that we are ahead across the board. I’m sure you’ll agree.

Yes, and I think, Nick Ramsay, I did say we’re not complacent, we have more to learn and we would want to look at the evidence. Clearly, that’s the case.

As I’ve said, we do have new developments to bring forward in terms of new patient pathways that can help prevent sight loss, and better support for people living with low vision. I’m very conscious of the fact that Mark Isherwood particularly always encourages us to talk to the people who actually experience sight loss or other issues, conditions and barriers in their lives. Of course, that’s what we have to do, as well as looking at evidence of how services are being provided cross-border and elsewhere, not just here in Wales or the UK.

Significant progress has been made in improving access and tackling conditions that have had an impact on people’s sight, from investing in new services that detect conditions as early as possible to providing more services closer to people’s homes. I think, since the launch of the eye care delivery plan, which was refreshed and renewed in 2013, the Welsh Government has seen the tremendous efforts by all health boards, including secondary care ophthalmologists, primary care optometrists, local authorities, community health councils, and the third sector. But I am also glad that Nick Ramsay has mentioned the importance of addressing the needs of children and young people. Again, an example of how this is an all-age cross-Government policy area where we need to ensure that we look, in this context, to our education services, our teaching profession, and indeed beyond that into the wider life needs and circumstances of children and young people, which is very important out of education as well as in education. But, as the Member has said, the ALN Bill will provide an opportunity to look and consider these needs further.

I think Nick Ramsay has introduced this short debate today in a very powerful way. You had that experience of walking through Monmouth town. I remember recently going on to the track in Llandow, in the Vale of Glamorgan, which many Members will know of, where I had to go in a go-kart with a blindfold. I think it was actually organised by the RNIB, and it was a terrifying experience. But this is where you learn very quickly. It’s only for us just a one-off experience, isn’t it? I hope I’ve been able to demonstrate today the importance that the Welsh Government places on improving health and well-being of all those people in Wales who are blind or partially sighted. Challenges remain, of course, particularly with an ageing population, but it is an all-age issue in terms of needs. We have got legislation, policies and programmes in place to support and meet these needs. We’re determined to ensure that those living with sight loss can lead inclusive and fulfilled lives. Once again, I want to thank Nick Ramsay for bringing this very important issue so powerfully to the floor today.

Thank you very much. That brings today’s proceedings to a close. Thank you.

The meeting ended at 18:14.