[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

I have accepted one urgent question under Standing Order 12.66. I call on Rhun ap Iorwerth to ask the urgent question.

Will the Cabinet Secretary make a statement on the Welsh Government’s response to the Healthcare Inspectorate Wales report on ophthalmology services in Wales? EAQ(5)0116(HWS)

Thank you for the question. We have action in place to improve our healthcare in Wales through the eye care delivery plan, together with the planned care ophthalmology improvement plan. The HIW report underscores the need for further improvement across Wales. I expect health boards to implement the required actions to ensure better outcomes for all patients.

Thank you for that answer. In a recent audit of health issues brought to my attention by constituents, ophthalmology actually was near the top of the list, making me think that there is a particular issue here. Of course, with ophthalmology, a long waiting time is more than just an inconvenience or a longer time than necessary in pain, because we know that long waiting times for some patients are causing harm, including sight loss, and the report does show that. It also says that management in two health boards are prioritising lower-risk patients who are more straightforward to treat over those with greater clinical need so they can avoid failing to meet referral-to-treatment time targets. Will the Government investigate, as a matter of urgency, that very serious allegation, and will action be taken against managers who are found to have acted in this way, and will there be a review of the targets, with clinicians and with patients also, to ensure a more robust system designed to prevent sight loss?

Thank you for the series of points and questions there. It’s worth reminding us all that there is, of course, increasing demand for eye healthcare. So, it’s part of the ability to detect more conditions, but also the success story of more of us living longer. Of course, not all waits cause harm, but some potentially do, and there’s the point about clinical need.

I take a slight issue with just some of the language but not the thrust, as it were, of your question, in that managers may not have done this, because HIW recognise in their report, in the language, that it does not know if the allegations are true, or represent a systemic policy by the health board. But I have been clear, on several occasions in the past, that patients should be seen in order of clinical need. I’ve already asked my officials to contact the health board mentioned to go through the allegations that are made.

On your broader point about outcome measures, it’s fair to say the Royal National Institute of Blind People, for example, support our agenda and the moves that we’re making to improve eye healthcare, with more care in the community, and they, as do I, want to see more pace and consistency. I’ve had a very constructive conversation with them about both what we are doing and the areas of challenge, and that includes our targets and outcome measures, because I think there is a powerful case that our current RTT targets in this area do not promote the best interests of patients, or help to support the service to make sure that clinical need is the prioritisation. So, there is an ongoing conversation between the RNIB and clinicians about how we reform and revise those targets, and I’m expecting to have a report come to me this spring. So, there’s work already in train, because I’ve already recognised that we could and should make improvements to not just service, but how we measure and understand what success looks like in the service to support and underpin best clinical practice.

Cabinet Secretary, the HIW report focused primarily on wet age-related macular degeneration services, but the problems highlighted reflect wider problems with ophthalmology services in Wales. Waiting lists for ophthalmology are excessively high. RNIB Cymru have repeatedly highlighted that patients are going blind whilst waiting for treatment. Every time the RNIB raise this issue, they’re told that the RNIB’s views do not reflect the current position of services in Wales.

The latest waiting times figures show that the average waiting time for cataract surgery is 115 days—twice as long as in England. That’s the current situation, and when you combine this with the fact that many ophthalmologists are having to rely on posting photos of retinopathy because the IT systems are not up to scratch, you can see why the RNIB make such claims.

Cabinet Secretary, what is your Government going to do to ensure ophthalmology services in Wales meet the needs of the constituents?

Thank you for the comments. I think in my supplementary response to Rhun ap Iorwerth’s first two questions, I tried to set out that we recognise that we are actually saving the sight of more and more people. The challenge is that more and more people need to have the service. There are more and more people coming into our services—it’s about meeting the demand that we have. That’s why we do need to have the sort of system reform that is set out in the Government plans, which has been put together with clinicians. There is no hiding away from that, and I’ve never tried to do that, but I don’t think people should take the view that every single thing said by the questioner necessarily accurately represents the RNIB’s view. For example, on cataract waits, it’s an area where you can wait for a longer period of time without there being clinical harm. If we get lost into saying, ‘Cataract waits must come down as the priority’, we’re potentially then skewing our system in a direction that does not meet clinical need.

Our RTT times are actually falling in ophthalmology, but our challenge is not just are our current RTT measures falling, but actually whether they’re the right and the sort of intelligent measures that we should have to tell us about how successful our service is, and I think there’s a powerful case that they don’t. That’s why I’ve told the service, with the RNIB, that I want to see us having a different approach, to try and have a more intelligent approach to this. We’re already investing in IT to make sure that images are able to be swapped digitally between secondary and primary care, and we’re giving out messages for people to go to their high-street optometrist for eye health care, not to a GP. So, we’re doing much of what the question suggests we should do. The challenges are the pace, the consistency and an intelligent set of performance measures.

Thank you, Cabinet Secretary.