We now move to the short debate.  If Members are leaving the Chamber, could they do so quickly and quietly, please? If you're leaving the Chamber, please do so quickly and quietly, because I'm moving to the short debate and I call on Nick Ramsay to speak on the topic he has chosen. Nick Ramsay.

An audio-visual presentation was shown. The transcription in quotation marks below is a transcription of the oral contributions in the presentation. The presentation can be accessed by following this link:

Audio-visual presentation.

'Sight loss is not black and white.'

'Ninety three per cent of us who are registered blind or partially sighted can see something.'

'My eye condition is glaucoma, and, if you imagine in my left eye, I've no perception of light at all, so it's completely black, and in my right eye, it's almost like I'm looking through a really murky kind of watery fog machine, if you like.'

'I have Usher syndrome type 2. That's a combination of hearing impairment and retinitis pigmentosa. The most common misconception about my sight loss in particular is that I don't "look blind".'

'I have macular degeneration. I can't see your face now, there's just a big round blob there and I have double vision as well. The first couple of years were horrendous, it was like a bereavement really. I was so afraid. I might cry. People are absolutely brilliant, but without the white cane, I would not be as confident.'

'In the UK, more than 2 million people are living with sight loss. Being registered blind doesn't mean you can't see anything. There's a whole spectrum of sight loss out there and that's what people need to know about.'

'RNIB Cymru. Golwg gwahanol. See differently.'

Diolch, Dirprwy Llywydd. I've agreed to give Dai Lloyd a minute of my time during this debate. This video that you've just seen, produced by the Royal National Institute of Blind People, is from the How I See campaign and raises a number of issues that I wish to put before you today. 

Sight is often cited as the sense that people would be most afraid of losing, and it can be tough. From difficulty accessing treatment and services to a lack of emotional and practical support, blind and partially sighted people each face their own set of challenges every day.

Feelings of isolation are unacceptably high, and only one in four blind or partially sighted people of working age has a job. And we know the numbers will increase dramatically. An estimated 107,000 people in Wales live with sight loss and this is expected to double over the next 20 years. That means there will be approximately 218,000 people in Wales living with sight loss by 2050. 

Sight loss affects people of all ages, but, as we get older, we are increasingly likely to experience it. People with sight loss are more likely to have a fall and are more likely to live in poverty. They're more likely to have depression, to be unemployed and have problems with everyday life, such as going out, cooking and reading. Today, I want to touch on just some of the barriers that blind and partially sighted people face and to challenge us to see and do things differently.

As most sight loss conditions are degenerative, but also treatable, it's crucial that people have timely access to eye care and ongoing treatment. Ophthalmology is one of the highest volume hospital outpatient services, and many eye patients have an ongoing need for timely follow-up to preserve their sight. As a member of the cross-party group on vision, I've heard from patients on hospital eye clinic waiting lists that their appointments are being cancelled at exceptionally short notice. I know we've got other members of the group here today, too. Delays to treatment can put people at risk of irreversible sight loss. That said, I would like to welcome Welsh Government's recent announcement of investment to support implementation of the new ophthalmic outcome focused measures—the first nation in the UK to have specific measures for eye care. This is something I've championed for several years and raised the need for in my last debate on this subject.

These new measures will provide clinically approved targets and prioritise patients according to their risk of irreversible sight loss. No-one should lose their sight in Wales because of a treatable eye condition. I look forward to hearing that health boards have implemented these new measures and to receiving the first progress reports in April 2019. It's high time we had transparency from health boards as to the number of patients at risk of losing their sight. This is a long overdue system change for eye care in Wales, and let us not forget the patients in all of this. We need to make sure that they're kept fully informed about the changes, and understand what it means for their care and treatment.

For people living with sight loss, it can impact on every aspect of life—physical and mental health, the ability to live independently, to find or keep a job, their family and social life. Timely access to support from social services is critical to help mitigate the impact of sight loss. Rehabilitation is a specialist service that helps a person with sight loss to adapt to the world around them. The service supports people to relearn skills they need to live an independent life. It could include emotional support, help with mobility, aids and adaptation, or help to assist with activities of daily living such as laundry, cooking and cleaning.

Now, every year in Wales half of those over 80 will have a fall in their home. Almost half of all falls experienced by blind and partially sighted people have been attributed to their sight loss. What's more, falls have been estimated to directly cost the NHS £67 million per year. The cost of falls in Wales related to vision alone is estimated to be £25 million annually. It's a no-brainer in my view that rehabilitation should be a universal offer to all blind and partially sighted people. The economic value alone of vision rehabilitation per referral is estimated at £4,487.

However, it's unacceptable that when it comes to accessing rehabilitation, too often we see a postcode lottery in Wales. In some areas of the country, some people are having to wait over 12 months to see a specialist rehabilitation officer, during which time their sight condition may be deteriorating and they risk becoming quickly isolated. Forty-three per cent of people who lose their sight will suffer significant and debilitating depression. The problem is further exacerbated by the fact that not enough people are being trained to replace retiring rehabilitation officers. Charities in the sight loss sector are increasingly concerned about the provision of rehabilitation for visually impaired people. In some areas, waiting times are unacceptably long, and in others people are getting screened out of rehabilitation assessments completely, or they're being assessed by unqualified staff. Local authorities and health boards need to develop clear referral routes into rehabilitation and early intervention and preventative services where this is not already happening. It's unacceptable that this profession is not being futureproofed. We need to establish plans for future workforce development and encourage people into the role. Ultimately, we need to make sure that people have timely access to rehabilitation services no matter where they live, to enable them to live as full and independent a life as possible.

Turning to the ability to access information and advice, the majority of people who lose their sight also lose their ability to communicate via standard print. This is vital for anyone to maintain their well-being and have voice, choice and control over their life.

In 2013, the accessible healthcare standards for people with sensory loss in Wales were launched. Wales became the first country in the UK to lay out how NHS services will be delivered accessibly to people who are deaf, hard of hearing, blind, partially sighted or have dual sensory loss. Accessible information might mean receiving information in Braille, in large print, in audio or e-mail—whatever is right for that patient to support them to participate fully in their healthcare, as fully as possible. But it is now five years since we launched those standards. The stark reality is that these have had a limited effect, and people are still facing major barriers to healthcare. Patients are still leaving hospital every day unsure of how much medication they are meant to take, or unsure of what advice they have been given. Yes, there has been tentative progress in some areas, but, overall, charities such as RNIB and Action on Hearing Loss tell us that there has been little demonstrable change for people with sensory loss in Wales. Moreover, we were proud, and rightly, that Wales was the first nation in the UK to implement the standards. Why then are we still in many ways no better than across the border in England? Surely, it's high time that the standards, like the Welsh language standards and others, became mandatory. Why isn't Welsh Government setting annual targets from each health board to monitor the improvements? This is a patient safety issue. Patients need to be able to engage in and fully understand their consultations with healthcare professionals.

The built environment is another area where we can minimise barriers for blind and partially sighted people. RNIB Cymru's Visibly Better programme supports organisations to develop environments that more people feel confident in getting in and around. The design principles help prevent falls and promote confidence by establishing appropriate lighting levels, colour and tonal contrast, and fixtures and fittings that aid way finding. Visibly Better design has been used in the newly refurbished radiology department at the University Hospital of Wales. The whole area is now much easier for patients to navigate confidently and safely. We need to futureproof our environments for our ageing population, and we need a commitment to these principles being applied to other public spaces in the future.

If I can just touch on shared space, the concept of shared space is, on the face of it, a most appealing one. Spaces are deregulated to ensure that no-one has a sense of priority. The space is jointly shared by vehicles, pedestrians and cyclists. It all sounds great, but it relies on the ability to make eye contact and that is not easy if you can't see. That means that that space becomes unsafe and avoided. This situation can be worsened by the removing of any crossings and differentiation between pavement and road. The Active Travel (Wales) Act 2013 was introduced with the primary aim of promoting the increased benefit of walking and cycling. However, blind and partially sighted people risk not feeling these benefits when poor planning of shared space puts them at risk of collision with cyclists, so something that starts off as a good idea can end up with a different consequence. A survey carried out by Guide Dogs showed that 97 per cent of people with sight loss have collided with street clutter such as A-boards. 

Finally, Dirprwy Lywydd, I just want to address the issue of transport. Many blind and partially sighted people are reliant on public transport for most of their everyday journeys. In rural areas where people may feel more isolated and public services are further away, blind and partially sighted people rely on public transport that is often old, with bus stops that have no information. That affects people who are fully sighted as well, so we all appreciate those problems.

Can I end by wishing RNIB a very happy birthday as it marks 150 years of championing the rights of blind and partially sighted people this year? We in Wales need to find new solutions and new ways to build a country where the equal participation of blind and partially sighted people is the norm. These are just some of the barriers that people with sight loss face every day, and I know we can tackle them. We can do things differently, and we can see things differently. Diolch yn fawr.   

Thank you. Dai Lloyd. 

Diolch, Dirprwy Lywydd, and can I commend Nick Ramsay's excellent presentation setting out all the facts and the details? And it's good to highlight the issue of sight loss here in the Assembly, as chair of the cross-party group on vision. As Nick alluded to, earlier in the summer we had figures through that showed that there were 54,000 patients in Wales on follow-up waiting lists in ophthalmology clinics in our hospitals that were at risk of losing their sight. These are people that had been seen by specialists, were due to be seen again in three or six months—they had glaucoma, or whatever—but those appointments were always being put back for a variety of reasons, and sometimes they would not got seen for months, sometimes years. They're at risk: 90 per cent of sight loss was happening in those follow-up waiting list situations. It is a situation that needs to be tackled, because these people have been diagnosed and they've been lost to follow-up because of delays. There are initiatives, as Nick was saying, and we look to Government to bring those figures down. Diolch yn fawr. 

Thank you. Can I now call on the leader of the house to reply to the debate? Julie James.

Thank you, Deputy Presiding Officer, and I very much thank Nick Ramsay for raising this very important issue, and I'm pleased to be able to talk about the actions this Government has been taking to help remove the barriers for people who are blind or partially sighted, or to see differently as Nick Ramsay has put it. 

Last month, the Cabinet Secretary for Health and Social Services announced a £4 million investment as part of measures to transform eye care services across Wales, to ensure patients are diagnosed and treated more quickly. We've requested advice from an independent panel on how to allocate the £4 million, and we are working to involve everyone in designing the best way to implement changes or standardise and simplify what is already being done. We will make sure patients are kept fully informed about any changes and understand what it means for their current treatment. We do accept entirely what Nick Ramsay has said about people being involved and engaged in the care that they receive.

The service changes will support the introduction of a new performance measure to be introduced later this month and it will be based on the patients' clinical needs. Wales will be the first UK nation to introduce a measure of this kind for eye care patients alongside the existing referral-for-treatment target. The challenges facing ophthalmic services are well known. Nick Ramsay pointed out a number of them.

The number of people with sight problems is set to increase dramatically, and as such obviously the burden on current services will also increase. As the video is very dramatically showing us, and quite rightly so, currently nearly 107,000 people in Wales are living with sight loss, and this is predicted to double by 2050. Improving access and speeding up diagnosis are vital to ensure eye care services are fit for the future. We absolutely recognise that some waiting times are too long and there is a much needed system change for eye care—that is why the Cabinet Secretary for health is announcing these. We do need to find new ways of working alongside the community. 

The Cabinet Secretary for Health and Social Services has also emphasised that we expect all patients to be seen as quickly as possible and in order of clinical need. As Nick Ramsay says, we are rightly proud of the fact that we're the first Government in the world to have an eye care delivery plan and are now the first in the UK to introduce a performance measure of this kind for eye care. These changes are in line with our long-term vision for the NHS in Wales to transform the way services are delivered and provide quality care closer to people's homes.

We are also bringing forward new patient pathways to prevent sight loss and better support people to live independently in the community. Since 2001, the NHS Wales eye care service has enabled optometrists and ophthalmologists, so primary and secondary care tiers, to work at the top of their licences to reduce the number of patients being referred to hospital eye departments. The service works to firstly preserve sight through the early detection of eye disease and then to provide help to those who have visual impairment for which further treatment is not appropriate. 

Two ophthalmic services are unique to Wales and are providing high-quality services and support to people with eye problems. They are the eye health examination service, which enables people to access services in their local optometry practice instead of their GP surgery or hospital department, and the diabetic eye screening Wales service, which screens all patients with diabetic retinopathy to help prevent them going blind unnecessarily.

As well as improving patient pathways, Nick Ramsay rightly also brought up the issues around essential work that needs to be done to ensure that we support independent living. The Government is incredibly proud to be able to promote the social model of disability. That is to say that we recognise that there are organisational, attitudinal and environmental barriers to equality and inclusion that must be removed to create a level playing field and to ensure any person living with a disability has access to the same opportunities as everyone else. We obviously also take this approach with sight loss.

A third eye care service, also unique to Wales, is the low vision service. This enables people living with sight conditions to make the best use of the sight they have by prescribing low-vision aids and enabling them to live as independently as possible. Working with the low vision services for Wales, we are working to ensure effective referrals to social services and the third sector to offer vision impaired individuals help to establish the support they need and wish to achieve.

We'll shortly publish a new framework, entitled action on disability, the right to independent living, in October of this year—in fact, in this month of this year. The new framework will continue to be rooted in the social model of disability. We've been extensively engaging with disabled people and their representative organisations over the last year to identify areas of inequality that matter most to disabled people of all ages in Wales, together with their potential solutions. 

Our ambition for the low vision service is one of many actions in the framework's action plan tackling some of the key barriers identified by disabled people themselves. These key barriers will be no surprise to Members to hear. Nick Ramsay pointed out many of them. They are: accessible information, access to buildings, access to shared space, including active travel routes and street clutter issues, and access to public transport. I think you highlighted all of those in your contribution, Nick. 

We also introduced the all-Wales standards for accessible communication and information for people with sensory loss in December 2013. The aim of the all-Wales standards is to set out the standards of service delivery that people with sensory loss should expect to receive when they access healthcare in Wales. The key part of the all-Wales standards is the requirement that every patient or service user who requires communication support should have this need met.

As a result of this requirement, the new accessible data information standard has been issued to meet the need to provide communication support. This is a national project, led by the Welsh Government in partnership with the Centre for Equality and Human Rights, health boards, NHS trusts, the NHS Wales Informatics Service, and third sector partners. The standard enables GP surgeries to capture, record, flag and share the communication information needs of patients with sensory loss. It is a tool, or an enabler, to help GP practices and healthcare professionals meet their legal duty under the Equality Act 2010 to make reasonable adjustments for those with a disability. It also enables GP surgeries to do this in a consistent manner across all health boards. And, in addition, a Welsh health circular has now been issued with an implementation plan giving details of this new accessible data standard.

One of the other areas I also want to mention—and, again, Nick Ramsay raised this—is access to employment opportunities for people living with disabilities, including impaired vision and sight loss. Seventy-five thousand disabled people in Wales are either actively seeking work or would very much like to work. Just 45 per cent of working-age disabled people are currently in employment, compared to 80 per cent of those not disabled, which is a really pretty shocking disability employment gap of around 35 per cent.

We've been working very hard in this sector to identify these barriers because they're very often beyond the control of the disabled person. So, organisational systems, attitudinal, physical and environmental barriers. Many of the commitments set out in our employability plan are aimed at tackling this disability employment gap. We work with partners to address the issues, including employer attitudes, job design and working practices.

I was very pleased to speak at an employability inclusion summit in Swansea last Friday, where I had the privilege and pleasure of meeting a large number of disabled people and talking to them about some of the barriers they had encountered, but much more importantly, and optimistically, about some of the available assistance to employers, and there were a large number of employers there who were very able, eager and willing to look at some of the small adjustments that they could make to ensure that they could continue to employ people with disabilities.

We've also established an officials working group on equalities and employment, which includes driving forward actions on disability in employment, to supporting our commitments within our employability plan to increase the number of disabled people into work. In partnership with disabled people, we are working to develop a meaningful target that will reflect their needs and wishes and that will be ambitious and achievable. We hope this will provoke the step change necessary, both within workplaces and society, to break down the barriers faced by disabled people and those with long-term health conditions while seeking employment.

I just want to say, Dirprwy Lywydd, at this point, that we know that in trials where personal characteristics are stripped out of application forms, employers are often shocked then to discover that the person that they previously said wasn't acceptable to them actually has all of the qualifications necessary. We know that this employment gap exists at all levels of skills. So, disabled people with a PhD are less employed than other people with a PhD, and all the way down there's a skills gap. So, it's very much the social model: it's around us accepting that disabled people very often, if not always, have the skills available to them and, actually, what we need to address is the inclusivity of our employment practices, both in the public and private sector in Wales.

Our business skills gateway webpages have now dedicated pages setting out the support available to employers and individuals to assist them to employ disabled people, and we're working with the DWP to help develop an employer pack of information about access to work, which will include further information to help employers seek specialist advice to help with the recruitment of disabled people. Lastly, a new disability action plan for apprenticeships will be published in autumn this year, focusing on practical actions to break down barriers to disabled people accessing apprenticeships.

The question was asked in Nick Ramsay's contribution: how can we remove the barriers to equal participation in society of blind and partially sighted people? And the answer is that we can do that by improving patient pathways; using the social model of disability; listening to the community and taking action on the issues that matter most to them, such as accessible information, employment, and the clinical pathways that Dai Lloyd also emphasised. So, I'm very grateful to the Member for raising this important point and I think that, together, we can continue to make Wales an exemplar in this field. Diolch. 

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

The meeting ended at 18:14.