The following amendment has been selected: amendment 1 in the name of Rebecca Evans.

We'll move on to the next item on the agenda, which is the Welsh Conservative debate on sight loss. I call on Angela Burns to move the motion. Angela. 

Motion NDM7110 Darren Millar

To propose that the National Assembly for Wales:

1. Notes that:

a) there are currently 111,000 people living with sight loss in Wales;

b) the number of people with sight loss is predicted to increase by 32 per cent by 2030 and double by 2050.

2. Welcomes the introduction of new performance measures for eye care patients.

3. Regrets that 1 in 3 patients deemed to be at high risk of losing their sight are waiting longer that their target waiting time for ophthalmology appointments.

4. Calls on the Welsh Government to:

a) robustly hold health boards to account over their failure to meet eye care waiting time targets and implement its eye care measures;

b) develop a national workforce plan for ophthalmology to ensure sufficient capacity in eye clinics to meet the current and future needs of the people of Wales;

c) improve the capture, analysis and learning from complaints and serious incidents where sight loss has occurred;

d) urgently publish a timetable for the development and publication of a new eye care delivery plan for Wales.

Motion moved.

Thank you. I'm delighted to have the opportunity, Deputy Presiding Officer, to open the debate today. I want to begin by thanking Elin and the team at Royal National Institute of Blind People Cymru for their assistance in providing some excellent case studies and for enabling and illuminating and moving the patient panel, and I know a great number of them are with us today.

The Llywydd took the Chair.

It's a timely debate because of the recent publication of the new performance measures, especially as sight loss is a subject that will impact many of us, either directly or indirectly, throughout our lives. I want to begin by actually thanking the Minister and the Welsh Government for listening to users and experts, and for introducing the new performance measures for eye care patients. It is great that Wales is the first part of the UK to introduce these new outcome-focused measures, and it should help health boards to prioritise patients according to their clinical needs. The challenge that we now face is ensuring that this new way of measuring does not deflect away from delivery, and that patients most urgently in need of surgery or assistance receive it before irreversible damage is done to their sight.

As our motion sets out, the number of people with sight loss is predicted to increase by, to be frank, a staggering 32 per cent by 2030, and double by 2050. Currently, there are approximately 111,000 people living with sight loss in Wales, and in the two counties that I represent, over 13,500 people are living with some form of sight loss, and approximately 1,500 people are registered blind. Let us just pause and consider what this means. In 30 years' time, around 7 per cent of the Welsh population will have sight loss. This means that they'll be living with the loss of one of the most important of our senses. Now, many of us in the Chamber, myself included, wear glasses to correct our vision, and isn't it frustrating when we misplace or lose them for a short while, and we can't see very clearly? Just think what that must be like on a permanent basis, and often with no prospect of being able to see clearly again, or in the worst case, at all. Think then of the long-term impact to a patient's mental health of having to accept that they're losing their sight, and then consider the cost to the NHS and the state of supporting a person with impaired vision or sight loss.

These indirect costs associated with sight loss cost the Welsh economy around £268 million every year, and according to the Access Economics figures produced in 2017 by Deloitte, the associated reduction in well-being and health due to living with sight loss totals £1 billion every year in Wales. And I've just talked money here. We've got to remember the personal cost to the individual. And the RNIB put it very clearly: the barriers people with sight loss face every day already create deep inequality, and it will become a national catastrophe unless we do something radical. The current situation shows that ophthalmology waiting lists have spiraled out of control, and one in three patients are deemed to be at high risk of losing their sight or waiting longer than their target waiting times. In Cardiff and Vale, this figure is far worse—almost 50 per cent of people—and across Wales ophthalmology is the second worst of all disciplines for waiting times.

I've met with a number of people via my constituency work and through the RNIB patients group, some of them sitting here, as I've already said, and I want to reinforce the message that none of these patients are criticising the hard-working doctors, the clinicians, the healthcare staff. When they get the treatment, it's great; it's getting the treatment that so difficult. They want to make sure that this is a better service for other people. And, Minister, it is these lives, these people, who are impacted by the decisions that your Government takes, and one of the key concerns is around appointments. There are waiting lists. And, of course, we all accept that waiting lists will exist for certain conditions. And, of course, success creates waiting lists. I thought it was interesting to read over the weekend that the procedure that exists to repair cataracts is now the most successful and the most popular and most universal of any operation carried out by the NHS in the UK. But this success comes with a price—that of more people being referred, longer waiting lists without necessarily the extra budget. Imagine the frustration; a world-class solution that is so universal that specialists can be dropped into countries with poor medical facilities and deliver sight-saving surgery, whilst in our comparatively wealthy nation access to cataract surgery is rationed in an inconsistent manner.

A similar Government initiative, again very welcome, in the fourth Assembly concerning glaucoma was very successful, but led to extra pressure being placed on clinics. And I've heard it's not unusual for patients to be left waiting for over four hours when attending their appointments. And it's not just the waiting time for appointments that was raised, but the issue of cancellation of appointments. A freedom of information request to Betsi Cadwaladr highlighted that, over the last five years, that health board has cancelled close to 40,000 ophthalmology appointments; 7,900-odd were in the last financial year. And I've heard patients say things like, 'I've had enough cancellation letters to wallpaper my bedroom.' We've been told about how people were actually standing there in the queue waiting to be seen and they've heard the receptionist on the phone to a parent or to a spouse back in their home saying, 'Oh, please do tell him he can't come in', and they're standing in front of the receptionist, waiting to be checked in.

We need to do something about it. Minister, I'm asking you to do something about it, because this is absolutely vital. Patients speak about how the loss and deterioration of sight has a huge impact on their mental health. It leads to isolation, anger, loss of friends. People have to give up their driving licences, which has a massive impact, especially if you live in a rural community. I was told by one patient, who used his local leisure centre to swim, that once it was obvious he was losing his sight, he was told he couldn't make use of the centre because he was a health and safety hazard. Unfortunately, sight loss is something that has a huge amount of stigma.

And I'd also like to point out, Minister, that not all patients are born with eye problems or have problems that are linked to the ageing process. I'm concerned that not enough understanding or support is given to those who experience sudden sight loss due to brain injury or other causes of rapid sight loss. I'd like, Minister, for you to have a look at your vision strategy and urgently address the situation. I'm going to stop right now; I'm not going to have enough room to basically conclude. I'm looking forward to hearing what everybody else says. Minister, you're doing well; we could do better. Please listen very carefully to us.

I have selected the amendment to the motion, and I call on the Minister for Health and Social Services to move formally amendment 1.

Amendment 1—Rebecca Evans

Delete all after sub-point 4a and replace with:

progress publication and implementation of the national workforce plan for the whole of the eye care sector and issue a Welsh Health Circular to ensure sufficient capacity in eye clinics to meet the current and future needs of the people of Wales;

improve the capture, analysis and learning from complaints and serious incidents where sight loss has occurred;

continue to drive forward implementation of the eye care delivery plan recommendations in its final year and notes the Chief Optometric Advisor will work with stakeholders across Wales over the coming months to agree next steps.

Amendment 1 moved.

Formally.

Thank you. The contributions now are to be three minutes only. So, Helen Mary Jones.

Diolch, Llywydd. I'd like to thank the Conservative group and Angela Burns for bringing this motion before us today. We will be supporting the motion unamended. I'd also like to associate myself with the thanks that Angela's made to the RNIB for very useful and powerful information, and I would agree with everything that Angela said in her contribution and I won't trouble the Assembly by repeating it.

I just want to talk about two things, and one is to talk a little bit about the impact on people's lives, because this is a situation that happened in my own family. My father was diagnosed with cataracts; there were very long waiting times—this was a long time ago, in the early 1990s. We could not persuade him to break his principles and allow us as his children to pay for private treatment. He felt that that would be wrong. He voted for the Government in 1945 that created the national health service, and he wasn't going to jump any queues. But the upshot of that was that, by the time he was eligible for his NHS operation he was no longer treatable; there was damage under the cataract.

I don't always talk about personal experience, but I think it's important to do so here, because the impact on somebody's life, that loss of independence that Angela was talking about, not being able to read a book, not being able to travel without having to have us with him, and the effect on his dignity was, I think, the worst thing of all—that being dependent, having been such an independent person. So, I think it's important whatever we do, and, indeed, when we talk about other health issues we've got to remember how it affects people. I agree with what Angela said that it is really positive that now these issues within the service are visible because of action that the Welsh Government has taken, but I do think that they need more urgency than the Government amendment would suggest is there.

And the other specific point I want to make in addition to the impact on people's lives is about accessible information. If people are missing appointments and there is some pushback in the system saying, 'Well, it's not our fault that there are so many missed appointments', say the health boards, 'It's because people don't turn up', well, if you don't send a blind person information in an accessible format, if you don't phone them, if you don't get them to identify somebody they want to receive the information for them, they will miss appointments and that will have an effect on the system. So, I'd really like to ask the Minister today to have a close look, as he drives this agenda forward, at whether the health boards are consistently providing information in accessible formats. Blind people should not have to have their children and their grandchildren reading appointment letters to them—it's not appropriate—or people who are losing their sight. I'm, again, grateful, and I won't say much more, to the Conservatives for bringing this forward. This is a very, very important agenda and I really think we need a sense of urgency, because every day there will be one of our fellow citizens who is losing their ability to see needlessly, and none of us, I'm sure, can be content with that.

Angela's figures mean that the number of people with sight loss in Wales is expected to double to 222,000 by 2050 and sight loss and blindness affect independence and mobility, including the risk of falls, of injury, mental health, cognition, employment and educational attainment. It's therefore imperative that the Welsh Government and local health boards are robustly held to account over failure to meet eye care waiting time targets and the implementation of eye care measures.

Last October, the Wales Audit Office reported that NHS Wales follow-up waiting lists have increased substantially with ophthalmology the second worst of all disciplines. In April, the Welsh Government published the first health board performance data against the new eye care measures for NHS out-patients. RNIB Cymru believes that the publication of this data is a major step forward in making health boards more accountable for the delivery of eye care services. The charity has welcomed the Welsh Government's commitment to developing new targets for new or follow-up appointments according to the patient's risk of irreversible sight loss—something that Helen Mary sadly shared with us in terms of her own family. However, the April data showed that not a single health board is yet meeting the new Welsh Government targets. RNIB Cymru states that this reflects what patients in Wales have been saying for years, with thousands having experienced repeated cancelled and delayed appointments, putting them at real risk of losing their sight because they aren't getting the right care and treatment at the right time.

It is RNIB Cymru that is, therefore, calling for health boards to be robustly held to account, a major drive to redesign services and a strategic national and multidisciplinary approach to ophthalmology workforce planning. Action on Hearing Loss also states that we're still seeing failings five years after the introduction of the all-Wales standards for accessible communication and information for people with sensory loss—sight and hearing—in the NHS, that there is currently no measuring or regulation of the standards, and that this should be part of quality improvement by Welsh Ministers and NHS bodies to include patient experience. After all, the Welsh Government states its support for the social model of disability, which recognises that people are disabled by society, not their impairment, that we must tackle the barriers to access and inclusion for all, and that everyone must be allowed independence, voice, choice and control in their lives—nothing about us without us. The Social Services and Well-being (Wales) Act 2014 Part 2 code of practice states this,

'puts in place a system where people are full partners in the design and operation of care and support.'

And, finally, the Well-being of Future Generations (Wales) Act 2015 states that public bodies must demonstrate the involvement of the people that services or activities are going to benefit or affect from as early a stage as possible. Legislation is only meaningful if it's implemented. Diolch yn fawr.

I thank the Welsh Conservatives for tabling this debate, but I am disappointed that it's a 30-minute debate as opposed to one hour, because I think it's such a valuable subject. The fact that people have gone blind whilst waiting for treatment—

Will you take an intervention?

Yes.

I heard what you said there and I think it was very uncharitable. When was the last time you tabled a debate on eye care, and did you have any plans to do so before today?

Let me just say, Darren, I think it's such a valuable subject, so I was actually complimenting you on that, you know? But, there we are, you don't know a compliment when you hear it, so—.

The fact that people have gone blind whilst waiting for treatment should be a matter of great shame for our nation. I therefore welcome the fact that the Welsh Government is getting its act together and investing in transforming eye care services.

RNIB Cymru have welcomed the new measures that will, for the first time, allow us to see the true scale of the challenges facing ophthalmology in Wales. The new measures outlined by the Minister finally put the patient first, giving priority to those most in need. It is now up to the health boards to deliver these improvements and make full use of the new guidelines. And I hope local health boards will actually deliver this time. The £7 million set aside for the new digital system for eye care is also most welcome. Hopefully Welsh Government can buck the trend on past IT projects and deliver the system quickly and efficiently. Once the new system is in place with direct referrals we should eliminate long waits for treatment. Until that time, we must ensure that the health boards streamline the referrals process as efficiently as possible. Swift referrals will help to speed up diagnosis and treatment and ensure that patients do not lose their sight due to long waits.

But there is still much more to do, and a shortage of rehabilitation officers for the visually impaired is certainly putting people’s safety at risk. We are not offering the best available treatments, some of which can actually reverse sight loss. And whilst we will be supporting the Government’s amendment today in order to recognise the progress that is being made, I urge the Minister to ensure that the next delivery plan addresses shortfalls in treatment and support options. I look forward to the chief optometric adviser’s recommendations, hopefully sooner rather than later. Let’s ensure that no-one else loses their sight whilst waiting for treatment and support, because the harrowing case highlighted by Angela Burns earlier should never happen, and it give us all an opportunity to reflect on how much improvement is needed in Wales. Diolch yn fawr.

Thirteen people lose their sight in Wales every day, adding to the staggering fact that 111,000 people live with sight loss here. Sight loss and blindness have a substantial effect on individuals. For example, over 14,000 people aged over 65 with sight loss are thought to experience one fall annually; 40 per cent of blind and partially sighted people have said that they are moderately or completely cut off from society; and according to RNIB, only one in four blind and partially sighted people work in the UK.

Every time I am back in north Wales, I am reminded of those affected by sight loss. Indeed, the town where my office is based and where I live, Llandudno, is fortunate to be home to the blind veterans training and rehabilitation centre; a hotel with rooms designated to visually impaired guests; and we have Mr Billy Baxter, our fabulous town crier, the only blind town crier in Europe and the second in UK history.

Now, it will come as no surprise to you, therefore, that I like to think of Aberconwy as a community that is trying and succeeding to be sight-loss friendly. However, I do fear that thousands of my constituents are being failed by the lack of appropriate treatment. Thanks to the new performance measures for eye care patients, I am aware that 11,310 patients in Betsi board are waiting beyond clinically safe levels for an out-patient appointment. That is the highest number of individuals waiting beyond targets in any health board.

Sadly, the trouble in Betsi forms part of a depressing national picture in which one in three patients deemed to be at high risk of losing their sight are waiting longer than their target waiting time just for ophthalmology appointments. This is particularly bad for follow-up patients, as RNIB Cymru has estimated that 90 per cent then face the risk of irreversible sight loss. However, it is likely that the situation is even worse, as the eye care measures only show the number of R1 patients waiting to be treated, not those classed R2 or R3. Health boards and you as a Welsh Government must be held to account for these figures.

Currently, there is huge reliance on locum provision. For example, 50 per cent of unfilled staff and associate specialist ophthalmology doctor posts require locum cover in Wales. That is more than the UK average. Clearly, there is a need for a nationwide workforce and an eye care delivery plan, to help ensure that demand is met and that health boards can tackle the crisis on a national basis.

With the numbers in need of eye care expected to rise significantly over the next decade, it is essential that action is taken now. Therefore, I implore the Members here today to support the motion so that we can all help individuals with sight loss across Wales, and, for me especially, in Aberconwy, where the problems under the care of Betsi Cadwaladr health board are significant. Again, my constituents shouldn't have to lose out in this important area.

Jenny Rathbone.

Thank you very much and thank you for calling me. The Public Accounts Committee has been taking quite a lot of evidence around this, and the quality of the evidence given by the RNIB was absolutely excellent. I'd like to pay tribute to the work they do—particularly Gareth Davies, who is the RNIB stakeholder engagement lead—in advising people on the significance of the correspondence they get from their health board, because it's really important that patients know whether the cancellation of an appointment is something that should be contested, because of the urgency of their issue, or whether it's something that's entirely routine. The concern that the RNIB was raising was that people are having their appointments cancelled almost before they get the letter of the appointment. Clearly, there has been a major problem at Cardiff and Vale, which has certainly caused me to have a lot of individual correspondence—

One of the things that I find in my own constituency is people receiving letters cancelling their appointments, sometimes on the day of the appointment, and, very often, those letters not even being suitable for the visually impaired. They're in small font sizes and things. Is this the sort of problem you're also having in Cardiff and Vale?

I certainly haven't come across the small print, but I've certainly had—this was some of the evidence that was given to us by the RNIB, and I can't say whether it was in Cardiff and Vale or not. 

I just want to make two or three quick points. One is that that the 7 per cent increase in the number of people needing eye care is not in any way the fault of the Government. In some cases, this is something to be applauded, in the sense that more people are coming forward because they realise that their eyes are not in the state they need to be.

Secondly, people are living longer, so, obviously, as we all get older, we have to start using glasses, and as we get older and older—I predict that that I will have serious eye problems just because of my family history. The issue here is how we organise the services to meet the increased demand, and I think that that is something that the Welsh Government is working on, which is why I will be voting for the amendment.

But there are also other issues that we need to do things about. One is that it should not be necessary for someone who has been seen by a high-street optometrist, who has identified that this person needs to see a specialist, to have to go via their GP in order to get a 'Dear Doctor' letter to get to the specialist department. That is a ridiculous waste of time of the primary care service, as well as unnecessary for the individual patient.

Secondly, new technology enables the ophthalmologist in the hospital to examine the urgency of the case of the individual without the need to have the patient in front of them. Because, with the health Minister, I visited a completely excellent optometrist in Pentwyn who I saw being able to send very high-quality images of the eye direct to the hospital specialist. That is a wonderful innovation, and one we should applaud, because it enables them to prioritise those whose cases are really urgent and need to be seen immediately because their sight is at risk as opposed to those who probably have a problem but don't need to be seen this week. So, that is another thing that's really, really important.

But the third thing that we've had a lot of difficulty on in Cardiff and the Vale is ensuring that those who've had routine cataract operations, which are done by the thousands on the day in the most remote parts of India, like Bihar—they do not need to go back to the hospital, unless there is a specialist reason for it. They can be seen back in the high street by the optometrist just to make sure that the cataract operation, which is a routine operation these days, has been a success and that there is no problem—

You do need to bring your comments to a close now.

Thank you, Presiding Officer, for calling me.

The Minister for Health and Social Services, Vaughan Gethin.

Thank you, Presiding Officer, and to Members who have spoken in today's debate, which I'm happy to respond to. As everyone has recognised, poor eye health is a common problem that can have a devastating impact on people and their families. And, as we recognise, the number of people in Wales living with sight loss is predicted to double by 2050. So, given the importance of eye healthcare, I do welcome the opportunity to set out the changes that we are making to improve services for people using them now and to ensure that they're sustainable and equipped to respond to future demand.

There are people in Wales who are still waiting too long for their initial treatment, and I recognise that is not good enough. However, despite increases in the number of people needing our services, we have seen significant improvements in referral-to-treatment times over recent years. At the end of March 2019, there were 218 people waiting longer than 36 weeks for their first appointment, and that's the best position since March 2012, and a 93 per cent improvement since the low point of March 2015, when over 3,500 people were in that position. But, importantly—and this is the reason for the new measures—we know that referral-to-treatment time measures only apply to new patients. Most ophthalmology patients need regular, ongoing review and treatment to ensure improved sight or to reduce the risk of avoidable sight loss, and clinical evidence suggests that approximately 10 per cent of new patients are at risk of irreversible sight loss compared to 90 per cent of follow-up patients.

Again, I take on board the points that Jenny Rathbone has helpfully made about the way we are trying to reconfigure our system to make better use of the professionals who exist on our high street, where people can be safely and appropriately managed outside of a consultant-led service in a hospital. But the figures that we've quoted and discussed in this debate are stark. Healthcare professionals and the third sector raised concerns that referral-to-treatment time measures did not reflect the things that were most important. And, interestingly, there has been lots of conversation about cataracts, and part of our challenge, of course, is that, if we want to improve old referral-to-treatment time measures, because you're on a waiting list initially for cataracts and yet actually it's clinically safer to wait with a cataract than with other conditions—. That doesn't mean to say you can wait forever, but our previous measures were driving us towards meeting a target without properly considering clinical need.

So, the old measures didn't capture delays later in the patient pathway and, as I say, could drive services to prioritise appointments for new patients. As a result, I listened to what was said by both clinicians and the third sector, and patient representatives in particular, and we've set out on piloting a new way of understanding what new measures could look like and how they could be designed. And, at the end of that process, I've introduced the new measures that I've recently announced. It's been devised to account for both new and existing patients, based on clinical need and a risk of adverse outcome. And the work has been fully supported by the vision cross-party group, and I do recognise and welcome their support.

And this has been a bold move for us because what we've essentially done as a Government is we've set out the areas where we need to do more in a much more honest way, because we could, frankly, have left the old measures and said, 'We're meeting our referral-to-treatment targets', and we could have essentially not been able to properly expose the nature of the challenge. And we are the first UK nation to do this. We regularly talk about: are measures comparable between UK nations? Well, they're not, because we made a deliberate choice to change our measures, and I believe it's not just clinically appropriate because of the advice I've had, but actually I believe that people in Wales should get a better service because of the drive to meet those new targets that we've introduced.

I'll take the intervention, then I should make some progress.

Thank you. I just wanted to say briefly, because I didn't have time to come in—I'll just declare an interest, my father has glaucoma—what wasn't mentioned in this debate was the way that some of the systems behind sight loss treatments are being privatised. My father has had a call from a private company in Preston to change his appointment from the Prince Charles Hospital in Merthyr to the Royal Glamorgan, and hasn't had an appointment in many, many months. It's not only him; since he's done some public work on this, people are being referred to services outside of their areas, because, simply, those particular appointments are not—specialists are not being held in those areas, so they can't be seen locally. What are you doing to challenge some of the operations behind this issue, if you have this new vision? Why are private companies involved in this process?

I think that's getting away from the topic of the motion, but we do use providers outside the health service to catch up. It's what we do in a range of areas in order to make the best use of NHS capacity, but the challenge is, if we don't make use of services outside the national health service, then the reality is that more people wait for longer. And, actually, part of the point of what we're trying to do is to have a measure that is clinically appropriate and tells us the honest scale of the challenge we have. We then need to invest in our service, both in system reform, but also the targeted investment I previously announced as well, to improve capacity where we're needed so that our system is in balance, so that we don't need to make regular use of services outside the national health service to make sure that people don't wait for too long.

I published performance against the new measure in June of this year and will continue to report back each month. The data shows that two thirds of patient pathways assessed at the highest level of risk were waiting within their target time or within 25 per cent of the date, and that's clinically acceptable according to the clinicians who have designed and piloted the new measure before I made the decision to introduce it across Wales. And the data does shine a light across the patient pathway and demonstrates clearly that further work is needed to improve services for new and returning patients.

So, health boards have developed plans to improve their position, and I've provided targeted investment against that to support development. And the actions they take will build on the progress that has been made since the launch of 'Together for Health' in 2013. Our approach is in line with prudent healthcare and the direction that I've previously outlined in 'A Healthier Wales'. So, there will be a continued and renewed focus on providing more treatment and care within the community and making better use of optometrists to ensure that ophthalmologists are free to see people who really do need to see them.

Our Wales eye care service delivered by optometrists leads the way in the UK and is widely recognised as a significant advance in the provision of primary eye care services and it's helped to reduce the backlog, and there is more to do. 

I'll turn to the closing, Llywydd, as I can see the clock is up. Over the next 12 months, we will consider carefully with partners what steps we should take once the eye healthcare delivery plan comes to an end. And reviewing performance against the new measure will be an important part of that. There is still much to do, but real progress has been made in Wales in the provision of eye healthcare services and I do, again, want to recognise the contribution of health professionals across primary and secondary care in the way that they have designed and delivered the change in services that we are now making. I'd also like to thank partners, including patient reps and the third sector, for the challenge and collaboration that continues to inform our approach: new measures that are clinically appropriate and a UK first with targeted investment that supports system reform. And we will now have much greater honesty and scrutiny about the challenge we face. Our target now is to deliver.

Angela Burns to reply to the debate.

Thank you, Presiding Officer. Minister, as I said at the beginning of my speech, the Welsh Government have been brave, but you need to be braver still, and there are a couple of very, very clear things that you could do. The treatments here aren't expensive. What we need is consistency, we need the feet of the health boards to be held to the fire to stop them from cancelling again and again and again, because many people have multiple cancellations—not one or two, but five, six, seven. That's the first thing. The second thing is we need to have rapid sight loss looked at properly within your strategy. People who have sight loss through brain injury and other issues like that, they're not really catered for, they need a different kind of support and you could do that. Be brave. I'm asking you to do that.

We also need to look at optometrists. You've actually said yourself what a great service they provide. I agree with you 100 per cent. However, they are not able to do two things. One: they're not able to prescribe, and so, if somebody comes to them and needs a prescription, they have to then send them back to the GP—waste everybody's time. There surely must be a workaround. The second thing an optometrist can't do: I don't know about most of you—and I am trying to hurry up and speak as fast as I can, Presiding Officer—but a lot of us will go to the optician that's near where we work. I live in Pembrokeshire, my optician is here in Cardiff, but if I have a problem with my eyes, he cannot refer me to the Pembrokeshire health board. He has to refer me to this one, or I have to then go and find myself an optician. So, why can't we just get rid of that, because that's an unnecessary barrier?

'A Healthier Wales'—it's all about prevention, it's about keeping people sane, safe and in an environment that they're happy with. For most of us, that's our home and with our friends, without having to have all the other pressures of life. If we want to keep our population in that, if we want to do this prevention, then what we have to do is keep people and give them the tools to allow them to stay in their homes. Losing your sight creates loneliness, isolation and all manner of mental health stresses. The world is a very difficult place to navigate without signposts. You've done an awfully good job so far—be braver, because this is one part of the health service that all of us could really get right, and it would help so many people for the future.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I will defer voting under this item until voting time.

Voting deferred until voting time.