Dr Rosena Allin-Khan
MP for Tooting · Labour · United Kingdom
“I hope my hon. Friend’s mum is making a swift and healthy recovery, and I am sorry to hear that that was her family’s experience. I agree that prioritising care for the frailer, elder population can often be dealt with more effectively before someone comes to hospital.”
“My hon. Friend and I are not performing a double act today, but he leads me on perfectly to the next part of my speech, as I go on to say that “corridor care” is something of a misnomer.”
“We cannot have a debate like this without recognising the terrible inequalities that scar our healthcare service—we have to work to reduce the disproportionate burden of long waits on deprived communities, older patients and people with mental health needs.”
“The hon. Member is right, but I know that the Government care deeply about this. This is not something on which I am in tension with the Government in any way.”
“By healthcare staff I do not just mean doctors such as myself, but nurses, porters, healthcare assistants and cleaners—we are one big family in the NHS, and no one job is more important than any other. We are unable to do any of our roles without all the others, and for that we are truly grateful.”
“As I have just outlined, this unacceptable and dangerous situation is shared not just by patients, but by their families and NHS staff, who are trying to do their best in a difficult situation.”
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“I could not be more proud to work with my hon. Friend in this space. He is a powerful advocate and I wholeheartedly support all his efforts, and those of Members across the House, to support people who are living with alcoholism, and their families. I thank him; we will continue to support his work.”
“I thank the hon. Member; it has been a pleasure to work with him in every single debate about mental health that I have held in the past three years, since I started my role. He speaks to the important point that prevention is the watchword that counts when it comes to mental health.”
“I thank my hon. Friend for assisting me in writing my speech; she has pre-empted much of what is to come. She is a powerful advocate for her community and I am proud to share the Opposition Benches with her.”
“Black people are five times more likely to be detained under the Mental Health Act 1983 than white people. People with eating disorders are being put on a palliative care pathway.”
“I will make some progress, but I would be happy to take further interventions after that. Amid all the anguish and pain, one thing comes through: people cannot access the mental health services they need. The stark fact is that the way the UK’s mental health services are funded and distributed can exacerbate the problem, so instead of making people better, they are making them worse. The current reality is that 1.6 million people are waiting for treatment. More than 1 million people had their referral closed without receiving any help in the last year alone. Last year, children in mental health crisis spent more than 900,000 hours in A&E and almost 400,000 children are on waiting lists. In the same period, adults experiencing a mental health crisis spent over 5.4 million hours in A&E.”
“It has been a pleasure to work with the hon. Member on the draft Mental Health Bill. However, as I will say later in my speech, I have little confidence that the draft Mental Health Bill will move beyond the draft stage. We need to debate the issues in the House, to ensure that what we know needs to be fixed is actually fixed, so that we can help people in our communities, including black people, who are more likely to be detained under the Mental Health Act, and people with autism and neurodiversity, who are mistreated simply as a result of having that diagnosis, so that their lives can be better lived. We need these issues to come before the House, so that we can debate them and move forward.”
“There are over 5,000 children and 40,000 adults stuck on mental health waiting lists across his integrated care board. Thousands of local people were turned away from services before treatment; I am sure the Minister will agree that that is unacceptable. As ever, we have smoke and mirrors when we need bricks and mortar. If this seems bleak, that is because it is.”
“Friend the Member for Croydon North (Steve Reed), passed unanimously, but it has not been fully implemented. It was passed almost five years ago and there have been three subsequent Ministers, and yet we are in the highly unusual situation where it has not been commenced in full. Who exactly is against the monitoring of the disproportionate use of force? The House certainly was not against it when the Bill was passed. The Government have announced plans for new mental health hospitals, but those new hospitals are not new. The hospitals announced on 25 May—Surrey and Borders, Derbyshire and Merseycare—were already in the pipeline. Let us talk about the Minister’s own patch, to really see the scale of the issue. At his closest hospital, adults experiencing a mental health crisis waited 11,000 hours in A&E last year.”
“My hon. Friend makes a powerful point; he is right. It is also a false economy because of the impact mental ill health has on families. Not investing in one person’s mental ill health not only has an impact on their working and earning potential, but has a knock-on impact on that of their parents, siblings and other family members. People are currently sitting at home on suicide watch for their children because they cannot get access to the timely help and treatment they need. This is Tory Britain. What has been the response from the Government to these alarming facts? Ministers have junked the 10-year mental health plan and binned thousands of responses to the consultation. Seni’s law, set out in a private Member’s Bill introduced by my hon.”
“They would see the junior psychiatrists whom I met recently—junior doctors who have devoted all their training to this profession, and half of whom plan to leave the NHS at the end of their training. They would see the doctor who told me of an incident in which six police officers were in A&E for 18 hours with a patient detained under section 136 of the Mental Health Act 1983. They would see a child arriving at A&E after self-harming, having been referred by the GP a long time ago but not been seen for weeks, which led to an escalation point and a crisis in A&E. We are seeing a system in crisis, people in pain and families in distress.”
“How many times have we heard that trotted out? Actually, I can tell the House that it has been used more than 90 times over five years, and it has been spent in myriad different ways. Then there is the £150 million for mental health crisis units. But the amendment fails to mention the serious patient safety concerns that doctors have raised, and it is clear that the pressure on A&E remains as fierce as ever. There is also nothing about the recent announcement from the Metropolitan police that they will not help people in a mental health crisis. Ministers need to get out of Whitehall and see what is really happening in our mental health service. If they did so, they would see what I have seen in recent months.”
“I entirely agree with my hon. Friend, who works tirelessly on this issue. After more than a decade of Tory Governments, if people need help, all too often no one is there. Last year, emergency service workers took more than a million sick days because of stress. NHS staff are at the sharp end of this mental health crisis. I know them, I work with them, and I see what they are coping with daily. They are heroes, but they simply do not have the resources, the staff or the leadership from Ministers that would enable them to do their jobs. They themselves suffer exhaustion, depression, stress and anxiety. About 17,000 staff—12% of the mental health workforce—left last year. You will be pleased to know that I have had a look at the Government’s amendment, Mr Speaker—I do my homework. There is the tired old £2.3 billion figure.”
“I invite the hon. Member to have a look at the plans we already have in place. She will be pleased to learn that one of our pledges is the provision of a mental health specialist in every school. I invite her to support those Labour plans—and to come and join us over here if she feels like it.”
“With a clear plan, with clear costings and with resolute leadership, we will deliver the world-class health system that our society truly deserves.”
“Fifthly, Labour Ministers will allocate to mental health its fair share of funding, as the economy grows and as resources allow. For starters, we will close tax loopholes, putting the country’s mental health first. That is our plan and, crucially, it will not be solely the responsibility of the incoming new mental health Minister; it will be the responsibility of the whole Cabinet and the whole Government. We have seen enough plans, we have heard enough announcements, and we have watched enough Ministers pass in and out of the revolving doors of 39 Victoria Street. Let us have no more Tory sticking plasters. Labour’s health mission, guided by prevention and anchored in community, gives children the best start and boosts the economy, with more people in better health.”
“We will open a mental health access hub for children and young people in every community, providing early intervention and drop-in services, and we will provide access to a mental health professional in every school. This is a true community, preventive approach in action. Fourthly, we will stop mental health policy being placed in a silo. As I said at the beginning of my speech, mental health policy cannot be disentangled from social and economic policy. A decision on Bank of England interest rates takes its toll on the mental health of a family in Tooting. We are all interconnected. The economy is not an abstract concept; it is people. The next Labour Government will present a long-term, whole-Government plan to improve mental health outcomes—mental health in all policies.”
“Labour will guarantee treatment within a month for all who need it, which will be better for patients and better for the NHS. Secondly, we need a tough new target for delivery—something for the whole system to drive for, and something for the voters to judge us on. Labour will recruit 8,500 new staff, so that 1 million more people can access treatment every year by the end of Labour’s first term in office. Thirdly, we will reach out to our young people, and give the next generation the support that they desperately need. This is the generation who have known little or no security: children who have gone through the great financial crash, austerity and covid, robbed of their future and dismissed as snowflakes.”
“After a series of allegations in different settings, the Government have dragged their feet, and we are still waiting for the findings of their data exercise, in which no one even spoke to families or patients. They could start by giving statutory powers to the inquiry into deaths in Essex mental health units. What else needs to change? First, we need to speed up diagnosis and treatment. The longer we leave a mental health disorder untreated, the worse it gets—just like cancer, sepsis and heart conditions. Delays cost patients their wellbeing and their families their peace of mind, and of course it costs the taxpayer more to treat a patient who is more acutely unwell after months and years of delay. The argument for prevention, early intervention, speedy diagnosis and timely treatment is clear.”
“My hon. Friend is spot on in making the point, very articulately, that prevention is our watchword. It is vital that we have mental health access hubs in every community to give people the support that they need; it is essential that we have mental health specialist support in every school; and it is essential that mental health does not operate in a Health silo, because when it comes to improving adverse childhood experiences that can lead to poor mental health in later life, that is every Department’s issue. I have asked Ministers six times to tell us of their meetings with mental health trusts where there are reported abuse scandals, but they have failed to respond. In-patient services across England must be reviewed, with patients’ voices at the centre.”
“A 14-year old climbing out of hospital windows; a child absconding to a local railway station; a teenager with complex needs brought to A&E, requiring four police officers to spend an entire shift watching them, only for them to abscond the next day. There is a pattern here. At almost every step of the way, children needing mental health services face a perfect storm of delay and treatment in inappropriate settings, fuelled by an under-resourced service with over-stretched staff. In light of the Met’s announcement that they will stop attending emergency mental health calls, is it not time for the Government to get their act together, or simply do the right thing and step aside?”
“This may surprise you, Mr Speaker, but I have found evidence that the Health Secretary has got something right. He recently hailed the power of local news outlets, and he was spot on. I have here a story from his local paper, exposing the shocking length of waits in A&E for those in a mental health crisis: 5.4 million hours across England in just one year. He is very welcome to have a look if he would like to. Given his admiration for local journalism, does he feel embarrassed for his Government’s failings and will he apologise to all the people across the country who are stuck waiting in A&E?”
“There is a mental health staffing crisis of the Government’s own making. Figures out last week show that there are more than 28,000 mental health vacancies in our NHS, which is up on the year before and the year before that. Are we seeing a pattern here? The number of mental health nurses is down 5% since 2010, but do not worry, Mr Speaker: just so the Secretary of State is aware, Labour has a plan to recruit and retain more mental health staff and to get waiting times down. Can he put a word in with the Chancellor in case he wants to nick that too?”
“Since then, however—I accept that the Minister has not been in post that entire time—the Government have missed the target; I hope the situation will improve. Disappointingly, only 60% of urgent cases were seen within one week last year. That means that four in 10 children and young people were not seen at the point of desperation. Children and young people are being left on lengthy waiting lists, unable to access support. Meanwhile, their families are helpless, and are trying their best to support their children without vital help from mental health professionals.”
“How many more people will lose their life before the Government get a grip on safety in in-patient settings? We need a Government who will get serious about mental health and eating disorders. As we have said time and again, access to proper treatment can be life-changing. Prevention is important, and early intervention provides the best chance for recovery. Think of those families who have lost loved ones, knowing that it could have been prevented, and that we in this place have not yet done enough to save these lives. Targets on accessing treatment are being routinely missed. In 2016, a clear standard was set that 95% of children and young people experiencing the most urgent eating disorder cases should receive treatment within one week.”
“They have an all-encompassing fear of the unknown when it comes to what their loved one will eat that day. They are concerned that they may have to give up their job, or even not care as much for their other children because they are obsessed with what one child is eating. They know that the child could lose their life at any moment. It has been agonising to listen to the recent reports of the death of 19 eating disorder patients in in-patient settings; serious concerns were raised about their care. Lives should not be needlessly lost because of poor care and a lack of understanding of eating disorders. My heart goes out to their friends and families. Far too many families—not just the families of those with eating disorders—have lost loved ones in mental health hospitals.”
“It works so hard to combat the negative stereotypes and misleading perceptions of eating disorders, which are sadly all too common. As was said eloquently today, people experiencing an eating disorder can often find themselves in mental health hospitals. To pick up on the point made by my hon. Friend the Member for Sheffield, Hallam (Olivia Blake), about the use of restraint, I have written to the Minister on that topic. I look forward to having a meeting about it, and to seeing the end of the inappropriate use of restraint. Mental health in-patient settings must be a place of safety, where patients and their loved ones can expect to be treated with dignity and professionalism. However, that is clearly not always the case. For the families of those with eating disorders, the situation is crippling.”
“It is so important to remember that eating disorders can manifest themselves in a variety of ways—through people eating too much or too little, or even restricting what they eat. To echo what has been said, we must never forget that eating disorders can affect people of any age, gender, ethnicity and socioeconomic background. We have heard that one in four people with eating disorders is a man. It is staggering that it is still so difficult for boys and men to come forward and talk about their issues with eating. In my work in A&E, I see younger and younger people—especially boys—talking about their struggles with food and body image. They often cite social media and peer pressure as the source of those struggles. I always like to thank the charity Beat for its incredible work.”
“Across the UK, as many as 1.25 million people are living with an eating disorder. That is a staggering number, if we actually think about what that means. We have heard about the considerably high mortality rates; anorexia claims the most lives of any mental illness. With timely and appropriate treatment, people can go on to live healthy and fulfilling lives, so how many of those deaths are avoidable? That is the truth that we have to face. I welcome the fact that we have opportunities in this place to mark Eating Disorders Awareness Week, but we have to do so much more all year long to challenge the stereotypes and assumptions that so many people still hold about eating disorders.”
“What a pleasure it is to close for the Opposition with you in the Chair, Ms Harris. I thank the hon. Member for Bath (Wera Hobhouse) for bringing forward this debate; I am honoured to be part of it again. It is a shame that we have to be here every year talking about this issue, but it is a testament to how seriously we take it. We will be here until we see the issue resolved. This is normally the point at which I mention a few comments from Labour Members and say, “Didn’t they do well?”, but every single contribution and intervention was valuable. I learned new things on a topic that I thought I already knew very well. I hope that this debate will not just be filled with words about what needs to change, but that there will be something tangible—some action—at the end.”
“We will place a mental health specialist in every school, and we will place an open-access mental health hub for young people in every single community. The Government can no longer continue to neglect mental health services.”
“Eating disorder psychiatry and child and adolescent psychiatry are two of the three psychiatric sub-specialties with the highest consultant vacancy rates. Where is the Government’s workforce plan? Patients are suffering. After more than a decade of Tory mismanagement, patients are being failed, waiting lists are soaring and services are struggling to cope. I do not like to make eating disorders a political football—they are not—but the truth has to be told: the Government have failed thus far on their commitment. If they cannot get a grip and improve services, Labour will. We stand ready with a bold plan to recruit 8,500 additional staff in order to provide mental health treatment within a month for all who need it. Labour will put prevention and early intervention at the forefront of our approach to mental health.”
“Without a shadow of a doubt, not investing in a person with a mental health need often has a knock-on impact on four, five or six members of the family. Ultimately, we then need to use more mental health resources to serve their needs as well. It makes no economic sense, and no moral sense either, so I thank the hon. Member for her intervention. The strain that an eating disorder places on an entire family is immense. As I say, parents often have to stop working to care for their child around the clock. How can the Government continue to fail young people with mental health needs? This cannot go on. For how long do the Government think it is acceptable for young people to be stuck on waiting lists for mental health treatment?”
“I truly believe, unfortunately, that the longer the Conservatives are in power, the longer patients will wait, because a 13-year track record has nothing to show us other than that fact. Labour will lead on early intervention and prevention by providing a mental health specialist in every school, allowing children with ADHD or autism—who disproportionately experience mental illness—the ability to access mental health support in their school. This debate is timely, because it is Children’s Mental Health Week, and perhaps that policy could be adopted in a cross-party way to ensure that children do not have to wait in the way that they are doing. For people with ADHD or autism, receiving an assessment is the first step to accessing often life-saving support. We cannot allow people to be failed at the first hurdle.”
“That is a failing of what we can do in this place to make things better. There is a moral imperative on us to do that. When will the Government increase capacity and resourcing to ensure that waiting times for assessment can be reduced? It is unacceptable that a six-month wait has become the standard for autism referrals, with many adults waiting years to be seen. The Government keep kicking vital health strategies into the long grass, with yet another new strategy scrapping those that came before it. There is no clear message from the Government about what that means for people living day to day with autism or ADHD. Will the Government please now outline whether future work on major conditions will tackle waiting times for assessment of autism and ADHD?”
“How many more people with ADHD or autism will be left behind, stuck on long waiting lists with their mental health steadily worsening, before this Government finally get their act together? I know that we do not like to play political football in this place—well, we do, but this is not one of the issues on which we ever like to do it. I know that the Minister is full of integrity and cares greatly about this issue, but we need the Government to take their head out of the sand and to take action on waiting lists. The NHS does an incredible job with the resources that it has. However, long waits for treatment have a considerable impact on patients and families. It is heartbreaking to hear Members in this Chamber talk about constituents who have lost children—children who felt that there was no other option but to take their own life.”
“It is inhumane that autistic people can end up detained in inappropriate settings because they are incorrectly diagnosed. I thank the National Autistic Society for feeding into the draft Bill and for its input during the pre-legislative Joint Committee —its evidence was vital. I appreciate that this debate is specifically about assessments, but I would like to hear from the Minister about what the Government are doing to provide tailored, appropriate care for people with autism or ADHD after the assessment stage. Speedy access to an assessment is prevention in action—prevention of worsening mental health in people with ADHD or autism—yet the Government fail to ensure that assessments are readily available.”
“Without a formal ADHD or autism diagnosis, many people will struggle at school, in the workplace and at home. It is crucial to understand that people with autism or ADHD are more likely to experience mental illness and, all too often, end up in crisis and, at the very worst, taking their own life. Imagine the desperation someone must feel to do that. Over the past few months, I have been honoured to sit on the Joint Committee on the reform of the Mental Health Act 1983. In an evidence session, we heard from Alexis Quinn. Her evidence cut to the core of how patients are being failed and why the Government must act. For anyone present who does not know, a misdiagnosis meant that Alexis was locked inside in-patient mental health settings for three years. Eventually, she had to flee the country to get help.”
“Reports are emerging of patients having to spend thousands of pounds on private healthcare to get a much-needed assessment and diagnosis. Frankly, patients and their families are being failed. That is simply not good enough. A diagnosis of autism or ADHD is vital to accessing appropriate support, which we know can make such a difference. Concerning reports have emerged recently of people waiting up to five years for an ADHD assessment. That is five years without the crucial support that they need and access to services. For ADHD assessments, there is no NHS waiting time standard. How can it be right that we have no idea of the number of people waiting for assessment? Without routinely published figures, we cannot get a handle on the scale of the issue. Will the Government please reconsider that?”
“The vast majority of those people are waiting longer than the National Institute for Health and Care Excellence’s recommended 13-week wait, and far too few have a care contact each month. Far too often, there is sadly a postcode lottery when it comes to access to a timely assessment. Waiting times are still far too long in many parts of the country, leaving some autistic adults and children waiting many months or even years for a diagnosis. A constituent of mine, a woman in her late 20s, will not mind me telling the House of the letter she sent me to confirm that she had been accepted on to the waiting list, but it is expected to be 36 months before she is seen. That is 36 months of insecurity in the workplace, in her marriage and in her life.”
“I have many friends, colleagues and constituents who live in purgatory—they just want to know when they can get help and support for their child. The feeling of being at the school gates and not knowing what kind of day their child is going to have stays with them for the entire day, so they cannot even concentrate at work. Many parents take time off work, so are unable to contribute to the economy, to raise children who will never fulfil their potential because they have been let down. In 2021, the Government committed to making progress on reducing diagnosis waiting times in their national autism strategy for England. However, the latest data shows that more than 125,000 people are currently waiting for an autism assessment—an increase of more than 30% in the past year alone.”
“Some of the take-homes, which are really stark, are things that I knew already but which have been brought to the forefront of my mind yet again. For example, hon. Members raised the increased suicide rate among those with ADHD and autism. It is a wasted opportunity for a life well lived when someone takes their own life. That could have been avoided if they had early diagnosis and treatment, and that is why it is so important that we are here today. On the postcode lottery, it is alarming that there is a real divide based on where someone lives, how much money they have and their ability to access private care. As a parent, I understand the desperate feeling—although not with regard to autism and ADHD—of just wanting the best for one’s child.”
“What a pleasure it is to close for the Opposition with you in the Chair, Dame Angela. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) and the Petitions Committee for securing this incredibly important debate. I also thank every person who signed the two petitions, and everyone in the Public Gallery for their time, patience and commitment to the cause, which has led to them to sit here for a number of hours. We are all very grateful to have them here. Normally, when we close, we pick a few comments from those on our own side to praise, but every single contribution to this debate has been heartfelt. Many have been personal, and every single one has added a great deal to the discussion. It is always a pleasure to see cross-party agreement in this place that an issue absolutely needs to be dealt with.”
“Member for Central Suffolk and North Ipswich (Dr Poulter) will agree that the Government should put patient voices at the heart of this legislation and take the Joint Committee’s recommendations on board.”
“I thank all those patients, campaigners and experts who provided evidence to the Joint Committee. I give special thanks to Alexis Quinn, whose account of her own lived experience with autism touched many Committee members. I also thank the Committee members for what was an incredibly valuable experience and a true example of when cross-party working goes really well. I am honoured to have worked on a once-in-a-generation opportunity to improve the rights of patients experiencing a mental health crisis, and to tackle the health inequalities enshrined in current legislation. For years the Government kicked updating this legislation into the long grass, and now the draft Bill still does not go far enough to tackle the health inequalities and racial disparities of those detained under the Mental Health Act. I hope the hon.”
“In mental health we rely on staff, not shiny machinery, so why is the Secretary of State rehashing old announcements and scrapping plans? It is because the Government have run out of ideas. Labour has a plan. We will recruit 8,500 more mental health professionals, ensuring a million more patients get treated every year. We will double the number of medical school places. We will train 10,000 extra nurses and midwives every year, and we will focus on retaining the fantastic staff we already have. Where is the Government’s plan? We have had our plan for two years, but they are binning theirs.”
“Sticking plasters are not enough. We need a Government that will grasp the root causes of the staffing crisis in the NHS. That is why Labour will end tax breaks for non-doms and use the money raised to expand our NHS workforce. The next Labour Government will train a new generation of doctors, nurses and midwives to treat patients on time again. We will double the number of medical school places to ensure we have the workforce that we need across different specialties, including ophthalmology. Labour has a plan. I would be grateful if the Minister set out the Government’s position and explained to patients why they continue to wait so long for treatment. They cannot afford to wait any longer.”
“Here is yet another example of Government decisions costing people a full and healthy life. Along with tackling the workforce challenges, enabling the effective integration of primary and secondary eye care services is key to the plan for eye health. The Labour-run Welsh Government are leading the way in ophthalmology data and referrals and in reform of the general ophthalmic services contract. Wales is ensuring that there is more detailed data on ophthalmology waiting lists. It is also developing a comprehensive, interoperable electronic patient record system, as recommended by the Royal College of Ophthalmologists. When will the Government be serious about eye health and do the same? The next Labour Government will take eye health seriously. We will pull every available lever to get ophthalmology patients treated sooner.”
“I ask the Minister, what assessment has the Department made of the impact the current ophthalmologist workforce shortages are having on patient care? Will the upcoming workforce strategy include a commitment to fund the workforce that is identified as being needed to meet patient demand? I am pleased that the debate as also focused on the devolved nations. In Northern Ireland, at the Western Health and Social Care Trust, the average wait for routine cataract surgery is more than six years. These are grandparents who cannot see their grandchildren properly; these are people who have to give up work because they cannot see. Patients are suffering. The stress and anxiety that long waits such as those have on patients cannot and should not be ignored. There is a huge personal cost.”
“Waiting lists have increased every year since 2010. For years, there have been calls for the Government to act, but those calls have fallen on deaf ears. It is 12 years of Conservative Government failure that have caused waiting lists to grow and left ophthalmology services in the state they are in now. Patients simply deserve better. Increased staffing pressures compound the issue. More than three quarters of units in the UK reported unfilled consultant posts, with over two thirds of hospital eye units using locum doctors to fill those vacancies. Many eye units rely, to a large extent, on non-medical clinical staff working in extended roles, or doing work traditionally performed by an ophthalmologist.”
“It is very welcome that NHS England has appointed the first ever national clinical director for eye care, a role that aims to put ophthalmology on a par with other major specialties and that will lead to the development of a national strategy. As we have heard today, NHS eye services are not keeping pace with demand. Waiting lists for ophthalmology treatments have increased by more than 130% over the last 10 years. Over 650,000 patients are stuck on NHS ophthalmology waiting lists in England, with tens of thousands of patients waiting longer than a year. That is unacceptable. Those waiting lists have been longstanding; even pre-pandemic, the system was in trouble. In 2018, the APPG on eye health and visual impairment found that the current system of eye care was failing patients on a “grand scale”.”