Age-related Macular Degeneration: NHS Funding

Marsha De Cordova Excerpts

Tuesday 9th April 2019 Westminster Hall

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I beg to move,

That this House has considered NHS funding for age-related macular degeneration.

I begin by welcoming the Minister to her place. I am very pleased that she is now a Minister and I look forward to having many more interactions with her.

Sight is a wonderful gift. Sight allows us to witness and experience the world we live in. It is not surprising that, in survey after survey, the fear of losing one’s sight comes top in comparison with other conditions. It is remarkable that we do not hear more about the leading cause of blindness in adults, which is age-related macular degeneration or AMD for short.

AMD is the breaking down of the macula, which is the sensitive and small tissue at the centre of the retina. It is responsible for processing central vision and allows us to see colour, detail and sharpness in objects. There are two types of AMD: dry and wet. Dry AMD, which affects 90% of people with the condition, is caused by thinning of the under-layer of the macula, which can lead to blurred vision. Thinning of the under-layer of the macula is caused by small white or yellow deposits called drusen. They may at first not affect vision all that much, but as they build up over time, they can lead to blind spots in someone’s central vision and can later become wet AMD.

Wet AMD is usually caused by new blood vessels growing underneath the macula that bleed and leak into the macula, which can cause blindness and distort vision in that eye. The onset of wet AMD is more rapid and can be more damaging, leading to irreversible vision loss. According to the charity Fight for Sight, AMD is the leading cause of sight loss in the UK, predominantly affecting people aged over 65. It accounts for 50% of severe sight impairment and 52% of all Certificate of Vision Impairment registrations in England and Wales.

AMD progressively damages a person’s central vision, which in some cases can leave them unable to read, drive or recognise faces, although they may retain their peripheral vision. It is estimated that 600,000 people in the United Kingdom are living with late-stage AMD. Industry data suggest that by 2026 there will be 9.7 million people in the UK affected by all stages of AMD and 800,000 of them will have late-stage disease that affects their vision. Projections suggest that by 2050 the figure for people with late-stage AMD could rise to 1.3 million unless measures are taken now to address this issue.

[Marsha De Cordova (Battersea) (Lab)]

I congratulate my hon. Friend on securing this very important debate and I, too, welcome the Minister to her place. Significant numbers of people will potentially lose their sight. My hon. Friend has cited some of the figures. By 2050, the number of people living with sight loss will be in excess of 4 million. Does my hon. Friend agree that, given the numbers, it is time that we had a UK-wide vision strategy on eye health and sight loss?

--- Later in debate ---

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. We should all visit opticians on a regular basis, because they can detect a whole series of other eye conditions.

My second ask is for the publication of a workforce development plan for ophthalmology. That should also be a priority. There is already a shortage of eye care specialists who can diagnose and treat AMD. The number of ophthalmologists in the UK is the second lowest in Europe. The numbers are expected to reduce further, while the patient population is likely to increase significantly. The Department of Health and Social Care should commit to producing a workforce development plan that addresses the current situation and assesses future demand and provision need.

NHS RightCare should also develop guidance and a workstream for AMD, and data packs that can be shared as a resource and inform improvement in treatment for AMD. An IT platform that allows better integration of services is needed—for example, from primary care to hospital-based ophthalmology—so that a more joined-up approach can lead to better outcomes for patients with AMD.

Finally, it should be remembered that there is a link between sight loss and mental health, depression and frailty. The secondary effects of sight loss should also be considered when making both national and local policies on commissioning services.

[Marsha De Cordova]

My hon. Friend is being very generous. On that point about the impact of sight loss and the link to mental health, does he agree that a clear strategy would enable all services to be more joined up, so that when somebody is diagnosed with losing their sight all the relevant support would fall into place because there is a clear pathway?

[Bambos Charalambous]

My hon. Friend makes an excellent point. The impact of sight loss can lead to depression and other mental health issues, so they should form part of any strategy related to sight loss. I agree with her 100%.

I ask the Minister to recognise the need for more attention to the needs of people with AMD, and to set about taking on board and implementing the suggestions that I have raised.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a particular pleasure to serve under your chairmanship, Mr Walker, as I respond to my first debate as the new Public Health and Primary Care Minister. I thank all hon. Members for their good wishes and reassure my officials that, although I have found my voice again, I will try not to alarm them too much.

I thank the hon. Member for Enfield, Southgate (Bambos Charalambous) for bringing this important matter forward for debate. Age-related macular degeneration—AMD—is a devastating disease that seriously affects the lives of many people, particularly older people. It is the leading cause of sight loss in the UK and affects over 600,000 people. As the hon. Gentleman outlined, the two main types are dry, or early, degeneration, and wet, or late, degeneration.

Around 75% of people with AMD suffer from dry generation. For most of them, it causes milder sight loss or even near-normal vision. Although there is currently no effective treatment for that form of AMD, its impact can be reduced with vision aids. A minority of those with dry degeneration, however, will progress to wet degeneration, which can be far more serious and threaten their vision. A number of treatments for it are available, including regular eye injections or a light treatment called photodynamic therapy.

The National Institute for Health and Care Excellence has recommended a class of drugs, anti-VEGF therapies, as the clinically appropriate and cost-effective treatments for wet AMD. Currently, there are two licensed options: Lucentis and Eylea. As such, NHS commissioners are legally required to fund those treatments for patients where necessary to comply with NICE’s recommendations. NICE is currently considering whether to examine a further drug, brolucizumab, for treating AMD and recently consulted stakeholders on the suitability of referral to its technology appraisal work programme, and a decision will be taken shortly.

There is some dispute about whether nutritional therapy and a healthy diet high in antioxidants, or the prescription of supplements, can assist with the management of AMD. NHS England has advised me, however, that it has informed CCGs not to prescribe lutein or antioxidants to patients with AMD, as evidence suggests that those treatments have low clinical effectiveness.

Although we have some effective treatments for AMD, we do not rest on our laurels. Medicines continue to evolve, and we continue to look for better treatments to improve outcomes for people living with AMD. The Department provides significant funding for medical research, mainly through the National Institute for Health Research. NIHR welcomes funding applications for research into any aspect of human health, including AMD. It is important to set out some of the ways in which NIHR engaged in advancing learning in that area and is funding research.

In 2017-18, the total spend by NIHR for eye-related research was just over £20 million. That covered a wide range of studies and trials, including research relating to AMD. In that year, the NIHR clinical research network supported 38 clinical studies and trials related to the treatment and care of people with AMD and other retina-related conditions. Since 2014, NIHR has provided £9.6 million for seven research grants and awards related to AMD, including five health technology assessment studies.

I pay tribute to the excellent work of the NIHR Moorfield Biomedical Research Centre, which is a partnership between Moorfields Eye Hospital, with its unique clinical resources that support over half a million patient visits per year, and the University College London Institute of Ophthalmology, which is one of the largest and most productive eye research institutions. The partnership was awarded £19 million over five years from April 2017. It is now conducting a wide range of ground-breaking biomedical research on AMD through several of its research themes, which will ultimately translate into significant improvements in the treatment, diagnosis and management of people with eye diseases.

Prevention is an absolute priority, both for me as the new Minister for Public Health and Primary Care, and for the Secretary of State, as we prepare to publish our prevention Green Paper later this year. At the heart of the NHS long-term plan that was published earlier this year is the idea that prevention is better than cure. AMD is one of the top four causes of sight loss, alongside glaucoma, diabetic retinopathies and cataracts. All of those conditions are most prevalent in older people and we know that, once lost, vision is especially hard to restore. The Royal National Institute of Blind People suggests that 50% of cases of blindness and serious sight loss could be prevented if they were detected and treated earlier. Research shows that almost 2 million people in the UK are living with sight loss, which is vision less than six out of 12. As the hon. Member for Enfield, Southgate and the hon. Member for Battersea (Marsha De Cordova) mentioned, by 2020 that number is predicted to increase by 22% and to double to 4 million people by 2050. Those increases are due mainly to an ageing population. Eye health will be particularly relevant to these matters, given that more than 80% of sight loss occurs in people aged over 60.

I pay tribute to Galloway’s, a charity in my constituency that does amazing work with people on sight loss. My hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat), who is no longer in his place, also mentioned the Kent Association for the Blind in this capacity.

[Marsha De Cordova]

I thank the Minister for giving way. She is picking up on some really important points. She talks about prevention, but there is a national need for a vision strategy. We cannot have prevention in isolation, nor living with sight loss in isolation. Everything needs to be joined up. Does the Minister agree that it is now time for a vision strategy to be part of the long-term NHS plan?

[Seema Kennedy]

I will respond to the question that the hon. Lady raised in her intervention later on in my remarks. We know that regular sight testing can lead to early detection of these conditions. In his capacity as chair of the all-party group, the hon. Member for Strangford (Jim Shannon) referred to the importance of regular eye tests, given that, combined with early treatment, they can prevent people from losing their sight. That is why we continue to fund free sight tests for people over 60 and, alongside NHS England, are fully supporting the aims of the UK Vision Strategy to improve the eye health of people in the UK. A mark of the priority that the Department places on eye health is the inclusion in the Public Health Outcomes Framework of an indicator of the rate of avoidable blindness, both as a headline measure and by main cause, to highlight and track the direction of travel at national and local level.

The hon. Member for Enfield, Southgate has raised a number of wider important issues for the eye care sector. Many of those were highlighted in the report from the all-party parliamentary group on eye health, “See the Light”, which was published last summer. The Department welcomes this report and, along with NHS England, is carefully considering the key recommendations.

The hon. Gentleman said that eye clinic capacity was insufficient. I of course share any concerns about delays to treatment. National guidance is clear that all follow-up appointments should take place when clinically appropriate, and patients should not experience undue delay at any stage of their referral, diagnosis or treatment. To help address that issue, two key initiatives—“Getting it Right First Time”, led by NHS Improvement, and the elective care transformation programme, led by NHS England—have been set up to consider what can be done to ensure that patients do not suffer unnecessary delays in follow-up care. My Department is following that work closely.

The hon. Gentleman also asks that we establish a national target to ensure that patients requiring follow-up appointments are seen within a clinically appropriate time. As I am sure he will appreciate, the intervals for follow-up appointments will vary between different services or specialties, and between individual patients, depending on the severity of their condition. That is why all follow-up appointments should take place when clinically appropriate. For patients who require further planned stages of treatment after their “referral to treatment” waiting time clock has stopped, treatment should be undertaken without undue delay and in line with when it is clinically appropriate and convenient to the patient to do so.

The hon. Gentleman and the hon. Member for Battersea both raised the matter of a national eye health strategy. The Department takes sight loss very seriously. We are working with NHS England to ensure that the commissioning and development of eye services are of high quality and sustainable. I look forward to meeting the hon. Lady to discuss all matters relating to vision and sight loss.

CCGs are responsible for commissioning all secondary care ophthalmology services, and are also available to commission primary care services such as minor eye services and monitoring, in the community, to meet identified need. It is therefore right that the planning and commissioning of high-quality eye care services that meet the needs of the local population should happen locally, not at a national level.

The hon. Member for Enfield, Southgate, also referred to the national ophthalmology database, and asked that it be expanded to collect data on AMD. Data is currently collected on cataracts as part of a five-year programme funded by NHS England. I understand that at an earlier stage the programme funding panel considered expanding the focus, but decided that the focus should remain on cataracts in that time-limited audit.

I recognise the hon. Gentleman’s concerns and thank him for raising the matter. We are working incredibly hard, alongside NHS England, Public Health England and other partners, to ensure that eye care policy is focused both on preventing disease and, where disease develops, on ensuring that there are high-quality, sustainable eye care services for people across the country. I hope that the significant focus on effective treatment, prevention and AMD research that I have outlined means that he can reassure his constituents that we take AMD incredibly seriously. Maintaining good vision throughout life is of the utmost importance, especially as we grow older.

Safeguarding Vulnerable Adults: Care Homes

Marsha De Cordova Excerpts

Tuesday 26th February 2019 Commons Chamber

[Dr Allin-Khan]

I thank the hon. Gentleman for his intervention, and I am sorry that his constituent has had to live through that for eight years. I know how terribly difficult it has been to deal with such a situation for one year. His constituent is very lucky to have him raising this matter on his behalf again.

From the very first meeting with the safeguarding team at Wandsworth Council, my brother and I felt as though we were being put on trial. A new manager from Ensham House was present, but he had no idea about what had happened to my father, despite having been sent the horrific photos of his brutal injuries. The safeguarding team had not even looked at them. London Care had no answers as to why we were not called, and again had no answers as to how it could have happened. It was not until the wonderful police officer arrived, at my request, viewed the photos and showed visible alarm at the injury patterns that the Wandsworth Council staff actually took notice. I would like to extend my thanks to the fantastic police that we have in Wandsworth and up and down the country, who give of themselves day and night to ensure the safety of our community, even though they often stand up for people for whom they may never get answers.

It was agreed with Wandsworth Council’s safeguarding team that a police investigation would now commence, but it was explained to us that because Optivo housing association had not placed any CCTV cameras anywhere in Ensham House other than in the communal areas, and because my father could not communicate what had happened to him, it was very likely that we would not receive the answers we were looking for, and that a criminal conviction would be very difficult to obtain. As the police commenced their investigation, we expected the council to start conducting its own investigation, at the very least, because regardless of whether there had been criminal activity, questions needed answering. They were not answered, however.

In the following months, we found my father bruised again on two further occasions, with no explanation. He started to sleep in the communal area, for fear of being alone in his room. By this time, the Ensham House care staff knew that we were paying close attention because we were incredibly concerned, and that is when they started to attempt to claim that, despite a year of living there with no issues relating to him, my father was being difficult. The allegations were not corroborated by his community psychiatric team or any staff at the day centre where he spent up to 25 hours a week, and there had been no record of any issues prior to the first incident. Relatives of other residents started to tell us that staff had boasted that they were trying to get dad out because we were asking too many questions.

[Marsha De Cordova (Battersea) (Lab)]

I congratulate my hon. Friend not only on securing this debate, but on sharing her personal experience. By doing so, I hope that we will see some change. Where Wandsworth Council and other councils contract out care to private providers, does she agree that the right checks and balances must be in place to ensure that her father’s situation happens to no one else?

Oral Answers to Questions

Marsha De Cordova Excerpts

Tuesday 27th November 2018 Commons Chamber

[Matt Hancock]

That was a bit of a surprise, because the hon. Gentleman is normally such a reasonable fellow. I thought that he would welcome the record number of GPs in training, and the record number of nurses in the NHS. Because we love the NHS, of course we want to do more, and we will.

[Marsha De Cordova (Battersea) (Lab)]

5. What assessment he has made of the ability of people with learning disabilities to access GPs.

[The Minister for Care (Caroline Dinenage)]

People with learning disabilities still face significant health inequalities. Data from 2017 shows that about half of patients with a learning disability received an annual GP health check, and our target is 75% by 2020. We will shortly consult on plans to introduce mandatory learning disability and autism training for all health and care staff.

[Marsha De Cordova]

There are shocking health inequalities between people with learning disabilities and the general population, and that is recognised by GPs: 60% say that they have received less than a day’s training in how to meet the needs of patients with learning disabilities and autism, while 98% say that they would appreciate more training. The Government are clearly failing people with learning disabilities. Will they commit themselves to ensuring that every new GP who is trained in England is also given training in how to meet the needs of people with learning disabilities and autism?

[Caroline Dinenage]

Yes. That is already part of the training framework. As I have said, however, we are consulting from early next year on plans to make training on learning disabilities and autism mandatory for all health and care staff, not just medical professionals.

Budget Resolutions

Marsha De Cordova Excerpts

Tuesday 30th October 2018 Commons Chamber

[John McDonnell]

The facts speak for themselves.

To make a real difference to the lives of young people, the Chancellor needed to address the housing crisis, deal with the toppling mountain of student loans, and restore work allowances for single people and couples without children. Instead we got piecemeal, unambitious housing announcements and re-announcements, nothing on student finances, and nothing on universal credit recipients who are single and without children.

[Marsha De Cordova (Battersea) (Lab)]

The Chancellor’s meagre contributions to universal credit will do nothing to reverse the social security cuts for disabled people. Does my right hon. Friend agree that for the millions of disabled people, austerity is far from over?

[John McDonnell]

I will come on to the plight of disabled people, who seem to have been a particular target for this Government, given how they have withdrawn funding and services.

On older people, there were more than 31,000 excess winter deaths among the over-65s in 2017, and well over 150,000 elderly people are in arrears in their social care payments. The Local Government Association, which works on a cross-party basis, said that £1.5 billion was needed by 2020 just to fill the funding gap in adult social care. The £650 million that was announced yesterday is less than half of that.

What comes out of the analysis is this. The burden of austerity has fallen disproportionately on who? On the shoulders of women. Yesterday, that did not just continue; it got worse. The share of the Government’s tax and benefit changes impacting on women increased from 86% to 87%—another year with an increase. The 1950s women, who have been treated so unjustly, have been overlooked once again.

The victims of possibly the harshest cruelty inflicted by this Government are disabled people. A UN inquiry into the rights of persons with disabilities found this Government guilty of “grave and systematic violations” of their human rights. When have any UK Government been charged with that by a UN body? Never. To be frank, we know—

NHS Long-Term Plan

Marsha De Cordova Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

We will set up a single, central procurement system so that every hospital in the NHS can benefit from the efficiencies gained from bulk buying, but we have to do that in a way that does not shut out smaller companies from bidding for NHS contracts.

[Marsha De Cordova (Battersea) (Lab)]

The Government’s new NHS funding includes no additional funding for social care. The Secretary of State has said that the Government will publish a social care Green Paper in the autumn. Will he confirm—yes or no—whether the Green Paper will include social care funding for working-age disabled adults?

[Mr Hunt]

We will consider the provision for working-age disabled adults as part of our review of the whole social care system, because that is extremely important.

[Marsha De Cordova]

Will it be in the Green Paper?

[Mr Hunt]

We are doing that work in parallel to the Green Paper, but the hon. Lady is absolutely right to highlight it.

Leaving the EU: NHS

Marsha De Cordova Excerpts

Thursday 22nd March 2018 Westminster Hall

[Andy Slaughter]

Yes, the system is fully integrated across EU countries, and the whole is greater than the sum of its parts.

Last November, the president of Imperial College, Alice Gast, revealed that some of the 2,000 staff at Imperial College who are EU nationals have already left. I will come on to why that should be the case, given what the Government have said on EU nationals. Half of them—1,000 people—have taken legal advice on their positions post Brexit. A quarter of the staff and a fifth of the students at Imperial are from the EU. In the healthcare sector across London there are 20,000 staff from the EU, which is about 15%.

A good example is another of my local hospitals, the Royal Brompton, where 30% of the clinical staff are EU nationals. I have visited the Royal Brompton, and it has the most extraordinary paediatric cardiac surgery unit doing the most advanced and delicate operations on newly born babies. When I visited, all the surgeons who were operating were EU nationals, I think from five different countries. The Government may say, “Well, so what?”, but I do not imagine that they maintain, as has been said previously, that we can give a sudden opportunity to replace many doctors and nurses with home-grown doctors and nurses. That is not going to happen overnight. We know that the demand is such that we will continue to rely on clinicians from abroad for the indefinite future.

[Marsha De Cordova (Battersea) (Lab)]

My hon. Friend is making an incredibly valid point about staffing in our hospitals. My local hospital, St George’s, has already experienced a loss of staff because people from the EU are leaving. Our patients have to wait longer to be seen. For example, one lady who had to see a radiographer was seen within a day, but now she has to wait up to six weeks to be seen. Does he agree that what the Government say does not ring true in reality?

[Andy Slaughter]

I agree with my hon. Friend. If Members are honest, that is the experience that many of us will have had. There are many questions about the health service, as I have indicated, and the situation is simply being exacerbated by removing one of the most compatible, professional and necessary parts of the health service: its staff from the EU27 countries.

Why are we losing those staff? We hear protestations from the Government that those who are here now and until 29 March next year are welcome to stay, but that is not correct. First, there is uncertainty, because nothing is agreed until everything is agreed. Secondly, the rights of EU staff will not be the same as they are now, as my hon. Friend the Member for Westminster North (Ms Buck) indicated in her intervention. There is no continuity of rights; settled status has to be applied for, there has to be a register and there might be identity cards. As often happens, certainly with people in medical research grades, they might leave the country for five years but want to come back, yet they would then no longer have settled status. The position in the transitional phase, we understand, will be different again.

Even if some legal certainty is eventually given, there is still the climate or mood among EU citizens. I can speak confidently about this, because more than 20% of my residents in Hammersmith are EU citizens—it is one of the top three boroughs in the country for the percentage of EU residents—so I talk to them every week. I have now talked to and corresponded with not hundreds but thousands of them over the past two years, and they are extremely concerned. Let us be honest: they have transferrable skills and they can go to work in countries where they feel more welcome and valued than they do here.

The Government have not done enough—indeed, the Government cannot do enough—to reassure those EU citizens. The message that Brexit sends is that they are at least not as welcome as they once were. I will end on this, which I came across when preparing for the debate. It is something that Imperial College Healthcare Trust put out shortly after the referendum, when it introduced #LoveOurEUStaff. The management wrote to the staff:

“Our country is currently in a place of uncertainty. There has been no clear message from the Government about what the future holds for EU citizens living in the UK… I’ve heard that many EU and other overseas citizens are feeling concerned about their futures in the UK. I’ve also seen the media reports of an increase in racist incidents following the referendum vote.”

Eighteen months on, I wish I could say that those comments no longer applied. Sadly, they do. The fact that we are barely nearer certainty in the matter means that every day individuals are voting with their feet, feeling that they will be more welcome and their skills more valued in other countries. Frankly, the Government are not doing very much to address that point. I, too, read the debate and hear what the Minister says about that. I wonder what the Government can do, given the hole that they have dug themselves into.

Oral Answers to Questions

Marsha De Cordova Excerpts

Tuesday 10th October 2017 Commons Chamber

[Christian Matheson (City of Chester) (Lab)]

8. What assessment he has made of the effect of the public sector pay cap on staffing levels in the NHS.

[Marsha De Cordova (Battersea) (Lab)]

11. What assessment he has made of the effect of the public sector pay cap on staffing levels in the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

NHS staff do a fantastic job in tough circumstances, and pay restraint has been challenging for many of them. However, given the financial pressures, it is also true that the NHS would not have been able to recruit an additional 30,000 staff since May 2010 without the cap.

[Mr Hunt]

As I said in my previous answer, without pay restraint we would not have 11,300 more doctors in the NHS and 11,300 more nurses on our wards. The hon. Gentleman will know that we recognise that it was not sustainable to carry on with the 1% rise going forward, which is why we have been given the leeway to have more flexible negotiations next year.

[Marsha De Cordova]

Hospital wards and GP surgeries are chronically understaffed, and the knock-on effect is that waiting lists are spiralling out of control. Is it not in the best interests of patients to scrap the pay cap so that the NHS can be run with the relevant number of staff in place?

[Mr Hunt]

I welcome what I think is my first question from the hon. Lady, and I can give her some good news: the pay cap has been scrapped.