Age-related Macular Degeneration: NHS Funding

Debate between Marsha De Cordova and Seema Kennedy

Tuesday 9th April 2019 Westminster Hall

[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.