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Mr. Stunell: First, I wish to thank the ministerial team for the work that they have put into the Bill. It has had the most remarkably chequered history and I am well aware that--as well as causing us stress--it has caused the ministerial team some stress. Occasionally, that has been visible, despite their smiling attempts to deny it. When I saw the list of amendments for Report, I derived some wry amusement from realising that, despite the 50-odd clauses we had successfully deleted in Committee, a few had escaped Ministers' eagle eyes and had to be deleted today. I recognise what a difficult and hard job they have had.
The overall shape of the Bill is now right and it should proceed, but it still has significant faults. We have tried to demonstrate those faults, in Committee and on Report, and to indicate how they might have been rectified. I hope that there will be opportunities to do that in the other place.
I would highlight the fact that, despite the many good intentions and smooth words and the emollient approach of the Minister for Competition and Consumer Affairs in Committee, there are no firm targets for delivery on
We believe that an opportunity that could have allowed the renewables sector to blossom and grow, as has happened in some neighbouring countries has been missed. As a result, the United Kingdom will miss out on some growth and export opportunities, as well as on the opportunity to reach the Kyoto targets that the Government have pledged to achieve.
We are worried about some of the matters relating to the consumer council in its new combined form. The council is the way to go, but we think that it may turn out to be too centralised and bureaucratic, and we are worried about the availability of information to it. It would be only too easy for the regulator and the industry to shut up shop and keep information away from the council.
Ministers have given reassurances on the record that I hope can be prayed in aid when information is denied. However, we would have preferred the requirements to protect the consumer and to make information available to be specified on the face of the Bill.
Our underlying belief is that, although it is right and proper for the Bill to do all that it can to open up competition in the gas and electricity industries, at every level from generator to supplier, making the market the determining force for the introduction of renewables and the achievement of environmental targets will not work. We also doubt that the market will be the right force to achieve the Government's social objectives. The Bill has some weak links that the Government will have to address, either in Parliament or in some other way, in the very near future.
The Bill has some very positive features, however. We have welcomed the new electricity trading arrangements and the increased competition that will be introduced to the gas and electricity markets. We also welcome the integrated regulatory framework that will be provided in the future. In the past, there has been inconsistency between regulators and, on some occasions, the regulatory framework has fostered a jobsworth attitude. I hope that the Bill will put an end to that.
Mr. Paul Marsden (Shrewsbury and Atcham): I am pleased to present a petition signed by 1,176 local people on the sensitive and sometimes heartbreaking issue of gaining equal access to fertility treatment.
That with one in six couples seeking help for infertility at some time, there is an overwhelming need for better funding for this treatment on the NHS, the current provision of which is patchwork across Britain and very minimal in Shropshire and mid-Wales.
The petitioners therefore request that the House of Commons urge the Secretary of State to ensure that adequate resources are available for infertility treatment and that access to this treatment should be on a fair and equitable basis across the country.
And your Petitioners, as in duty bound, will ever pray.
Mr. David Crausby (Bolton, North-East): I am grateful for the opportunity to raise the subject of macular eye disease and so, I hope, to increase awareness of a debilitating disease that is the most common form of registrable visual impairment among the elderly in the western world. Age-related macular degeneration affects 40 per cent. of people aged over 75, despite which it is relatively unheard of.
I first became aware of the problems associated with the disease when I was invited to attend a newly formed macular eye disease group in my constituency. Bolton macular disease group is a self-help organisation comprising people with a common aim of providing support for each other and discussing problems and exchanging ideas on how to cope with their difficulties. The group was formed with the help of the Bolton social services department's visual impairment team, which had done good work for those who suffer from impaired vision.
It is all too fashionable these days to criticise social services departments, and it is a pleasure to highlight the essential work that they do and to congratulate them on it. I pay tribute to the macular group in Bolton and similar groups around the country. They do a tremendous voluntary job in helping sufferers and their partners with advice and support. Most importantly, they reassure people who have the disease that they are not alone. The Bolton group is part of the national Macular Disease Society, which has many branches across the country.
To assist those who are unaware of the problems of macular degeneration, I shall briefly describe the disease. The human eye operates like a camera, the main difference being that a camera has a layer of film in the back while the eye has a layer of tissue--the retina. The image focused on the retina is converted to a digital image that is transmitted through the optic nerve to the brain, where it is perceived as sharply focused vision. The macula is found at the centre of the retina, where incoming rays of light are focused. The macula is responsible for what we see immediately in front of us--the vision that we need for detailed reading or writing. It controls our ability to appreciate colour.
The macula receives most of its nourishment from blood vessels in a deeper layer, which is separated from the macula by a membrane. If the membrane is damaged, the macula does not function properly. If the membrane breaks, new and abnormal blood vessels form to try to repair the damage, but they may bleed and displace the macula. The delicate cells of the macula can sometimes become damaged and stop working. No one seems to know why, but it tends to happen as we get older, although children and young people may also suffer from inherited macular degeneration: indeed, sometimes, several members of a family will suffer.
Macular degeneration impairs your ability to look straight ahead, Mr. Deputy Speaker. There is a blind spot in the centre of your vision. It is always there; it never goes away. It is as if someone were holding a coin six
Because macular degeneration is normally age-related, it usually involves both eyes, although not necessarily at the same time. For many people, the visual cells simply cease to function, just as the colours fade in an old photograph: that is known as dry degeneration. Fortunately, it is not a painful disease and it never leads to complete blindness, even though it is the most common cause of poor sight in people aged over-60. It never leads to complete loss of sight because only the central vision is affected, so those with macular degeneration will have enough side vision to get about and to maintain their independence. Dry degeneration accounts for the majority of cases; in effect, it is untreatable.
A significant minority of cases are of wet macular degeneration, which is much more severe. However, it is treatable if diagnosed early enough. AMD Alliance International estimates that more than 500,000 people in the UK suffer from various forms of the disease. Between 10 and 15 per cent. of those patients have wet AMD, but they can be treated if the disease is caught early enough.
Every year, throughout the world, 500,000 new patients develop wet AMD; between 40 and 60 per cent. of sufferers will develop the lesions that are the predominant sign of the disease. Patients with that condition lose their ability to read, drive and recognise faces in as little as two months or as long as two years.
Because wet AMD can cause profound and rapid loss of vision, it has been the subject of many years of research by scientists and clinicians throughout the world, and various new treatments have been promoted. New developments are upon us. Only last week, the United States Food and Drug Administration approved an exciting new treatment, and the European Union recommended approval of a treatment involving a combination of laser beams and the drug Visudyne.
Two centres in the UK--Liverpool and Aberdeen--have been taking part in international studies to evaluate photodynamic therapy, which is a new treatment for wet AMD. Last month, the brief results of the second year of the study were released. They demonstrated that the beneficial effects of photodynamic therapy had continued into the second year.
The therapy works by preventing the leaking blood vessels from causing further damage. The procedure takes place in an out-patient clinic and takes about 30 minutes. It starts with a 10-minute intravenous infusion of Visudyne--a light-sensitive dye that sticks to the inner lining of the new vessels. Five minutes after the infusion, the dye is activated by a light shone on to the surface of the eye. The activated dye then damages the vessels, causing them to close.
I should warn hon. Members that photodynamic therapy is beneficial only for certain categories of the disease and that treatment needs to be commenced within six months of the onset of visual deterioration. That is why it is so important to highlight the disease and to encourage awareness and early diagnosis. Of course, Visudyne offers a solution for only a small minority of those with AMD; a much larger majority of sufferers will continue to depend on visual aids, equipment and conventional treatment.
The normal first port of call for those who are experiencing problems with their vision is their optician. The introduction of free eye tests for the elderly from the beginning of this month is of immense importance in the early diagnosis of AMD. Regrettably, far too many elderly people simply could not afford to attend their optician regularly and they could have missed out on early treatment and support.
I am optimistic that regular eye testing will be most helpful in ensuring that people aged over 60 who are at risk of AMD will be able to receive regular eye examinations. The Royal National Institute for the Blind recommends that elderly people should have an eye test every two years. More frequent examinations will obviously result in patients with signs of eye disease being referred for the specialist treatment that they require.
I am concerned, however, that the standard of service from opticians is irregular. I am advised that they do not always effectively test for the disease. A standard optical test involves external examination and internal examination of the eye to detect signs of injury, abnormality or disease, and examination of the retina. The use of an ophthalmoscope would be expected to uncover macular degeneration when it is well established. There is, however, a test known as the Amsler grid, which is designed to map the field of vision and uncover any problems, but there is no requirement for an optician to use this test routinely. I would appreciate it if my hon. Friend the Minister were to investigate the situation.
The second port of call for those experiencing a visual difficulty is usually their general practitioner. They, like opticians, have to decide whether a referral to a consultant is appropriate. This can cause problems with people missing out if the GP is insufficiently trained in recognising when it is necessary to refer a patient to an eye consultant.
It is only when patients see an eye consultant that treatment becomes available, and it is by this time often too late effectively to treat the disease. There is still much that can be done, however, even when vision has deteriorated either through wet or dry degeneration. For example, the patient may be registered as blind or partially sighted, and only the consultant has the authority to make the registration decision. Registration automatically leads to referral to the local social services department, which will instigate action from its visual impairment team or its local equivalent.
If the consultant feels that the patient would benefit from the use of magnifiers or aids of any sort, a referral would be made to the low-vision aid clinic, which is usually part of the same hospital. That clinic will recognise that one of the main difficulties for a patient with AMD will be reading and examining small detail. The clinics are able to measure close as well as distance vision, and can prescribe magnifiers to assist with close work. The optometrist will also advise on the importance of correct lighting levels to enhance the patient's remaining vision.
In addition, virtually all social services departments will have a provision for visually impaired people. Their role is to assist these people in retaining their independence and quality of life. Social services will conduct an initial assessment of the individual's needs.
These days there are numerous aids and pieces of equipment for reading, writing, mobility and general daily life. They include closed circuit television, talking books, magazines and newspapers, big-button telephones, talking watches and clocks, tactile oven controls and even talking microwaves. There are clubs and societies such as the Macular Disease Society, which do such good work in Bolton and which first made me aware of this disabling disease.
My aim in initiating this debate on macular eye disease was to raise awareness of a disability that is so little known and yet affects so many people. I am eager to enlist the Government's support in highlighting and improving the services that are available to sufferers.
As I have said, there are some exciting treatments on the horizon, but the harsh reality is that for the vast majority it is too late to cure the disease. It is not too late, however, to provide modern visual aids. With such rapid strides being made in new technology, there will no doubt be many more exciting prospects available on the horizon.