A clue to this medical condition's impact can be readily detected from its name. Age-related macular degeneration (wet AMD) is the most common cause of poor eyesight in the 60-plus age group. It causes the central field of vision to deteriorate and can result in blindness among sufferers. But help is at hand in the form of a new medical treatment that can be effective in improving the vision of patients in perhaps three-quarters of cases; rather, help should be at hand.
Given the condition's baleful impact on the quality of life of sufferers, the decision taken by the Scottish Medicines Consortium (SMC) in June to approve the treatment, Lucentis, for prescription was understandably given a warm welcome. Two months down the line, however, the picture is infuriatingly patchy on the provision of Lucentis to treat patients across Scotland. A postcode lottery operates that results in patients benefiting from Lucentis in some parts of the country but being denied it in others. Why this should be so is not clear. In health boards as far apart as Ayrshire and Arran and Shetland it is available. In others, from Glasgow through Fife to Grampian, it is not.
To those who thought the iniquity of postcode lotteries in the health service was a thing of the past, the revelation in The Herald today that the impact is to discriminate against patients simply because of where they live will shock. Lucentis comes at a price: £761 a dose. Each new treatment adds to the pressure on health board budgets and forces them to make tough decisions. But there are three good reasons why the decision to prescribe this treatment should be easier to make. First, it is efficacious. Secondly, prompt treatment reverses what can otherwise be the steady onset of blindness. This clearly strengthens the case for intervention at the earliest point. Thirdly, given the impact of the treatment on quality of life of patients and their families, is it such a price to pay (perhaps £3.6m a year) against a backdrop of annual spending on the NHS in Scotland soon to break through the £10bn barrier for the first time? It must be assumed that the SMC took these factors into account when approving Lucentis. But it just does not make sense that some health boards should, at best, prevaricate about making the treatment available.
The SMC has carried out a thorough assessment and passed Lucentis. Why should health boards need to carry out their own evaluation? Dr Michael Gavin, a consultant ophthalmologist in Glasgow, tells this newspaper of his disappointment at the failure of some local management teams to put in place the infrastructure to deliver the service. Given the figures for managers and bureaucrats in the health service, there surely cannot be an insufficient number of administrators to process the paperwork.
Sterile conditions are required to administer the treatment of Lucentis. If operating theatres are not available during the day (surveys suggest there is excess capacity in some areas), the treatment could perhaps be delivered out of normal hours, utilising the flexibility built into consultant contracts. It is plain to see that there is no excuse for tardiness on the part of some health boards to make Lucentis available, on a level playing field, across Scotland.
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