§ 9.13 p.m.
§ Mr. Jim Craigen (Glasgow, Maryhill)
I am grateful to the Minister for making himself readily available at short notice to deal with the subject of facilities for treating arthritis and rheumatism in the West of Scotland, although I do not intend to confine myself to that area. As he knows I have a considerable constituency and general interest in this matter, not least because the Centre for Rheumatic Diseases at Baird Street lies within my constituency, although it serves a fairly wide part of the West of Scotland.
One of the problems in discussing the subject of rheumatism and arthritis is that it has the image of a music hall joke. It is not a dramatic condition in the way that cancer or leukaemia is. To that extent this public image does not help in obtaining action to improve the facilities available to those who are unfortunate enough to suffer from one or other of the many rheumatic complaints. It is certainly not amusing if one happens to suffer pain from one form of rheumatism or another, or if one is unfortunate enough to be severely crippled and bed-ridden.
This year, 1977, is World Rheumatism Year. It has become a fashion to have these designated years when we attach more importance to a particular topic, but the plain fact is that those who suffer from rheumatism and arthritis are not just concerned with the 365 days this year, because they really are suffering from a long-term condition.
The Arthritis and Rheumatism Council has just published its third report entitled "A Walking Miracle". As the Minister will no doubt know, this deals with the long waiting periods for those who are seeking to have surgery for the replacement of joints. It is a particular problem in many parts of the country, and not least in the West of Scotland, that there are long waiting lists for people seeking admission to hospital for treatment. I suspect that we shall never have sufficient facilities to cope with the rising trend of demand.
If we think in terms of the proportion of the population over 60 and how it is likely to grow over the next five or 348 10 years, it is obvious that there will be increasing demands for joint surgery and the replacement of joints. As the Minister will recognise, this problem is not confined to the elderly, because a good many people of working age or young people unhappily sometimes require joint replacements, whether it is a knee joint, fingers, or hips.
In dealing with this growth industry, will the Minister say how he thinks the National Health Service might cope with the domestic demand, and whether the Service has looked at the possibilities in bio-engineering and even at the export potential of the manufacture of joint replacements to raise additional resources for home demand?
I turn in particular to the Centre for Rheumatic Diseases at Baird Street. I am sure that the Minister must be aware of the uncertainty that has existed for some time among staff and patients about the future of this centre which, as we understand, is in time to be absorbed into the new Glasgow Royal Infirmary. That still leaves a good deal of anxiety among staff and patients about the precise timing and the actual arrangements for these changes in the next few years.
Here we have a centre that was opened in 1965 and that each year has about 12,000 outpatients who benefit from the centre's facilities.
The centre is supported by the Greater Glasgow Health Board but also receives some financial assistance from the Arthritis and Rheumatism Council, and indeed from time to time some outside professional assistance which the present director has been able to attract to the centre from a teaching point of view.
A number of reports have recently indicated that the incidence of arthritis and rheumatism complaints in the West of Scotland is more serious than in many other parts of the United Kingdom. I think that in Merseyside, for example, the incidence is also particularly bad. Yet we have about three consultant rheumatologists practising in the West of Scotland. As my hon. Friend knows, I have taken up this matter with him both in correspondence and in Questions. The last reply I received indicated that his Department was operating a target programme whereby there would be an increase within the next year or two in 349 the number of consultants or registrars devoting their full-time professional attention to this problem area.
It may be that the climate in the West of Scotland is one of the factors in creating such a high incidence of trouble, although some evidence suggests that this may affect only the pain thresholds of those suffering from various forms of arthritis. Some medical authors take the view that dietary factors are involved in certain types of arthritis. I do not know whether my hon. Friend has any information on this matter. However, he will be aware that we in the West of Scotland like our cakes, scones and potato crisps. According to some medical authors, a diet with a high concentration of carbohydrates does not exactly help certain arthritic conditions. The soft water in the West of Scotland gets blamed for certain heart troubles. I do not know whether any research has been done on the correlation with arthritis.
I know what the hon. Member for Ealing, Acton (Sir G. Young) is hoping to say a few words. He will no doubt be dealing more particularly with the problem in England. However, it is heartening to see the amount of research that seems to be going on in some of the centres in London, because no matter where the research is conducted the chances are that the benefits will extend over the country as a whole.
I gather that a team at the Kennedy Institute of Rheumatology in London has made something of a breakthrough. That kind of work ought to be fully supported by the DHSS. I was particularly sad, however, to read earlier this year that those involved in research in St. Bartholomew's Hospital in London were having difficult in guaranteeing the hiring or purchasing of an analytical machine to help them in their work. I know that my hon. Friend does not have ministerial responsibility for hospitals in London, but I just make that point.
More especially, I would raise with my hon. Friend the interest within the medical profession generally in rheumatic and arthritic problems. One sometimes has the impression that professionals take an interest in certain subjects which are of great interest to them but not of great concern to the general public. Has the Department taken any steps to encourage 350 the medical profession to give more time and attention to the problems of arthritis and rheumatism in student medical courses and in subsequent in-service courses for GPs? Much of the time of general practitioners is taken up with the problems of people suffering from those ailments.
How much interdepartmental activity is taking place on this broad subject? A total of 44 million days are lost to industry because people are away from work suffering from some form of arthritis or rheumatism. The figures show that in production terms about £400 million is lost to British industry each year due to this cause. The Treasury and more especially the Department of Employment should be taking a keen interest in the savings to industry that might accrue from more research and improved outpatient and in-patient facilities within the National Health Service.
This problem is not confined to the elderly but affects many working men and women. We know that there are pressures on public finance, but is there any possibility that more industrialists can be persuaded to take a special interest in sponsoring research and in seeking improvements to facilities to be afforded to working people who suffer from various forms of arthritis?
I know from my experience with the Scottish TUC in the mid-1960s, where I had special responsibilities for the social services, that trade unions attach a great deal of importance to the problem. This is not necessarily backed by hard cash, but many unions recognise the need to improve facilities. While I was working for the Scottish TUC, Dr. Watson Buchanan, the present director of the Baird Street Clinic, took up his post. I organised a meeting at the headquarters of the STUC when Dr. Buchanan addressed members of the General Council on this problem. He tried to persuade trade union leaders to take a greater interest in the subject. In the past decade Dr. Buchanan and others in this field have dedicated themselves to improving the lot of arthritis sufferers.
I hope that the Minister will give me an assurance on three specific matters. The first is that he will make a statement to allay the fears of the staff at the Centre for Rheumatic Diseases, who are very worried about their future and the 351 patients who attend the centre who are becoming increasingly anxious about their continued treatment.
Secondly, I hope that the Minister will have discussions with his colleagues at the DHSS about the lack of priority attached to this problem of rheumatism and arthritis. The White Paper "The Way Ahead", published last April, did not really give any indication that rheumatism and arthritis loomed very large in the Health Service's priorities in Scotland. This may reflect the attitudes within the medical profession, and I hope that the Minister will follow up with the profession in Scotland the whole area of medical education and indicate to the area health boards—particularly the Greater Glasgow Area Health Board—that he will give full support to the efforts being made in this field. I hope, too, that he will look at the research being done in Scotland at present and will give whatever encouragement he can to those who are making a breakthrough in this area.
Thirdly, I hope that the Minister's Department will look at some of the factors that seem to create, or at least lead to, a greater incidence of the complaints of rheumatism and arthritis in the West of Scotland. There are people in Florida, which is not exactly the coldest place in the world, who suffer from certain rheumatic and arthritic complaints. However, the problem in the West of Scotland seems to warrant special attention.
This has been an unexpected opportunity to debate this matter and if the Minister, who made himself available at relatively short notice, will give an assurance that he and his officials will bring fresh impetus to this problem, the debate will have been well worth while.
§ 9.38 p.m.
§ Sir George Young (Ealing, Acton)
I begin by congratulating the hon. Member for Glasgow, Maryhill (Mr. Craigen) on selecting this most important subject for debate tonight. If more of his hon. Friends and more of mine had known that the debate was to be held, I am sure they would have wished to join in, because this is a very important matter.
This is World Rheumatism Year and this week a concerted attempt is being made by the bodies involved to draw attention to the particular problems of 352 those who suffer from rheumatism and arthritis. It is right that we should spend some time debating the matter in this House.
Earlier today we heard the most welcome statement about vaccine-damaged children. That is a worthy cause deserving our sympathy and attention. But let us not forget the less dramatic but equally painful disease that affects far more of our people and for which there is no known cure.
Some 700,000 women and 200,000 men suffer from rheumatoid arthritis—the most common crippling disease in this country. In addition, some 5 million people suffer from osteo-arthritis, a disease which usually affects the elderly. We spend some £2.5 million annually relieving the pain that is caused by arthritis, which will disable roughly 10 per cent of us. It is estimated that six children out of every 10,000 will suffer from some form of swelling in the joints and from the pain which that causes.
Each week the average general practitioner will see two new patients suffering from arthritis. A quarter of the over-45s who visit their GPs do so because they suffer from this disease. It is a widespread disease which afflicts a large number of people.
I suspect that our response to this disease is totally inadequate. At the moment only 4½ per cent. of our National Health Service resources are devoted to tackling this illness. There are only 150 full-time rheumatologists in the whole country. Our hospitals are poorly equipped to deal with this illness, and services are threatened by public expenditure cuts.
There is a long waiting list for hip replacement, which is an expensive operation. It costs the NHS about £1,000 per operation. It is doubtful whether we can continue to treat this disease in this dramatic way when the cost is so high. The injection of steroids has been tried, but they produce particular side effects and were no long-term solution to the problem.
There is an active branch of the British Rheumatism and Arthritis Association in my constituency which does what it can to try to relieve the pain, and it campaigns very effectively for services. It is 353 a warning sign to all of us that a voluntry organisation such as that should have so many members, because that indicates that there is a gap in statutory services. I should like to outline briefly some points the answers to which would I think minimise the problem.
First—this reinforces something said by the hon. Member for Maryhill—we must find out why some people are more vulnerable to this disease than others. We must discover what environmental or hereditary factors may be at work that make people susceptible to this illness.
Secondly, what is it that happens to joints? We need a better understanding of the illness if we are to try to get effective solutions.
Thirdly, the search for new drugs to relieve the pain and inflammation must be stepped up. We need drugs with minimum adverse side effects. Perhaps the Medical Research Council has a rôle to play here since it currently spends only £1¼ million on research into this disease, which compares unfavourably with its budget for research into other illnesses.
Fourthly, we need more mechanical aids to help those who are severely afflicted. There is some concern that the current cuts in services will hit those most severely afflicted by this illness. It would help if we could exempt expenditure on research and other facilities for the relief of arthritis from Health Service cuts. It is one of the Cinderella services in the NHS and it should be exempt from any retrenchments.
I end on a positive note. I am convinced that a cure for arthritis can be found if we are prepared to devote the resources to it. However, it means a shift in priorities. If this debate has contributed to that shift, it will have been well worth while.
§ 9.43 p.m.
§ The Under-Secretary of State for Scotland (Mr. Harry Ewing)
I thank my hon. Friend the Member for Glasgow, Maryhill (Mr. Craigen) for his indication that he intended to raise this matter on the Adjournment should time allow. In all fairness to him, I should say that he gave me ample warning. I am grateful for the courteous manner in which he approached me. I know that my hon. Friend, in conjunction with my right 354 hon. Friend the Member for Rutherglen (Mr. MacKenzie), has been deeply concerned about rheumatic diseases in the West of Scotland with particular relevance to the Baird Street clinic in Glasgow.
Before dealing with the points made by my hon. Friend I should like to refer to what was said by the hon. Member for Ealing, Acton (Sir G. Young), who made a very good and relevant contribution. The hon. Gentleman referred to the need to protect the treatment of rheumatism and arthritis from cuts in public expenditure as they affect the National Health Service. I have no responsibility for the Health Service in England and Wales, but my right hon. Friend the Secretary of State for Social Services, when speaking at the launching ceremony of World Rheumatism Year, gave the assurances that the hon. Gentleman was seeking.
It is worthy of note that the Secretary of State took the trouble to go to the launching ceremony of the World Rheumatism Year to express his concern and recognition of the problem that affects those who suffer from rheumatism and arthritis. We all recognise the problems that such people suffer.
I now turn to the Baird Street clinic. The things that brought the clinic to the attention of people in the West of Scotland was that it was decided last year, because of the Glasgow Fair Fortnight—the traditional two weeks when people in the West of Scotland have their annual holidays—and the rather reduced use of the resources of the clinic that the clinic should be closed for that fortnight and that in-patients should be transferred to the Glasgow Royal Infirmary. It was that, not the nature of the disease, but the fact that the clinic had been closed for a fortnight, that was the single factor that brought to the attention of the people of the West of Scotland the fact that so many people suffer from this unfortunate disease of rheumatism and arthritis.
Of course, my hon. Friend the Member for Maryhill rightly took up the matter of the closure of the Baird Street clinic. We assured him of the assurances that we had received from the Greater Glasgow Health Board that the fortnight's closure had taken place against the background of the holiday period and the greatly reduced use of the resources. We told my 355 hon. Friend of the assurance that we had been given that there was no question of any degree of permanence about the closure. However, my hon. Friend asked me towards the end of his speech to give him some assurance about the future of the clinic. This is a matter for the Greater Glasgow Health Board, but it is an open secret that the possibility is that the clinic will indeed be transferred to the Glasgow Royal Infirmary.
The allocation of consultancies, consultant specialities and the actual number of consultants in each specialty are also matters for health boards. In this case, it is the Greater Glasgow Health Board. The Secretary of State does not lay down any hard and fast rules to the boards about how many consultants they should have in each specialty. That is left for the boards to decide against the background of the conditions prevailing in their particular areas.
§ Mr. Craigen
I recognise that the Scottish Office will not lay down hard and fast ratios to the boards, but since the problem seems to be more prevalent in the West of Scotland than it is anywhere else, will the Scottish Office give a little more attention to the situation that appears to exist there? I do not ask the Scottish Office to lay down hard and fast ratios but simply to say that it would like to see more consultants made available to the patients in the West of Scotland and that it will do something about it. I am not looking for more researchers but for more people who will put their professional skills to the assistance of the poor sufferers.
§ Mr. Ewing
The need for consultants is a matter for the health boards. It is absolutely true that if any health board thinks about increasing the number of consultants in its area, it must obtain the approval of the Secretary of State, but in the first instance it is a matter for the board to consider. I accept what my hon. Friend the Member for Maryhill says about the higher incidence of the disease—I was about to say the high incidence, but that would not be strictly accurate—of rheumatism and arthritis in the West of Scotland than in other parts of Scotland.
I was interested in the quotation that my hon. Friend gave from an American 356 magazine suggesting that this incidence might be related to diet and water in the West of Scotland rather than to the factors that have hitherto been thought responsible for the higher incidence of rheumatism and arthritis. If a certain amount of rheumatism and arthritis is caused by what people eat and the fact that they drink too much water—as the article implies—we must exercise even greater caution on the preventive aspects and consider what we eat and how much water we drink. It is an interesting theory that has not been properly examined in the West of Scotland. It is worth examining to see whether there is something that can reduce the higher level of arthritis and rheumatism in the West of Scotland.
My hon. Friend referred to joint replacements. When such a new technique in surgery is developed, there is always a high demand for it in the early stages. One of our problems is dealing with that demand. The technique certainly brings relief for those suffering from rheumatism and arthritis and we hope that we shall be able to overtake the demand and cope with it.
My hon. Friend also referred to waiting lists and associated factors in the West of Scotland. There has been an increase in the number of out-patients, but this has been gradual rather than dramatic and I understand that the health board is capable of handling it.
Surgery on the hands of those suffering from rheumatism and arthritis is usually carried out in the Glasgow Royal Infirmary and when it is necessary to use the facilities at the Baird Street clinic staff have to be transferred from the infirmary to staff the theatre at the clinic. No doubt the health board will bear this in mind when considering the use of resources.
§ Mr. Craigen
I have written to my hon. Friend about our having facilities at the clinic that could not be used because of the lack of nursing staff. I had a subsequent meeting with the Greater Glasgow Health Board. Where facilities exist, every effort should be made to use them unless there is some contravention of health or safety requirements.
§ Mr. Ewing
I believe that the health board makes the maximum use of theatre facilities, certainly at the Royal Infirmary and the facilities for hand surgery on 357 people suffering from rheumatism and arthritis at the Gartnavel Hospital. There was some question about the operating theatre facilities at the clinic and the need to increase the limit of the costs involved.
My hon. Friend mentioned the number of days lost to industry because of rheumatism and arthritis. The figures for Scotland show a welcome decrease in the number of days lost to industry because people suffer from rheumatism. In 1969 627,500 days were lost to industry from that cause. In 1975 the figure had dropped to 445,600 days. That is a substantial reduction in a period of about six years. We may take it that the reduction is due in no small part to the new forms of treatment and to early diagnosis of the disease, which makes it easier to treat and which gives a greater degree of success.
I was interested in my hon. Friend's comment that industry should pay more attention to the problems caused by rheumatism and arthritis. Last week I had an interesting meeting with a senior civil servant from Bavaria who is a doctor by profession. He had responsibility for industrial health in his country. He was responsible for the way in which industry in Bavaria conducted its health programme. I understand from him that the law in Bavaria demands that each industry—each factory and firm—must employ a doctor. He was most eloquent in his praise for the preventive aspect of that work and of the savings that it brought to industry in terms of days lost and to the State in terms of direct savings to the health services. It was an interesting conversation that set me thinking.
My hon. Friend gave me good and reasonable warning about the debate. I have sought to assure him about the future of the Baird Street clinic. Even if it does not remain as a clinic, the facilities will remain there although they will be contained within the Glasgow Royal Infirmary. The Baird Street clinic 358 is not the only centre for rheumatism. We have one in Edinburgh and another in Aberdeen. There is a close link between physicians and surgeons in all our district general hospitals. In that respect there is a continuous flow of treatment to patients.
My hon. Friend also asked me whether I would have discussions with the Department of Health and Social Security about the lack of priority attached to the treatment of arthritis. He mentioned the White Paper "The Way Ahead". That document applies not to the DHSS in England and Wales but to Scotland. "The Way Ahead" is a document that shifts the emphasis in the health services in Scotland from the short-stay acute situation to the long-stay situation in which we are most anxious to take care of geriatrics, psycho-geriatrics and mentally deficient patients, an area which, by and large, has been neglected.
I think that that neglect is to all out shame. No one can escape blame for that. By and large, it has been a neglected area down through the years, but no doubt in that situation health boards will certainly give the most serious consideration to the problems of rheumatism and arthritis.
§ It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Frank R. White.]
§ Mr. Ewing
I was about to draw my remarks to a conclusion by saying that if there are any points in my hon. Friend's speech that I have not answered, certainly we shall write to him about them. I conclude by again thanking him for taking the opportunity to raise this very important subject. It is certainly most important to those who suffer from rheumatism and arthritis.
§ Question put and agreed to.
§ Adjourned accordingly at Ten o'clock.