BACK PAIN (Hansard, 18 January 1980)

§ The Under-Secretary of State for Health and Social Security (Sir George Young)

Back pain has probably been an affliction of man ever since our remote ancestors first reared themselves up on their legs. As most of us suffer from back pain at some time in our lives, it is a subject which is always topical. It is an affliction which no Government concerned with the health of the population at large can possibly ignore. Ministers are probably especially vulnerable as we stagger around carrying our boxes and briefs. All Ministers will take the advice of my hon. Friend when they pick up their boxes—namely, to squat and not to stoop.

It was inevitable that the subject should be raised in this Parliament at some time, and it is appropriate that my hon. Friend the Member for Twickenham (Mr. Jessel) should have raised it, as he is well known, and is to be commended, for the enthusiasm with which he has taken up the cause of those who suffer from back pain and for the help he has given to the Back Pain Association, of which he is a patron. The time is appropriate, too, as the Government are now considering in detail the recommendations contained in the report of the working group on back pain which the previous Administration established but whose report was not published until May 1979.

That report tells us that more than 375,000 people a year—a proportion approaching 1 per cent. of the population—experience a spell of certified sickness incapacity because of back pain and that this leads to the loss of more than 11.5 million days from work. However, these figures do not include those of the working population who do not claim sickness benefits, nor most married women, nor the elderly retired. It has been suggested that in any period of 14 days some 21 per cent. of the population experience back pain. Thus, as the report goes on to 2177 say, back pain imposes a substantial economic and financial cost on the community—how great a cost in monetary terms I consider it unprofitable to speculate. The working group report gives some figures and others have given others. What matters is that we would be much better off as a nation without both the cost and the pain from which it derives.

It is one thing, however, to say that there is a problem and quite another to provide the means of solving it. Before we can begin to get rid of back pain, we must know what it is and what causes it. I quote from the report: Back pain is a symptom and not a disease. It may arise from a wide variety of established causes; from injury at one extreme, these extend through a diversity of disease states even to cancer. Clinical experience suggests that most back pain is mechanical in nature, mostly affecting the base of the spinal cantilever. The causes of other forms of back pain are still uncertain, despite many and conflicting orthodox and heterodox theories to explain its occurrence. Lack of more satisfactory etiological understanding is a severe obstacle not only to improving methods of treatment, but also to discovering means of prevention. In another paragraph on how to prevent back pain, the report states: Unfortunately there is insufficient basis at the moment for formulating advice that could be incorporated into health education directed at the prevention of back pain. In another section on treatment of those with more chronic back pain, the report states: there is disturbingly little evidence that whatever is done is effective in exerting any influence on the natural history of the underlying condition, apart from at times affording temporary relief of the pain". Faced with a report by a group of experts who themselves admitted that they did not know sufficiently what caused back pain, what could be done to prevent back pain and what could be done to cure it in its manifestation as a symptom of many causes, what can those concerned with the public health do but accept the main recommendations in the report of the working group on back pain? Those recommendations may be summarised as being advice that they persist in research to dispel that woeful ignorance.

The Government have accepted those main recommendations. In reply to a written question by the hon. Member for Ormskirk (Mr. Kilroy-Silk) on 27 June last year, I said: 2178 Research into the causes of and treatments for back pain is already given high priority by the Department. My right hon. Friend is satisfied that adequate resources are available to the Department and to the Medical Research Council for support to be given to any soundly based research proposals in this field, including comparative studies involving heterodox therapies. Most of the working party's recommendations are for further study and he hopes that the report will stimulate research proposals. Other recommendations are still under consideration."—[Official Report, 27 June 1979; Vol. 968, c. 205.] My hon. Friend the Member for Twickenham asked me about the amount of money spent on research. I shall write to him about what is being done and how much we are spending. This is still the position and, as Lord Cullen said on behalf of the Government in another place on 21 November last, a statement on the other recommendations will be made in due course.

Meanwhile, I should like to take the opportunity that this debate gives me of repeating that it is the Government's firm conviction that we shall not reduce the incidence of back pain until we know what causes it and what can prevent it or minimise it. Theories are not enough. We need positive and conclusive knowledge. While doctors and others in the National Health Service and other practitioners outside it go on treating their patients, often with success and according to their own convictions, and while bodies like the Back Pain Association continue to approach the problem of how to prevent back pain by the advocacy of solutions which their experience has shown to offer a promising measure of success, it is incumbent on the Secretary of State for Social Services and the Medical Research Council—which my right hon. Friend the Secretary of State for Education and Science represents in this House—to go on providing support for research by those able and qualified to undertake it.

As my hon. Friend said, support for research need not be confined to what can be made available from public funds. The pharmaceutical and other industries have a part to play—and, indeed, play it—in financing research into analgesics and into the production of electronic and other devices, as well as belts and supports that can reduce the pain in back ache and help to expedite recovery. Industry in general also stands to gain a great deal from giving financial support 2179 either directly to research projects or to such bodies as the Back Pain Association, the Society for Back Pain Research, Atlas and other voluntary organisations that devote themselves to finding ways in which those of us who are prone to back pain can avoid it by taking sensible care in how we use our bodies in the course of our daily activities. If such an experiment has the effect of reducing sickness and absence from work caused by back pain, the contribution made to it by industry will be an investment that brings a very substantial return.

One problem is that there are many who consider that they already know what causes back pain, what prevents it and what cures it. The Back Pain Association has promised that if it is funded from Government moneys with £250,000. it will, within three to five years, save the nation a sum in excess of £100 million. Those are brave words that should not be lightly disregarded and which the Government do not deride, but it is difficult to point to convincing evidence that such a return may be achieved.

There are in this House and in the other place those who speak regularly and with conviction about the contributions which chiropractors and osteopaths are making to the treatment of back pain and who deplore the fact that we have not found a means of bringing these non-medically registered practitioners within the National Health Service. I am myself constantly approached by the Society of Orthopaedic Medicine with the request that I do what I cannot do—compel the medical profession to adopt the principles of Dr. Cyriax, late of St. Thomas' Hospital; and there is the British Association of Manipulative Medicine and there are exponents of other theories within and outside the medical profession.

We are approached from all sides to prefer this method of treatment and then that by persons whose genuine beliefs derive from their own very real experience. The Government reject none of these approaches, but they cannot adopt any one of them to the exclusion of the rest—which is why I have said that I believe that it is the role of the Government to encourage and facilitate research, however financed, which will establish the one truth or the several truths that will ultimately rid the population of at least a part 2180 of the burden of pain, inconvenience and expense that back pain imposes upon it.

My hon. Friend said that one in 14 visits to general practitioners are because of back pain. He may well be right, but we do not have sufficient statistics to enable us to confirm that. It is, however, accepted that musculo-skeletal disorders generally are a major cause of disorders of the elderly. Arguing from that, he expressed the view that doctors, particularly general practitioners, are inadequately trained in the treatment of back disorders, and that in the hospitals, too, many specialties are involved in their treatment. That is a point of view that my reading of its report suggests was taken full account of by the working group on back pain. It is not, however, one on which I can properly express a view.

The content of medical education is the responsibility of the medical profession, and it falls to its members, who share my hon. Friend's concern, to press for such changes in medical education at both the undergraduate and postgraduate levels as they consider necessary. I should be surprised if they are not doing so.

If I may, I shall revert to the subject of the Back Pain Association, with which my hon. Friend, the Member for Twickenham is closely associated, and to the matter of the financial support it seeks from public funds. Its brochure describes it as a registered charity formed to promote and finance research into the causes, cures and prevention of back pain and says that it disseminates information about research findings and modern methods of diagnosis and treatment to the medical and paramedical professions and provides an Industrial Advisory Service to advise on the avoidance of spinal stress in the working environment". It also establishes local back pain groups throughout the country in which back pain sufferers and others can meet regularly to discuss the best ways of helping those who suffer from back pain and to provide that help.

These activities are commendable and worthy of support, and there are many who owe a great deal, I am sure, to the indefatigable efforts of the association's chairman, Mr. Grundy, his devoted fellow members and the association's distinguished patrons. Since it was launched 2181 by Mr. Grundy, Sir Richard Powell, Admiral Caspar John and others in 1968, the association has taken initiative such as only a voluntary organisation can take.

Governments have been impeded by the variety of views of what ought to be done, in the absence of scientific evidence of what is most effective in reducing the frequency and severity of back pain and in treating it. The Government-financed Health Education Council has conflicting priorities in determining on which measures for the promotion of better health it should concentrate its efforts at any one time.

The Back Pain Association is, as a voluntary organisation, unfettered in reaching its decisions about what to commend and promote and can devote itself wholeheartedly and exclusively to the attainment of its chosen objectives. It was in recognition of Government support for the endeavours of the association that my hon. Friend the Minister for Health attended its annual general meeting in these precincts on 25 July last year.

The association qualifies for financial support under section 64 of the Health and Public Services Act 1968 because it is a voluntary organisation whose activities consist in, or include, the provision of a service similar to a relevant service —that is, a service that the Secretary of State for Social Services has in law a duty to provide— the promotion of the provision of a relevant service or a similar one, the publicising of a relevant service or a similar one or the giving of advice with respect to the manner in which a relevant service or a similar one can best be provided". The Secretary of State is limited in which activities of such a voluntary organisation he can specifically assist, and financial assistance is usually given for the maintenance of the headquarters management of the voluntary agency. The Back Pain Association received a grant of £7,000 in each of 1978 and 1979 for that purpose.

The Secretary of State and the Medical Research Council finance health service and biomedical research projects, respectively, by making grants directly to those conducting the research or to the organisations, such as health authorities, uni- 2182 versities and medical schools, that employ the researchers. They cannot give grants to another body that will then determine on what research it shall be spent.

It has not therefore been possible for my own Department, for example, to accede to the request of the Back Pain Association that it should underwrite 50 per cent. of the cost of the research projects which it selects for financing. That does not, however, mean that such of these research projects as are not biomedical, and so appropriate for Medical Research Council funding, should not receive support direct from the Department, if applications for such support are made directly to it.

My hon. Friend the Minister for Health has, however, agreed that it would fall within the competence of the Secretary of State for Social Services to fund the publication by the Back Pain Association of a bibliography of published material on back pain up to a total of £15,000 in the present financial year, provided that the bibliography can first be examined for its comprehensiveness and its utility. The Back Pain Association has also been offered a section 64 grant of £12,000 for the year 1980 to assist it with its headquarters office, staffing and management expenses. At a time when it is difficult to maintain the value of the total allocation for such grants in real terms, although my right hon. Friend has already given an undertaking that he will try to do so, this grant of £12,000 represents a considerable percentage increase over the £7,000 the association received last year.

This sum, of course, falls considerably short of what the association asked for, but I ask hon. Members to bear in mind that the number of worthy and deserving voluntary organisations operating in the health field is large and that very many of these look to my Department for assistance. Funds available under section 64 of the Health Services and Public Health Act are limited, not merely for valid financial reasons at this time but because it is the firm conviction of this Government that voluntary organisations, such as the Back Pain Association, should remain voluntary and under their own members' control and not become agents of the State.

Had it been possible for the Back Pain Association to be given the £250,000 for 2183 which it asked—excluding the additional 50 per cent. of its support to research projects it would, on the basis of its accounts for the year ended 31 December 1978, have derived about 75 per cent. of its income from public funds. This would inevitably have deprived it of much of the independence it must preserve if it is to continue to be effective and attract further support from private and corporate donations.

I concede that there are some voluntary organisations which will this year, as they have in the past, receive section 64 grants appreciably in excess of what has been offered to the Back Pain Association. This means not that my right hon. Friend does not rate the Back Pain Association highly but rather that he has had to have regard to the provisions of that section of the Health Services and Public Health Act that I have quoted. Some voluntary organisations, more than others, provide relevant services—for example, for the socially and mentally handicapped—which, did they not provide them, the National Health Service or other statutory bodies would have to provide, probably at greater cost and 2184 without being able to bring to them the same invaluable amount of personal and community involvement.

Future requests by the Back Pain Association for financial support will be considered against the measure of its success in demonstrating that it has gone some way towards saving the nation the vast sums it believes it can help to save and its success in attracting from private individuals—and, I hope, industry—substantial contributions towards its expenses in this endeavour. I wish it every success in its efforts and take this opportunity of commending them.

Meanwhile, the Government will, as I have said, seek to fund such research as may ultimately teach us what causes back pain, what prevents it and what cures it. The National Health Service and private practitioners who provide services for the treatment of back pain will, I am sure, continue their own efforts to relieve the misery of those who still continue to suffer from pain in their backs.