§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pope.]
12.29 am§ Mrs. Eileen Gordon (Romford)Thank you, Mr. Deputy Speaker, for the opportunity to discuss back pain, an issue that affects many people's lives.
I am lucky in that, to date, I have not suffered back pain. However, since becoming a Member of Parliament, I have gained empathy for people who do. I had not realised before my election that Members of Parliament are like nomads: they seem to spend a lot of time moving from place to place, carrying in bags what feels like everything they own. As I travel from my Westminster office, to my constituency office, to the House of Commons Library, loaded down with paperwork, I am conscious that my neck and shoulders ache at the end of the day. Indeed, shoulder and neck problems are among the commonest problems presented to the occupational health unit in the Palace of Westminster.
Why is it that receptions that we have to attend seem to entail standing around for a couple of hours when every bone in our body tells us that we want to sit down? Then there are late-night sittings, when I try to rest between votes in armchairs that are totally unsuitable. Such sittings may be part of democracy—although not for much longer, I hope—but they are not much good for the back, so, although I have been lucky so far to have avoided back pain, I am not sure that it will not catch up with me later. Therefore, I come to this debate not as an expert, but just as someone who would like to share a few ideas and observations.
When I was elected last year, one of the first events to which I was invited was a back pain awareness day organised by Peter Moore of the Havering branch of the National Back Pain Association. It was at that awareness day that I became aware of the scale of the problem, and of how many people are affected by back pain. The association issued "back facts", which show that there were some 117.56 million days of certified incapacity in 1995–96, 30,715 work-related back injuries, 33,000 work-related accidents and 500,000 work-related illnesses. The cost to industry is at least £5.1 billion, and to the national health service £480 million. The occupations with the highest incidence are, as hon. Members might expect, nursing, agriculture and construction.
The Manual Handling Operations Regulations 1992, designed to protect adults in the workplace, assume that loads of up to 20 kg that are held against the body will not be carried more than 10 m without rest. I want to talk about a group of people who are not covered by any regulations: our children.
There has been a worrying increase in the incidence of back pain among young people. From studies, it looks as if many of the causes can be prevented. One such cause is the carrying of heavy school bags. When I was at school, which admittedly was a long time ago, children had their own desks where they could leave books and equipment. That is no longer the case in the vast majority of secondary schools. Children now seem to carry their whole lives around with them.
163 I remember my two teenage children staggering out of the house with bags that I could not even lift, plus, in my daughter's case, a cello. I felt sorry for them, but now I know that they could have been doing real damage to their still growing, immature spines.
Some children carry around 13 per cent. of their body weight. In some cases, children carry 60 per cent. of their body weight—sometimes it is as much as 25 kg, or around three stone. The highest risk group are 11 to 12-year-olds carrying up to 25 per cent. of body weight. Forty-four per cent. of children carry those heavy weights for up to the 25 minutes that it takes them to walk to school, as well as carrying them around school.
Children carry not only heavy weights but uneven weights. They tend to carry their bags on one shoulder, rather than distributing the weight more evenly by using both straps on a rucksack-type bag. Fashion has a lot to do with that—although some schools do not permit bags to be placed on both shoulders, as swinging a rucksack on to one's back could be hazardous. However, it is an even greater health hazard to carry an unbalanced weight. Schools must be made to realise that fact and the importance of wearing bags properly.
Lockers in schools would help, as children would then at least not have to carry their bags around all day. However, only 40 per cent. of secondary schools have a locker available for each child in the school. I am proud to say that the school in which I serve as a governor—Marshall's park school, in Romford—provides a locker for each child, and, just as important, encourages students to use them. Schools that do not offer such a facility should seriously consider doing so.
Perhaps parent-teacher associations could take locker provision on as a project. However, I think that lockers may be one matter on which the Government should consider regulating. Locker provision for new schools could be incorporated at the planning stage, by ensuring that corridors are built sufficiently wide to accommodate lockers.
Young people think themselves immortal, and really do not think about what will happen in 20 or 30 years—and why should they? It is up to us as adults to build a framework that will prevent injury to our young people, either now or in the future. I believe that the Government should be considering regulations to protect our children that are similar to those protecting adults. Health and safety regulations, quite rightly, are very strict in trying to protect people at work. Our young people deserve no less than to have regulations determining maximum weights that should be carried. Some countries already do so.
The National Back Pain Association recommends that the ideal bag weight objective is 10 per cent. of body weight. The association is also conducting trials on a specially designed bag. The challenge will be to make such a bag desirable to young people. I hope that head teachers and education authorities will support such initiatives to lighten the load of our students.
Let us make no mistake about it: back pain can dominate and debilitate people, making their lives a misery. Chronic or severe pain can lead to severe depression and an inability to lead a normal life.
164 Back pain treatments were mediaeval—in which people had to lie on a board for weeks on end and rely on pain killers. My husband had to undergo such treatment, after his back seized up as he was running for a train. Although his pain was obvious, he was given no real advice on how to deal with it, or on rehabilitation. Thank goodness the old treatments are now discredited. For most back pain similar to that which my husband suffered, two days in bed is considered better than seven days—or even weeks—in bed. Longer spells in bed will cause back muscles to stiffen and lose strength.
It is now recognised that self-care techniques, such as pacing—by performing tasks in a measured and controlled fashion, without overdoing or straining—stretching and relaxation, can greatly help with back problems.
There are very positive developments in treating back pain. One excellent example is the input pain management programme at St. Thomas's hospital. After careful assessment, sufferers are equipped with techniques that help them to live with their condition, build up stamina and improve mobility. Many people disabled with back pain have been able with the programme's help to return to work. One person who was helped by the scheme said:
Before, I was lucky to be able to walk for 10 minutes without pain. I have just completed my first one-hour walk and felt that I could have gone on longer.I have mentioned St. Thomas's programme specifically not only because it was drawn to my attention but because I have read the excellent advice that it provides to its general practitioners. Moreover, it is only across the river from this place. I am sure that there are many other examples of pain management units, but I understand, however, that provision is patchy throughout the country. I ask my hon. Friend the Minister to look at any similar schemes around the country, and to spread best practice so that equality of treatment is available.The British Medical Association in its "Home Healthcare Guide", issued to celebrate the 50th anniversary of the national health service, gives positive advice on back and neck pain, emphasising relaxation exercises and the need to exercise to strengthen stomach, neck and side muscles.
Awareness, support and information are important. The Havering branch of the National Back Pain Association has hundreds of members. For those who miss the meetings, a video is available. For those depressed by chronic pain, there is a listening ear service, and for those who want more information there is a library and a newsletter. It is even on the internet.
In the past, too many people with chronic pain felt isolated. Support groups take away that feeling. Nothing is worse than feeling that one is the only person with a particular problem. Again, I thank Peter Moore for his excellent work, and for staying here tonight and listening to the debate. He has been there himself and still suffers chronic back pain, but he has learnt to manage his pain, and he now works tirelessly to help others overcome their problems. Pain management, with rehabilitation and support, is the ideal combination for dealing with the problem.
As I said, back pain is costing people a great deal in pain and loss of quality of life. It is also costing the country billions of pounds in lost production and health care.
165 There are ways in which back pain can be prevented, especially for young people, for whom serious problems that may not be evident for many years are starting now. I encourage my hon. Friend the Minister to look at the whole area of prevention, in partnership with the Department for Education and Employment. To help those suffering with back pain, my hon. Friend should encourage hospitals to set up pain management and rehabilitation units, and spread best practice.
We are not talking about a few people here. Some 60 per cent. of adults suffer back problems annually, and 30 per cent. of adults become chronic sufferers. National Back Pain Week begins on 5 October, so it is appropriate that we have managed to debate the matter before the summer recess. The National Back Pain Association will be holding many activities, and the specially designed school bags will be available. Hopefully, all right hon. and hon. Members will take part in local awareness activities during the week, especially with local secondary schools.
We all lead much more sedentary lives now. We tend to sit in front of the computer or television for long periods. Badly designed furniture increases the risk of back pain. That is true in schools, too. The need to keep up with technology leads to the ever-present demands to buy computers and software, but all too often children are sitting on badly designed chairs and working on unsuitable desks, not designed for computer work. Evolution has adapted us for many things, but it has not kept up with our soft lives—moving from soft beds to cars to desks and back again.
I have highlighted only a few issues tonight, but I should be glad to provide any further information I can to my hon. Friend, whom I thank for listening so intently to me at such a late hour. Back pain is a big issue, and one that I am sure the Government take seriously.
§ The Minister for Public Health (Ms Tessa Jowell)I congratulate my hon. Friend the Member for Romford (Mrs. Gordon) on introducing tonight's debate, and on the extremely eloquent and informed way in which she addressed the issue. She highlighted the problem of children and young people with back pain. I appreciate, as do other hon. Members, how debilitating back pain can be, and the effect that it can have not only on the general health of sufferers, but on their social, economic and psychological well-being as well as that of their families.
As my hon. Friend said, back pain can be costly to employers and, if it is not properly treated, to the national health service. There are, however, fairly strict regulations for adult workers. It is the responsibility of the Health and Safety Executive to formulate guidance and to oversee the implementation of European and United Kingdom regulations.
We do not think it necessary to legislate for how people should go about their everyday tasks or how schoolchildren should carry their books or other possessions. However, I take the point, which my hon. Friend made so forcefully, that we need to take account of the damage that many young people may be inflicting on themselves. Certainly we should do well to remember that the child with back pain today may be the adult with a chronic disability tomorrow.
Nearly a third of the population will suffer some back pain at some time in the year; possibly half that number will consult their general practitioners about it. For a 166 small proportion—about 3 to 5 per cent. —of people, back pain will be a chronic condition, which will, in many cases, prevent them from working and require them to rely on disability benefits or to claim compensation through their employers or insurance companies, with all the difficulties that that involves.
Back pain in adults can be serious, although it is generally short-lived. There are clinical guidelines on treatment and programmes of rehabilitation. Moreover, there are a number of research projects and, thanks to organisations such as the National Back Pain Association, to which my hon. Friend paid tribute, there are good sources of advice and information, including information on self-help, as she made clear.
Back pain in children brings with it different considerations, such as the effect it can have on educational development and the carry-over of problems into adulthood. The Department of Health has noted reports of an increasing number of children being referred for treatment of back pain. Although the design and weight of school bags may play a part in that, other factors—such as physical fitness, good posture and healthy life styles—are also important.
The reported increase in back pain is a matter of considerable concern for both the Department of Health and the Department for Education and Employment. For children to realise their full educational potential, they must be both physically fit and mentally receptive, as both Departments fully recognise—we have been working together on a number of initiatives aimed at achieving precisely that objective in schools.
The Department for Education and Employment's White Paper "Excellence in schools" identified the importance of a good education for all children, especially those who were likely already to be disadvantaged because of their social background. The Government's consultation paper "Our Healthier Nation" has continued that theme, stressing the importance of the link between educational achievement and some of the social problems that teenagers, in particular, may face.
When the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Birmingham, Yardley (Ms Morris), and I launched the initiative on healthy schools in May, we were both aware of the need to promote better recognition of the link between health and education and to encourage schools to lay down foundations on which children could go on to lead healthy, active and productive adult lives. The problem of back pain is only one aspect of that, although it is important and of growing significance.
I fully appreciate my hon. Friend's concerns about the problems that pupils may experience in carrying heavy bags and the possible effects in later life. The National Back Pain Association has focused on the problem of heavy school bags and will, I understand, promote the sale of a specially designed school bag later this year.
We are pleased to welcome that practical development, but we should remember that some children's decisions are defined by fashion and culture rather than any thought for their future health. Many children regard the odd twinge as a price worth paying to seem to their friends to be at the leading edge of fashion. There are clear parallels with parental battles over sensible footwear—not something to which a fashion-conscious 13-year-old will give a great deal of thought.
167 There may be a number of other possible solutions, such as having lockers, desks, or at least safe places available for children to store their books in school; or limiting children's need to move to different classrooms during the day. Those are matters for the school authorities, which must also take into account other factors, such as security and practicability. It is also for the school to plan its timetable and decide where and when lessons take place.
It is important not to look at the problem of heavy school bags in isolation. The general health of children and young people will affect their susceptibility to back pain and other disorders, as will posture and life style.
Although we need to recognise the prevalence of, and to do something about, low back pain in both adults and children, we also need to put it in the wider context of public health. Exercise and physical activity are acknowledged to play an important part in maintaining good health and helping to prevent not only serious conditions such as coronary heart disease or stroke, but minor disabilities that can cause distress and affect a person's mental well-being.
In children and young people, in particular, physical activity is known to have multiple health benefits. Activities such as walking or cycling can improve the growth and development of bone and muscle, control blood pressure and promote the development of a healthy body weight.
We in the Department of Health are not simply preaching about those benefits. Indeed, preaching is likely to guarantee that the message will fall on deaf ears. We are working with the Department of the Environment, Transport and the Regions and the Department for Education and Employment to promote safe cycling and walking to and from school. We contributed to the DETR's White Paper on integrated transport, which aims to develop active modes of transport through, for example, dedicated cycle paths and better facilities for cycle parking at schools.
Last year, we funded through the Health Advisory Council a symposium of experts known as "Young and Active", which brought together specialists to agree new recommendations on the amount and type of physical activity that should be encouraged in order to benefit children's health. We have asked the council to produce recommendations that will help to inform future departmental strategy on physical activity and young people. I hope to be able to launch a report later this year.
That may seem to stray from the problem of children carrying around heavy bags of books, but I hope that hon. Members will recognise the need to see that problem in the wider context of healthy life styles for children and adults. People who are active tend to be those who were 168 active in childhood, and children with prolonged back pain are likely to find the condition recurring when they are older. We must not forget the beneficial effect that physical activity can have on low self-esteem, particularly for children from disadvantaged groups and those with learning difficulties.
My hon. Friend's suggestion that legislation should limit the weight of children's bags is not likely to be the most practical or the best way to tackle the problem. Guidance to schools, parents and children is simpler and far more likely to be effective. The National Back Pain Association has produced guidelines for head teachers, and those have been welcomed. I should be happy to arrange for officials to meet the NBPA and other interested parties to discuss the most helpful way forward. That should be seen in the broad context of the Government's healthy schools initiative.
The Government fully recognise the seriousness of back pain. The Clinical Standards Advisory Group made a major advance in a 1994 report that highlighted the condition and made practical recommendations. One was that rehabilitation programmes should be set up for patients who had had back pain for more than three months. The report put particular emphasis on the need for an active rehabilitation programme provided in a multi-disciplinary setting with access to a wide range of professional skills and close links to other services and organisations. As well as medical supervision and physiotherapy, a programme might include education and training in back function, and the teaching of the type of relaxation and coping strategies referred to by my hon. Friend.
The findings of the advisory group were welcomed by both the professions concerned and the Department of Health. The report was distributed widely within the NHS, so that health authorities and trusts could consider action to improve services for people with back pain. As part of our plans to develop the new NHS, there will be greater emphasis on treatment and rehabilitation in the community. That should mean that most people with back pain can be seen earlier and closer to home, without the need for hospital treatment.
Back pain is a major cause of absence from work in the NHS itself. Methods of treatment must improve, but so must occupational health policies on the welfare and well-being of NHS staff. I believe that there is now more awareness of the need to give greater emphasis to promoting good back care and preventing avoidable injuries. There is a clear incentive for employers to reduce back injuries—the resultant days off work, and risks of litigation.
I reiterate my thanks to my hon. Friend for raising an important issue and for discussing prevention of injuries and the health of children.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes to One o'clock.