HC Deb 13 December 1999 vol 341 cc123-30

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jamieson.]

10.3 pm

Mrs. Eileen Gordon (Romford)

Thank you, Madam Speaker, for allowing me to raise the issue of arthritis. The subject is of keen interest to me, as hon. Members will realise when I say that today is my 30th wedding anniversary, and I am here rather than out with my husband. Some would say that it is a case of familiarity breeding contempt, but I prefer to think that it is one of absence making the heart grow fonder.

As you know, Madam Speaker, Members of Parliament are invited to many events and asked to support many causes. Sometimes one of those events sparks a particular interest, and that is how I became involved with pain management and arthritis. Two years ago, I attended an exhibition put on by the Havering branch of Backcare, which is run by Peter Moore. He has developed an holistic approach to the self-management of back pain. Too often in the past and, unfortunately, still today, people with back pain are told that nothing can be done. They are given painkillers and sent home.

Peter Moore's programme of self-help, "Fighting Back", is based on appropriate exercise, relaxation and techniques for lifting and moving things. The results from those attending the programme show less use of drugs, more confidence and better mobility—in effect, a much improved quality of life. If the Minister wishes to know more about that programme, I should be only too happy to provide more information.

Backcare is a member of the British League Against Rheumatism—BLAR. BLAR is an umbrella organisation for 23 groups including Arthritis Care—which has produced an excellent document, "Arthritis: getting it right"—the Lady Hoare Trust for Physically Disabled Children, the British Society for Rheumatology, Lupus UK and many more.

In this debate, I am using the term "arthritis", although there are of course many different types of arthritis. I hope that the groups concerned and those suffering from arthritis will forgive me for using just the generic term.

I became interested in BLAR's work on musculoskeletal conditions and its self-management course, "Challenging Arthritis", which has similar aims to "Fighting Back". Last week, I hosted an exhibition for BLAR and a reception at the Palace of Westminster, which was very well attended and well received. I heard sufferers from various age groups give moving testimonies of the problems associated with the condition. I thank BLAR for the information and help that it has given me, and especially thank Sophie Edwards, its chief executive.

Musculoskeletal conditions are the biggest cause of physical disability in the United Kingdom. More than 8 million people suffer from arthritis in the UK, and if we include back pain, the figure rises to 11 million. There are some 11,000 sufferers in my constituency and approximately 1,300 of them are under 45 years of age. An estimated 70 Members of Parliament have arthritis. I remember Jo Richardson, who challenged arthritis and battled against pain. She was a role model for many of us. I think also of my assistant Vanessa, who has arthritis of the hip.

Given the statistics, we must all know someone with the condition, yet we constantly underestimate the numbers affected. In a recent survey among Members of Parliament, 90 per cent. of those polled underestimated the total number of people in the UK who have arthritis; 50 per cent. put the number at 3 million or fewer, yet, as I have said, the true figure is 8 million.

The conditions have a massive effect on the individual, the national health service and the country. The cost to the NHS is estimated to be £600 million a year, involving more than 4 million general practitioner consultations each year. That number is set to rise. There were 10,000 knee replacements in 1989. Between 1985 and 1990—the years for which we have the most recent figures—the national rate almost doubled in patients aged between 65 and 84.

The cost to the individual is great. The major symptom of arthritis is pain. Indeed, 37 per cent. of people with arthritis are in pain all the time, and 60 per cent. have their sleep regularly disturbed. There is no cure, although joint replacement helps, and we still do not know the cause of many forms of arthritis.

For people in constant pain, the impact on established relationships can be dramatic. A spontaneous hug can cause excruciating pain, resulting in tension in the relationship. For people in work, arthritis can mean the abrupt end of a successful career: 50 per cent. of all people with rheumatism and arthritis are forced to stop working within five years of diagnosis—some because employers will not adapt the working environment to allow them to continue.

Arthritis does not only affect elderly people. Of the 8 million people whom I mentioned earlier, 1.2 million are under the age of 45 and more than 14,500 are children. For young people, there can be problems at school. The student may look no different from any other, but will need care, may need medication during the day and may have mobility problems. Teachers need to be aware of how to deal with the condition. Adaptation of school buildings is often suggested and, if not done, can result in a student's inability to take part in the full range of school activities.

A young man at the reception spoke of access problems. His choice of exam subjects had been restricted, and he felt that his life chances had been badly affected. Young patients may have time off school because of hospitalisation, and there must be better support for tuition in hospitals. Fellow students need to understand the condition and its impact on those affected.

If we as a Government are keen to promote social inclusion, the effects of arthritis must be considered, from access to buildings and services to access to goods—people with arthritic hands find it difficult, if not impossible, to cope with modern packaging.

Unlike sufferers from other chronic conditions, arthritis patients bear their own prescription charges. A recent study shows that the cost to the individual for drugs and adaptations or special equipment averages £4,000 a year. For many people, that is a considerable burden.

Although arthritis cannot be cured—as I mentioned, joint replacement helps in many cases—there is effective pain relief, and new drugs are being developed. Groups such as BLAR welcome initiatives such as the establishment of NICE—the National Institute for Clinical Excellence—and the Commission for Health Improvement, but they are concerned that those should not become a barrier to access to treatment or a device for rationing. I would welcome my hon. Friend the Minister's assurance on that matter.

There is a need for further training for general practitioners and for consultant expansion, if the Royal College of Physician's target of one rheumatologist per 85,000 population is to be met. Currently in the UK, there are 420 consultants working in rheumatology in 242 rheumatology departments, so there is a long way to go. The best provided region is North Thames, with one rheumatologist per 154,384 population. I hope that my hon. Friend will look into expansion in this specialty.

I mentioned the self-management programmes, "Challenging Arthritis" and "Fighting Back". I hope that my hon. Friend will endorse those initiatives and, if possible, make money available to set up and broaden the availability of self-management courses. Those could form a central part of the expert patients programme. Self-management of pain empowers people to be more independent. It helps to reduce pain and the anxiety and depression that often accompany constant pain.

Those courses are run by volunteers, but arrangements may be made for health and social services professionals to visit the local course—indeed, many already refer patients to them. The courses do not offer medical advice and are not intended as a substitute for medical treatment. They are complementary, but their effect not only benefits the patient, but can have long-term advantages for the health and benefits budget by helping people to return to work and gain independence.

I ask my hon. Friend to encourage health authorities to take up and fund such courses so that they become available to all arthritis sufferers. I urge fellow Members of Parliament to ask their health authorities what services they provide for people with arthritis. Can my hon. Friend give me an assurance that the national service framework on older people will address the needs of older people with arthritis and other conditions, such as Paget's disease, osteoporosis and osteoarthritis? Many older people feel that they do not receive the best treatment because of their age. The National Association for the Relief of Paget's Disease can provide my hon. Friend with many examples of such ageism. It would be good to have a national service framework for arthritis.

I should welcome a special meeting between my hon. Friend and representatives of BLAR to discuss all these issues. Such a meeting would be appropriate, as the decade of bone and joint begins in 2000. That initiative has been endorsed by the United Nations and the Government.

Arthritis Care is running a roadshow next year from March to November, which will be travelling throughout the United Kingdom. The roadshow will provide information, advice and support to people with arthritis. It will also give information to the public. It will have 43 stops on its route and it hopes to reach 100,000 people. I hope that time will be found to visit Romford.

I thank the Minister for his attention during the debate and his consideration of the matters that I have raised. I am asking for more awareness, social inclusion, better access to school, work and health care and for the needs of 8 million people to be taken into account in future health planning.

10.15 pm
The Minister of State, Department of Health (Mr. John Hutton)

I congratulate my hon. Friend the Member for Romford (Mrs. Gordon) on raising this important issue and on her thoughtful and well—informed comments. She has often shown a keen interest in health issues in the past, and the management of arthritis, as she has said, is an important aspect of health care.

Arthritis means inflammation of the joints and it is the principal cause of physical disability in the United Kingdom. The term "arthritis" encompasses more than 100 diseases affecting joints, the surrounding tissues and other connective tissues. These diseases and conditions include osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, which was a particular concern of my hon. Friend, and fibromyalgia.

Arthritis has a significant impact on health and community services, on those who experience its painful symptoms and resulting disability, and on their family members and carers. Its main symptoms are pain and loss of mobility, but the extent and severity of the condition vary from one individual to another.

Arthritis can, and does, affect people of all ages, as my hon. Friend has made clear, from young children to older people, but prevalence generally increases substantially with age. For example, it is estimated that about 70 per cent. of 70–year—olds suffer from some form of arthritis, mostly osteoarthritis. The leading charity in this area, Arthritis Care, believes that between 8 million and 10 million people in the UK suffer from some form of arthritis. This includes about 1 million adults under the age of 45 and about 15,000 children.

The pain and disability accompanying arthritis can be minimised through early diagnosis and appropriate management. These management tools include physical activity, self-management, physical and occupational therapy and joint replacement surgery. There are several ways in which arthritis can affect individuals. As my hon. Friend has said, the main impact is clearly physical. Arthritis sufferers endure pain, loss of joint motion and fatigue. As a result of these symptoms, people with arthritis are significantly less physically active than the rest of the adult population, even after taking their disability into account. Such a lack of activity puts them at greater risk of other diseases, including premature death, heart disease, diabetes and higher blood pressure.

Arthritis can make people more prone to stress, depression, anger and anxiety, and they may experience difficulty coping with pain and disability. That can lead to a feeling of helplessness, lack of self-control and changes in self-esteem and image. People with arthritis frequently experience decreased community involvement and can have problems finding suitable employment. These were both issues to which my hon. Friend was right to draw attention.

Rheumatoid arthritis is a family of related diseases, not a single entity. The problems are primarily a consequence of persistent inflammation of the joints. While any joint can be affected, it is usually in the small peripheral joints, such as the fingers or wrist, that the condition is first noticed. Rheumatoid arthritis currently affects about 5 per cent. of women and 2 per cent. of men in Britain. Sadly, the causes of RA are still unknown.

Treatment of rheumatoid arthritis includes the use of non-drug treatment such as rest and physiotherapy, but drugs may also be required both to control symptoms and to slow down the progression of the disease. That is important because the longer the disease persists, the more the joints will become damaged.

The arthritis self-management programme is a promising development in the field of arthritis care and treatment—I know that my hon. Friend is especially interested in that aspect of arthritis management. Arthritis Care has developed a self-management programme for people with arthritis that is based on work undertaken in the United States. That has demonstrated major benefits to people with arthritis in America and has reduced the use of health services.

Encouraged by those developments, the Department of Health provided funds for Arthritis Care from 1996–97 to 1998–99 to help develop and pilot a self-management programme for people with arthritis in England. My right hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), when she was a Health Minister, launched the initiative in November 1997.

The arthritis self-management programme is a major project and has several components. It involves the development and provision of self-management courses around the country for people with arthritis. It is a user-led programme, in which all the course leaders are people with arthritis. The programme is delivered by volunteers, is community based and is concerned with empowerment and the development of self-effectiveness. The Department funded the evaluation of this programme, which has demonstrated improved pain management, reduced depression and also resulted in less drug dependency among those participating in the courses.

The Long-term Medical Conditions Alliance also uses the model to ascertain whether people with other conditions find it helpful in managing their illnesses. The Department is providing the LMCA with funding of almost £100,000 over a three-year period to 2001. The aim is to increase knowledge about self-management programmes and the availability of information about living a healthy life with chronic conditions. My hon. Friend expressed anxiety that the Government were not doing enough about such issues. I hope that she is reassured that we take them seriously and that we are trying to respond to them.

In the White Paper "Saving Lives: Our Healthier Nation", the Government announced their intention to set up an expert patients task force, led by the chief medical officer, Professor Liam Donaldson. Its task is to develop a programme to help people with chronic conditions to maintain their health and improve their quality of life by supporting them to take an "expert" role in managing their conditions.

Arthritis Care's self-management programme was used as an example of good practice in the White Paper. The programme, which is equally applicable to people with other chronic conditions, helps participants to develop a range of skills to deal with their conditions. The pioneering, patient-led project will inform the work of the task force and the approach is likely to form an important component of the final programme. Another vital part of the task force's work will be to link self-management programmes, developed in the voluntary sector, with mainstream NHS and social care services. My hon. Friend gave an example of such a development programme and I should be happy for her to explain her interest in that scheme in more detail at some other time.

The Government also support medical and clinical research into several conditions, including arthritis. The main agency through which the Government support research is the Medical Research Council. The council is an independent body which receives its grant in aid from the Office of Science and Technology, which is part of the Department of Trade and Industry. The most recent figures, for the year 1998–99, show that the council spent nearly £1.3 million on research into osteoarthritis, rheumatoid arthritis and rheumatism. That included £160,000 on projects involving juvenile arthritis.

The Department of Health's policy research programme funded a study entitled "Primary Care Interventions in Osteoarthritis". It was a four—year study undertaken by the university of Nottingham, and designed to determine whether exercise could lessen the burden of knee pain in the general population. The report of the study's findings is now at the final draft stage.

Several other studies into arthritis are currently under way, including one in Oxford to investigate key design features of the current hip replacement. Another major investigation at Stoke—on—Trent into the treatment of rheumatoid arthritis aims to identify whether the disease should be treated aggressively, with the aim of suppressing the inflammatory response, or symptomatically, with the aim of minimising functional loss and pain. All patients in the study will be over 18 and will have been diagnosed with rheumatoid arthritis that has had a duration of between five and 20 years. The study is on—going and will cost around £600,000.

My hon. Friend also referred to the availability of drugs to treat arthritis. She will be aware that many different classes of drugs are used to treat patients who suffer from the condition. They include, for example, analgesics to control pain and non-steroidal anti-inflammatory drugs. The latter decrease the body's inflammatory response to disease or injury, but have little or no effect on the underlying disease and therefore cannot prevent the progression of joint destruction or organ damage. There are also a number of side effects associated with most drugs currently used to treat arthritis.

Cox–2 inhibitors, which are a new class of pharmaceuticals, are being developed. They promise similar benefits to other similar drugs, but with a much lower risk of causing ulcers. There is likely to be uncertainty over the appropriate use of these products, especially in relation to simple over—the—counter alternatives such as paracetamol. The National Institute for Clinical Excellence has been asked to review the evidence on Cox–2 inhibitors, make recommendations that will forestall any possible variations in uptake and help to ensure that patients are appropriately targeted. It is expected to report in January 2001.

There is, of course, always hope that new technologies will be developed that can alleviate pain and disability for arthritis sufferers. We have, for example, asked NICE to assess the possible benefits of a new treatment in which damaged hip or knee cartilage is taken out, repaired in the laboratory and replaced in the patient's body. We need to know whether the procedure is cost—effective and whether, over time, it could lead to a reduction in the prevalence of debilitating osteoarthritis. Such a scientific breakthrough could have a major impact in the future. Today, however, patients may be offered interventions ranging from heat treatment to major surgery. Keyhole surgery techniques, through the use of arthroscopes, are commonplace in orthopaedic departments for assessing osteoarthritis of the knee or removing damaged cartilage, and 100,000 such procedures are carried out annually in NHS hospitals. However, for many, mainly older, patients, the total hip or knee replacement offers the most effective treatment for the debilitating and distressing health problems associated with osteoarthritis. Those are the treatments of choice for most older patients and the latest figures show that 35,000 primary hip replacement operations and 25,000 primary knee replacements are carried out annually by the NHS in England.

My hon. Friend will be reassured to know that the Government are determined to cut NHS waiting lists and thus reduce waiting times for all patients. Patients needing orthopaedic procedures are already benefiting from the action we have taken: during 1998–99, the number of patients waiting for NHS treatment was reduced by 225,000 and almost 500,000 extra patients were treated in the same time. Since March 1998, the number of people waiting for hip and knee replacements and other orthopaedic procedures has fallen by 12 per cent., and the number of people waiting more than 12 months has fallen by 13 per cent. I hope that she welcomes those figures.

Such operations represent two of the great success stories of the NHS. People move from being confined to a wheelchair or their homes and become mobile and free of pain. They are then able to lead more independent lives, with all the benefits that that brings to them, their carers and the wider community. The national Horizon scanning centre has also identified several other new drugs that treat musculo—skeletal disorders. NICE is currently considering whether they should also be fast—tracked for assessment because they could provide a substantial added benefit to a large group of patients suffering from arthritis.

My hon. Friend expressed her concerns about measures to help disabled people into work, especially those suffering from arthritis. Most disabled people are able to make very effective use of mainstream employment and training programmes. However, for some people who are unemployed, such as people with arthritis, their disability represents an additional hurdle in their search for work. That is why there are specialist programmes to help them find, keep and train for work. The Employment Service plans to spend £189 million this year on specialist programmes to help those with disabilities, including people with arthritis.

My hon. Friend also expressed her concern for children. The Education Act 1996 sets out arrangements for identifying and providing for children with special educational needs in accordance with a statutory code of practice on the identification and assessment of special educational needs. Parents who think that their child may have special educational needs can ask their local education authority to assess their child's needs. The authority has responsibility for determining whether the child has special educational needs and what provision should be made to meet them.

The schools access initiative gives capital support for projects to make mainstream schools more accessible for pupils with disabilities, including those suffering from arthritis. In 1999–2000, £20 million will be available, which is a fivefold expansion of the £4 million inherited from the previous Government. That forms part of a £100 million programme over the next three years.

I have tried to outline some of the measures that we have taken or set in train to improve the quality of life for arthritis sufferers. There is clearly still a great deal to do. We look forward to working in partnership with Arthritis Care and others who share our ambition, as my hon. Friend does, to see that services for people who suffer from this condition continue to develop and improve in the future.

Question put and agreed to.

Adjourned accordingly at twenty—nine minutes to Eleven o'clock.