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Musculoskeletal Conditions

I agree entirely with my hon. Friend. I requested this debate because we could do a lot with the available money if there were better co-ordination. In 2006, the Government published a framework for musculoskeletal services, "A joint responsibility: doing things differently". It did exactly what my hon. Friend says and was produced with input from a range of Departments, including the Department for Work and Pensions and the Department for Transport, to produce a co-ordinated response on dealing with such conditions. However, unlike other frameworks that predated and followed it, there was no clear standard or framework to guide the development of services for people suffering from musculoskeletal disorders. For example, despite one in five patients presenting with a musculoskeletal disorder, standards were not written into the GP contract, no network was created and no health tsar was appointed to ensure the establishment of a common framework. That is in stark contrast to diseases such as cancer or heart disease, where treatment, time frames and follow-ups have been rigorously applied nationally. Funding for musculoskeletal conditions is incredibly variable across PCTs. ARMA reported a three-fold variation in the average amount of funding provided for each person with a musculoskeletal condition, ranging from £204 per patient in Camden PCT to £632 in Gateshead. In my region in the north-west, average spending in 2007-08 was £474 per patient, compared with a national average of £401. Only 18 per cent. of PCTs in the north-west reported that they had audited the outcomes of people living with long-term conditions such as a musculoskeletal condition, compared with a national average of 40 per cent. If we do not audit what happens to people and the services that are provided, how can we make the best use of the huge financial resources? Only 25 per cent. of PCTs in the north-west reported that they had mapped the resources available to support people living with long-term conditions such as a musculoskeletal condition. Such mapping is a key recommendation of the musculoskeletal services framework, but again, the national average for that is only 16 per cent. In the north-west, 47 per cent. of PCTs have made links with local pathways to work—I mentioned that earlier. It is a key pledge and recommendation in Dame Carol Black's report, and we must ensure that it is done. On mapping and indicators, Bury PCT—which is next door to my constituency—was perhaps the most honest: in response to the ARMA questionnaire, it said that it did not use outcome indicators because there are no nationally agreed outcomes. Clearly, that is a glaring error. At a meeting of the Public Accounts Committee on 23 November 2009 to consider the National Audit Office's report on rheumatoid arthritis, David Nicholson, the NHS chief executive, agreed that improving musculoskeletal services and outcomes was primarily about management and planning rather than additional resources. I hope that when she responds, the Minister will assure us that we will see that co-ordination and planning to ensure uniformly good provision on the ground. At the moment, there are huge variations between what is available and what patients can receive. In my view, Oldham PCT, which is next door to my constituency, is a beacon that shows what can happen when a primary care trust gets its act together and brings together teams of clinicians and support to assist people to live normal lives. Yesterday, I visited the Chapel Allerton centre in Leeds, which has been supported by ARC and NHS research and is a model of the research community working with the NHS to improve clinical outcomes and services that are provided for people in the north of England. However, there is a totally unacceptable postcode lottery. Why should where someone lives or which condition they have determine the level of their treatment? That is unacceptable for cancer, where clear targets have been set—the Government are to be congratulated on that—so why should a condition that affects one in four of the working population and which, as I have said, costs the country dearly, not have the same level of co-ordination? Again, I emphasise that this is not about additional resources; it is about using what is available and better co-ordination. We would like to see the following proposals, which were mentioned by ARC in its report and picked up by my hon. Friend the Member for St. Ives (Andrew George) First, to improve co-ordination and ensure delivery on the ground, we need the appointment of a national director to ensure that current and future initiatives have a strategic focus and to help to develop a proper musculoskeletal network across the country. Treatment should not depend on where someone lives or on a particular hospital or PCT in their area. People should get the early treatment that they need, which can make such a difference. The second point, which was picked up by Dame Carol Black, is that because GPs are on the front line and many of their patients present with a musculoskeletal condition, there should be enhanced training for GPs through both PCTs and centres of excellence, to ensure that doctors are kept up to date. A key Government response to Dame Carol Black's report set targets for that to happen. Thirdly, we need better information about expenditure and outcomes, so that we do not have a repeat of the situation where Bury PCT reported that it did not bother measuring outcomes because there was no set standard. There must be agreed outcomes. If we have a standard on getting people seen within 18 weeks, why can we not do the same for people with musculoskeletal conditions, so that they know what they can expect? Another important point picked up in the ARMA report is follow-up: it is no good seeing someone within 18 weeks if they then have to wait six months for a follow-up appointment to see how they are getting on. People could move backwards. The fourth thing we need is better information about spending and outcomes, including a common framework. Finally, we need to improve public awareness, so that people know where to seek treatment, what is available and what they should avoid. We are not asking for a new miracle drug or for the Minister to commit billions of pounds to new research facilities—ARC already provides the bulk of such research. We are not asking for brand new hospitals, although a centre such as the one in Leeds is a model and beacon of what can happen. We are asking for co-ordination and better use of that £4.2 billion of resources, so that patients—our constituents—do not face a postcode lottery, but can go to a doctor where they live and be guaranteed early treatment, continuing support, advice and, when they need it, a specialist centre. I do not think that that is a lot to ask in the 21st century.