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Musculoskeletal Conditions

I am glad to see the Minister shaking her head because physios and occupational therapists are always seen as low priorities when we talk about emergency medicine and emergency surgery and it is important that we protect them. Obviously, I have seen huge changes in treatment during my professional life. Until about 15 years ago, disease-modifying drugs were very toxic and not that effective. We had things such as gold and penicillamine. Then we had methotrexate, which was quite a breakthrough. Recently, we have had the unbelievable advance of the so-called biologicals, which have been mentioned. When they work, they can be almost like a miracle, but they require careful follow-up and specialist staff, particularly specialist nurses, are needed to do that follow-up. With such conditions, people cannot be referred back to primary care for follow-up unless the GP has been specially trained in following up people on anti-TNFs, so they have to be followed up by the specialist in the hospital. The take-up of anti-TNF drugs has been mentioned. I was at a meeting of the National Rheumatoid Arthritis Society last February at which Professor David Isenberg, a consultant rheumatologist at University college London, said:""Postcode prescribing results in huge variations across the country. Why does it happen that one patient can get a NICE-approved drug straight away, but for another patient they might have to wait three months?"" He added:""So far as the anti-TNF treatments for RA are concerned, only 5-10 per cent. of UK patients are receiving them, despite NICE approval."" That was virtually a year ago, so I hope that the Minister will tell us that things are better now. Hon. Members have already mentioned the crucial importance of better records and information—I echo those comments. As for employment, since emphasis was placed on capacity for work rather than incapacity, and since the change from personal capability assessments to work capability assessments, I have heard several complaints about the nature and accuracy of the medical assessments, particularly for people with long-term conditions. The tests are performed by a firm called Atos, and some of those about which I have heard complaints have been overturned on appeal. I wonder whether the Minister has received complaints about those medical assessments, and especially about lack of notice. I was so concerned that I wrote to the Department for Work and Pensions, and I received a reply from the Under-Secretary of State for Work and Pensions, the hon. Member for Chatham and Aylesford (Jonathan Shaw), who is the Minister responsible for disabled people. A particular concern was that medical evidence that had been submitted was not really taken into account. The Minister wrote:""The guidance for examining healthcare professionals specifies that they are required to read and consider all the evidence on file in preparation for the interview with the claimant."" I also wrote to Dame Carol Black and she passed the letter to the chief medical advisor for the DWP, Dr. W. J. Gunnyeon. He replied:""The healthcare professionals carrying out the WCA receive training tailored specifically to the task of carrying out the assessment…As the purpose of the assessment is to identify the functional affects of those conditions, the specific training which they receive focuses on disability analysis."" The reply from Atos was:""It may be beneficial if I explain that the HCP provides their medical opinion based on the documentary evidence, the interview and observation of the customer and on an appropriate medical assessment"." We therefore have it absolutely straight that the previous illness and medical evidence must be taken into account. I should be interested to hear from the point of view of the Department of Health whether the Minister has had complaints about such assessments.