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Musculoskeletal Conditions

It is a pleasure to serve under your chairmanship, Mr. Streeter. I think that this is the first time I have done so. I am sure that your elevation was recent, and it is certainly well deserved. I congratulate my hon. Friend the Member for Rochdale (Paul Rowen) on initiating this important debate and taking up the cudgels on behalf of musculoskeletal sufferers. It is clearly an important topic, but it is also, as my hon. Friend made clear, a huge one, covering a range of conditions, some of which have clear and definite physical symptoms that can be seen on an X-ray, and some of which, such as fibromyalgia, are rather more difficult to tie down, and to treat. The topic is huge also in the sense that it involves 10 million people in the UK. It is important to the sufferers, who endure daily torment, but also to the nation. The National Audit Office report established that better treatment of rheumatoid arthritis could save the nation £1.8 billion, and we could do with an extra £1.8 billion at the moment. Apparently, £7 billion is lost to the economy from all musculoskeletal disorders. It is important that the NHS should get the treatment of those 10 million sufferers right. All the research that I have looked at identifies a crucial role for primary care to play—particularly GPs. The NAO report, which I think centred exclusively on the issue of rheumatoid arthritis, said that there was sometimes a nine-month wait between the time when symptoms first occurred and the start of treatment, which made quite a difference to long-term outcomes. If things are not got right in the early stages, the disease will progress more rapidly, with more damage. There is thus a crucial role for primary care. The literature makes it apparent that there is a crucial role for the primary care trusts. In every PCT worth its salt, there is talk about the expert patient initiative—and voluble talk about how long-term conditions can be managed by the patient and practitioner together. Much of that, however, going by evidence presented by my hon. Friend the Member for Rochdale and others, is lip service, because there is not effective bespoke commissioning everywhere. PCTs without such commissioning can learn something from those where it exists about employing interventions that work—because things are not going that well in the national health service. According to statistics given to the Liberal Democrats under the Freedom of Information Act, in the past three years, 3,337 NHS staff with a range of conditions, the bulk of which were of the musculoskeletal kind, went for treatment outside the NHS. That leads one to be suspicious about whether they were able to find good enough treatment wholly available within the NHS. Then, of course, there is the collateral damage to the ability and confidence of those affected. There is also the unspoken problem of mental health. People who cannot move very well and do not feel very good about themselves may suffer more frequently with depression and the like. Three quarters of people diagnosed with rheumatoid arthritis are found to have it while still at working age—a point made by the hon. Member for Manchester, Blackley (Graham Stringer). When identified, the prognosis is rather dim. They end up being off work for long periods and, worse still, sometimes without much sympathy. The back has always been the passport for malingerers wanting to get out of a job, so those who have a genuine problem with their back do not necessarily get the sympathy that they might receive if they had another sort of complaint. Given all that, an awful lot of people tend to be plain philosophical. My mother suffers with rheumatoid arthritis, but she just gets on with it. She moans about it from time to time, but she does not do anything about it. She regards it as an occupational hazard of getting old. She does not like us drawing attention to it, because its disfiguring aspect upsets her. She prefers to ignore it and get on with her life as best she can. It is obvious that if such conditions are allowed to develop unchecked, they will become severely disabling. There are knock-on consequences for other aspects of health. For instance, the cardiovascular system can be affected, and mental health problems can occur. If it is unchecked in the nation—or at least not well checked—it could have a huge social and financial impact. What needs to be done? We obviously need to tackle the problem with more urgency. We also need something that was alluded to earlier—a recognition that we need more diversity. If 200 different problems can be encompassed in musculoskeletal conditions, as we were reliably told by my hon. Friend the Member for Rochdale, and I believe him, it is unlikely that they can all be resolved with the same solution. Various professionals will be involved in the treatment—physiotherapists, physiologists, occupational therapists, and even acupuncturists and bone surgeons—but it is important to recognise that it is a diverse problem that requires a range of solutions. My hon. Friend the Member for Rochdale spoke of the need for more co-ordination and coherence, and we cannot argue with that. Certainly a good interconnection is needed between those who prescribe and those who manipulate, between the secondary and the primary sectors and between the workplace or the Department for Work and Pensions and the surgery. The literature that I have seen does not demand that the Government do something new, but they have been asked in parliamentary questions whether they have any intention of updating the musculoskeletal framework. They responded in various ways. They did not reject the need to do something, but they pointed out that they are committed to improving care and outcomes for people with long-term conditions. They said that they want to improve the quality of service in a safe and effective way; that they will start fit-for-work pilots; and that they have learned something from "Working for a healthier tomorrow". All those things were said in answer to parliamentary questions, but clearly not to the satisfaction of many hon. Members here today. I have a small element of sympathy for the Government. We can give too much credence to a framework, as though it would magically abolish the problem—as if, once it is in place, and the tick-box exercise has started, everything will be better. I an anxious that the Government may be too firm and overarching in dictating local priorities, as all hon. Members would want to support local provision. I have a little sympathy with the Government's wish to conduct pilots. Before they tell people what to do, they genuinely need to know what is best practice and what works best. The problems that we are debating are slightly different from those linked to cancer, which was mentioned by my hon. Friend the Member for Rochdale. For a start, there is greater variety. I know that cancers vary, but musculoskeletal conditions vary even more. Some people may fear that pilots will become a substitute for action—that a pilot is doing something about a problem to which the Government have been alerted. There is clearly no need to pilot certain things. For example, as the hon. Member for Wyre Forest (Dr. Taylor) said, key conditions such as rheumatoid arthritis are well understood and are relatively easy to diagnose. We do not need to reinvent the wheel. The challenge for the Government is to act on National Audit Office findings and the many representations made here today and by the associated bodies and charities that support people with such conditions. Unless we take another hard look at ensuring effective action to deal with the problem, we will be wasting money and wasting people's lives. We will also be wasting known medical expertise.