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Musculoskeletal Conditions

May I say what a pleasure it is to serve under your chairmanship, Mr. Streeter? I apologise for my loss of voice, which may mean that I shall be brief. I congratulate the hon. Member for Rochdale (Paul Rowen) on scoping out so well some of the issues that face those with musculoskeletal problems. "Joint Working? An audit of the implementation of the Department of Health's musculoskeletal services framework" by the Arthritis and Musculoskeletal Alliance quoted a number figures, as have several hon. Members who have spoken today. I shall try gather them together—they vary, but I hope to show at least some of the range. The ARMA report noted that musculoskeletal conditions place a significant burden on the NHS, accounting for between £3.5 billion and £4.5 billion of NHS spending every year. They also cause a loss of working days every year: we were given a figure as low as 11 million but it could be as high as 28 million. The report expresses concern, which is shared by hon. Members who have spoken in the debate, that the Department of Health's musculoskeletal services framework has been implemented in an inconsistent way, and recognises the variations in standards of care across the UK for patients living with those conditions. That concern should be addressed. The report also calls on the Government to consider the recommendations, and I am sure that the Minister will want to respond to them. There are between 150 and 200 musculoskeletal diseases and syndromes, which are usually but not always progressive and which are associated with pain. Indeed, a number of hon. Members here could say that they have at some point suffered from a musculoskeletal condition, albeit minor—except for the hon. Member for St. Ives (Andrew George), who is no longer in his seat, for whom it is more significant. Such conditions result from trauma and inflammation or a number of other factors. Rheumatoid arthritis, osteoarthritis, osteoporosis, low back pain, and limb trauma are particularly significant. More than 50 per cent. of the population have reported musculoskeletal pain at one or more sites for at least a week. Population surveys show that back pain is the most common site of pain, and the prevalence of physical disability is higher in women than in men. It increases with age; 60 per cent. of women aged over 75 who live in the community have reported some physical limitations. In individuals of working age, musculoskeletal conditions, particularly back pain and generalised widespread pain, are a common cause of sick leave and long-term work disability. Hence, they are a big problem for the individuals affected and have significant economic consequences for society. Rheumatoid arthritis, osteoarthritis and osteoporosis are associated with loss of independence and sufferers require more support in the community or admission to residential care. Between 15 per cent. and 20 per cent. of GP consultations are about musculoskeletal conditions—they take up a significant time in GPs' surgeries—and many of those people are referred to allied health professions, such as physiotherapists, occupational therapists or chiropractors. We should not underestimate the huge impact that such professionals have in improving the life and prospects of people with musculoskeletal conditions. Then we have the rheumatologists, orthopaedic surgeons and the rehabilitation specialists, of whom the hon. Member for Wyre Forest (Dr. Taylor) is one—we always welcome not only his professional expertise but his significant contribution to debates such as these. In most European countries, total joint replacement—knee or hip—is one of the most common elective operations for old people. We are therefore talking about a significant disease that has a significant impact on our economy and the well-being of the people in this country. Much of the treatment is not complex: massage, physiotherapy, drug self-management and vitamin or mineral supplements are all used to relieve pain. As the disease progresses, joint surgery and more complex drug treatment are also necessary. In 2006, the musculoskeletal services framework recommended offering care closer to home, with improved ways to access diagnostic services. The document aimed to help local health communities to improve orthopaedic services and to deliver a waiting time of 18 weeks. However, as hon. Members have said, there are problems about diagnosis. Setting a target of 18 weeks may be laudable, but the clock only starts ticking when a patient has that much-needed diagnosis. The musculoskeletal services framework dealt with such issues by describing best practice, which is built around evidence and experience. It also promoted a redesign of services, full exploitation of skills and roles, and better outcomes for people with musculoskeletal conditions through more actively managed patient pathways, as well as sharing of information and responsibility agreed between stakeholders in all sectors. The central tenet of the document was to provide the appropriate level of high-quality information, support and treatment to those with musculoskeletal conditions. Sadly, however, that is not happening. If the problem is bad now, it will get worse with an ageing population. The associated problems, which have been touched on, are not just a loss of working days and the cost of musculoskeletal problems, but an increase in mental health problems. As people become less mobile, they become more isolated, and the burden is then placed on family and friends. I repeat: the problem will only get worse with an ageing population. It is very hard for people with musculoskeletal conditions to get the attention they deserve. Despite the figures, public and media attention is often difficult to grab. Questions continue to be raised about whether GPs always recognise the problem—I have already mentioned the problem of diagnosis. We must focus on GP training and continuing professional development. Complaints about diagnosis relate not only to musculoskeletal conditions, but to illnesses such as epilepsy and asthma. It is an area that we must get right. I know that a great deal is put on the plate of GPs, but it is vital that they continue their professional development and that we continue to emphasise the importance of early diagnosis. I smiled to myself when the hon. Member for Wyre Forest mentioned multi-disciplinary teams. Multi-disciplinary teams go in a little box of things that I remember coming into being in the early 1980s, when I was a district nurse—the Minister may share this memory. Like many things from 30 years ago, the idea appears to have languished on the beaches—although it is often mentioned in documents, it is, sadly, rarely put into practice. There is no doubt that multi-disciplinary teams have a huge role to play in treating musculoskeletal conditions. We need to see them working on the ground. The teams need a lot of leadership from not just Government but local PCTs and GP practices to ensure that they play their part in treatment. In my party, we have talked about speeding up NICE drug appraisals; that is critical, particularly in the later stages of treatment. If that were done, fewer drug cases would have to go to exceptional cases panels, because PCTs would have earlier guidance on what should be prescribed for such conditions. We also believe that the societal costs of disease should be taken into account in NICE appraisals. That is particularly relevant for people with musculoskeletal conditions. Individual budgets have a crucial role to play. If someone with a long-term condition who was living at home could be assessed through a single assessment process, which incorporated both health and social care needs, a "pooled budget" could be determined for them. The calculation of the budget would consist of two parts: one would relate to social care and be means-tested, the other would be health care-related and free. Based on that, an individual and their carer would be given the flexibility and empowerment—most important if one is suffering from a long-term chronic illness—to choose their providers and where they get the care to alleviate their problems. They should be able to exercise that flexibility across the social and health care divide. Giving real choice to patients and allowing professionals to decide on the best strategies for providing health care will not be possible unless GPs, patients and providers can access sophisticated data about the performance of treatments, hospitals and doctors. I am confident that the provision of high-quality information, available in the public domain and presented to patients by GPs, will make the providers of NHS care truly accountable to patients and improve the standards of care. I am even more confident that, as information drives greater choice for patients, so patients' experience of their health care will improve. Some 20 to 25 per cent. of our constituents suffer from musculoskeletal problems, and they account for one in four visits to GPs. Up to 28 million working days a year are lost due to musculoskeletal problems, which is some 22 per cent. of our long-term capacity. Will the Minister tell us what the Government have done and what they intend to do to resolve the huge range of problems? ARMA states in its audit of PCTs that only 60 per cent. of those responding have mapped resources for long-term conditions and their use by people with musculoskeletal problems. Some 60 per cent. of PCTs have not audited outcomes, which is shocking, and 57 per cent. have not linked up to local pathways to work schemes. Most important, David Nicholson, the chief executive of the NHS, agreed that improving the outcomes for people with musculoskeletal problems was about management and planning rather than additional money. That is a joy to the ears of all of us in these very difficult financial times. We have a chance to improve the mobility, the well-being and the productiveness of literally millions of people without additional costs. I have a number of questions for the Minister. What can be done to improve the working practices affecting current sufferers of a musculoskeletal condition? According to a survey by the Office for National Statistics, the majority of MSC sufferers over 60 do not have access to health services due to a lack of information and help from their GPs. What can be done to ensure that those who need both information and care receive them? Is the Minister aware—this was also raised by the hon. Member for Manchester, Blackley (Graham Stringer)—that the King's Fund report of 2006 found that spending on musculoskeletal problems varied eightfold across PCTs in the country? The Minister must also be aware from work on the Government's musculoskeletal services framework that MSC patients have endured some of the longest waiting times for hospital care and have, in many areas, faced fragmented and incoherent services that provided poor access to care. Four years on, can the Minister tell us what has happened and what she is now doing to address the situation? Can she also say why the Department of Health does not take a clinical lead? I mentioned leadership earlier and said that leadership must not only come from Government, but a Department of Health clinical lead would have a significant impact by giving people and their musculoskeletal problems the attention that they deserve. Finally, what steps is she taking to improve commissioning of services?