Baroness Thomas of Winchester
To ask Her Majesty’s Government whether they have commissioned any research into the benefits of hydrotherapy for people with progressive conditions.
Baroness Northover
The health technology assessment programme has published research on the effectiveness of hydrotherapy for lower-limb osteoarthritis and for juvenile idiopathic arthritis.
Baroness Thomas of Winchester
I thank my noble friend for that Answer, which seemed rather brief and limited in its scope. I would like the Minister's advice about how those concerned with this question could persuade the National Health Service of the benefits of ongoing hydrotherapy for people with progressive conditions who will never fulfil the criterion of a positive outcome that one might have with a broken leg. I am thinking in particular of boys with Duchenne muscular dystrophy. The sad truth is that hydrotherapy in this country is better known as a treatment for horses and dogs than for people.
Baroness Northover
Surely not. My noble friend has done a great deal herself to promote the potential psychological and physical benefits of hydrotherapy, and I am sure that she will continue to do so. Following her conversations with me over the past week or so, and at her request, I have sought for her and for other noble Lords with an interest in this area a meeting with the relevant Minister in the Department of Health, my honourable friend Anne Milton. That has been agreed and therefore I hope that the noble Baroness and others will be able to take this further forward.
Lord Walton of Detchant
My Lords, is the noble Baroness aware that the All-Party Parliamentary Group on Muscular Dystrophy last year carried out a major survey of facilities across the UK for patients with Duchenne muscular dystrophy—to which the noble Baroness referred—and discovered that boys with that very serious progressive disease who live in places like Newcastle, Oxford, London around Queen Square, and Oswestry, survive into their 30s and sometimes even their 40s, whereas in other parts of the UK they still die in their teens? There is evidence that in the rehabilitation of these patients, hydrotherapy plays an extremely important role. What efforts are the Government making to make certain that this form of treatment, which is invaluable, becomes more widely available across the United Kingdom?
Baroness Northover
My Lords, I am well aware of the report in the name of the noble Lord, Lord Walton. It is a most impressive report that had an effect on the then Government. We are doing our best to take that forward. One thing that struck me when I looked at the research in this area was its paucity. The Department of Health can do so much, but clinicians can do a lot more. It is worth bearing in mind that the use of hydrotherapy is a matter for clinical judgment. By and large, clinicians and patients must take this forward. Therefore, it is very important that clinicians undertake research with larger groups of patients than has been the case heretofore. Anything that the noble Lord can do to promote that would be extremely welcome.
Baroness Thornton
My Lords, I say to the Minister that this is also a matter of resources. Is she aware of the potential benefits of hydrotherapy for people with long-term conditions, such as stroke, Parkinson’s disease and multiple sclerosis? How will she ensure that hydrotherapy treatment is both continued and expanded for key groups when funding is transferred from PCTs to GPs, and how will the Government support GPs in the effective commissioning of these expensive rehabilitation and reablement treatments for people with these long-term and progressive conditions?
Baroness Northover
As the noble Baroness will recognise, the provision of this treatment up and down the country has been an ongoing problem. It is something that the previous Government tried to tackle, and the emphasis then, as now, was very much on local decision-making. However, the national commissioning board will be looking at the provision of specialised services and will try to ensure that, where there is this kind of need for a small group of patients, provision is catered for. At the moment, as the noble Baroness knows, the Department of Health is assessing the results of the consultation on the White Paper, which has just closed, and proposals on specialist commissioning will be brought forward. However, it is extremely important to recognise that this is not a new problem and it is not an outcome of the proposed changes.
Lord Campbell of Alloway
My Lords, perhaps I may ask a very simple question. Are no steps to be taken until we have a report from various quarters? What is the position? We have heard a lot but I cannot understand what is to be done.
Baroness Northover
I apologise if I have not been clear, and I shall try to be clearer. PCTs currently commission locally for hydrotherapy. Physiotherapists decide whether their patients need hydrotherapy and, if they or clinicians recommend that that is what the patients need—and in many cases it is not advised because there could be infection, balance or other problems, so it is not ideal for all patients—the PCT commissions the treatment locally. That will continue to be the case, as it will under GP consortia but with the umbrella protection of ensuring with the commissioning board that specialist care is not squeezed out by an emphasis on what the majority need locally.
Baroness Finlay of Llandaff
My Lords, as the Government are establishing an outcomes framework for the delivery of treatments, are they looking specifically to have a very flexible and alternative model for those with long-term conditions which takes account of the benefits in terms of both quality of life and welfare, and which also takes account of the avoidance of problems such as the earlier onset of contractures in those with neuromuscular disorders or neurological damage?
Baroness Northover
I thank the noble Baroness for that question as it enables me to point out, as she will know, that one element of the proposed NHS outcomes framework is enhancing the quality of life of people with long-term conditions. That is relevant here—it is not just a matter of seeing whether someone’s leg mends after it has been broken. I heard from my noble friend about the experience of the noble Baroness, Lady Campbell, and about the psychological benefit to her of having hydrotherapy. It is not simply a matter of physical benefit; there is also a psychological benefit.