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Tom Randall (Gedling) (Con)
I beg to move,
That this House has considered World Arthritis Day.
It is a pleasure to serve under your chairmanship, Ms McDonagh. This House was in recess on 12 October, but that date has been celebrated—if that is the right word—as World Arthritis Day since it was established by Arthritis and Rheumatism International in 1996. Its aim is to raise awareness across the world of the existence and impact of rheumatic and musculoskeletal diseases, and to educate people about symptoms, preventive measures and treatment options. I thought it might be helpful to bring this debate to the Chamber today—the closest date to World Arthritis Day that we could arrange—to raise awareness, to highlight the extent and impact of arthritis and musculoskeletal conditions in Britain today and to continue the debate on what we can do to mitigate the impact of arthritis.
What is arthritis? Arthritis refers to painful, stiff or restricted joints, which are common symptoms in conditions that cause joint damage or inflammation. They include osteoarthritis, which happens when the body can no longer maintain and repair one or more joints; autoimmune inflammatory arthritis conditions, including axial spondyloarthitis; crystal arthritis such as gout; or symptoms of inflammatory connective tissue diseases, such as lupus. Arthritis is used as an umbrella term for a range of conditions, and that is how I will use it in this debate, although there are certain issues specific to particular conditions that I will mention later.
The subject is worthy of debate for three reasons: first, to recognise the inherent issues in living with arthritis, and how widespread it is; secondly, to highlight the wait for diagnosis and treatment; and thirdly, to understand the economic costs of not dealing with musculoskeletal conditions effectively. We might think that arthritis only affects old ladies, but it is more widespread than that. More than 10 million people in the UK—one in six of our constituents—have arthritis. One in six of our constituents is in pain and experiences fatigue and often restricted mobility.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on bringing forward this debate. In Northern Ireland, where we have a population of 1.95 million, there are 525,000 people living with arthritis or another musculoskeletal condition. That gives some perspective— it is more than one in four. The scale of the issue is massive.
Does the hon. Gentleman agree that for those in the early stages, help in dealing with pain and strengthening the muscles can prevent further untimely deterioration? We should ensure that people stop classifying arthritis as an old person’s disease, so we can allow younger people to determine what they have and how to manage the progression that the hon. Gentleman wishes to achieve.
Tom Randall
The hon. Gentleman is absolutely right. When we have debated this subject in the past, he has raised the issue of arthritis in Northern Ireland; I am so pleased to see him raising it again. He is right in the perspective that he takes on the breadth of the issue, which affects a wide variety of people. I will come on to that point shortly.
One of my Gedling constituents puts it this way:
“Living with arthritis changes you and turns your world upside down. Things you took for granted become obstacles and daily challenges to be overcome. On a good day, you might not look like you’re living with a chronic condition but it never goes away. It’s hard to plan ahead because you don’t know if you’ll be up to going out or meeting up. Arthritis doesn’t only affect the person with the condition but their family too. I have watched Rheumatoid arthritis rob my mum of a life and now I have it too. It makes me frightened for my daughter’s future.”
Early diagnosis and prompt treatment can improve the futures of people living with arthritis and musculo- skeletal conditions, but not always. In the case of axial spondyloarthritis, in which I declare an interest as chair of the all-party parliamentary group on axial spondyloarthritis, a key challenge remains timely diagnosis. In this country, the condition currently takes an average of eight and a half years to diagnose, which puts us behind most comparable nations in Europe.
The latest report of the national early inflammatory arthritis audit, which is run by the British Society for Rheumatology, found that patients are experiencing diagnostic and treatment delays, with 44% of patients still not referred within the target of three working days and 48% of patients experiencing symptoms for longer than six months prior to referral. Although the average time to treatment has improved in England, having been reduced by three days, delays are an average of 12 days higher than the quality standard of 42 days.
The impact of arthritis is ultimately a human story, but the economic cost is also worth mentioning. According to the Office for National Statistics, 23.3 million working days were lost in 2021 due to musculoskeletal conditions. I have thought about how to put that figure in a way that politicians and politicos can understand. Think back to the winter of discontent in 1979, when 29 million working days were lost due to strike action. That was a politically pivotal year, which was notorious for how many working days were lost, and we are facing the equivalent of 80% of that figure—not just in one year but every year because of musculoskeletal conditions.
People with arthritis are 20% less likely to be in work than people without arthritis. Twelve per cent of sickness absence in the NHS between September 2021 and August 2022 was due to back problems and other MSK conditions. The National Axial Spondyloarthritis Society estimates that
“A patient aged 26 who waits 8.5 years for a diagnosis is likely to lose around £187,000”,
the majority of which derives from a loss of productivity due to reduced employment. The average patient also incurs costs of around £61,000 in out-of-pocket expenses while waiting for a diagnosis. That includes the cost of medication, travelling to appointments and private healthcare appointments, including visits to chiropractors.
I first praise the Government for making musculoskeletal conditions part of the major conditions strategy. Making MSK one of the six major conditions signals the importance of this issue, and I believe that it demonstrates that the Government are serious about tackling it. I hope that it will be understood that there are a range of measures that can be taken to improve matters. The Government have made reducing waiting lists one of their top priorities to improve the lives of those with arthritis and musculoskeletal conditions, including those waiting for joint replacement surgery, but I would welcome clarification that it will remain a key Government priority and clarity on how that will remain the case in the face of likely future winter pressures.
According to the British Society for Rheumatology, growing the rheumatology workforce would reduce the health and societal costs of newly diagnosed rheumatoid arthritis by £50 million, so I welcome clarification from the Minister on plans to grow the rheumatology workforce.
Everyone recognises the valuable role that primary care can play. Raised public awareness can help to encourage early presentation in primary care, but there is also work to be done to help GPs and other healthcare professionals to recognise conditions. I spoke earlier of the delay to the diagnosis of axial spondyloarthritis. Fifty-six per cent. of that delay time occurs in primary care, with GPs often failing to identify the symptoms of axial spondyloarthritis and thinking that the patient may have mechanical back pain or back pain associated with injury. That can lead to repeated primary care visits and causes patients to be bounced around in the system, placing further burdens on the already stretched system. I welcome any opportunity to follow up with the Minister separately on that point, particularly on what can be done to improve public and primary care awareness of these conditions.
World arthritis day only comes once a year, but for those living with arthritis and musculoskeletal conditions it is a constant issue. While they might dream of a world free of pain and discomfort, that is not yet a reality. I am grateful for the opportunity to raise this issue on the Floor of the House today and I look forward to hearing further contributions on how we might make that the case.
The Minister for Health and Secondary Care (Will Quince)
It is a pleasure to serve under your chairmanship, Ms McDonagh. Let me first congratulate my hon. Friend the Member for Gedling (Tom Randall) on securing a debate on this hugely important issue. I know that he is a tireless campaigner for those living with arthritis, in particular axial spondyloarthritis, and his experience is invaluable in bringing a voice from that community to this place. He made a very emotive and powerful case in his usual articulate and eloquent way. I would also like to thank him for sharing his constituent Elizabeth’s experience, which shows how much further we still have to go in supporting people with this condition.
I would also like to pay tribute to the outstanding charities that support the 10 million people living with arthritis in the UK. I know that my hon. Friend works closely with the National Axial Spondyloarthritis Society—the NASS—and many other charities, such as Versus Arthritis and the National Rheumatoid Arthritis Society, which do such fantastic work to support patients and drive improvements in care. He referenced arthritis week—those charities have collectively made arthritis week a resounding success and do stellar work raising awareness not just during that week, but all year round, as my hon. Friend rightly pointed out.
My hon. Friend is also absolutely right to point to the impact that arthritis has on not only people suffering from the condition, but their families and carers. I know from my own experience of growing up with my grandmother, who lived with rheumatoid arthritis, the impact it had not only on her, but on my mother and the wider family. He is also right to highlight the difference that early diagnosis, the quality of care and proper support can make. He raised a number of important points in this debate; I will turn to each one now.
My hon. Friend made a hugely important point about early diagnosis of the condition and set out some of the challenges. He is right to stress the difference that early diagnosis can make to long-term quality of life. Research from charities shows that one year, rather than eight years, to diagnose inflammatory arthritis can save individuals over £150,000 in lost income and medical expenses. I know that NHS England is working hard to improve early diagnosis rates through its GIRFT—getting it right first time— rheumatology programme, which is designed to improve the diagnosis, treatment and care of patients, but I appreciate and recognise that we have further to go on this. I would be very happy to work with my hon. Friend to see what further improvements we can make alongside NHS England.
In terms of treatments for arthritis, the Government are committed to supporting timely and, vitally, consistent access to effective new medicines for NHS patients with arthritis. The National Institute for Health and Care Excellence has recently recommended several new medicines for arthritis and other rheumatological conditions, including Rinvoq, Tremfya and Skyrizi. These allow patients to benefit from pain reduction and an improved quality of life and are now, I understand, routinely available for clinicians to prescribe to eligible NHS patients in line with NICE recommendations.
My hon. Friend was generous in setting out details about the major conditions strategy, and I agree with so much of what he said. In January of this year, we announced our plan to publish the major conditions strategy, which is designed to tackle the key drivers of ill health in England. We have now published our initial report, “Major conditions strategy: case for change and our strategic framework”, which sets out our plan to promote prevention of non-pharmaceutical interventions. The idea is to create a truly personalised approach for patients. I can assure my hon. Friend that my firm commitment is to continue engaging with charities such as Versus Arthritis and the NASS as we develop that strategy going forward. That is absolutely right; in fact, it is critical that we work with those charities to ensure that we are getting it right as we develop the strategy.
I would also like to touch on gene and cell therapies. In my view, having looked into this not just in relation to arthritis but more broadly, they have huge potential. I am passionate about the UK’s status as a life sciences superpower, and I am really pleased that the Medicines and Healthcare products Regulatory Agency has launched the innovative licensing and access pathway to reduce the time it takes to get innovative medicines to market. In April of this year, the National Institute for Health and Care Excellence recommended Upstaza for aromatic L-amino acid decarboxylase deficiency, which is a horrific genetic disorder affecting children. That is the first gene therapy for children with that condition, which is administered directly into the brain through a minimally invasive procedure.
My hon. Friend touched on elective recovery, and he is right to do so, because we know the size of the waiting list and the impact that has on patients. He rightly raised the waiting times for operations that patients often need, such as joint replacements. Of course, alongside that, it will not have escaped his notice that cutting wait lists is one of the Prime Minister’s five priorities. That is why we are putting record staffing numbers and record levels of funding into our health service. We are spending over £8 billion from 2020 to 2025, plus an additional £5.9 billion specifically for capital projects: funding for new beds; new tech and equipment; community diagnostic centres; and surgical hubs. We have virtually eliminated 18-month waits, and from this month patients waiting over 40 weeks will be informed of their right to be treated somewhere with a shorter waiting list—which of course includes those with arthritis and other musculoskeletal conditions. Patient choice is going to be at the heart of that.
My hon. Friend and I have previously had conversations about prescriptions—particularly free prescriptions—the charges for people with arthritis, and the need to review the current medical exemption list. I believe there has been only one addition to the list since 1968, which was specifically for cancer. I apologise for what may be a disappointing response, but we do not have any plans to make another exemption at this time. However, I would say to my hon. Friend and all those raising this issue that around 89% of prescription items are currently dispensed free of charge, and there are already a wide range of exemptions from prescription charges for those who meet the eligibility criteria.
My hon. Friend has also raised the issue of mental health with me in the past, and we know that about 30% of people with rheumatoid arthritis develop depression within five years of their diagnosis, and that 20% of people with osteoarthritis experience depression or anxiety. Of course, those statistics should concern us. That is why we have made it centrally clear to commissioners at the local level that we expect NHS talking therapies to be integrated into physical healthcare pathways. It is absolutely critical that, alongside their physical health, we also support the mental health of patients. Our NHS long-term plan commits to an additional £2.3 billion a year for the expansion of mental health services by 2024, so that an additional 2 million people can access NHS-funded mental health support.
I hope that my hon. Friend will be reassured by some of the measures that I have outlined today. I recognise that we have to go further, and my hon. Friend made a powerful case for that. To respond to his request for me to work with him, alongside NHS England, to explore how we can do that, my door is of course always open to him and other colleagues on this issue. I would like to thank him again for giving me the opportunity to reiterate our commitment to the very highest standards of care for the 10 million people living with arthritis in this country. I will of course look at what more can be done to address the needs of those affected by arthritis. I will take his points away and give them further thought, so that together we can continue to create the kind of care that patients deserve, to allow them to live their lives to the fullest. I would like to close by again thanking my hon. Friend and the charities for all their work in keeping a spotlight on this issue so that arthritis awareness remains constant in the public eye, not just for one week but every day of the year.
Question put and agreed to.