Disabled People

Lord Luce Excerpts

Thursday 9th May 2019 Lords Chamber

[Lord Luce (CB)]

My Lords, I am delighted to follow the noble Lord, Lord Lingfield, who demonstrates how many types of disability we have to consider. I thank the noble Lord, Lord Borwick, for setting us the very good challenge of imagining where we would like to be in the field of disabilities in 50 years’ time, and even enticing us with the prospect that we might all be here in 50 years’ time to take part in this debate again and to take stock—indeed, that we might have a Green Paper or even a White Paper to consider for that debate.

I want to say one thing in particular. There are noble Peers in this House, many of whom have taken part in this debate, who suffer from very notable disabilities and we owe them an enormous debt of gratitude for the service they give here, the courage they show and the leadership they give to all those outside this House who suffer from these varying disabilities. For my part, I declare an interest as someone who for 50 years has suffered from chronic pain linked to musculoskeletal problems. As I will say in a moment, there are many millions of people who suffer from this. I just want to put down two considerations in this debate for this category of people. First, we need to implement a national chronic pain management service which is well co-ordinated and effective: we have a long way to go. Secondly, in the field of work and health, we need to ensure that people who suffer from chronic pain and other disabilities in their jobs retain those jobs or, if they have lost them, are helped to get back to work.

I shall give some facts. First, some very cautious figures, there are at least 8 million people who suffer from chronic pain, many with musculoskeletal links, of which 4 million suffer from severe chronic pain that hinders their activities quite seriously. Of course, it is true that those who are over 65 suffer more pain, but let us take people in their jobs. Some 25% of those who do jobs and suffer from chronic pain lose their jobs—that is a critical figure. Moreover, in five out of 10 global diseases, pain is a major component. So pain is common, expensive, disabling and distressing. People want to see a reduction in their pain and an improvement in their quality of life. I have worked with other specialist pain organisations in the last 10 years to campaign for this.

The first thing we need to recognise is that there are core quality standards for dealing with pain management services. NICE has set out certain standards on back pain, for example, and how to deal with it. Pathways have been established. There is evidence of best practice—inSheffield, Gloucestershire and Scotland, for example. What is missing is the effective, well co-ordinated implementation of these guidelines. Across the country, it is still very much a lottery, with particularly poor services in areas with people who have very low levels of income, who suffer badly. These pathways should indicate, in my view, a kind of pyramid of pain services, because at least 50% of patients can be dealt with through primary care. GPs have been described to me very well as acting as a sophisticated sieve to do the initial assessment, but the more serious cases enter the region of multidisciplinary support, which is what they need. That needs to be tailor-made to their particular setting and their own problem.

The key to this is to learn self-management, but you then have to draw on the multiplicity, the battery, of different specialisms. There is medication, of course. I will not get into opioids now, but I have weaned myself off opioids after 10 years and I think that that is quite a good thing to do. Physiotherapy is critical and there is osteopathy and acupuncture, of course. Psychologists can be vital, because there is not yet a recognition of the mental health aspects of suffering from pain. I will come in a minute to the role of occupational therapists, who play a vital role in getting people back to work. Learning self-management is like conducting an orchestra: you need to know what instruments to draw on—what medical specialisms to draw on—in conducting that orchestra in order to strengthen one’s own health and reduce pain. Providing a national service is the first priority.

The second priority is health at work. Over the last 10 years Dame Carol Black has produced two remarkable reports on how to make it easier for people who suffer to stay in their jobs, or come back to their jobs if they have lost them. In that period, one thing that has been achieved is that it is now accepted that work is good for the health of people who suffer from a disability. Indeed, I was a great friend of Mrs Pearsall, who invented A-Z maps, who suffered from intense pain for 50 years. I asked her the secret—“How do you deal with it?” She said, “Divert the pain’s attention”. I replied, “That’s easy during the day—you just work hard. What about the night, when you can’t sleep?” She said, “My dear, it’s very easy. You just read the Bible all night”. I have not quite got to that stage, although I am trying hard.

Many at work suffer and, as I have already said, many lose their jobs because they suffer from chronic pain and related problems. Those who have pain are a big cost to the economy: £12 billion a year. The challenge for the Government is to improve employment for adults. They have set a very good target of getting another 1 million disabled people into work by 2027, but to achieve that, you need to ensure that you have an effective scheme. What has been known as the Fit for Work scheme is not working. Here, we have to recognise that it is not so much about the large employers who provide some occupational assistance but the small businesses. Above all, I emphasise occupational therapy, which I would like to ask the Minister about. There is a vital role to be played by occupational therapists in helping people to assess what is needed to enable them to stay at work, to ensure that the employers have a flexible system. What progress is being made with the Wellcome expert working group that has been set up to study occupational health and see what improvements can be made?

I welcome the progress that has been made but there is a long way to go if we want to keep people in jobs, improve their quality of life and indeed improve productivity for this country. That is what we should aim for in 50 years’ time.