Crohn’s and Colitis Treatment: England

Andrew Gwynne Excerpts

Wednesday 24th February 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I, too, commend the hon. Member for St Albans (Mrs Main) not only on securing the debate and the eloquent way in which she opened it, but on the work she is doing to help raise awareness of Crohn’s and colitis. Although the debate is about the situation in England, we have had a valuable set of contributions from Members from Wales and Scotland. While it is right that the public health Minister is responsible for this policy area in England, there is a lot of experience and research that we should be sharing. We should also be sharing a lot more understanding of what each part of the NHS in each respective part of the United Kingdom is achieving in the work to try to tackle some of the issues.

I put on record my thanks to Crohn’s and Colitis UK for all its hard work in briefing Members of Parliament for this debate, and for all the work it has done since its inception in 1979. I will let you into a secret, Sir Roger. I am fairly new to the shadow public health role, although I have been on the shadow Health team for some time now. I must confess to not being entirely abreast of the issues facing IBD sufferers before looking at them for this debate. Frankly, what I found stunned me. More than 300,000 people in the UK suffer from Crohn’s or ulcerative colitis, and that equates to some 460 people in my constituency alone.

While that is a lot of people, IBD is not as prevalent as some of the more common long-term conditions. That means that research funding, as we have heard over the course of this debate, is thin on the ground, and there is not the same level of awareness in the general public at large. Put simply, it is not a glamorous cause. There are few outward signs of having the condition, but the effect on lifestyle is massive for the people concerned. Many of the problems that we discuss regularly in terms of cancer are just as pronounced when it comes to IBD, and not only include pain, fatigue, sleep deprivation and disruption to life in general, but also relate to awareness, diagnosis and psychological impact, and I want to touch on those things.

First, I want to address the problems of diagnosis. GPs need to be more aware of IBD. Every medical practitioner knows of instances of general abdominal pain and irregular bowel function being written off as IBS. As I have already said, I was not fully aware of the problem of misdiagnosis until I heard from Crohn’s and Colitis UK, so the matter does come down to awareness both among the general public and, importantly, among the medical community. Because the most pronounced symptoms of IBD are often the most embarrassing to discuss, the issue often gets swept under the carpet, even in the GP’s surgery.

Studies have shown that 35% of people with Crohn’s had three or more emergency admissions before they received a diagnosis. Frankly, that just is not good enough. I accept that some delays to diagnosis are inevitable, considering the nature of the disease, and clinical judgment should receive an appropriate degree of latitude, but we can and we must do much more.

There are some welcome signs. In 2013, NICE recommended faecal calprotectin testing as one option for doctors to help distinguish between IBS and IBD, which is welcome. There can be more effective use of that at primary care level, which would save not only money but would ensure better and more efficient care for patients: an undeniable win-win situation for all involved. How will the public health Minister improve the efficiency of the identification of suspected IBD? We also need to reduce the unnecessary use of endoscopies where less intrusive tests would do just fine.

I want to spend some time talking about the psychological impact, which Members have touched on today. Last year, the Opposition established the post of shadow Mental Health Minister, a job in which my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) is making a significant impact. Mental health is of paramount importance to the Labour party, and it is often the unseen damage that is most destructive. IBD symptoms, diagnostics and treatment can have a disastrous impact on a sufferer’s mental health. The uncertainty and sense of lost potential must be absolutely awful, and I cannot help but imagine how I would feel were one of my children told that they had IBD.

An audit in 2014 found that only 12% of services have a clear process to enable people suffering from IBD to see a psychologist or professional with knowledge of IBD. That figure may have improved—we might see that when the next audit is carried out—but however we look at it, it is not good enough. About 41% of IBD sufferers experience high levels of anxiety, and so of course we must do more, because many people living with IBD feel that simply having easier access to psychiatric services at critical points would help immensely. With the Government’s laudable commitment to ensuring parity of esteem, which we are fully behind, what is the Minister’s Department doing to make sure that people with IBD across England have the appropriate level of access to tailored psychological support with professionals who are familiar with the very specific issues they face?

I am pleased that hon. Members have mentioned the access to toilets strategy formed by my Labour colleagues in Wales. Obviously, an episode of incontinence in public is extremely embarrassing, and with incredibly poor access to public toilets being endemic across England, a person with IBD can feel anxious even being in an unfamiliar place. Many people with IBD have seen a devastating impact on their capacity to lead normal lives when they are away from home. I am therefore pleased that the Welsh Government have led by treating access to public toilets as a public health issue.

The Welsh Assembly is now considering the Public Health (Wales) Bill, which is close to the final stages of the legislative process. Some fairly simple steps can have a big impact on the ability of Crohn’s and colitis sufferers to lead normal lives when out and about. Councils, for example, could make better use of the toilets that are already in the community, whether in public buildings or private businesses. The Bill will place a duty on every council to publish a local toilet strategy. The Welsh Government are leading the way, and I hope the UK Government will follow suit. I appreciate that it might require intervention by the Minister’s colleagues in the Department for Communities and Local Government to halt some of the public toilet closures that we have seen in recent years, but will the Minister offer to discuss this not only with her colleagues in DCLG, but with my Welsh Labour colleague, Mark Drakeford? I think there is plenty of potential here.

My thanks go to all hon. Members for their contributions this afternoon. Some incredibly astute points have been made, and I hope the Minister goes away better informed, as I know I will, as a result of this debate. We owe it to those 300,000 people in the UK suffering from Crohn’s disease or colitis to come up with some better ideas in the coming months and years. This debate has given us a good starting point, such as the need for better public toilet access, and the need for more widespread use of less invasive diagnostic techniques. About 18,000 new cases of IBD are diagnosed every year, so this is not some fringe problem, but an issue facing people in every single community across the country. I look forward to hearing the public health Minister’s response.