Health: Neurological Conditions

Baroness Gardner of Parkes Excerpts

Monday 11th October 2010 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what is their assessment of the role of allied health professionals in maintaining the health and social well-being of people with long-term neurological conditions.

[Baroness Gardner of Parkes]

My Lords, the notice of the opportunity for this debate was very short, but the topic is an important one and I am delighted that we are debating it this evening. I thank those who are speaking. I know that in some cases they have had to alter their arrangements to enable them to be here and that many others who also have a particular interest in or knowledge of the subject cannot be here today.

I start by giving noble Lords the Royal College of Physicians’s definition of long-term neurological conditions:

“Long-term neurological conditions (LTNCs) form a diverse set of conditions resulting from injury or disease of the nervous system that will affect an individual for the rest of their lives. They include: sudden onset conditions (eg acquired brain injury of any cause (including stroke), spinal cord injury) intermittent conditions (eg epilepsy) progressive conditions (eg multiple sclerosis (MS), motor neurone disease (MND), Parkinson’s disease (PD) and other neurodegenerative disorders) stable conditions with/without age-related degeneration (eg polio or cerebral palsy). Taken together, LTNCs are more common than most clinicians realise. Some 10 million people in the UK are living with a neurological condition which has a significant impact on their lives, and they make up 19% of hospital admissions”.

Many of us would be glad to learn the precise definition of allied health professionals. There are 15 health professions registered with the Health Professions Council, including speech and language therapists; radiographers; therapeutic radiographers; and prosthetists and orthotists, who mainly make artificial limbs—two different words but the same profession. There are also podiatrists; some still use the word “chiropodist”. A podiatrist is principally concerned with keeping patients steady and supported on their feet. The aim is to reduce falls, which are a main cause of serious injury and hospital admission for people with long-term neurological conditions. It is interesting to learn that Botox injections in the ankle and foot may help patients with cerebral palsy.

There are also physiotherapists. Some call themselves chartered physiotherapists, but they are the same profession whether they are chartered or not: it is just a distinction. There are paramedics. Television has made us all familiar with paramedics and it is interesting to see how their roles have developed and are constantly expanding as new treatments are discovered and put to use.

There are also orthoptists, who look after eye health; occupational therapists; dieticians; art, music and drama therapists; hearing-aid dispensers; practitioner psychologists; and clinical scientists. A clinical scientist oversees specialist tests for diagnosing and managing disease, advises doctors on using tests and interpreting the data, conducts research and devises new therapies.

Each of those professions plays a significant part in the care of long-term neurological conditions. Often, their work is interrelated. It is always to the benefit of the patient and makes the difference between maintaining quality of life and losing that quality. Usually, a multidisciplinary approach is needed and used.

Many Members of the House will know of my personal interest, but I will formally declare it again. My eldest daughter, Sarah, was diagnosed with multiple sclerosis at the age of 21. Now, 30 years later, she continues to make the most of life and plays a full part in the community. She is a patron of the Multiple Sclerosis Trust and only this year became a council member of the Royal Horticultural Society. She knows, as do all of us in her family, the real difference that allied health professionals have made in her life. Under the care of the National Hospital for Neurology and Neurosurgery, she has an excellent consultant neurologist, but the practical help and advice for everyday life is given by allied health professionals.

AHPs are important to people with long-term neurological conditions, as they provide a vital input throughout the whole disease process—I emphasise the whole disease process—from early intervention to prevent disability, through the management of complex symptoms, to end-of-life care. For the National Health Service, they provide effective management of admission and discharge from hospital, thereby minimising hospital admissions and reducing length of stay. Maintaining people at home, thus preventing in-patient admissions, is very cost-effective for the National Health Service; £2,000 is the minimum cost of any admission. The use of specialist expertise to manage specific symptoms including those related to cognition, fatigue, pain, spasticity, speech and swallowing improves quality of life for the person with the condition, enabling people to maintain important life roles, such as working or looking after their family, reducing the cost to UK taxpayers. Interventions also prevent additional complications through treatment.

Allied health professionals enable people to self-manage and to remain within the community, again reducing national health costs. Allied health professionals bridge the gap between health and social services, working with people in home, work and leisure environments. In the current climate of wishing to ensure that health and social services are working together, the allied health professionals are vital. They are well placed to work with the new GP consortia to engineer service redesign and provide leadership for services. Multidisciplinary teams can provide a holistic and co-ordinated approach to intervention.

Professor Alan Thompson at the National Hospital for Neurology and Neurosurgery at Queen Square stated that,

“any model of care for MS has to have both breadth and expertise to address the wide range of problems and the flexibility to cope with variability, unpredictability and changing pattern of need”.

I believe that applies to all the long-term neurological conditions set out in the definition from the Royal College of Physicians.

Physiotherapy is probably the best known of the functions carried out by the allied health professionals. Although familiar to all, it is not always appreciated that benefits are not only physical but psychological and socio-economic. I was rather shocked to learn that there is not a single specialist physiotherapist for the 4,000 multiple sclerosis cases in Northern Ireland, and I wonder why that is so. For people with motor neurone disease or multiple sclerosis, physiotherapy cannot regenerate tissue that has been destroyed, but works to maintain functional strength, endurance and independence. In Parkinson’s disease, physiotherapy helps to maintain general levels of fitness and enable patients to maintain independence for themselves. It helps to prevent or manage falls, for example, by working on specific balance training. A physio usually works with an occupational therapist to look at ways in which to free the home environment of hazards. The Parkinson’s Society refers to the vital role of allied health professionals in neurology in treating the individual patient and not just the condition; it is important that each patient receives the therapies that they need at the right time to ensure the best management of their condition. That will prevent unnecessary deterioration and reduce the burden on the health and social care system.

Radiographers are necessary in diagnosis to provide accurate imaging examinations. The importance and limitation of the short window wherein a scan can benefit a person who has suffered a stroke has often been discussed in your Lordships' House. Speech and language therapists not only help with speech—a most necessary task to restore confidence after a stroke. They can also help patients with swallowing difficulties, which can occur in various conditions due to changes in mouth secretions. Podiatrists provide essential assessment and foot care for a wide range of patients, including those with cerebral palsy and peripheral nerve damage. Those podiatrists specialising in biomechanics are particularly relevant to the elderly. Dieticians are the only qualified health professionals who assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Their input is of great value in hospitals, care homes and the wider community.

Each of the allied health professions plays a vital part in the treatment of people with long-term neurological conditions. I have spoken about some of these professions, but my speaking time is over. I pay tribute to all for the wonderful job they do and recognise that it is the working together of those professions that makes them so effective. As long as people have these neurological needs, they will continue to need and value the great work being done by the members of the allied health professions. The points I have made summarise why all long-term neurological conditions are difficult for the NHS to manage, but the allied health professions are having a real impact.

I have not spoken about dementia but I am delighted that the noble Baroness, Lady Greengross, is here and I hope that she will do so, as it is so important in our lives. I would be glad to hear the Minister confirm that he understands the importance of the role played by the allied health professionals and that their work with patients will continue.