National Arthritis Week

Christina Rees Excerpts

Thursday 20th October 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered National Arthritis Week 2016.

It is a pleasure to serve under your chairmanship, Mr Betts. I am delighted that today, for the first time in five years in this House, there is a dedicated debate in Parliament examining the impact of arthritis. It is a privilege to speak in this House; that opportunity is not something we take for granted. It is good to come along to expound and inform on an issue that is so important. I am very pleased to see the Minister in his place. I think he and I will be in this position many times, debating health issues that interest us. It is good to see right hon. and hon. Members here. I know they will all make significant contributions.

Arthritis, along with musculoskeletal conditions, has a massive impact on people’s everyday quality of life. While I am disappointed that we have not spoken sooner in the past five years about this topic, I am pleased that time has been allocated today by the Backbench Business Committee, which I thank, for such an important debate that enjoys cross-party support. Opposition Members seem to be well balanced, and I am pleased to see the hon. Member for Congleton (Fiona Bruce), who is always here; I thank her for that and look forward to her contribution.

I should make it clear at the outset that the title of this debate is a slight misnomer, as the National Arthritis Week campaign has been replaced by the “Share Your Everyday” campaign, led by Arthritis Research UK, which is encouraging the public to share their stories of living with arthritis so that research is better targeted at the issues affecting most people with arthritis. We need to break the stigma of talking about pain and loss of dexterity and mobility, so that we can help to alleviate it. I urge Members to show their support for the campaign by sharing their own stories. I know there are Members here today who will do so, and that will be a very effective way of underlining this issue.

We should begin by discussing arthritis, because the burden on the individual is clear and substantial. It brings pain, isolation and fatigue and stops people doing the things that matter to them, keeping them from the world of work, from enjoying leisure time and from spending time with their families. Those are all key issues. I want to thank Arthritis Research UK—some people from it are in the Gallery—for supplying us all with notes and information to help the debate develop. We thank it for the hard work it does.

Arthritis should not be seen as a by-product of old age. For some it is, but for others it is not. The examples that I, along with others, will give show that arthritis is not only an elderly person’s ailment. It affects thousands of young people and millions of working-age people. One in five people over 50 have osteoarthritis in their knee. There is a young girl in my constituency who I went to appeal with several times. She suffers from chronic inflammation of the bowel—a by-product of severe arthritis, which led to her being medically retired at the age of 28. This is not an elderly person’s disease by any means.

The burden of arthritis on society warrants greater debate. Arthritis has an impact in a number of ways, particularly on our health and care system. Each year, 20% of the population consults a GP about musculoskeletal problems. The NHS spends £5 billion per year on arthritis— its fourth largest programme budget. That puts into perspective the enormity of what we are looking at today. I was struck by the stories shared on the Facebook page set up for this debate, so many of which are genuinely heart-breaking. One that stood out was that of a young girl of 27 who is waiting for a hip replacement, having suffered from arthritis since she was 20. That underlines, again, that this is not an old person’s disease. It knows no barriers, no age restrictions and certainly no class or creed barriers.

There is also the issue of workplace absence, with 30.6 million working days lost to the economy each year. The indirect cost to the economy of arthritic conditions is £25 billion. We do not necessarily want to focus on the financial aspect, but we can look at the figures as an indication of how important it is to address this issue and to raise awareness through this debate.

The scale of the burden is growing, with an ageing and increasingly physically inactive population. The numbers are sure to rise in the coming years. I briefly want to describe some of the characteristics of arthritis. When we talk about arthritis, we are talking about a number of different musculoskeletal conditions within the categories of inflammatory conditions, joint conditions and fragility falls and fractures, which are key factors.

The first group is inflammatory conditions, such as rheumatoid arthritis, where the immune system rapidly begins attacking the joints in the body. Those conditions affect around 1% of the UK population, including people of all ages, and have serious consequences. The second group is a range of conditions that cause musculoskeletal pain, the most common being osteoarthritis. Some 8.75 million people have sought treatment for osteoarthritis, with the true number of sufferers likely to be even higher. As is often the case, we are just scratching at the surface. The gradual onset means the condition mainly affects the elderly, but 2.36 million working-age people in the UK have sought treatment for knee osteoarthritis. Lower back pain, the most common form of disability in the UK, also falls into this group of conditions.

The final group is osteoporosis and fragility fractures. Osteoporosis is a silent and painless disease, but it causes fragility fractures after falls from standing height that afflict mainly but not exclusively elderly patients. The disease causes weakening of the bones and some 300,000 fragility fractures in the UK per year, of which 89,000 are hip fractures. The impact of those fractures on elderly, frail patients can often be severe, taking away their mobility, independence and, in some cases, their lives. We have to consider that.

Arthritis is not inevitable. Preventive measures must be the focus in tackling it. We need to address the risk factors for arthritis and musculoskeletal conditions. Links between being overweight or obese and long-term conditions such as heart disease, cancer and diabetes are well known—I declare an interest, as a diabetic. I am glad to say that I am almost back to the weight I was before I got married, which is quite something. I am trying to keep off all the sweet things, if I can. However, being overweight or obese is also a major risk factor in various forms of arthritis. It is the single biggest avoidable cause of osteoarthritis and increases the likelihood of developing inflammatory conditions such as rheumatoid arthritis.

Every one of us, as an MP, is aware of these issues because our constituents come to see us. In many cases, we deal with related benefit issues, and that is how we come into direct contact with people affected by arthritis.

[Christina Rees (Neath) (Lab/Co-op)]

I am grateful to the hon. Gentleman for securing this really important debate. These conditions cause not only physical but psychological problems. A girl came to see me, aged 19. She said:

“Arthritis is unpredictable. It flares up suddenly. Medication problems make it difficult for me to manage. It is hard to explain to my friends why I cannot do something I could do last week, because I look so normal.”

Does the hon. Gentleman agree that we have to look at the damage these problems are causing youngsters in their everyday lives, including in how they associate with their friends?

[Jim Shannon]

I thank the hon. Lady for her intervention and for outlining how arthritis can affect people at the age of 19. I am aware of a constituent who is even younger, which really surprises me.

Rising levels of obesity, combined with our ageing society, could lead to a near doubling in the prevalence of osteoarthritis in the UK by 2035. The Government need to make sure that musculoskeletal health is always included in assessment of the population’s health locally and nationally; that the benefits of physical activity for people with musculoskeletal conditions are emphasised in health promotion messages; and that, when programmes targeting lifestyle factors such as obesity and physical inactivity are being designed and delivered, their impact on musculoskeletal health should be explicitly included. So there are many things the Minister could respond to, and I look forward to that.

Above all, the Government need to make sure that effective physical activity services are available locally. This is crucial, and I hope colleagues from all parties will join me in calling for a National Audit Office review of physical activity services for people with osteoarthritis so that services help people across the UK to maintain good musculoskeletal health. We need to address that.

I want to speak about benefits as well. I know about osteoarthritis and rheumatoid arthritis because I have sat across a table from a person helping them fill in disability living allowance forms, now personal independence payment forms. People tell me their story, because we need to know their story when we help them fill in the forms. We need to know what they have done and what they have discussed with their GPs and consultants. The issues are very clear. I know that the Minister is not responsible, but for the record I implore the Department for Work and Pensions to make sure that, when it comes to filling in PIP forms, people have their full medical story told. They need an understanding person at the other end of the phone. I am not being disrespectful to anybody, but sometimes when we phone up about PIP, the person at the other end of the phone does not understand the medical details. I respectfully and gently say to the Government that we need someone on the phone who understands the medical condition and understands the issues and can therefore empathise with the person who does their 10-minute interview at the first stage of their PIP form before they do the full form. I think every MP would recognise that particular issue.

As I mentioned earlier, falls and fractures are a pressing public health issue among older people. Falls are the second greatest contributor to the burden of disability in the UK and a major cause of mortality. Around 300,000 fragility fractures occur each year in the UK, including some 89,000 hip fragility fractures, with 1,865 cases submitted to the national hip fracture database in Northern Ireland. Hip fractures are the most common cause of accident-related death in older people, resulting in some 14,000 deaths in the United Kingdom every year. We know that 20% of hip fracture patients die within four months of their injury and 30% within a year. This is a growing problem. Projections show that by 2036 hip fractures could account for 140,000 hospital admissions in the UK each year, with care and treatment costs rising to £6 billion. Let us put that into perspective and do the sums. Let us address the issue early on and do away with the cost impact further down the line.

We need more joined-up treatment in such cases because, once a first break occurs, it is vital that a second break is avoided. A fracture liaison service, the FLS, which provides targeted assessment and treatment for those with fractures, is widely regarded as the best way to address the problem of preventing future fractures. It is both a clinically effective and a cost-effective solution. Despite this, only 37% of local health services in England have a fracture liaison service. We need local commissioners to ensure that a fracture liaison service is linked to every hospital and held to account for commissioning fracture liaison services that cross the boundaries between health and social care so that the two marry. It is important that it does so. Arthritis may not kill, but it attacks what it means to live. The normality of life will never be the same with arthritis.

The condition limits people in doing the things that matter to them, but with greater personalisation and help in managing their condition, the NHS, care services and our welfare system can help people push back the limits of their condition. Too few people with arthritis currently have a care plan. Many people cannot quickly access physiotherapy without a GP referral, and people with arthritis need more help so that they can be in work, which is where most of them want to be if only that was possible. People with arthritis know how their condition affects them better than anyone else. Personalised and person-centred healthcare is therefore essential to move forward.

Care planning is an approach that people with long-term conditions can use to manage their health and wellbeing. It is based on a two-way conversation with a healthcare professional where goals are shared and actions agreed. If we could arrange that, we could help them. A better system should be in place to make sure that that happens. This can offer important benefits to people with arthritis, yet only 12% of people with arthritis currently have a care plan. If it is only 12%, there is something wrong and we must address that. That number needs to increase if we are to enable more people to manage their condition.

There are other tools that health and care services can use to enable people with arthritis to manage their conditions more effectively. Physiotherapy is a clinically effective therapy that can substantially reduce pain and restore movement for people with arthritis. Again, is it available for everyone? If it is not, it should be. I gently ask the Minister how can we make that happen. I look to the Minister, as I always do, for a sympathetic and understanding response.

Self-referral to physiotherapy is a system that lets people go directly to an NHS physiotherapist without a GP referral. This system is associated with improved health outcomes and patient experience. It is good that it is cost-effective and reduces the burden on GPs. All people with arthritis in Scotland and across much of Wales can already access physiotherapy directly. We have many friends and colleagues here from Scotland, and I know that they will make contributions that I suspect will indicate what is being done in Scotland. I must say I am envious of some of the things being done there. I would love to see those things in place in Northern Ireland and across the whole of the United Kingdom.

In the rest of the UK, for example, only a third of clinical commissioning groups in England offer self-referral and it is still only being piloted in Northern Ireland. That needs to change. When inflammatory conditions such as rheumatoid arthritis strike, delay can be a major risk factor and the clock starts ticking once symptoms develop. Early identification and treatment is needed rapidly to control disease, minimise long-term joint damage and avoid lifelong pain and disability, but the NHS does not currently assess people with rheumatoid and other forms of early inflammatory arthritis—EIA—quickly enough, and national guidelines are not being met. Again, I gently say to the Minister: if the guidelines are not being met, what are we doing to improve that?

A recent clinical audit by the British Society for Rheumatology found that only 20% of people who see a GP with suspected rheumatoid arthritis or EIA are referred to rheumatology specialist services within three days, and only 37% of people referred with suspected rheumatoid arthritis or EIA are seen by a specialist within three weeks. Again, that needs to be addressed and I again look to the Minister for a response on that. Local commissioners across the UK need to achieve earlier diagnosis of inflammatory conditions. Arthritis and other musculoskeletal conditions are the most common diseases in our working population, and as the population gets older, an even greater proportion of workers will have conditions that include osteoarthritis and back pain. Those workers want to keep working, so we have to improve the system of healthcare to enable that.

Many people with arthritis want to work, and they can with the right support. However, only two thirds of working age people with a musculoskeletal condition are currently in work, compared with 74% of those without health problems. What is more, the rate of employment for people with arthritis is 20% lower than for people with no condition. We need better support to enable people with arthritis to work and we need to promote the Access to Work scheme that is in place, which pays for practical support and equipment. It is good that we have such a system, but I want to see better utilisation of it and fiscal incentives for employers to provide health and wellbeing initiatives that promote musculoskeletal health.

It is vital that more is known about people with arthritis so that research can be targeted at what matters most to them, but, worryingly, key data are not being collected. Arthritis Research UK is working to increase the quality and availability of data about the experiences of people with arthritis and about the public services that improve their quality of life. Arthritis Research UK and Imperial College London have developed a model for estimating prevalence using the existing NHS data currently available in England. I encourage all Members for English constituencies to visit the Arthritis Research UK website to get access to the data, which I understand will soon be available in Scotland, and later in Northern Ireland and Wales. We have a lot to do to catch up.

However, not enough data on people with arthritis are being collected, and that limits our understanding of the prevalence of the condition and action that can be taken in response. Moreover, data that are collected are not uniformly classified across the system. Definitions of musculoskeletal conditions used in other national data sets, such as those for benefits, are inconsistent. National survey content may need greater co-ordination. Again, I say gently and with respect that it is a question of how to do things better. I am speaking very quickly, Mr Betts, because I am conscious that other Members want to speak. I am probably rushing faster than usual, but I hope everyone can follow what I am saying.

A pivotal issue is the need to protect and build the UK’s excellence in medical research, so that researchers can continue working on a cure for arthritis. How important it is to find a cure. The centres funded by Arthritis Research UK have been at the forefront of research aimed at improving the lives of people with arthritis in the UK. It is marvellous and encouraging that they have uncovered breakthrough treatments that push back the limits of the condition. In the 1990s, centres supported by Arthritis Research UK—it has given us all the information—discovered that a molecule called tumour necrosis factor was causing the disruptive auto-immune inflammation of joints. The anti-TNF therapy that they developed has freed millions from the pain and disability caused by rheumatoid arthritis; it was also an inspiration for the field of biologics, medicines that use the body’s own molecules to combat diseases. It is crucial that that work, and the work of all medical research charities, should be supported by the Government in the long term with a real-terms increase in science spending. It is not something for the Minister to respond to, but I would seek his assistance and support on that point.

Within the life sciences sector, substantial investment by medical research charities drives improvements in health and generates wider societal and economic benefits. In 2013, medical research charities invested about £1.3 billion in UK medical and health research, which represents more than a third of all publicly-funded medical research in the UK. The Government have recognised that our science base is a vital national asset— a view that I and all Members present, including the Minister, subscribe to—and they have reaffirmed their intention to make Britain the best place in the world for science. We all support that ambition. It is crucial to uphold that commitment, through a real-terms increase in science spending over the long term.

That would include bolstering the charity research support fund, which provides an uplift to support charity-funded research in universities. It is a marvellous asset, investing a lot of money in research. That joint funding of research ensures that charitable donations are invested directly in research that meets the needs of people with medical conditions. In 2013, the Government’s £198 million investment through the CRSF leveraged some £833 million of investment by charities in English universities. That is a significant, marvellous, gigantic sum of money to help to find cures. When the House debates rare diseases—and we do our best in these matters—we often refer to the good work done by charities, universities and the relevant partnerships.

[Christina Rees]

rose—

[Mr Clive Betts (in the Chair)]

Liz McInnes. Sorry, Christina Rees.

[Christina Rees]

My arthritis is in many ways self-inflicted; it comes from a lifetime of playing sport. I have no cartilage in my right knee, which is severely arthritic. Then there is my lower back—I do not think anything much works any more. Does the hon. Gentleman think that there should be more research on people who have played sport and become arthritic? In this day and age we advocate participation in sport, without really looking at the long-term consequences.

[Jim Shannon]

The hon. Lady is right and I think many of us recognise what she says. We encourage people who are obese to do more sport. We encourage young people, rather than playing on computers and laptops, as they so often do, to take part in more physical activity. However, we must consider the side-effects of that as well, and ensure that we help with them. I hope that what I have said about responding early has been taken on board. With an early response to signs of deterioration, the hon. Lady might not today be in as much pain; although I can tell hon. Members that I have seen her moving around the House, and she moves at some rate. The hon. Lady is obviously not completely restricted, and I say well done to her.

Without the CRSF there would be less funding to invest in world-class research. The UK’s medical research landscape is currently undergoing major change with the formation of UK Research and Innovation through the Higher Education and Research Bill. I expect that the whole House would agree that is crucial that the CRSF should increase in line with charitable investment, within the new research funding system, to safeguard research in the long term.

I look forward to hearing the remarks that will follow in the debate, including the personal experiences of arthritis of Members’ constituents—and perhaps also those of Members themselves. Much more can be done to improve the quality of life of people with arthritis, and to push back the limits of that worrying condition. We have an opportunity in Parliament to play a huge part in ensuring that our constituents get a better quality of life. I look forward to hearing the speeches of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and of the Minister.