Health: Parkinson’s Disease

Lord Walton of Detchant Excerpts

Monday 10th January 2011 Lords Chamber

[Lord Walton of Detchant]

My Lords, in speaking in this important debate I must first declare an interest as a vice-president of Parkinson’s UK, and as a neurologist who has looked after a great many people with Parkinson’s disease in the course of my professional career.

It was in 1817 that James Parkinson, a general practitioner in Hoxton in London, published an essay on the shaking palsy, describing a disease that had previously been known as “paralysis agitans”. As a result of that important essay, the disease eventually became known across the world as “Parkinson’s disease”. The pathology of the disease was well recognised many years ago, largely dependent upon the failure of nerve cells in a part of the brain stem called the substantia nigra. It was in the middle of the previous century that two Viennese pharmacologists discovered that the normal substantia nigra produced an important neurotransmitter called dopamine, and that when these cells degenerated, the dopamine declined. That ultimately resulted in the introduction of a drug, a precursor of dopamine called L-Dopa, or levodopa, which was of course a major development in the treatment of this condition. I had the privilege in the 1960s of conducting and supervising the first controlled trials of treatment in Parkinson’s disease conducted by the Medical Research Council in the UK.

Many new drugs have been developed since that time. Some of them are new precursors; some of them are what are known as dopamine agonists, trying to persuade the cell to produce more endogenous dopamine; and there are many others. The treatment has improved immensely. The side effects of the treatment, however, are substantial. One of the lessons that everyone looking after patients with Parkinson’s disease has learnt is that it is crucial to develop expertise in knowing how to handle that drug therapy—to adjust it according to the on-off periods that occur. This is a matter of great expertise, which is why Parkinson’s patients require the expertise of a well trained neurologist or, at the very least, a well trained geriatrician with neurological training. That is crucial.

There have been crucial developments in research. We now learn of the importance of the alpha-synuclein gene and we note that free radical scavengers play a part in the etiology of this disease. There has even been exciting work done in which foetal nigral neurones have been implanted into the brains of some patients, producing dopamine. The benefits have been substantial but the side effects are great, and more work will have to be done before these forms of treatment become a most effective part of the management of these patients.

I am grateful to the noble Baroness, Lady Gale, because it was a privilege to serve on this inquiry, which she expertly chaired, dealing with the management of patients with Parkinson’s disease and the range of services available across the country. I repeat the first point: neurological assessment and the proper handling of treatment and drug therapy are crucial. However, so too are the services provided by carers, physiotherapists, speech and language therapists, occupational therapists and others. There is no doubt whatever that to have a team of people looking after those with Parkinson’s disease, with a range of expertise, reduces the number of patients who are admitted to hospital for emergency care. That in turn is of great benefit to the National Health Service.

Sadly, though, as the report has demonstrated, the postcode lottery continues; it is alive and well. The range of services across the country is still desperately uneven. We have heard about the 2005 national service framework and the NICE guidelines that were published in 2006 to try to persuade health authorities across the country to provide a standardised range of services for people with Parkinson’s disease, but they have not been universally adhered to.

I have serious concerns about the proposed GP commissioning consortia. I talked to the Secretary of State who said that the specialised commissioning services for this and other neurological problems will be handled by the specialised health commissioning board. I cannot see that a single national board is going to be capable of dealing with all the complexities of the specialised neurological services that Parkinson’s and others require, and I do not see how it will work without some kind of continuing regional services for the commissioning of these services. Whatever the excellence of the general practitioners and the commissioning services of consortia that they produce, I do not believe that this will be adequate to meet the needs of patients with Parkinson’s disease.

It is right that the Government must take action to do what they can to produce uniform national standards of care. Under the health Bill, have the individual care packages and accounts that were proposed by the previous Government made any contribution in the care of patients with Parkinson’s disease? Are the Government taking account of the work of the neurological commissioning support service established by three major charities—the Motor Neurone Disease Association, Parkinson’s UK and the Multiple Sclerosis Society? This body has made several important and far-seeing proposals. It is very important that the Government should take account of its views.

These developments are things that people with Parkinson’s disease and their families deserve. I hope the Government will take full note of what has been said today. I thank again the noble Baroness, Lady Gale, for so expertly chairing this inquiry.