Ankylosing Spondylitis

Norman Lamb Excerpts

Monday 25th February 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate the hon. Member for Ogmore (Huw Irranca-Davies) on securing the debate, and I was also delighted to hear from the hon. Member for Linlithgow and East Falkirk (Michael Connarty). I am conscious that, having allowed an additional speaker, we are quite short of time, but if I cannot deal with all the issues that have been raised, I will be happy to write to hon. Members who have participated in the debate to answer their questions.

I know that the hon. Member for Ogmore has worked tirelessly in this cause and speaks with great personal experience. One of the great values of debates such as this is that they focus our minds on subjects that otherwise do not get the attention that they might deserve, and we all benefit from that. I am grateful to him for that.

The Government fully recognise the importance of early diagnosis, of differentiating ankylosing spondylitis from other causes of back pain and of effective drug treatment. The hon. Gentleman spoke movingly of the impact that anti-TNFs have had on him, and the transformation that they have made on his life, along with regular exercise to maintain mobility, has clearly been quite remarkable. He is putting his words into action with his 50-mile walk. I would love to join him, and I would really enjoy his company, but sadly I do not think it will be possible. However, I absolutely agree to the meeting that he asked for as an alternative —it is an attractive alternative, and I look forward to it.

The Government also understand the importance of accessible information and support so that people can take care of their own condition. The ability to self-care is critical, as is regular follow-up by specialised practitioners. I welcome the lead that the National Ankylosing Spondylitis Society has taken in publishing its good practice guide, and I recognise that there is still too much variation within the NHS in the provision of services for AS and for musculoskeletal conditions in general. The question is what should be done to remedy those deficiencies.

The last Administration sought to improve the quality of care for a number of major conditions by means of a rather top-down improvement model, and I totally understand why. It involved a combination of national standards, a uniform national programme with target dates for achieving standards, ring-fenced funding for specific improvement initiatives, demonstration programmes and top-down performance management to ensure that the NHS delivered. The programme was clearly well intended, and we recognise that it achieved demonstrable improvements in a small number of major conditions—coronary heart disease and cancer, for example. However, that model of quality improvement would be totally impracticable and unsustainable if we attempted to replicate it across hundreds of less common conditions.

I recognise that 200,000 people have this condition—as the hon. Gentleman said, that is more than have Parkinson’s and MS—and such a move could overwhelm the capacity of NHS management, not to say that of national bodies such as the National Institute for Health and Clinical Excellence. The entire NHS budget could be tied up with rather inflexible packages of ring-fenced funding. It therefore seems that we need a general model of quality improvement that recognises that real people are different in all sorts of ways, and that increasingly people suffer from more than one long-term condition and need holistic, not atomised, care that meets their particular needs.

Given that time is tight, I will turn to the specific points raised by the hon. Gentleman. I agree completely about the importance of raising awareness of this condition among GPs, especially given the importance and difficulty of early diagnosis. The hon. Gentleman mentioned his long and winding road to finally getting a diagnosis after 10 years, which, as he said, is the experience of many people. I salute the valuable work done by the society’s GP awareness campaign, but we must also recognise that in their day-to-day work GPs have to deal with and recognise a vast number of different conditions and may meet a new case of ankylosing spondylitis only once every few years. There is no easy answer to that dilemma although in future computerised decision aids such as clinical knowledge summaries may help to prompt GPs to recognise or at least suspect more serious but rarer conditions such as AS.

The hon. Gentleman drew attention to the society’s recommendation that MRI scans should be used in the diagnosis of early AS, rather than waiting for damage to become apparent on a X-ray. I understand that a consensus for that proposal is developing among clinicians, but I am not sure whether there are any further actions that the Department or Commissioning Board could usefully take at this stage to promote a greater uptake of such an approach. In a sense, word is spreading among clinicians about the potential value of such a move.

The hon. Gentleman asked whether we should commission NICE to develop a quality standard or clinical guidelines for ankylosing spondylitis, but I am afraid I cannot offer a lot of comfort. As he may be aware, we have recently published a list of all quality standards that we currently expect NICE to develop, following extensive consultation with professional and patient organisations. The list includes a number of the more common musculoskeletal conditions but not AS. In future, the NHS Commissioning Board will be responsible for requesting NICE to develop additional standards. In the meantime, it is open to the National Ankylosing Spondylitis Society to propose to NICE that the quality standard for chronic pain should include a statement on the need to consider other serious conditions for patients presenting with chronic back pain. That might be a valuable thing to do.

The hon. Gentleman drew attention to the importance of support for self-help in managing this condition, and he leads from the front in that respect. As I have made clear, we are in complete agreement on that point, and the model of care to which I have already referred—which of course applies to other conditions and not just AS —will strongly promote that approach.

Finally, the hon. Gentleman invited me on his walk. I wish him well and hope that he gains great fitness as a result of it. I also think that a meeting would be of great value. I am delighted to have had the opportunity to debate this important issue, and I pay tribute again to the eloquent way in which the hon. Gentleman made his case for better care for people with AS. I hope that this debate will help to bring those issues even more into the public spotlight.

Question put and agreed to.