National Arthritis Week

Philip Boswell Excerpts

Thursday 20th October 2016 Westminster Hall

[Philip Boswell (Coatbridge, Chryston and Bellshill) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank everyone who has contributed to this important debate. Arthritis is a disease that affects many; most people know personally someone who suffers from it. I particularly thank the hon. Member for Strangford (Jim Shannon) for bringing this important issue and debate to the House.

The hon. Gentleman mentioned some of the good work carried out in Scotland. One initiative that is worth mentioning is self-referral for physiotherapy. A multi-centre national trial involving 26 general practices and 3,000 patients in Scotland identified that an average episode of care was more cost-effective when it followed self-referral for physiotherapy than when it followed GP referral. That equated to a saving of 25%. If the initiative was rolled out across Scotland, it would provide an average cost-benefit of £2 million a year. I hope that the Minister is listening.

A common misconception about arthritis is that it is a disease that primarily affects older people—something touched on by hon. Members in the debate. Arthritis affects people of all ages and takes many forms, a number of which, such as rheumatoid arthritis, can begin at a very young age—again, that was highlighted by the hon. Member for Strangford. Many individuals in the working-age population face the prospect of managing this long-term degenerative illness while in employment. Arthritis is not always a visible condition, and the prevalence of the disease among the working population can easily be underestimated.

In fact, according to Arthritis Research UK, musculoskeletal disorders are the most prevalent diseases in the UK working population. Worryingly, the statistics indicate that not enough is being done by employers to support employees affected by these conditions. It may be surprising to many people, but musculoskeletal problems cause the greatest number of working days lost; 30.6 million working days are lost each year. Back pain alone costs the economy about £10 billion a year.

Unfortunately, due to a lack of support, only just under 60% of people of working age with arthritis are in work. However, the responsibility to support those with arthritis lies not only with employers, but with the Department for Work and Pensions and the wider UK Government. The role that this Government must play in assisting those with arthritis and other musculoskeletal disorders in the workplace has become even more important with the growth of the gig economy and the prevalence of those who are self-employed, a large portion of whom are not self-employed by choice.

I have one constituent, whom I will not name, whose story is incredibly pertinent to the debate. My constituent was diagnosed with rheumatoid arthritis at the age of 14. For those who do not know, three quarters of people with rheumatoid arthritis are of working age when diagnosed. Two years after onset, one third of those diagnosed will have stopped working. Within 10 years, half are unable to work. The Disability Discrimination Act 1995 requires employers to make provision for employees with disabilities and long-term conditions. However, my constituent does not have an employer because he is self-employed. As I said before, this is not through choice, but from necessity, given the increased flexibility seen in the workplace over the past few years—by flexibility, I mean the mechanisms implemented for the erosion of workers’ rights that is so prevalent in our society today.

As my constituent is self-employed, he does not have the same protections as those who work for traditional employers. He cannot take time off work, as that would directly affect his income. He is not entitled to sick pay, and often finds himself having to work despite flare-ups. As he is a joiner—a job that is much more physical than others—he is particularly affected during a flare-up; even something as simple as driving to a job can be a struggle. However, he enjoys his work, has invested his career and a number of years in building up his skill set and, in addition, has a family to provide for and simply cannot afford to retrain for a different role. In many ways, he is stuck between a rock and a hard place, and he has both my sympathy and my full support.

The UK Government are not just failing to support those who are self-employed; there are also substantial failings in support for those employed in a traditional sense. As I am sure many of us here can attest, numerous constituents come to us for help because they have their personal independence payments unfairly stopped or reduced after assessments. This is of particular concern for those who struggle with arthritis, which is very much an invisible disability—a point touched on by the hon. Member for Neath (Christina Rees). In addition, symptoms can fluctuate in severity, which can make an accurate assessment of the impact of the disease difficult in a time-restricted interview setting. In a recent survey, almost three quarters of people with musculoskeletal conditions who had a face-to-face work capability assessment said that they did not feel that they had received sufficient support to help them get back to work. Clearly, more action needs to be taken.

In summary, no one should have to take redundancy because of a lack of support for a manageable long-term illness. I look to the Minister and his Government to do more to support arthritis sufferers. Let us see whether there is indeed such a thing as a caring Conservative. The test will be in the action of the Government, rather than the words of their spokesperson.

--- Later in debate ---

[David Mowat]

I thank the right hon. Gentleman for his intervention. The fourth division of the Liverpool Shipping league is probably a higher division than I played in during my very short football career.

Due to the time, I will not refer to every speech. The Scottish National party spokesman, the hon. Member for Linlithgow and East Falkirk (Martyn Day), talked about what Scotland is doing on managing obesity and chronic pain. I would like to see England learning more lessons from Scotland’s health system; and, I humbly suggest, vice versa—I also include Wales in that. Health is devolved and we are beginning to do things in different ways. Sometimes things will work well, and sometimes things will work less well. One of the highlights of these debates is to hear what happens in other nations, and those remarks are interesting.

The shadow Minister also gave a good speech. She talked about budgets and health spending, particularly public health spending—she has now been able to tell two Health Ministers about that issue—and it is true that the public health budget was cut. The UK spends above the OECD average on health and adult social care, which has not always been the case. We are not the highest spender—we spend 9.9%, but France and Germany probably spend about one percentage point more—but we are above the OECD average. It matters very much how effectively we spend that money. There are always decisions to be made, and those decisions are sometimes difficult.

What are we doing? I will not be able to answer all the points in great detail other than to say that MSK is a priority because it is so important. MSK is one of the national programmes within NHS England, and in 2013 we appointed a clinical director, a gentleman called Peter Kay, who is running a £5 billion programme covering a number of areas and seven strands of work, which I will briefly run through.

First, we need to ensure good awareness of the signs and symptoms of MSK. That is about public health and things such World Arthritis Day and the UK “Share your Everyday” campaign. It is also about the important Public Health England activities that we have heard about. We ran a successful public health campaign on arthritis last year, and we need to maintain that pressure.

Secondly, we need high-quality clinical guidance to diagnose and manage the disease. Thirdly, we need to provide holistic care, support, and planning in partnership with patients. Fourthly, and this is important, we must spread best practice across the NHS—I would go further and talk about spreading best practice across the health systems of all the Administrations within the UK. Fifthly, we have heard a lot today about the benefits of physical activity for MSK patients, notwithstanding some of the issues experienced by the hon. Member for Neath and the right hon. Member for Knowsley. Fitness and exercise are of course a preventive measure for nearly everything, particularly for MSK diseases.

Penultimately, we need to do more to enable people to remain in work and to return to work. Finally, we need to invest in research. Those are the seven streams of activity, and I will talk a little about the one that has been spoken about most this afternoon, which is what we are doing to keep people in work. As I said, the points about DWP and PIP were well made, and I will see that that is reflected to DWP Ministers.

[Philip Boswell]

I am delighted to hear about the open door to Arthritis Research UK, which has been excellent in championing the rights of arthritis sufferers, preventing the onset of arthritis, developing a cure for arthritis and transforming lives. Arthritis Research UK’s work is considerable, and it is worthy of our support. I thank the Minister for his words and his initial actions.

[David Mowat]

I thank the hon. Gentleman for those words. It occurs to me that I have to give the hon. Member for Strangford time to say a few words at the end. I will write to Members about the various specifics that have been raised. I will now sit down and allow him half a minute or so. I apologise for there being so little time.