Musculoskeletal Conditions

Sonia Kumar Excerpts

Tuesday 17th December 2024 Westminster Hall

[Clive Efford (in the Chair)]

I understand that Sonia Kumar has agreed that another hon. Member can make a contribution. I will then go straight to the Minister. As is the convention with half-hour debates, there will be no opportunity for the mover to sum up at the end.

[Sonia Kumar (Dudley) (Lab)]

I beg to move,

That this House has considered the diagnosis and management of musculoskeletal conditions.

I am grateful for the opportunity to have this debate. As chair of the all-party parliamentary group on osteoporosis and bone health, and as an advanced practice physiotherapist and first-contact practitioner, musculoskeletal health is my speciality. I am here to discuss the provisions needed to improve the diagnosis and management of MSK conditions.

My experience as an advanced practice physiotherapist is very much autonomous. I do not think many people know that physiotherapists work from paediatrics all the way to elderly care—from nursery all the way to palliative care. Most people do not know the work of a first-contact practitioner, which is a new service in which physiotherapists work with GPs to diagnose, assess and refer to secondary care, if needed. I was part of that vital service at Dudley Group hospitals, so I declare my interest as working on the bank there.

MSK physiotherapists work not only across hospitals and primary care but also in tertiary care. They work in fracture clinics, rheumatology, pain management and A&E. Not many people realise what we do. MSK physiotherapists are the specialists and experts in musculoskeletal diagnosis. That could include referring people for X-rays to look for suspicion of fractures or for MRI scans to look for sinister pathology, a differential diagnosis, masqueraders that look like Pancoast tumours, metastases or spinal or multi-joint cysts. Along with ultrasounds, guiding injections and prescribing, the scope of physiotherapists has expanded year on year, to a point where they are now specialising and moving their practice on to do simple surgeries, such as carpal tunnel releases.

I look not only from a diagnostic point of view but at the importance of managing MSK conditions, including in respect of rehabilitation.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate. There have been some worrying trends in the press in the last six months, in relation to children as young as 11. Does she agree that the NHS plan for change over the next five years is necessary, given that children as young as 11 are being diagnosed with arthritis? We need help and guidance for those whose lives might be impaired from an early age right through to older life, and who need coping mechanisms. The importance of this debate cannot be underlined enough.

[Sonia Kumar]

I agree with the hon. Gentleman. I have worked in paediatrics where many patients get diagnosed late and suffer with late onset. That affects their whole life from the beginning, including their ability to get involved with physical activity and to build relationships, or their mental health and sleeping patterns. Getting an early diagnosis is one of the solutions I want to put forward. I would like the Minister to consider involving physiotherapists from early on, at nursery stage, to find out why we are not picking up MSK conditions from a really young age so that we can provide health and wellbeing from day one.

[Dave Robertson (Lichfield) (Lab)]

I hear my hon. Friend’s point about early intervention and making sure that we diagnose MSK conditions as soon as possible. A member of my extended family suffers from pregnancy-related osteoporosis, which needs to be picked up as soon as possible so that appropriate treatment can be put in place and mothers supported through it. A new charity has been set up specifically for pregnancy-associated osteoporosis, and it is pushing for the #MeasureThatMum campaign to make sure that midwives are trained to pick up the condition at that point, as early as is physically possible. Does my hon. Friend support that?

[Sonia Kumar]

Of course. One of the things MSK physiotherapists look at is spinal fractures, 70% of which happen in the thoracic spine, generally in older women who have had poor bone health. It is essential to look after bone health from a really early age, while women are in their 40s, so that when they are older, in their 50s, 60s, 70s and 80s, they are on the right medication and doing bone health exercises to help for the future. For MSK conditions and osteoporosis, physiotherapists are essential. Spinal fractures are very often undiagnosed, and those who suffer spinal fractures as they get older are more likely then to have a hip fracture, after which the mortality rate becomes really high. My hon. Friend makes a very good point.

Let me explain why MSK physiotherapists and MSK care are so important. By 2035, two thirds of the population are expected to have two or more long-term conditions, which include MSK conditions. Versus Arthritis reports:

“Arthritis and related musculoskeletal conditions affect 20.3 million people in the UK.”

That means that one in six people has arthritis, which is a staggering amount. MSK conditions cost the NHS £5 billion a year, accounting for one in five GP appointments, 1.6 million hospital admissions and 30 million prescriptions a year. People with low confidence who feel that they cannot manage their conditions are more likely to attend hospital, while those who are most confident with long-term conditions have 38% fewer hospital admissions.

That is what we can do for the economy, but this issue is also about first-contact practitioners, as I mentioned at the beginning. With first-contact practitioners, we can save so many GP appointments. It is part of the long-term plan, which has been created to improve the impact on GP care and allied health professions that work in general practice. Working adults with MSK conditions are twice as likely to be economically inactive compared with those with long-term conditions. Of the people who are economically inactive due to ill health, 21% report having MSK conditions. It is about not just health but the economy and the wellbeing of the society that we are hopefully building together now that we are in government.

It is really important that we look at this issue in a holistic way. MSK conditions affect not just affect somebody’s mental health but their relationships and how they build them. They affect whether they can get into bed and sleep well, as well as their sleep hygiene. Perhaps a person eats poorly because they cannot get out, so they put on lots of weight. A person’s emotions, self-esteem and ability to work can be affected. I do not believe there is a silver bullet or that if we manage MSK conditions it will just fix one part. It has to be effective in respect of all the facets of somebody’s general wellbeing. We cannot tackle waiting lists and return people to work without that, and we need a strong workforce to plough back into the economy. It is incredibly important for people to understand that it is about holistic management and how we can improve health literacy and self-efficacy for people with MSK conditions.

I came to this debate to talk about solutions, as I am a solution-led person. We need to recognise the allied health professions in the NHS and build a workforce for MSK physios. That includes not just MSK physios but paramedics, podiatrists and every single person in the 14 allied health professions, all of which help to build resilience in the NHS, reduce waiting lists and build a healthier society.

MSK assessments need to happen from day one in nursery. We cannot expect paediatrics or care to be delivered well if we wait until the future, look back and say, “We should have done a better job when that person was younger.” If we looked at MSK conditions from day one—early in a child’s development and in their early years of support—there would not be a massive impact on society later in that person’s life because of having to do delayed diagnosis with multiple appointments and to look after their general wellbeing.

We also need to embed into society notions of what good health looks like from day one. That includes keeping active, going to classes and going to rehabilitation. We need a bigger awareness campaign about what being well looks like. It should not just be that the person leaves school and that is it; it needs to be lifelong. In the same way that people do continuous professional development, they should learn what looking after their body entails, and that should be translated into health policy.

We also need to increase the scope of physiotherapists’ practice. At the moment, they do not do DEXA scans, but they look at bone health in every other way. We look at X-rays, and work in fracture clinics, rehabilitation and trauma orthopaedics, but we do not look at the full picture of bone health. Will the Minister consider inputting that in future?

We need to increase the roll-out of community appointment days. We must provide same-day services for patients, including assessments, advice, health promotion and rehabilitation, and the community and volunteer sectors should provide support in a non-medicalised environment. If somebody has shoulder, knee or back pain, there should be a one-stop shop where they can be assessed appropriately, and they can then move on and get the right care at the right time.

We also need to put community care services on high streets and in places of worship. There are people who are not getting access, and there are massive health inequalities, so how do we promote care and health in difficult-to-reach communities? I would love to see care being put into places of worship and other locations people do not normally think of. I very much welcome the fact that the Government are already moving away from hospital care.

We also need to increase the number of first-contact practitioner places. A consultation with an FCP physio is £30 cheaper than the traditional GP-led pathway. MSK issues are one of the most common reasons to visit GPs, accounting for about 20% to 30% of appointments. Will the Minister meet me to discuss more of the solutions that I think need to be put forward to manage MSK issues? Would he be happy to visit my constituency to look at our fracture liaison service? I hope we will continue to fund that and that the service will be rolled out nationally.

[Clive Efford (in the Chair)]

I call Lizzi Collinge.

Oral Answers to Questions

Sonia Kumar Excerpts

Tuesday 15th October 2024 Commons Chamber

[Andrew Gwynne]

Given the national standards and framework that have been put in place in this regard, I hope very much that the NHS will be able to do precisely what the hon. Gentleman wants it to do.

[Sonia Kumar (Dudley) (Lab)]

Yesterday was Allied Health Professions Day, which raises awareness of 14 professions, including physios, speech and language therapists, and radiographers. Does the Minister agree that all the hard work of those professionals is really important for patient care?

[Andrew Gwynne]

My hon. Friend makes a really important point. The wonderful staff we have working across health and care ensure that our constituents receive, within a very tightly constrained health service, the best possible care that we can give them. The NHS is broken. We have to fix our broken health service, and having good-quality staff at the heart of it is how we are going to achieve that aim.

Mental Health Support

Sonia Kumar Excerpts

Thursday 10th October 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

It is a pleasure to serve under your chairmanship, Mr Dowd, and it is also a pleasure to respond to this debate on World Mental Health Day. I am grateful to my hon. Friend the Member for Ashford (Sojan Joseph) for securing the debate and for drawing on his long-standing experience of working in mental health care to raise so many important points in the debate. As several others have, including the shadow Minister, I thank everybody who works in the field of mental health, whether as a mental health practitioner or as one of the very many volunteers who give up their time freely to help people who are facing particular difficulties in their lives.

I am responding to this debate on behalf of Baroness Merron, the Minister with responsibility for mental health, so apologies if I do not answer everybody’s questions. I have taken copious notes and am sure that the powers that be sitting behind me have taken even more. If I do not answer all the points raised, Members can expect to receive something from the relevant Minister in due course.

It has been a great debate. I thank my hon. Friend the Member for Folkestone and Hythe (Tony Vaughan) and the hon. Members for Epsom and Ewell (Helen Maguire) and for Hinckley and Bosworth (Dr Evans). The latter made a really important point about the interrelationship between education and health in the whole sphere of special educational needs, autism and so on. I reassure him and others who made that point that the beauty of being part of a mission-led Government that has five missions—one is the health mission and another is the opportunities mission—is that it allows Ministers the opportunity to look at things in the round and break out of departmental silos. I assure him that on these issues I am having bilateral meetings with counterparts in the Department for Education about how we drive forward key elements of the health mission, and also about the role that the Department of Health and Social Care can play in achieving the Government’s opportunities mission. That work is taking place at departmental level.

I thank my hon. Friend the Member for Gateshead Central and Whickham (Mark Ferguson) for his contribution, and the hon. Member for Leicester South (Shockat Adam), who is not in his place but made some really important points, particularly about the impact of the Mental Health Act on black and minority ethnic groups. I, and the Government, think it is shameful that under the existing Mental Health Act black people are three and a half times more likely to be detained than white people and eight times more likely to be placed on a community treatment order. Our mental health Bill will give patients greater choice and autonomy and enhanced rights and support, and we will ensure that it is designed to be respectful in terms of treatment with the aim of eradicating inequalities. I put that on the record because the hon. Member for Leicester South made an important point.

I thank my hon. Friends the Members for Gravesham (Dr Sullivan) and for York Central (Rachael Maskell). My hon. Friend the Member for Hastings and Rye (Helena Dollimore) made a powerful contribution about Phoebe and about her ICB—I hope the ICB has listened. My hon. Friend the Member for Chatham and Aylesford (Tristan Osborne) made a contribution, as did my hon. Friend the Member for Stroud (Dr Opher). I reiterate to him that of course the arts have a powerful role to play in the health and wellbeing of the individual. I was fortunate last Friday to see the Manchester Camerata, one of the great orchestras in my home city, at the Gorton Monastery in my constituency, which is now a health and wellbeing hub. As well as understanding the work that it does, I also learned a lot more about social prescribing and about its powerful listening service.

[Sonia Kumar (Dudley) (Lab)]

As an NHS physiotherapist working in Dudley, I know very well that mental health is multifaceted. It affects not just one part of a person’s life, but everything: sleep deprivation, diet, overeating, undereating and building relationships. Does the Minister agree that we need more care in the community, including first contact practitioners, social prescribers and councillors in the community as the first line of treatment?

[Andrew Gwynne]

My hon. Friend is absolutely right. At the heart of the health mission that the Labour Government want to see is the shift from hospital to community, from analogue to digital and from sickness to prevention. What we do in the community really matters. Our ambition for the future of mental health services is wrapped up in those shifts, particularly the shift from hospital to community.

NHS: Independent Investigation

Sonia Kumar Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I am grateful to my hon. Friend for the work she does championing Milton Keynes. Therein lies the challenge: it cannot be right that delays in diagnosis lead to the difference between life and death. I am very lucky that my cancer was caught early. It was diagnosed quickly and treated quickly. Not everyone is fortunate, and I am so sorry that my hon. Friend’s family is bearing the consequences of what happens when things go wrong.

[Sonia Kumar (Dudley) (Lab)]

Despite the damning analysis of the state in which the Conservatives left the NHS, Lord Darzi says that its vital signs remain strong. Does the Secretary of State agree with the case for the health service being taxpayer funded, free at the point of use, and based on need and not the ability to pay?

[Wes Streeting]

I am delighted to see my hon. Friend from Dudley. I agree wholeheartedly, 100%, unequivocally.