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House of Commons Hansard

National Arthritis Week

20 October 2016
Volume 615

    [Mr Clive Betts in the Chair]

  • 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it clear at the outset that the title of this debate is a slight misnomer, as the National Arthritis Week campaign has been replaced by the “Share Your Everyday” campaign, led by Arthritis Research UK, which is encouraging the public to share their stories of living with arthritis so that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.

  • 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?

  • 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.

  • Liz McInnes. Sorry, 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.

  • 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.

  • The hon. Member for West Ham (Lyn Brown) has apologised in advance for having to leave early on account of new Front-Bench responsibilities. It is normal protocol for hon. Members to stay for the whole debate, but on this occasion I accept her apology.

  • I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate, and for his excellent contribution. I also thank the charities, such as Arthritis Research UK, that work every day to reduce the suffering brought about by joint disorders.

    Last week was National Arthritis Week. The pain of arthritis is often invisible. Trying to explain its constant, chaotic pain to someone who has not lived with it can be very hard. A survey conducted by Arthritis Research UK found that 28% of women with arthritis feel that people do not really understand the pain they face. Despite trying to talk about it, they feel lonely with the disease. That is why today’s debate is so important. By talking about arthritis in this place, we can begin to tell people that they are not alone.

    I want to do that in a literal sense, by sharing my experiences of arthritis. In March 2015, we were two months away from a general election, which, as Members on both sides of the House know, is a difficult, stressful and busy time to be a politician. As part of the shadow ministerial team, I was driving up and down the country with my tiny dog Cara in tow, visiting fire stations and sharing Labour’s plans for the future of the fire service. It should have been an exciting spring, sharing a vision that I was passionate about, and introducing my little four-legged friend to a bunch of soppy but very brave firefighters. However, it was made difficult as I had been experiencing mobility problems for quite a while, and it was not unusual for me to be in constant pain and experiencing stiffness. However, until that point I had been able to fight through. I had not considered that I had a condition.

    In March, I finally hit a brick wall. I felt completely and utterly drained of energy and could barely walk more than a few steps. I had to drag myself up the stairs of my house by pulling on the bannister. I was unable to stand at street stalls for any length of time, or go canvassing. I contacted voters only on the phone, or at meetings where I could be completely sedentary. I needed help putting on my bra. I felt humiliated, embarrassed and a complete and utter failure. At the worst, I was struggling to stay awake for more than six hours a day. It can be imagined what that did to my mental health. The stress of not being able to fight that election on my own terms was overwhelming. The tiredness and pain were looked after by a specialist, but throughout that period I had no idea whatever of what the problem was. At times like that, the internet is not a best friend. My imagination was in overdrive. Only the support of good friends, comrades, my wonderful husband and my family got me through that election.

    Let me be clear. I do not want to come across as some kind of stoic hero. I am not. I cried, mainly in my doctor’s surgery as I was trying to get some answers. The staff must have thought I was completely wet. I found it really difficult to cope with the condition and the demands of work at that time. I know that many people have that feeling, and it is little wonder that musculoskeletal conditions account for one in five working days lost to ill health in the UK.

    Despite being referred to my arthritis service in November 2014, it was early May 2015 before I was finally diagnosed with seronegative inflammatory arthritis. I now know that fatigue is very common among sufferers of arthritis due to pain, stress and sleep disturbance. More specifically—this is not very well known out there—fatigue is a symptom of inflammatory arthritis. Chemicals called cytokines are found in the inflamed tissues and cause extreme fatigue.

    At that point I was put on a course of methotrexate, which thankfully caused the aggressive nature of the condition to begin to recede, but it was still quite aggressive, and I needed additional medication to get me to where I am now, taking methotrexate and injecting myself every fortnight with CIMZIA, a biological injectable medicine. The pain and restrictive movement have now subsided considerably. A number of colleagues have told me as I walk around the House that I seem to be doing much better, and I am.

    When I first met my arthritis specialist, she asked me what my goals were. I said I wanted to be able to walk Cara again, to wear heels and to play tennis, which would be some feat as I have never played tennis before. She laughed and said, “Let’s keep this realistic and start with walking the dog.” I am happy to say that with the support of the NHS I can now walk Cara for over an hour, almost entirely pain-free. At Christmas last year, I bought a pair of blue polka dot shoes as an incentive and a symbol of hope. I have worn them twice and, although they are not as high as those of the Prime Minister, or indeed our former shadow Chief Whip, my right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), they are a symbol of the progress I am making. What is more, I have just enrolled on a course of tennis lessons, which I will start in March next year, two years after I hit that dreaded wall.

    I have had good treatment, advice and support, and I thank my doctors for that from the bottom of my heart. Ten million people in the UK suffer the pain of arthritis and not all are as lucky as I have been. Moreover, I am told that with an ageing population and rising physical inactivity, the number of people living with arthritis will rise. We must make sure that every patient has access to excellent treatment. Due to the high cost of the drugs and the guidelines of the National Institute for Health and Care Excellence, most patients have to wait at least a year before they can access the transformative biologics that have made such a huge difference to my life. I had to wait just over a year, and that year was hard.

    The wait means that we are not controlling the condition at an early stage or enabling patients to stay active, independent and in employment. Surely this wait is not cost-effective to industry and the economy. I know that this is ultimately an issue for NICE, but making these drugs more widely available will transform arthritis care for many, as it has done for me. Let us be honest: there are problems with traditional treatments. Although methotrexate has been really important for me, it can have long-term negative effects on the liver, but coming off it is certainly not an option for me at the moment. I urge the Government to support research on the long-term effects of existing drugs, and to continue to support vital research into new treatments and life-saving drugs, so that we can help people to live pain-free into old age.

    I will be positive: there have been substantial breakthroughs in arthritis treatment as a result of research funded by Arthritis Research UK. They include treatment for rheumatoid and inflammatory arthritis, and treatment to prevent miscarriages in women suffering from antiphospholipid syndrome, which again is something I have. If only I had known a couple of decades earlier.

    World-leading scientists, working in British institutions, such as Leeds, Birmingham and Keele Universities, the Kennedy Institute at Oxford, and St Mary's hospital, London, developed these treatments. The biological treatments I am on have been developed here in the UK. We should be so proud of these achievements, but we must make sure that our medical research sector remains at the cutting edge. Now more than ever, the UK’s excellence in medical research is under threat. Many of us warned before the EU referendum that funding for medical research would be hit if we voted to leave. Vicky Forster, a researcher, wrote in The Guardian:

    “many scientific disciplines will lose EU funding post-Brexit”.

    That is certainly the case with arthritis.

    Figures provided by Arthritis Research UK show that between 2011 and 2015 the EU contributed over £2.5 million to its projects. Those researchers have gone on to secure more than £18 million of European funding to support the next stage of their work. It should be a priority for the Government to maintain our world-leading medical research sector. To do this, they need to ensure that overall investment in UK science and research is protected and grown in the longer term.

    The risk to research posed by Brexit does not stop at funding. Sir Paul Nurse, director of the Francis Crick Institute, said:

    “Science thrives on the permeability of ideas and people and flourishes in environments that pool intelligence, minimise barriers, and are open to free exchange and collaboration.”

    Leaving the European Union threatens this melting pot of ideas. In 2014-15, Arthritis Research UK committed more than £30 million to research that was hosted in the UK, but had collaborators in 13 European Union countries. If the Government want to make sure that our medical research sector remains as vibrant and as successful as it is, it is important to maintain the current ease with which those involved in medical research are able to travel and work across the EU and the UK.

    We should be truly ambitious as a country and aim to expand arthritis research and medical research more generally, not merely preserve what we have. I have been told that structures need to be in place to encourage our NHS clinicians to participate in research. At the moment, this is not possible due to the demands on the NHS and a medical culture that puts research second.

  • I commend my hon. Friend on making this excellent debate so moving. She shows how important this issue is. She is a living, breathing example of why research is so necessary. She looks 10 years younger than she did last year.

  • I say to the hon. Lady that four other hon. Members want to speak, and there are only 20 minutes left.

  • In conclusion, Mr Betts, I hope that sharing my experience today has helped to play a small part in letting people who live with arthritis know that they are not alone. I was lucky to have good treatment. I can now walk Cara, wear heels and look forward to playing tennis. I want the Government to make sure that the UK remains a world leader in medical research, so that we continue to find ground-breaking treatments and more of the 10 million people living with arthritis can live their lives relatively pain-free.

  • Four hon. Members want to speak, which means five minutes each. I call Fiona Bruce.

  • Thank you, Mr Betts. I shall try to speak quickly, but possibly not as quickly as the hon. Member for Strangford (Jim Shannon), who I think holds the record in this House. I commend him for leading the charge in calling for this debate and for an excellent speech, in which he made some recommendations that I fully support.

    As hon. Members are aware, Arthritis Research UK runs an annual campaign to shine a light on the experiences of people with arthritis, and the stories that have emerged are compelling. They give an insight into the pain, isolation and fatigue that is suffered daily by millions of people throughout the UK and caused by this debilitating disease. The campaign is powerfully titled “Share Your Everyday”. I have also heard stories from my constituency of Congleton of people living with arthritis and the detrimental impact on their quality of life. Time prevents me from quoting all the stories that I have, but I will give voice to one of those people. A lady called Christine Walker has given me permission to share her experience, and I pay tribute to her for her bravery in campaigning over many years, as I now know, to raise the profile of the need for greater support for those who suffer from arthritis.

    Christine has severe osteoarthritis. The pain started in her knees when she was in her 30s. By her 40s, both hips were affected and she experienced pain doing everyday tasks such as getting out of the car. In her 50s she started to develop painful nodules on her fingers and had problems gripping objects. It became increasingly challenging for Christine to hold a pen, or a needle to sew. Chopping food was difficult, and paintbrushes slipped out of her hand. She even went so far as to say:

    “Sometimes I just wanted to get a knife and chop off the lumps on my fingers; they were so painful.”

    Of course, Christine is not alone. As we have heard, Arthritis Research UK states that back pain, for example, is very prevalent. Indeed, in my local authority area of Cheshire East, it is endured by more than 66,000 people—almost 18% of the population. Arthritis Research UK further states that about one in seven people in the UK lives with arthritis. At that national level, three in four people live with arthritis or joint pain. The Daily Telegraph and Arthritis Research UK have indicated in a recent survey that that pain stops them living life to the full. Just like Christine, many people are suffering severely owing to this crippling condition.

    As the leading cause of pain and disability, arthritis is estimated to cost the NHS £5 billion a year. As we have heard, one in five people consults their GP about a musculoskeletal problem such as arthritis every year. That equates to 100,000 consultations every day. About 21% of patient visits to GP surgeries relate to arthritic conditions, and that goes up to more than 30% in the over-50s. The prevalence of these conditions is set to rise even further with growing levels of physical inactivity, obesity and an ageing population. That is why I greatly support the proposal from the hon. Member for Strangford that we improve advice to prevent, rather than just try to cure, this disease.

    Why does arthritis so often find itself at the bottom of the heap, as far as acknowledgement of medical conditions is concerned, with treatment and care too often inadequate or inconsistent? The first annual report of the national clinical audit of rheumatoid and early inflammatory arthritis, published on 22 January 2016, identifies that although most services offer prompt educational support and agree targets for treatment with their patients, quality standards are not always met, so sufferers like Christine are often told that they can do little more than take painkillers. Unless prompt and decisive action is taken, people like Christine throughout the UK will be forced to continue to suffer terrible pain, isolation and fatigue. We need to accept that arthritis is a common and long-term condition that warrants the kind of treatment, monitoring and support that is available for other conditions. When we speak to people like Christine, it emerges as evident that a major focus must be on greater investment in patient education programmes, equipping and resourcing people to manage their condition better and endure less pain.

    I want to relay Christine’s story as I come towards the end of my speech. In 2010, after years of having to rely simply on painkillers, Christine, along with about 250 others with hand arthritis, was invited to join a study funded by Arthritis Research UK at Keele University. It was run by Professor Krysia Dziedzic at Keele’s Arthritis Research UK primary care centre. The trial tested the effectiveness of exercises; an occupational therapist taught participants strengthening and mobilising movements.

    Christine described the experience as life-changing. She was shown how to squeeze out a dishcloth and hold a kettle with two hands, and told about gadgets that would help her to open cans, peel vegetables and slice bread. Tasks she had avoided were possible again. The trial showed her practical ways of coping and made an enormous difference. NICE guidance recommends that those diagnosed with this condition be offered the opportunity to take part in such activities, including self-management programmes. We must ensure that NICE best practice guidelines are met in that respect. Much work is being done, but it needs to be offered much more widely.

    I would like to give the last word to Christine and Arthritis Research UK. Christine says, “Taking exercise to help with my arthritis was a life-saver”. A rehabilitation specialist at her local gym in Cheshire taught her how to exercise better. She began a programme to build her muscles and paid more attention to her diet. She says:

    “It’s all about strengthening problem areas—quads, hamstrings, calf muscles and the upper body…By doing this, I’m taking pressure off joints and easing pain. And today I keep the pounds at bay through healthy eating, reducing the pressure on my knees and hips…Because I have stayed active, I can keep gardening and have fun with my grandchildren.”

    We should be giving that kind of help to everyone in this country.

    Arthritis Research UK says:

    “We need MPs to speak up for people with arthritis in the debate and call for decisive action so that everybody can live fuller lives with arthritis today, and without it tomorrow.”

  • 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.

  • It is a pleasure to serve under your chairmanship, Mr Betts, and an honour to be mistaken for my very athletic hon. Friend the Member for Neath (Christina Rees). I thank the hon. Member for Strangford (Jim Shannon) for championing this debate. I know from my role as the chair of the all-party parliamentary group on medical research that this debate on arthritis has been a long time coming, given the five-year hiatus in discussing the issue in this House.

    First, I pay tribute to the courage and strength of the 10 million people living in the UK who suffer from the disease of arthritis and musculoskeletal conditions. Secondly, we must celebrate the work, commitment and endeavour of thousands of carers who look after, whether in a personal or professional capacity, those who suffer from this illness.

  • Although I do not, as far as I know, have an arthritic condition, I do have an impacted disc. Frankly, when it flares up, without the support of family members, and in particular my wife, I would be in an impossible situation. It is important that we pay tribute to all those carers and family members who support people with these conditions.

  • I thank my right hon. Friend for that relevant intervention. We must never forget the usually unpaid work that carers do and the vast contribution they make to keeping people out of hospital and saving the NHS money.

    As many other hon. Members have done, I also thank Arthritis Research UK for the work it does highlighting the issues around this disease, which affects nearly one in six people in the UK. Arthritis Research UK provides the support that people with arthritis need, such as in-work help and funding for accessibility, social care and medical research. Arthritis Research UK spent £6.6 million on research this year, and during 2014-15, it committed £30.9 million of funding across Europe with its research partners. As many hon. Members have mentioned, it promoted World Arthritis Day, which was last week, and the excellent “Share your Everyday” campaign.

    I was fortunate enough to be able to table an early-day motion, which garnered signatures from across the House, recognising the issues and people I have just spoken about. To date, that early-day motion has attracted 44 signatures, and I thank all those hon. Members who supported the motion; hopefully, after this debate there might be more.

    Before entering this House, as a biochemist in the NHS, I worked at the forefront of patient care and research and development. The work on arthritis research in the UK is pioneering; it is uncovering new ideas and breakthrough treatments that will end the way in which arthritis limits lives. In the 1990s, it was UK scientists who discovered that a molecule called tumour necrosis factor—one of the cytokines that my hon. Friend the Member for West Ham (Lyn Brown) referred to—was the key molecule causing the destructive autoimmune inflammation of joints that leads to the problems of arthritis. The anti-tumour necrosis factor therapy that they developed has freed millions from rheumatoid arthritis and has also inspired the field of biologics—medicines that use the body’s own molecules to combat diseases. That is something we should be very proud of.

    The crucial work of all medical research charities is supported, in the long term, by Government through a real-terms increase in science spending. It is essential that that is continued, and that we back research and development, now and post-Brexit. The Government also need to play their part in supporting medical research funded by charities. The charity research support fund provides an uplift to support charity-funded research in universities and to contribute towards the full economic costs of research—costs such as lighting, heating and maintaining labs. This may seem a minimal ask, but it is the basis and foundation of what scientists, and the laboratories they use, require to continue their vital research.

    This joint funding approach ensures that charitable donations are directly invested in research that meets the needs of people with health conditions. In 2013, the Government’s £198 million investment through the charity research support fund leveraged £833 million of investment by charities in English universities. That is a staggering amount; without the charity research support fund, we would have less funding to invest in our leading research. We must commit to securing continual funding for this, to help those with debilitating diseases.

  • It is a pleasure, as always, to serve under your chairmanship, Mr Betts, and a pleasure to follow the hon. Member for Heywood and Middleton (Liz McInnes). In my time, I want to focus on discussing employment and the personal feelings of people with arthritis, because it is astonishing that only 59% of working-age people with arthritis are in work.

    I employ a senior case worker, Pam Wilson, who was diagnosed with rheumatoid arthritis and osteoarthritis ten years ago, just after she turned 30. She has spoken to me about the taboos of her diagnosis and how people view her condition as being an old people’s problem, which we know is not the case. Arthritis can occur at any age during a person’s lifetime, can be extremely debilitating and, due to its nature, is not visible to others. Pam has described to me situations where she has been described as being lazy and excluded from certain situations in previous employments, purely on the grounds of her health issues. This situation is faced by many arthritis sufferers.

    I would like to hear from the Minister today about how we can increase the number of people with arthritis in work. Can we ensure that employers understand these issues? Can we ensure they are working with trade unions, which know about these issues in terms of dealing with employees who require reasonable adjustments in the workplace? Can we look at the Access to Work programme to help those with arthritis? Can we look at the issue sensitively in terms of work capability assessments?

    I visited the drop-in organised by Arthritis Research UK last week, talking about the many misconceptions people have about those with arthritis. Pam Wilson is not lazy; she is a hard-working employee in a hard-working team assisting the constituents of Glasgow South West on a daily basis.

    As Pam says:

    “Yes I have had bad days, some awful days too, but I also have days where I can cope with the pain and medication side effects. It’s all about managing your own expectations of yourself and understanding what your body is telling you. Sometimes though it is other people who don’t understand. They think you’re lazy because you’re not as active as they are, not walking anywhere, not running or cycling places. They are looking at you and think you’re OK. Because people with arthritis do look OK! Time and experience make you put on a face to the world—one that says I’m fine, but inside and behind closed doors we’re struggling in pain, we’re tired. But we still smile and get on with it, grateful that new medications keep us mobile.”

    Hopefully this debate will make people understand arthritis. Sufferers are always grateful when someone understands the daily struggle, and it takes two minutes to ask how they are and understand their situation. I look forward to the Minister telling us what more can be done to improve arthritis sufferers’ employment prospects and how we can help to prevent and cure this condition.

  • I thank the hon. Gentleman for being so succinct in his remarks. I call Martyn Day.

  • It is a pleasure to serve under your chairmanship, Mr Betts. I start by thanking the hon. Members for Strangford (Jim Shannon) and for Congleton (Fiona Bruce) for leading today’s interesting and timely debate. It is surprising that it is the first such debate for five years.

    We have heard from many speakers how arthritis affects people, including young people and working-age people, and I thank my hon. Friend the Member for Glasgow South West (Chris Stephens) for his excellent example of a person in work and the real troubles that they face. We have heard how it is a fluctuating condition with symptoms that can change on a daily basis, as well as many personal cases and constituents’ experiences that highlight this problem affecting many people. We all know members of our own families who are affected.

  • I do not come to this debate with any great expertise, but my gran suffered greatly with arthritis, which affected the joints in her hands and legs and basically left her housebound. Does he agree that one of the real benefits of today’s debate—I pay great tribute to those who have secured it—is that we can raise awareness of the condition more widely, and that it is incumbent on all of us to go forward from this debate and do that?

  • I agree entirely with my hon. Friend.

    The scale and significance of this issue has been clearly illustrated by several key statistics that we have heard today. Several speakers have told us how each year, a fifth of the population consult their GP about musculoskeletal problems. There are 30.6 million working days lost each year to arthritis, which account for a fifth of all working days lost. Scottish estimates tell us that 60,000 people have rheumatoid arthritis, and 2,500 people are diagnosed each year. One in five people in Scotland experience chronic pain and one in 20 experience severe, disabling chronic pain, with the back and joints being the most common location for chronic pain. Arthritis Care has estimated that approximately 800,000 to 900,000 people in Scotland alone are living with osteoarthritis.

    All those figures highlight the enormity of the issue. However, we must remember that data collection and management is particularly poor for arthritis and musculoskeletal issues and it needs to improve if we are to get a clearer picture of the numbers across Scotland and the rest of the UK. That point was made by my colleague, the hon. Member for Strangford.

    On a positive note, Scotland is the only nation in the UK to routinely publish data on chronic pain. That is welcome, as we have one in 20 living with disabling chronic pain that has a serious impact on physical wellbeing and mental health issues. There is no doubt that arthritis and musculoskeletal conditions can be very disabling, and we must take action to raise awareness about the conditions and improve musculoskeletal health —be that by promoting physical activity, tackling obesity or using medicines.

    The hon. Member for Heywood and Middleton (Liz McInnes) made a point that we should all echo about carers’ work, which is often overlooked. In my constituency —I am sure this will be the case for most—we have a number of support groups for arthritis sufferers. The central arthritis self-help group in Grangemouth is a good example, with monthly meetings including entertainment and social events, along with talks on health and other subjects. The group also organises outings, hydrotherapy and exercise sessions. As a society, we owe a debt of gratitude to groups such as that for the work they do and to everyone else who is helping sufferers.

    There is much that can be done for sufferers. One of the most important things is faster diagnosis of conditions such as inflammatory arthritis, as with earlier treatment, they can be controlled better. In Scotland, there is much focus on tackling obesity, both to prevent and to treat musculoskeletal conditions. We must strive to do more to improve diets and encourage physical activity—in saying that, however, I recognise the point made by the hon. Member for Neath (Christina Rees) about sport-related conditions.

    In my area, a good example is Together for Health—often known as T4H—which is a community-based project that works to promote healthy lifestyles in the Armadale and Fauldhouse areas within my constituency and that of my hon. Friend the Member for Livingston (Hannah Bardell). It works in partnership with a range of local organisations, businesses and community groups to promote healthy lifestyles and delivers a variety of activities and events to encourage people to move more and eat better, with the overall aim of reducing childhood obesity.

    Key messages of the project include the benefits of a balanced, affordable diet, and encouragement of children and families to be more physically active and spend less time doing sedentary activities. That is not just a Scottish or a UK problem, of course. We have a global ageing population and although the link between arthritis and ageing is well known in our own countries, there are fewer data on how older people in lower and middle-income countries are affected.

    What we do know, however, is alarming. The World Health Organisation estimates that 9.6% of men and 18% of women aged over 60 have symptomatic osteoarthritis, and that 25% of those with osteoarthritis cannot perform the major daily activities of life. Taking action internationally is important for the millions of older people who are directly affected, but it also has an impact on the lives of many of those who depend on them. Often older people in developing countries are the main carers of children whose parents have had to leave for work or who have been orphaned due to conflict or illnesses such as HIV.

    In conclusion, it is important that we do more locally and internationally to help alleviate these conditions, and we must make preventive measures a greater priority.

  • It is an honour to serve under your chairmanship, Mr Betts.

    Today we are debating arthritis and what more can be done to help those who suffer from this terrible health condition. It is very welcome that the Backbench Business Committee allowed this debate to happen today, which is in arthritis awareness week and so soon after World Arthritis Day. I also thank the Members from across the House who secured the debate with the Backbench Business Committee, and the hon. Member for Strangford (Jim Shannon) for leading the debate this afternoon. He eloquently and clearly set the tone, and I thank him for that.

    As we have heard, this condition can often go unnoticed or ignored by individuals and wider society, and I hope that the awareness work seen this week has helped somewhat in changing that, along with the role that everyone here has played in supporting that culture change. Nearly 10 million people in the UK live with arthritis. The symptoms can vary; there are over 200 known types of arthritis and rheumatic disease. The symptoms include inflammation of the joints, pain, fatigue, stiffness and difficulty moving. It is quite a common misconception that arthritis is a health condition affecting only the elderly, but it can often affect all ages. That is why it is important that we raise awareness, and that more be done to educate the public on the symptoms, and on the support and help that is out there.

    However, we must also be aware that, given the ageing population, more people will suffer with arthritis. The number of sufferers is expected to rise by 50% by 2030. It has to be said that the Government’s short-sighted cuts to public health grants will only cause havoc if the proper finances are not put in place to address our nation’s health.

    Arthritis may not be a killer, but it does attack the way of life of many people. As has been put so eloquently today, this condition can make life a very painful struggle, with one in 10 people saying that they live with unbearable pain, day in and day out. The words of those who suffer with this condition can make the strongest cases for reminding us just how tough it can be to live with arthritis.

    In the words of Sharon—I am not talking about myself in the third person here, Mr Betts—who suffers with psoriatic arthritis,

    “It’s the forgotten condition that no-one thinks is important. It affects everything. It’s exhausting, depressing and makes you feel angry and frustrated.

    It robs you of the life you thought you were going to have, the one you planned with your family. It robs you of a sense of purpose. You can’t do what you want, when you want, it’s unpredictable.

    Life has to be adapted and constantly changed. The drugs make you feel sick and depressed and have side effects as long as your arm. It becomes important not to look back at what is lost and make an effort every day to look forward and think positively. But it’s invisible, other people don’t see any of that, you just look a bit stiff.”

    Those are extremely powerful words and should be a reminder to us all of how important it is to do more to help those suffering with arthritis.

    Hearing the stories and experiences of those who live with the condition is important to help raise awareness. That is why the aim of the awareness campaign “The Future is in your Hands” for World Arthritis Day last week was to highlight the stories of those who suffer. It reinforced the comments made by the chief medical officer back in 2012, who said that osteoarthritis, the most common musculoskeletal condition, is a

    “generally unrecognised public health priority”.

    The Government must listen to contributions of medical experts such as the chief medical officer, and to the expert opinion of those who experience arthritis. They must then act to do more to help those suffering with the condition.

    The Government could help to prevent the development of arthritis with preventive measures that relate to obesity and physical activity. Studies have shown that obesity is the single biggest avoidable cause of osteoarthritis in weight-bearing joints. With two out of three obese people developing osteoarthritis, it is important that we seriously get to terms with addressing obesity; that will create an environment in which those suffering with arthritis can flourish, rather than struggle.

    One key way to alleviate symptoms and support people who suffer with arthritis is by promoting physical activity, as it has been shown that regular physical activity can be beneficial in helping to reduce the impact of the condition on people’s lives. My hon. Friend the Member for Neath (Christina Rees), who is no longer in her place, pointed out that it was a lifetime of sporting activities—she is a very well-known squash player—that probably caused, or exacerbated, her arthritis. However, the National Institute for Health and Care Excellence has published clinical guidelines that recommend exercise as a core treatment for people with arthritis, irrespective of the severity of their condition.

    We need to know which services are out there, so that we can help people acquire the recommended treatment. That is why it would be beneficial for the National Audit Office to conduct a review into physical activity services for people with arthritis. That would help to ensure that we, as policy makers, have the necessary information to drive the policy agenda, and would help to map areas with a shortfall in support and services for those with arthritis. I hope that the Minister will shed some light on plans to undertake that work. Such an investigation would also be important in the light of the cuts to public health grants under this Government. Those cuts are a false economy, and compound the problems accessing services for people who are seeking to manage and improve their lives.

    I quoted the following figures to the Public Health Minister at about this time last week from this very spot, but they are worth repeating to the Minister here today. In the autumn statement, the former Chancellor announced further cuts to public health grants, which amounted to an average real-term cut of 3.9% each year to 2021. That translates to a further cash reduction of 9.6%. That is in addition to the £200 million of cuts to public health grants announced in the 2015 Budget. The Minister must bear those figures in mind when responding to the debate and whenever the Department takes action on public health issues. It really is a false economy to cut funding to already overstretched and burdened public health services, as that will obviously exacerbate the problems with those services in the long term.

    The need for further awareness of arthritis and its symptoms was clearly shown in a UK-wide survey of more than 2,000 people conducted by Arthritis Care last year, which found that more than a quarter of arthritis sufferers had waited two years to seek help after their symptoms began. When asked why, some 52% said that it was because it did not occur to them that they could have arthritis, and 28% felt that nothing could be done to address their arthritis. I hope that those who have listened to this debate have heard, loud and clear, that help is out there, and that delaying seeking that help will not aid them or their long-term health and wellbeing. That point was made eloquently by my hon. Friend the Member for West Ham (Lyn Brown), who, I think hon. Members will agree, looks 10 years younger than she did a little over a year ago.

    Raising awareness is vital. Last week, world-famous performer Robbie Williams gave a candid interview explaining that he suffers with arthritis and describing the impact that has had on his performance; as a Robbie fan, that concerns me. The more we talk about the condition, and the more that high-profile people, such as the MPs here today, talk about their experiences, the better.

    There have been so many eloquent and personal accounts in this debate. I particularly mention the brave and moving account of my hon. Friend the Member for West Ham. She will be playing tennis soon with our own parliamentary tennis champion, Mr Speaker, and I, for one, definitely want a front-row seat for that one. My hon. Friend is a true inspiration to the 10 million arthritis sufferers across the country.

    I hope that the Minister has listened not only to the debate and contributions from Members present, but to the voices of those outside this place who have called on the Government to do more for those living with arthritis and the pain that comes with it. There are many ways for the Government to do something, and ideas have come from across the House to steer the Minister in a direction that will help the 10 million people who suffer with the various levels of pain associated with arthritis. Let us hope that this time next year, when we recognise National Arthritis Week again, we will have helped more people to lead a healthier, happier and more pain-free life.

  • It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Foyle on leading the charge—[Hon. Members: “Strangford!”] I beg your pardon; I meant the hon. Member for Strangford (Jim Shannon).

  • I have more hair than the hon. Member for Foyle (Mark Durkan), but not much more.

  • Don’t take it as a compliment. It has been a long day.

    It seems extraordinary, thinking about some of the subjects we debate, that it has been five years since we have debated this subject in the House of Commons. The debate has been such a pleasure, and I am sure that hon. Members here will see to it that it is not five years before we debate it again. An objective of having a debate in Westminster Hall is to raise awareness. People watch these things, so it is right that we do that and it is important that we do it again next year.

    I have been a Minister for about two months, during which time I have met many people, so it has probably been remiss of me not to have met with Arthritis Research UK yet. I am keen to do that. Its representatives are pushing at an open door if they would like to come and see me. As the hon. Member for Coatbridge, Chryston and Bellshill (Philip Boswell) said, it is about action, not words. We will organise that meeting if Arthritis Research UK would like it to happen.

    Several hon. Members have mentioned the statistics, but I will repeat them because they are so important. Some 10 million people in the UK—one in six of the population—have an MSK condition. The most common, with 3 million sufferers, is osteoporosis. One in six is an extraordinary figure, and there are 200 variations of MSK conditions. One in 10 people in the UK suffers chronic pain as a consequence of arthritis.

    The numbers are mind-boggling. Some 20% of GP consultations are due to MSK conditions, and this at a time when our GP services are stretched in Scotland and in England. MSK conditions account for 30% of GP consultations for the over-55s, and some 7.5 million working days are lost each year. This long-term condition alone costs the NHS between £4 billion and £6 billion, so it is right that we are having this debate.

    There have been a number of interesting and useful speeches. Westminster Hall is sometimes a better place to debate such topics. The hon. Member for Strangford talked about lifestyle factors and preventive factors, and he and another Member made an interesting point about DWP and PIP. We need to be more joined up in how we deal with some of these long-term conditions, particularly as they become more prevalent. He also talked extensively and knowledgeably about research—he has clearly been well briefed—and about what we are doing.

    The hon. Member for West Ham (Lyn Brown) made an excellent speech about her personal experience, and she emphasised the overlap with mental health. She talked about first suffering from this during her election campaign last year. In fact, it prevented her from canvassing. I note that she got 36,000 votes and her vote went up by 6%. I do not know whether those factors are related. Well done on 36,000. We pass on our congratulations and awe at her performance.

  • Maybe it was a telephone canvass.

  • Maybe it was. The hon. Lady also talked about the delays to the start of her treatment and the one-year delay before she got the right drugs, which have been so transformative for her. That is an impressive story.

    The hon. Lady also talked about the concerns about the consequences of Brexit. The Government have made it clear that, whatever version of Brexit we end up with, science research will continue to grow in real terms and ongoing scientific programmes will continue. I was a remainer, and we often talk about the money that Europe gives to programmes. She said that £2.5 million was given to a particular programme, which should be seen in the context of the £20 billion that flows in the other direction. The real point is that we understand the need for science and will continue to ensure that that funding happens.

    The hon. Member for Neath (Christina Rees) made a good intervention about the consequences of sport and the unpredictable flare-ups that she has. She made the interesting point that arthritis can be invisible for much of the time before flaring up. The right hon. Member for Knowsley (Mr Howarth) is right to remind us of the role of carers. I remind Members that we are putting together a carers strategy, which will focus on unpaid carers in particular. That will come out at the end of this year. We are talking to a number of charities about that because it is important, given the stress and strain on our various systems.

  • I am grateful to the Minister for giving way and for the thoughtful way in which he is responding to the debate. For the sake of completeness, I should say that my impacted disc results from playing rather over-enthusiastic football in the fourth division of the Liverpool Shipping league, which the Minister will know is not a lofty place to play. Unfortunately many of my sliding tackles were badly mistimed, to my detriment.

  • 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.

  • 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.

  • 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.

  • I especially thank the right hon. and hon. Members who have made such fantastic contributions —every contribution and intervention has been great. The attendance has also been great. It is genuinely refreshing to have a Minister who understands the issue and is able to respond. We will take him up on his offer to have a meeting with Arthritis Research UK—I thank him for that. I look forward to working on behalf of constituents from across the whole of the United Kingdom of Great Britain and Northern Ireland.

  • Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).