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1.13 pm
The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns): I thank the hon. Member for Stratford-on-Avon (Mr. Howarth) for raising this important subject. I was particularly interested to hear the valid and important points he raised, although I suspect that he would not expect me to accept his interpretation or analysis of certain issues.
As the hon. Gentleman said, neurological disorders affect large numbers of people. The Neurological Alliance estimates that about 1.8 million people suffer from them. Whether they are relatively common conditions such as Alzheimer's, stroke, epilepsy or Parkinson's disease, less common ones such as motor neurone disease, or very rare conditions such as progressive supranuclear palsy, they impose an enormous burden on sufferers and their families. In addition, statutory health and social services clearly have a vital role in providing appropriate and effective services and treatment.
The Neurological Alliance has produced a very useful document: "Living with a Neurological Condition--Standards of Care". I am more than happy to endorse its broad thrust and its general message, as my predecessor did with the alliance's 1992 document--of which it is a revision. I am sure that health authorities, NHS hospital and community trusts and GP fundholders will find it a useful aid when they are drawing up contracts for services for people with neurological conditions.
Patients with neurological disorders--and their carers--are the real experts in what it means to live with neurological conditions. That is why one of the six medium-term priorities for this year and next requires the NHS to give greater voice and influence to users of NHS services and their carers in their own care, the development and definition of standards set for NHS services locally and the development of NHS policy locally and nationally.
As far as the development of policy nationally is concerned, Ministers and officials of the Department of Health have close contacts with the Neurological Alliance--which includes nearly 30 charities representing people with neurological conditions and their carers. Indeed, my predecessor formally launched the alliance in the House in February 1994.
The alliance is receiving five years' core funding from the Department, amounting to £91,000 in total, and in 1996 we funded the production of its document, "Providing a service for people with neurological conditions", that includes a model of care which purchasers and providers of health services may wish to adopt. The alliance contributed to the NHS executive's listening exercise on the primary care-led NHS, and provided some very helpful comments.
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We attach great importance to the need to involve users of services and their carers and representative bodies in the development of policy. We also have close contacts with many of the Neurological Alliance's member organisations, several of which have received funding from the Department under the section 64 general scheme of grants.
For example, officials at the Department are working closely with the epilepsy charities on the Department's epilepsy initiatives, for which funding has been provided amounting to more than £300,000 so far, including more than £30,000 to NHS epilepsy services development projects. The MS Society was closely involved in the guidance we issued last year on the introduction of beta interferon to the NHS.
Some people argue that the Government should prescribe at national level what treatments the NHS should provide, including treatments for people with neurological disorders. I do not believe that that would be right. No such list of treatments could ever hope to accommodate the range and complexity of the different cases that individual clinicians face all the time. It would be entirely inappropriate to take decisions out of the hands of the clinicians treating patients and into the province of others who possess neither the experience of caring for patients nor the expertise to make such decisions.
The role of the centre is to set the strategic direction for the NHS--as we do in the annual priorities and planning guidance and in other documents such as our recent White Papers on primary care and "A Service with Ambitions". We said in "A Service with Ambitions":
Mr. Burns:
If the hon. Gentleman will bear with me, I hope to address later in my speech the question of the number of neurologists and what is being done to increase it to provide greater care for people suffering from neurological diseases.
The White Paper continued:
Patients need to be confident that those working in the health service have the right knowledge and skills to do their jobs properly. The White Paper "Choice and Opportunity--Primary Care, The Future" sets out proposals to ensure that professionals working in primary health care have access to education and training that matches the needs of their patients. It responds to calls
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Primary care has developed rapidly in recent years. Advances in medical knowledge, backed up by new technologies, larger teams of dedicated staff bringing new skills to primary care, and increasing investment, have raised both the quality and the range of services provided. At the same time, many primary care teams have taken on a wider role in the provision, planning and management of services through GP fundholding and GP-led commissioning.
However, those changes and opportunities have also led to pressures on the service. Changes in the work force, including expectations and aspirations of those involved, have contributed to the pressures. Although services have generally improved, we acknowledge that the effect has been patchy. Some parts of the country and some groups of people continue to be less well served than others.
The hon. Member for Stratford-on-Avon raised a valid and important question about GPs. He was right to say that GPs may only once or twice during their working lives--a relatively short time--see patients suffering from one of the more complex or rarer problems that he described. Obviously, one cannot expect GPs to be experts on the subject and to be able to address the problems of those patients, but it is important--as I am sure the hon. Gentleman agrees--that they have the ability and the knowledge to refer such patients to the relevant neurologist or other clinician who can deal with those cases.
The hon. Gentleman also raised the question of the number of neurologists working in the health service at present. There are currently some 260 consultant neurologists in England and Wales, and their number has increased by about 4.3 per cent. in the past five years. I can reassure the hon. Gentleman that the Department of Health and the specialist work force advisory group will continue to monitor the need for additional neurologists and to seek to redress the problem, if the research shows that to be necessary.
The hon. Member also mentioned collaboration between agencies, which is critical for the provision of a first class service. Collaboration, both at a strategic level and at the level of individual care packages, is essential to meet the needs of people with chronic diseases, such as neurological disorders, and for older people with complex needs. Groups representing people with chronic conditions have emphasised the need for care co-ordination and management responsibility to be clearly assigned within primary health care teams.
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The Department of Health, working with the Department of the Environment, has encouraged innovation in collaborative working, through guidance on joint commissioning and through training and development support. Further work is in progress to identify good practice in collaborative working across primary and social care boundaries.
People want and need information that will tell them about specific conditions and diseases, especially chronic conditions. The voluntary sector has developed a wide range of such information. For example, the British Epilepsy Association, the Motor Neurone Disease Association and the Parkinson's Disease Society all produce good, up-to-date, user-friendly literature to help to inform those who contact them. The freephone health information service puts callers in touch with appropriate support groups and provides condition-specific literature. The voluntary sector also provides people with information on appropriate services as well as advising what people can do for themselves to control or improve their condition.
I join the hon. Member for Stratford-on-Avon in paying tribute to the voluntary sector and to carers. They play an important role in providing practical and emotional support. In many ways, they are the unsung heroes of society, whose work all too often passes unnoticed because of their professionalism and commitment. They do not seek praise or attention: they get on with doing the job. By definition, people who are determined to get on with the job do not necessarily attract the thanks, support and praise that they richly deserve.
One of the principles of good primary care is that professionals should be knowledgeable about the conditions that present in primary care, and skilled in their treatment and in contribution to their prevention. Professionals need to be knowledgeable about the people to whom they are offering services, and services need to be co-ordinated by professionals who are aware of each others' contributions--including inter-professional working--and who know when to refer people for specialist care.
"the NHS and its partners should give increasing priority both to the prevention of physical and sensory disability, and to the problems associated with disability where it has been diagnosed. At the point of diagnosis people should be informed honestly, sensitively and fully of the nature and consequences of the disease and given access immediately to counselling, advice and support."
Mr. Gordon Prentice (Pendle):
Is it not a disgrace that, in some parts of the country, it can take up to six months from examination by a general practitioner to examination by a neurologist? My hon. Friend the Member for Stratford-on-Avon (Mr. Howarth) made a key point about the shortage of neurologists. In Lancashire, it can take six months to get an appointment to see a neurologist.
"The NHS should be leading the way in changing public attitudes towards disabled people."
I am sure that no hon. Member would disagree with that. We all, regardless of our political views or prejudices, should work together to advance that cause.
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