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DELEGATED LEGISLATION
Mr. Deputy Speaker (Sir Alan Haselhurst): With permission, I shall put together the motions relating to delegated legislation.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
That the draft Public Finance and Accountability (Scotland) Act 2000 (Transfer of NAO Staff etc.) Order 2000, which was laid before this House on 3rd March, be approved.
That the draft Organisation for Joint Armament Cooperation (Immunities and Privileges) Order 2000, which was laid before this House on 7th March, be approved.
That the Code of Audit Practice for Local Authorities and the National Health Service in England and Wales, which was laid before this House on 9th March, be approved.
That the draft Air Quality (England) Regulations 2000, which were laid before this House on 9th March, be approved.
That the Local Government Finance (England) Special Grant Report (No. 60) on 1999-2000 Special Grant for unaccompanied asylum-seeking children (HC 330), which was laid before this House on 13th March, be approved.--[Mr. Pope.]
Question agreed to.
11.40 pm
Mr. Desmond Swayne (New Forest, West): It is my privilege to present a petition in the name of my constituent, Mrs. Pamela Combes, which has been signed by some 750 of my constituents. The petitioners are concerned about proposals for new housing in Hampshire, equivalent to the building of a settlement the size of Southampton. They believe that that will devastate vast tracts of countryside, overwhelm the health, leisure and education services, cause massive congestion and overwhelm the life of rural communities.
The petition states:
Wherefore your petitioners pray that your honourable House ask the Deputy Prime Minister to totally reject the advisory panel's proposals to build 169,000 new houses in Hampshire.
To lie upon the Table.
Farmers (Midlands)
11.41 pm
Mr. Patrick McLoughlin (West Derbyshire): It is my privilege to present a petition to the House that was given me yesterday at a crisis rally of Derbyshire farmers and other farmers from the midlands, on the eve of the summit that the Prime Minister is to hold tomorrow.
The petition states that farmers in the midlands
wish to draw the attention of the House of Commons to the plight of farmers.
The petition is signed by some 2,400 people, and is a sign of the growing concern about the Government's treatment of the countryside.
They call upon the House to support positive action to provide the viable production of true British food and ensure the maintenance of the British countryside.
11.42 pm
Mr. John Bercow (Buckingham): It is my privilege to present a petition tonight on behalf of Mr. Tim Andrew and 541 other residents of the parish of Brill in my constituency. The petition objects to the proposed erection by Orange Communications Services Ltd. of three antennae on the fire station drill tower in Temple street or in any other densely populated area of the village, because of the villagers' concern about the health risks that the erection of the antennae could pose.
The 542 petitioners represent the overwhelming majority of those canvassed on the subject. They state:
The Petitioners therefore request that the House of Commons urge the Secretary of State for the Environment, Transport and the Regions to do all in his power to prevent the erection of the said antennae.
To lie upon the Table.
Pain Management
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Pope.]
11.43 pm
Mr. Paul Burstow (Sutton and Cheam): My interest in the subject of pain management was first aroused by correspondence from constituents--people writing with concerns and complaints about the fact that they were having difficulty securing access to services locally, and in particular that they were waiting a considerable time.
From those initial inquiries and the correspondence that I had with the local NHS trust, I began to develop an appreciation of the pain management services available to my constituents--their value and their potential.
One person who, I know, values the help and support that she received from the centre of pain education at Sutton hospital, which is part of the Epsom and St. Helier NHS Trust, is Denise. She even wrote a poem to the staff to show how much she appreciated their efforts. Denise was first diagnosed as having rheumatoid arthritis in 1977, when she was just 21 years old. She has lived with pain ever since. With the exception of the period following the initial onset of the disease, she has managed to hold down a full-time job and the running of a household. As she says in her own words:
I have not sought this debate because I have a beef with the Government. Rather, I hope to encourage the Minister to consider pain management, particularly the management of back pain, as a candidate for development and investment as part of the Government's NHS modernisation programme. I believe that investment in pain management services would substantial dividends for individuals, their families, their employers and society as a whole.
In preparing for the debate, I have been grateful to the patients and staff at the centre of pain education at Sutton hospital for their help and advice. I am also grateful to BackCare, which is the only national charity concerned solely with back pain and reducing its impact. BackCare has done an excellent job of collating a wide range of facts and figures about the prevalence and causes of back pain, many of which exist within Department of Health statistics, but it has brought them together in a way that makes them more comprehensible. I appreciate the work that it has done.
From that work, it is clear that back pain is clearly the No. 1 cause of disability in Britain. More than 1 million people are disabled by it. But back pain can affect us all. The most recent figures suggest that two in five of the adult population--more than 16 million people--have had back pain lasting for more than a day. One in five of the UK adult population have had pain which lasted for more than four weeks. For 2.5 million people, back pain is constantly with them, day in, day out, without respite.
Back pain costs the UK some £6 billion a year. As much as two thirds of that is accounted for by 180 million lost working days every year. The cost to the NHS alone
is put at between £360 million and £640 million a year, with 900,000 hospital bed days per year being taken up by people with back pain.
The longer someone is off work with back pain, the greater are the odds that they will never return to work. In one in three cases of back pain the condition becomes chronic. For many long-term sufferers, their condition is not susceptible purely to physical interventions or medication. Often psychological or social factors are at play.
I am interested in how effective care pathways can be devised to integrate primary and secondary care to treat acute back pain with earlier diagnosis and appropriate medication and treatment. Were such pathways developed, the number of people suffering chronic back pain could be reduced significantly.
Since the UK Clinical Standards Advisory Group reported in 1994 and recommended a number of treatments for back pain, research has found that the availability of pain management services throughout Britain is patchy--perhaps another case of the previous Government's postcode legacy.
Research for the Medical Research Council and BackCare by the Wolfson Institute of Preventive Medicine concluded that efforts to improve access to those services should be focused on health authorities and primary care groups.
This month's issue of Professional Nurse features an article entitled "Early management of patients with back pain" by Jan Austin of the James Paget Healthcare NHS trust. The author puts it this way:
The fact that such poor advice is being given is worrying, because in 1996 the Royal College of General Practitioners issued guidelines on the management of acute lower back pain, which explicitly ruled out bed rest for back pain. Despite that, studies have found that the management of back pain by GPs falls well short of the guidelines.
I understand that work is in hand by the National Institute for Clinical Excellence's orthopaedic protocols advisory group. The referral protocols that it is drawing up for back pain will be crucial to further progress. I hope that the Minister may be able to give some idea of how that work is proceeding and when it will be concluded and published.
Aside from the wider benefits of investment in pain management and the benefits for the individual, there are, as I said, savings for the NHS. Evidence from an evaluation of pain management for chronic lower back
pain conducted by the centre of pain education at Sutton hospital in 1995 found that every 100 people who completed its pain management course produced a saving of £32,000 on analgesics and epidurals. The evaluation also found that seven out of 10 people completing the course had no further appointments with or referrals to consultants.
The centre of pain education, or COPE, runs 10 out-patient pain management courses a year for people who live with back pain on a daily basis. The programme is provided through a multi-disciplinary team, which comprises a psychologist, a physiotherapist and a nurse, who, under the medical supervision of a pain consultant, use and teach a wide range of techniques for managing pain. Physiotherapy, acupuncture, aromatherapy, relaxation and counselling feature in the COPE armoury.
The COPE philosophy is holistic and can have a powerful effect. It delivers results. When I recently attended a COPE support group meeting, one person who had been on the course described it to me as coming to an accommodation with pain. COPE has six clear objectives: to reduce depression and anxiety; to increase independence; to review and reduce use of analgesic medication; to reduce absence from and promote return to work; to increase self-confidence in managing pain; and to reduce dependence on the NHS.
In 1997, 147 people were referred to the unit; in 1998, a further 136 referrals were made; and 120 more people were referred in the first six months of last year. Demand for the service and, consequently, waiting times, have increased. COPE evidence and the testimony of people who have attended the course show that it can change lives.
The courses stop the downward spiral of increasing use of ever stronger drugs, with all the side effects that that may involve. They give people the confidence and knowledge to ask about their medication. As one course attender described it to me:
I should like COPE to develop an outreach programme, perhaps on a pilot basis, in Sutton. It would be based at GP clinics, thus providing easier access and education for patients as well as support for GPs. Such an approach could cut waiting times and allow earlier interventions to occur.
In the same way, collaboration between GPs, practice nurses and pain management services could lead to guidelines being drawn up on the use of pain relief drugs. A common protocol would go a long way to helping patients who suffer from chronic pain to secure access to effective drug regimes and, if they so desired, strategies for coping with pain with fewer or no drugs.
COPE currently provides a service only for those who suffer from lower back pain. However, a pilot scheme last year expanded that to include other sites of pain. It showed that other groups of patients responded well to its philosophy. I wonder whether the Minister will therefore encourage such co-operation between primary and secondary care, not only in my constituency, but in other places, especially on developing common protocols and outreach work.
As a participant in the COPE programme put it to me:
The article in Professional Nurse to which I referred summed up the point:
I shall end where I began, with Denise. In a letter that she wrote to me, she painted a good picture of what pain management meant to her. One of the passages in her letter particularly struck me and underlined the way in which pain management makes a difference at a personal level. She said:
The final sentence of the Clinical Standards Advisory Group 1994 report gave a stark warning. It stated:
Pain rules everything you do. It affects your relationships, as you become irritable and self-obsessed. It affects your social life, as outings have to be carefully planned to take account of your mobility, comfort, etc. It also prevents you joining in with many everyday events because of your special needs.
However, pain management has transformed Denise's life.
The focus of early management should be to relieve symptoms of pain and prevent disability by prescribing simple analgesia, encouraging the person to take up appropriate activities and arranging physical therapy. At the same time, the GP should encourage the patient to think positively about his or her recovery and return to work, providing advice, reassurance and support using appropriate terminology to avoid the negative effect of poorly chosen language.
It is worth stressing that bed rest is not recommended. In fact, in many cases, it makes matters worse. But GPs are still recommending that course of action to as many as one in four of the people who come to see them about back pain. That is crazy. Such bad advice fuels a vicious circle of disability. Less activity leads to less mobility, which in turn leads to more pain and greater disability, and so on.
Too familiar is the patient that started off with back pain and ended up by going into renal or liver failure or both.
Perhaps that is a stark view, but it is echoed by many members of the support group whom I met.
Having attended the 8 weekly visits to Sutton Hospital COPE Unit my overwhelming regret is that I was unaware of how much difference the skills of the team could have made to my life had I known of them three years ago.
That person suffered three years of constant pain. Like many other sufferers, she needed primary and secondary care to collaborate closely.
Working within guidelines ensures that patients are referred to the most appropriate point of secondary care, preventing a journey through services with long waiting times and resulting delays in assessment, diagnosis and rehabilitation. Delays fuel frustration and despair, with the patient often waiting months or even years for a referral to a pain clinic when other disciplines have discharged them. Illness behaviour and pain is by then well-established and more difficult to manage.
Managing pain can make a dramatic difference in the quality of a person's life. It can reduce their dependence on drugs and help them to get back to work; it also has knock-on health benefits.
One other part of the course that sticks in my mind was the day when we were invited to bring a close relative or friend to one of the sessions. My partner, who has been with me for 17 years, came to the meeting. We realised that although we had coped with my problems for all those years, we had never actually talked about it! He said he learnt a lot about what I had to cope with and I learned how much more he wanted to help me. I realised that I had been struggling needlessly due to a sort of pride and embarrassment. We felt closer afterwards, and since.
There are beacons of hope and good practice. The Centre of Pain Education in my constituency is one of them. We now need clear guidance to GPs and primary care groups and trusts to build and signpost the care pathways and ensure that the necessary people-centred services are commissioned and provided in primary and secondary care.
If we do nothing to improve the situation, total social costs of back pain in Britain are likely to continue to increase by up to £0.5 billion per annum.
We need to do something about that; I hope that the Government will be able to do so.
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