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The Minister of State, Department of Health (Mr. John Hutton): I congratulate my hon. Friend the Member for Romford (Mrs. Gordon) on raising this important issue and on her thoughtful and well-informed comments. She has often shown a keen interest in health issues in the past, and the management of arthritis, as she has said, is an important aspect of health care.
Arthritis means inflammation of the joints and it is the principal cause of physical disability in the United Kingdom. The term "arthritis" encompasses more than 100 diseases affecting joints, the surrounding tissues and other connective tissues. These diseases and conditions include osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, which was a particular concern of my hon. Friend, and fibromyalgia.
Arthritis has a significant impact on health and community services, on those who experience its painful symptoms and resulting disability, and on their family members and carers. Its main symptoms are pain and loss of mobility, but the extent and severity of the condition vary from one individual to another.
Arthritis can, and does, affect people of all ages, as my hon. Friend has made clear, from young children to older people, but prevalence generally increases substantially with age. For example, it is estimated that about 70 per cent. of 70-year-olds suffer from some form of arthritis, mostly osteoarthritis. The leading charity in this area, Arthritis Care, believes that between 8 million and 10 million people in the UK suffer from some form of arthritis. This includes about 1 million adults under the age of 45 and about 15,000 children.
The pain and disability accompanying arthritis can be minimised through early diagnosis and appropriate management. These management tools include physical activity, self-management, physical and occupational therapy and joint replacement surgery. There are several ways in which arthritis can affect individuals. As my hon. Friend has said, the main impact is clearly physical. Arthritis sufferers endure pain, loss of joint motion and fatigue. As a result of these symptoms, people with arthritis are significantly less physically active than the rest of the adult population, even after taking their disability into account. Such a lack of activity puts them at greater risk of other diseases, including premature death, heart disease, diabetes and higher blood pressure.
Arthritis can make people more prone to stress, depression, anger and anxiety, and they may experience difficulty coping with pain and disability. That can lead to a feeling of helplessness, lack of self-control and changes in self-esteem and image. People with arthritis frequently experience decreased community involvement and can have problems finding suitable employment. These were both issues to which my hon. Friend was right to draw attention.
Rheumatoid arthritis is a family of related diseases, not a single entity. The problems are primarily a consequence of persistent inflammation of the joints. While any joint can be affected, it is usually in the small peripheral joints, such as the fingers or wrist, that the condition is first noticed. Rheumatoid arthritis currently affects about 5 per cent. of women and 2 per cent. of men in Britain. Sadly, the causes of RA are still unknown.
Treatment of rheumatoid arthritis includes the use of non-drug treatment such as rest and physiotherapy, but drugs may also be required both to control symptoms and
to slow down the progression of the disease. That is important because the longer the disease persists, the more the joints will become damaged.
The arthritis self-management programme is a promising development in the field of arthritis care and treatment--I know that my hon. Friend is especially interested in that aspect of arthritis management. Arthritis Care has developed a self-management programme for people with arthritis that is based on work undertaken in the United States. That has demonstrated major benefits to people with arthritis in America and has reduced the use of health services.
Encouraged by those developments, the Department of Health provided funds for Arthritis Care from 1996-97 to 1998-99 to help develop and pilot a self-management programme for people with arthritis in England. My right hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), when she was a Health Minister, launched the initiative in November 1997.
The arthritis self-management programme is a major project and has several components. It involves the development and provision of self-management courses around the country for people with arthritis. It is a user-led programme, in which all the course leaders are people with arthritis. The programme is delivered by volunteers, is community based and is concerned with empowerment and the development of self-effectiveness. The Department funded the evaluation of this programme, which has demonstrated improved pain management, reduced depression and also resulted in less drug dependency among those participating in the courses.
The Long-term Medical Conditions Alliance also uses the model to ascertain whether people with other conditions find it helpful in managing their illnesses. The Department is providing the LMCA with funding of almost £100,000 over a three-year period to 2001. The aim is to increase knowledge about self-management programmes and the availability of information about living a healthy life with chronic conditions. My hon. Friend expressed anxiety that the Government were not doing enough about such issues. I hope that she is reassured that we take them seriously and that we are trying to respond to them.
In the White Paper "Saving Lives: Our Healthier Nation", the Government announced their intention to set up an expert patients task force, led by the chief medical officer, Professor Liam Donaldson. Its task is to develop a programme to help people with chronic conditions to maintain their health and improve their quality of life by supporting them to take an "expert" role in managing their conditions.
Arthritis Care's self-management programme was used as an example of good practice in the White Paper. The programme, which is equally applicable to people with other chronic conditions, helps participants to develop a range of skills to deal with their conditions. The pioneering, patient-led project will inform the work of the task force and the approach is likely to form an important component of the final programme. Another vital part of the task force's work will be to link self-management programmes, developed in the voluntary sector, with
mainstream NHS and social care services. My hon. Friend gave an example of such a development programme and I should be happy for her to explain her interest in that scheme in more detail at some other time.
The Government also support medical and clinical research into several conditions, including arthritis. The main agency through which the Government support research is the Medical Research Council. The council is an independent body which receives its grant in aid from the Office of Science and Technology, which is part of the Department of Trade and Industry. The most recent figures, for the year 1998-99, show that the council spent nearly £1.3 million on research into osteoarthritis, rheumatoid arthritis and rheumatism. That included £160,000 on projects involving juvenile arthritis.
The Department of Health's policy research programme funded a study entitled "Primary Care Interventions in Osteoarthritis". It was a four-year study undertaken by the university of Nottingham, and designed to determine whether exercise could lessen the burden of knee pain in the general population. The report of the study's findings is now at the final draft stage.
Several other studies into arthritis are currently under way, including one in Oxford to investigate key design features of the current hip replacement. Another major investigation at Stoke-on-Trent into the treatment of rheumatoid arthritis aims to identify whether the disease should be treated aggressively, with the aim of suppressing the inflammatory response, or symptomatically, with the aim of minimising functional loss and pain. All patients in the study will be over 18 and will have been diagnosed with rheumatoid arthritis that has had a duration of between five and 20 years. The study is on-going and will cost around £600,000.
My hon. Friend also referred to the availability of drugs to treat arthritis. She will be aware that many different classes of drugs are used to treat patients who suffer from the condition. They include, for example, analgesics to control pain and non-steroidal anti-inflammatory drugs. The latter decrease the body's inflammatory response to disease or injury, but have little or no effect on the underlying disease and therefore cannot prevent the progression of joint destruction or organ damage. There are also a number of side effects associated with most drugs currently used to treat arthritis.
Cox-2 inhibitors, which are a new class of pharmaceuticals, are being developed. They promise similar benefits to other similar drugs, but with a much lower risk of causing ulcers. There is likely to be uncertainty over the appropriate use of these products, especially in relation to simple over-the-counter alternatives such as paracetamol. The National Institute for Clinical Excellence has been asked to review the evidence on Cox-2 inhibitors, make recommendations that will forestall any possible variations in uptake and help to ensure that patients are appropriately targeted. It is expected to report in January 2001.
There is, of course, always hope that new technologies will be developed that can alleviate pain and disability for arthritis sufferers. We have, for example, asked NICE to assess the possible benefits of a new treatment in which damaged hip or knee cartilage is taken out, repaired in the laboratory and replaced in the patient's body. We need to know whether the procedure is cost-effective and whether,
over time, it could lead to a reduction in the prevalence of debilitating osteoarthritis. Such a scientific breakthrough could have a major impact in the future. Today, however, patients may be offered interventions ranging from heat treatment to major surgery. Keyhole surgery techniques, through the use of arthroscopes, are commonplace in orthopaedic departments for assessing osteoarthritis of the knee or removing damaged cartilage, and 100,000 such procedures are carried out annually in NHS hospitals. However, for many, mainly older, patients, the total hip or knee replacement offers the most effective treatment for the debilitating and distressing health problems associated with osteoarthritis. Those are the treatments of choice for most older patients and the latest figures show that 35,000 primary hip replacement operations and 25,000 primary knee replacements are carried out annually by the NHS in England.
My hon. Friend will be reassured to know that the Government are determined to cut NHS waiting lists and thus reduce waiting times for all patients. Patients needing orthopaedic procedures are already benefiting from the action we have taken: during 1998-99, the number of patients waiting for NHS treatment was reduced by 225,000 and almost 500,000 extra patients were treated in the same time. Since March 1998, the number of people waiting for hip and knee replacements and other orthopaedic procedures has fallen by 12 per cent., and the number of people waiting more than 12 months has fallen by 13 per cent. I hope that she welcomes those figures.
Such operations represent two of the great success stories of the NHS. People move from being confined to a wheelchair or their homes and become mobile and free of pain. They are then able to lead more independent lives, with all the benefits that that brings to them, their carers and the wider community. The national Horizon scanning centre has also identified several other new drugs that treat musculo-skeletal disorders. NICE is currently considering whether they should also be fast-tracked for assessment because they could provide a substantial added benefit to a large group of patients suffering from arthritis.
My hon. Friend expressed her concerns about measures to help disabled people into work, especially those suffering from arthritis. Most disabled people are able to make very effective use of mainstream employment and training programmes. However, for some people who are unemployed, such as people with arthritis, their disability represents an additional hurdle in their search for work. That is why there are specialist programmes to helpthem find, keep and train for work. The Employment Service plans to spend £189 million this year on specialist programmes to help those with disabilities, including people with arthritis.
My hon. Friend also expressed her concern for children. The Education Act 1996 sets out arrangements for identifying and providing for children with special educational needs in accordance with a statutory code of practice on the identification and assessment of special educational needs. Parents who think that their child may have special educational needs can ask their local education authority to assess their child's needs. The authority has responsibility for determining whether the child has special educational needs and what provision should be made to meet them.
The schools access initiative gives capital support for projects to make mainstream schools more accessible for pupils with disabilities, including those suffering from arthritis. In 1999-2000, £20 million will be available, which is a fivefold expansion of the £4 million inherited from the previous Government. That forms part of a £100 million programme over the next three years.
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