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14 Jun 2006 : Column 293WH—continued
The Parliamentary Under-Secretary of State for Trade and Industry (Jim Fitzpatrick):
It is a pleasure to see you in the Chair, Mr. Williams. I congratulate the hon. Member for Orkney and Shetland (Mr. Carmichael) on securing this debate. We have had some excellent
contributions, and it should be nothing other than clear that the Government have heard the message. Having listened to the hon. Gentleman spell out his views and to other colleagues spell out their concerns, I shall make some brief introductory comments and then try to respond to their points. If I do not get through them all, I shall write to hon. Members.
The future of the post office network is an issue of relevance to every Member, whether we represent rural or urban constituencies, or mixed constituencies of the sort that my hon. Friend the Member for Rhondda (Chris Bryant) mentioned. We all share concerns about the future provision of post office services in our constituencies. Most of us also recognise, even if we are not always willing publicly to acknowledge it, that there had been underinvestment in the business for decades until this Government reversed the decline with a sustained programme of investment since 1999. Some £500 million was injected to help fund the Horizon IT infrastructure, and in 2003 the Government committed £150 million a year up to 2008 to support the rural network. That was mentioned by many colleagues. On top of that, the Government put £210 million into the urban reinvention programme, including some £30 million of investment grants to improve and modernise the remaining branches. That represents an investment of some £1.4 billion of taxpayers’ money by this Government.
Nevertheless, advances in technology, greater mobility and changes in shopping and financial habits have resulted in a growing proportion of people simply not using post offices as they did in the past. Custom across the network has sharply reduced, creating the spectre of a spiral of decline. If the post office network is to survive and to have a sustainable future, it must adapt to the changing circumstances and environment in which it operates. The Government want a post office network that can prosper on the basis of current and future needs, not on those of 20 or 30 years ago. The way in which customers want services delivered is changing, and the huge increase in internet sales has hit many traditional sectors, including the post office.
We must face up to present reality. Major sectors of the network are losing substantial amounts. The rural network is making losses in the region of £150 million a year, and the directly managed Crown offices have been losing about £70 million annually. It is clear that the status quo is not sustainable. Several important steps to restructure and revitalise the Post Office have already been taken, but the future of the network rightly remains an issue of national debate. It is clear that there are still considerable challenges ahead. I shall try to address some of the points that hon. Members have made.
In response to the hon. Member for Wealden (Charles Hendry), let me say that there is clearly strength of feeling on the matter. It is a huge national issue. I am sure that there will be debates in due course when the Government arrive at conclusions. In the meantime, there are the usual channels for securing debates. There are also Opposition days and these opportunities in Westminster Hall.
I very much agree with the hon. Gentleman’s comments about commending Allan Leighton, Adam Crozier and the staff for the turnaround in Royal Mail’s fortunes, which has been quite spectacular in the past few years. Clearly, we want exactly the same for
Post Office Ltd. I am grateful for the generosity of his remarks and for his giving me time, given my newness in the job. However, I do not believe that I will have very much time—this is far too important an issue.
The hon. Member for Orkney and Shetland opened the debate with comments about listening to sub-postmasters and sub-postmistresses. We have a good relationship with the National Federation of Sub-Postmasters, and I expect to meet Colin Baker, the general secretary, very soon. Indeed, officials of the Department of Trade and Industry and other ministries are directly in contact with that organisation.
On the BBC decision in favour of using PayPoint rather than the Post Office, I obviously regret that the Post Office was unsuccessful in re-tendering for the contract for over-the-counter TV licence sales, but I point out that the contract decision was a commercial matter for the BBC, which has a duty to licence holders to achieve value for money with its licence fee income, as the hon. Gentleman mentioned. To use both Post Office and PayPoint outlets would have been even more costly.
The hon. Gentleman also raised the question of why Post Office Ltd did not win the UK Passport Service authentication by interview tender. The decision was a commercial matter for the UK Passport Service, which set its tender specifications on bases that were considered necessary to provide the required levels of network coverage, security and physical suitability. Having reviewed what it could offer, Post Office Ltd made the commercial decision to withdraw from the tender process. However, the planned interview offices will not take any existing business away from post offices or offer any alternatives to the passport check-and-send service available from selected post offices.
The hon. Gentleman and several other hon. Members asked when the Government would make announcements about a subsidy beyond 2008. The Government are carefully considering options for the network beyond 2008. I am sorry, but at this point we are not working to a fixed timetable. There has already been extensive informal consultation with key stakeholders, and we expect to consult more widely in due course.
Finally, the hon. Gentleman asked why all banks do not have accounts available at post offices. He was correct in saying that there were some difficulties with some banks. However, all the banks have at least a basic bank account that can be accessed at a post office and many allow their customers to access their current accounts at a post office, but extension of those arrangements is a commercial matter for the Post Office and the banks. The Royal Bank of Scotland, HSBC and Halifax do not allow access to their current accounts. We are asking them to reconsider that, but clearly such a service is very much in their gift.
Discussions have taken place on the Post Office joining the Link network. It was not possible at a particular time, but discussions are ongoing. It is on my agenda to have meetings with Ministers in other Departments, including the Treasury, to consider what we can do to try to facilitate the process.
My hon. Friend the Member for Rhondda asked about state aid. As I said, we have been committing
£150 million per annum since 2003. That support is provided directly to Post Office Ltd to maintain non-commercial branches that otherwise would close. The funding is used to meet the fixed element of sub-postmasters’ pay and the huge infrastructure costs incurred in running such a large network, including, for example, IT and cash distribution.
The hon. Member for Falmouth and Camborne (Julia Goldsworthy) and several other hon. Members asked about the Post Office card account. She referred to a letter received by a constituent. If she wishes to write to me or preferably to my colleague with responsibility at the Department for Work and Pensions, I am sure that the matter will be considered. I believe that it was also raised by the hon. Member for Ludlow (Mr. Dunne).
My hon. Friend went on to ask about other services that the Post Office might exploit. It is now the UK’s No. 1 provider of foreign exchange, with 12 million transactions last year. It continues to broaden its range of financial services with its instant saver account, which was launched in March, and it is the largest independent provider of travel insurance, with 1 million policies sold annually. I am sure he knows that the Government are a big supporter of credit unions.
My hon. Friend the Member for North-West Leicestershire (David Taylor) made a point, but as he is not in his place, I shall move on to the hon. Member for North Shropshire (Mr. Paterson). I understand that the DWP has committed itself to placing the trials documentation in the Library, but I am sorry that I do not know the date. As the hon. Member for Ludlow said, we expected that information earlier but it has not been provided yet.
The hon. Member for North Shropshire also asked about the BBC over-the-counter licence service. I have already mentioned the commercial decision. The Prime Minister made this a cross-cutting issue with the announcement that MISC33 has been set up under the stewardship of the Deputy Prime Minister. I know that that was not welcomed by some colleagues, but the fact that a formal Cabinet Sub-Committee will review the issue demonstrates that it has moved up among the Government’s priorities. The first meeting will be held shortly.
On the migration of services, if the hon. Gentleman will forgive my making a small partisan point, I may say that it was the Conservatives who introduced payment into a bank or building society as an option in the 1980s. Even before the migration from order books started in April 2003, customers were already choosing to adopt alternative methods of payment. Forty-three per cent. of DWP customers had already opted to receive all their benefits by direct payment.
The hon. Member for Perth and North Perthshire (Pete Wishart) asked about sub-postmasters. We have discussed the statistics on the few people who use the smaller number of sub-post offices. I had planned to quote, if I had time to do so, from The SubPostmaster, the magazine of the National Federation of Sub-Postmasters, a letter that was published last August. It demonstrates just how quiet some sub-post offices are, although I decided that I might be regarded by colleagues as flippant, which was not what I intended. I wanted to try to introduce balance and to say that some smaller branches simply are not viable in any way,
shape or form. If they are kept open, they will require subsidy, and the Government are about balancing public accounts and achieving the best value for the taxpayer.
The hon. Member for Torridge and West Devon (Mr. Cox) asked about financial sustainability. I have made points about some of the technical changes in society. The hon. Member for Ludlow mentioned that there were 2,600 closures in the past three years, but the vast majority—more than 2,000—were related to the managed urban reinvention programme, to which we committed £210 million. The hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander)—
Hywel Williams (in the Chair): Order. We now move to the next debate.
Pain Treatment
4 pm
Mr. Malcolm Moss (North-East Cambridgeshire) (Con): I start by expressing my gratitude for this opportunity to raise such an important subject, which affects the lives of millions of people in this country daily.
Chronic pain affects one in seven people in every parliamentary constituency throughout the United Kingdom. Inadequately managed, conditions associated with pain can have a devastating impact on the quality of life of individuals and their families. In terms of repeated appointments, chronic pain costs the NHS the time equivalent of 800 full-time general practitioners, and it generates an incapacity benefit bill that is estimated by the Department for Work and Pensions to exceed £3.8 billion a year. The biggest cost of chronic pain is borne by employers and the wider UK economy. More than £18 billion a year is wasted in lost working days and reduced productivity.
The commonest causes of chronic pain are back pain and arthritis. Other causes include headache, injury, nerve pain, vascular pain, pelvic pain, cancer and rarer forms of pain, such as complex regional pain syndrome, or reflex sympathetic dystrophy syndrome, as it is sometimes called.
I applied for a debate on this subject because of a courageous constituent of mine, Trudy Lapinskis of Whittlesey, who suffers from an advanced form of RSD. She has borne and continues to bear her condition with great stoicism, but not fatalism, and has shown great determination to publicise RSD to as wide an audience as possible, in order to help other sufferers, particularly those in the early stages, when diagnosis and treatment could be so effective in improving quality of life. In Trudy’s case, early diagnosis would have avoided the severe disability that she has to live with today. This debate is by way of a tribute to her and her unstinting work on behalf of other RSD sufferers.
RSD is a chronic pain disorder. Common symptoms include intense burning pain, extreme sensitivity to touch, swelling, sweating, and changes in the colour and temperature of the skin over the affected limb or body part. RSD affects the nervous system, bones, muscles, skin and circulatory system. The aetiology, or cause, of RSD is most commonly a trauma or injury to an extremity, although it can affect any part of the body. The trauma does not have to be severe. Unfortunately, something as common as a sprained ankle, a knock or even a splinter in a finger can lead to RSD, which can then become a potentially disabling and lifelong problem.
In some patients, an exact cause cannot be identified. The first symptom associated with RSD is a pain that is usually described as a constant burning or deep aching pain. It progresses into severe chronic pain and swelling usually occurs in the injured extremity. At that point, the oedema is localised and the skin is very sensitive to touch, with even a slight breeze being capable of causing pain. Diminished motor function and a decrease in muscle strength are associated with the joint in the extremity. Tremors and muscle spasms can also be present.
Most patients experience a significant difference in the temperature of one limb as compared with the
other. Osteoporosis might be noted on bone scans and, as swelling in the injured area becomes pitted, the risk of skin infections increases. In some cases, those symptoms spread to other extremities, where no injuries have occurred, and the disorder becomes much more difficult to manage. Out of all chronic pain conditions, RSD is the most severe. According to the McGill pain index, arthritis has a pain rating of 18, a fracture rating of 19, cancer 26 and chronic back pain 27, while incredibly, RSD has a rating of 42.
RSD can affect anyone—male or female, adult or child—and at any age, but studies show that it is more common in people between the ages of 25 and 55 and is seen more frequently in women than in men. It is not more prevalent in a particular race. RSD used to be considered rare in children, but there has been a recent increase in the number of cases reported among children and teenagers. In view of all that, it is imperative that awareness should be raised among GPs and consultants, with early diagnosis and treatment encouraged, to minimise the terrible suffering brought on by the disorder.
I turn to a more general analysis of the problem of pain. Back pain affects most of us. Four out of five people will experience back pain lasting for more than a day at some time in their lives. It is the nation’s leading cause of disability, with 1.1 million people disabled by it. At any one time, 430,000 people in the UK receive social security payments primarily for back pain.
A recent national opinion poll showed that pain is experienced every day or on most days by one in five of the 975 people surveyed, which equates to almost 10 million people throughout Great Britain, while a further one in four people said that they had pain some days. The proportion of people with pain taking time off work has increased from 35 per cent. in a group surveyed in 2002, to 49 per cent. in 2005. Half of those questioned were depressed because of their pain and 72 per cent. were less active because of their pain, with work, household activities, family life, sex, social and leisure activities, and the enjoyment of life being affected.
Pain in the elderly is common. There is much evidence that it is treated badly because the elderly are often uncomplaining, because pain is not recognised, and because doctors are frightened of using strong painkillers, especially after the Shipman inquiry. Children also suffer from chronic pain, which is under-recognised and under-treated. Unrelieved pain in childhood can lead to long-lasting effects on social and physical development, and increases the chances of lifelong pain in adulthood.
Pain is the commonest presenting symptom at the first consultation with a doctor and is second in the top 10 most important symptoms listed by patients, but all too often it is ignored and thought to be unimportant. Why is that? Pain is generally regarded as a warning signal, and it is thought by doctors and lay people alike that, when the cause of the pain is discovered and treated, the pain will go away.
There are acute pains that indeed behave in that way, such as appendicitis, toothache, bone fractures and infections, but chronic pain—that is, pain lasting for longer than three months—serves no useful purpose. It is usually caused by a defect in the signalling mechanisms
for pain within the nervous system and is poorly understood. The patient with chronic pain is often subjected to investigation after investigation and multiple consultations, only to be told that a cause for the pain cannot be found, or that it is “only arthritis” and that no treatment is available. How demoralising is that?
Rarer types of pain, such as complex regional pain syndrome or RSD, might not be diagnosed at all, leading to long-term disability from pain, and an implication that it is all in the head. Cancer pain is dreaded by all. The cause might be known, but for about 8 per cent. of sufferers the pain is so severe that it cannot be relieved, even by large doses of morphine.
What can and should be done to manage chronic pain? Sadly, chronic pain cannot be cured, but in 95 per cent. of people it can be partially relieved and managed, such that the sufferer regains control over his or her life. Health professionals in this field want pain to be designated as the fifth vital sign after pulse, blood pressure, temperature and respiratory rate, so that pain is measured whenever a patient consults a doctor or nurse and so that the level is recorded consistently when a patient is in hospital.
The important first step is for the health professional to believe that the pain is real, to decide where the pain is coming from and to treat the pain, not necessarily the disease. That can be done by alternative medicine practitioners, nurses, physiotherapists and doctors. It may not be easy and may require a high level of skill and training to get it right. However, treatments will not be effective if the patient does not understand his or her pain and continues to seek a reason.
Treatment includes the judicious use of drugs—not just painkillers but drugs that modify the pain signals, such as anti-epileptic drugs and antidepressants. Physical methods are also used, such as TENS—transcutaneous electrical nerve stimulation—acupuncture, injections, nerve blocks, sophisticated spinal stimulators and spinal drug therapy. An effective way of helping with control over pain is a specialised pain management programme. I am talking about a multidisciplinary approach to pain management whereby a doctor, nurse, psychologist and physiotherapist, working together over a period, help the patient to gain control over the pain.
However, all that takes time, and pain management does not fit easily into the target-driven, rapid-treatment ethos of the modern NHS. The recent NOP survey shows that now 14 per cent. of patients with pain have seen a pain specialist compared with only 7 per cent. in 2002, but what of the other 86 per cent? Facilities for pain management are much more developed in the USA and parts of Europe. There is a desperate need for education of general practitioners: as undergraduates, medical students receive, on average, about four hours’ training on pain and they spend even less time on the prescribing of drugs for pain.
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