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It has been suggested that GPs are insufficiently aware of the prevalence of pernicious anaemia that they may fail to diagnose the condition and that the Department of Health should take steps to increase awareness. However, assessments of medical professionals and their awareness of conditions such as pernicious anaemia are not matters for the Department of Health. It would be for the relevant specialist professional bodies, such as the Royal College of Pathologists, to provide guidance and professional development on matters relating to haematology. The Department of Health has not issued any recent guidance to general practitioners on the diagnosis or treatment of pernicious anaemia. Nor has the National Institute for Health and Clinical Excellence, to whom the task has now been given.
I am aware that some patients take the view that injections should be offered more frequently, or that other treatments should be offered, and that patients may become understandably very distressed if they believe that their individual needs are not being taken fully into account. Some of the examples that my hon. Friend gave are very worrying. However, I do think that in this and in other cases, we must rely on GPs using their training, professional judgement and the evidence available to them to decide what treatment they consider appropriate, taking into account the particular needs of the person concerned. I hope that the Pernicious Anaemia Society stresses to its members that they must go to their GP and have a proper clinical assessment.
I know of the work of the Pernicious Anaemia Society in raising public awareness of pernicious anaemia and also of its proposals concerning diagnosis and treatment of the condition. I am aware that the PAS organised a parliamentary reception last week, and I apologise again to my hon. Friend for being unable to attend. The early-day motion in the name of my hon. Friend the Member for Bristol, North-West (Dr. Naysmith) has attracted over 70 signatures. It raises five main points and it may be helpful if I respond to each of these in turn, before covering the other points raised by my hon. Friend the Member for Bridgend.
The early-day motion states that there are fundamental problems with the diagnosis and treatment of vitamin B12 deficiency and pernicious anaemia. When vitamin B12 deficiency has caused anaemia, its diagnosis is not generally difficult, and I am not aware of significant problems of under-recognition. What people sometimes say, however, is that they felt unwell for some time before developing anaemia, and they attribute that to the early stages of vitamin B12 deficiency. Although that may be true, the difficulties of very widespread testing of the many patients with non-specific malaise and tiredness that would be necessary to detect a few people with very early vitamin B12 deficiency make this unlikely ever to be an appropriate policy. When anaemia is present, my understanding is that most patients respond well to treatment through quarterly injections of vitamin B12 and are able to get on with their lives, despite the inconvenience. I am aware of the discomfort of regular treatment and the impact of the condition. I am told that the injection is very painful because of the nature of what is being injected.
I am aware that some individuals with pernicious anaemia do not believe that sufficient heed is paid to their particular wishes regarding the nature and frequency of treatment. However, that is a matter for clinicians
and patients to decide, taking into account personal circumstances, and professional knowledge and experience. Some patients might wish to play a greater role in their own care, and I would encourage that. The personal experiences of individual patients need to be a significant factor in these discussions and decisions about treatment.
The early-day motion calls for a review of the efficacy and cost effectiveness of current treatment for pernicious anaemia. The Government established the National Institute for Health and Clinical Excellence to provide authoritative, independent advice to the NHS on different health-related interventions and forms of care. That is to increase fairness in access to treatments, to be a national source of robust clinical guidance and to speed up the uptake of cost-effective treatments in the NHS.
There is a clear process for the selection of topics for referral to NICE's work programme and final decisions on that work programme are taken by Ministers. I understand that a number of topic suggestions have been made around the diagnosis and management of pernicious anaemia, including one from the PAS itself. NICE is considering those proposed topics against its published criteria for possible inclusion in future work. However, I hope that my hon. Friend appreciates that NICE cannot advise on every condition or aspect of treatment, and that this topic will need to be considered alongside all the other competing priorities for NICE guidance.
The early-day motion calls for pernicious anaemia to be included within the national service framework for long-term conditions. As my hon. Friend is aware, we published the framework in 2005. It is a 10-year plan to address inequities in access, a lack of integrated service provision, work force shortages-if there are any-and variations in the quality of care across the country. The framework focuses on neurological conditions, and its quality requirements are based on evidence from services for people with neurological conditions. That focus on neurology highlights and sets in a clear context issues that are also relevant to the millions of people living with other long-term conditions, including pernicious anaemia.
I understand that the early-day motion proposes that treatment for pernicious anaemia should be more flexible and responsive to the needs of patients. The Government are committed to supporting patients in taking control of their own health and in the management of their own care. I am aware that some patients with pernicious anaemia might prefer to have more frequent injections or other forms of vitamin B12 to be administered by patients. Again, however, I am sure that my hon. Friend will understand that those are matters for individual patients to discuss with their general practitioners; it is not for the Department of Health to specify regimes of care in general practice-thank goodness!
The early-day motion also proposes that there should be a review of symptoms, diagnosis and treatment. As I have said, since coming into office in 1997, the Government have established a series of national service frameworks and other clinical strategies looking at diagnosis and treatment of major diseases. Through the NSF approach, we have substantially improved mortality rates and eased the burden of ill health caused by major diseases.
We recently announced our intention to produce a clinical service strategy for liver disease and we will shortly be publishing a draft strategy for chronic obstructive
pulmonary disease. However, we are aware that not every service area can be identified as a priority suitable for a national service framework or clinical service strategy. That has been recognised in the establishment of the National Quality Board, which is a key element of the NHS next stage review led by Lord Darzi. All recommendations for service reviews or strategies must now be considered by the National Quality Board, which will advise the Government.
This is a long overdue debate, which my hon. Friend has been requesting for some time. I congratulate her on raising the subject. I also welcome the activities of the Pernicious Anaemia Society in raising awareness of the condition among the public and clinicians. The society may wish to make representations to NICE about the
review of treatments for the condition and to the National Quality Board. I acknowledge my hon. Friend's request for the society to meet officials and I will ask officials to arrange that at the earliest opportunity.
Most people who have developed pernicious anaemia receive excellent support from their GPs in diagnosis, treatment and other forms of support. However, I cannot let this debate end without mentioning the district nurses, whom I believe will support their patients in the community to the best of their ability and follow the example set by this Minister, because patients are patients, wherever they happen to be.
7.31 pm
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