World Arthritis Day
The final item of business today is a members’ business debate on motion S3M-7169, in the name of Helen Eadie, on world arthritis day, 12 October 2010. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes that World Arthritis Day takes place on 12 October 2010; understands that arthritis and musculoskeletal conditions are a major cause of pain and disability, accounting for 48% of all work-related illness in Scotland; considers that this places a significant burden on both the NHS and society; acknowledges that it is estimated that over one million people consulted a GP or practice nurse in 2008-09 in relation to a musculoskeletal condition and that there were over one hundred thousand NHS hospital stays in Scotland in 2009 for which a musculoskeletal condition is recorded; pays tribute to organisations working to raise awareness of arthritis and other musculoskeletal conditions, such as the Arthritis and Musculoskeletal Alliance, Arthritis Care Scotland, the National Osteoporosis Society in Scotland, the Association of the British Pharmaceutical Industry (ABPI), Scottish Inflammatory Diseases and Rheumatology Industry Group (SIDRIG), the National Rheumatoid Arthritis Society (NRAS) and Psoriasis Scotland Arthritis Link Volunteers; looks forward to the publication of the national musculoskeletal programme and considers that it has the potential to develop a national framework for improving the standards of care for people who live with all forms of arthritis and musculoskeletal conditions; understands that a national lead has been appointed to support this work and a national programme board to ensure implementation; believes that people living with musculoskeletal conditions can usefully input to the national programme board, and would welcome publication of research into the prevalence of musculoskeletal conditions and on improving treatments and their impact on local NHS services.
17:04
I am grateful to Parliament for the opportunity to share with members the concerns of those who work with patients who suffer from musculoskeletal conditions. Two or three years ago, a group that named itself friends of arthritis and musculoskeletal conditions—some mouthful—and which comprised clinicians, the pharmaceutical industry, patients, their representatives and politicians who either work with or suffer from any one of the various musculoskeletal conditions came together. We have met regularly in the Parliament. Our most ardent campaigners have included Anne Simpson, who is well known to members, from the National Osteoporosis Society; Diane Thomson and Alison Culpen of the Scottish inflammatory diseases and rheumatology industry group; Jenny Snell from the National Rheumatoid Arthritis Society; Ros Meek from the Arthritis and Musculoskeletal Alliance, which represents 34 organisations that are involved in bone and joint conditions; Angela Donaldson of Arthritis Care; and Janice Johnson of Psoriasis Scotland Arthritis Link Volunteers.
The current Belgian Presidency of the Council of the European Union has prioritised the issue of rheumatoid arthritis and the European Parliament has adopted a key set of priorities that, it is hoped, will start to improve the lives of people with arthritis across Europe. The written declaration on rheumatic diseases was tabled in the European Parliament in January 2008. That was an achievement indeed, as only a few written declarations are made each year in the European Parliament. The broad cross-party initiative urged the European Commission and the Council to make rheumatic diseases, which affect more than 100 million people in Europe and cause severe damage to EU member country economies, a priority in the EU’s seventh research framework programme and future health strategy. The European Parliament resolution constitutes a strong reaction to the European Commission for having overlooked one of Europe's most common health threats.
I am delighted that the written declaration on arthritis has received overwhelming support from the European Parliament. As it is one of the most common reasons for consulting a doctor, it is incredible that arthritis is not up there with the feared and funded illnesses with which we are all so familiar. The written declaration highlights the prevalence and the human and economic cost of arthritis and outlines some measures that could improve outcomes for people who live with the condition. It also sets out four clear actions that will help to achieve that. They are:
“attach more importance to rheumatic diseases in the new Community strategy on health, given their high social and economic costs; encourage Member States to establish and promote the implementation of national plans to fight rheumatic diseases; develop a Community strategy on rheumatic diseases and draw up a Council recommendation on the early diagnosis and treatment of rheumatic diseases; develop a strategy to improve access to information and medical treatment”.
If one in five people has arthritis, at least 25 members of the Scottish Parliament are likely to be sufferers. Members’ support for my motion today is a reflection of just how many people’s lives are blighted by this crippling disease. I hope that, as a Parliament, we too will make a declaration to champion the battle against all forms of arthritis and musculoskeletal conditions and move its importance up the political ladder. I also hope that the Scottish Government or one of our major newspapers will consider establishing an annual award for pharmaceutical companies and researchers whose peers say they have achieved the most each year in developing new research and making effective treatments for patients.
One in five adults in Scotland is affected by some form of arthritis, with one in five general practitioner visits involving symptoms of arthritis. Musculoskeletal conditions are no respecter of age. For example, our principal Fife consultant, Dr Jane Gibson, runs special clinics for children and young people. I have been an arthritis and osteoporosis sufferer for many years. When I had the first of my two hip replacement operations, I was in my mid-40s, but people in the ward who were considerably younger than me were also having joint replacement operations.
At our most recent event in the Scottish Parliament, Professor Stuart Ralston and Dr Jane Gibson were the guest speakers. It was most interesting to learn about the major study involving 8,000 patients that Professor Ralston is undertaking into the genes of those who suffer from osteoarthritis. He told us that, for more than 30 years, there has been little or no progress in the treatment of osteoarthritis. However, the good news is that Professor Ralston is very hopeful that some new treatments may follow on from the results of the genes study. What is clear is that real progress in the treatment of rheumatoid arthritis is being made.
According to the National Institute for Health and Clinical Excellence, one third of people in the United Kingdom with rheumatoid arthritis stop work within two years of onset of the disease. Arthritis is also the most common condition for people in the UK who receive disability living allowance. Early intervention can help to minimise the damage that it causes and to improve people’s chances of staying in work and leading a fuller and more productive life.
The new biologic drugs have transformed lives and enabled people to dispose of their wheelchairs and to take up full-time employment. The drugs are expensive but, from a wider socioeconomic perspective, it can be argued that it is more cost effective for society to have a person engaged in economic activity than for them to be caged in at home, suffering pain and being depressed because of their illness.
There are many ways in which rheumatoid arthritis services could be improved, but those can be placed in three steps that would lead to a significant improvement in the condition of many people with rheumatoid and other musculoskeletal conditions.
The first is to ensure increased GP and patient awareness. The treatment journey begins in primary care, but diagnosis can often be drawn out and inconsistent. Early intervention is vital, so an information campaign that was designed to reiterate to GPs the importance of early intervention in suspected rheumatoid arthritis would be useful. Such a campaign would go hand in hand with an information programme aimed at the public, to make them aware of potential rheumatoid arthritis symptoms and to encourage them to visit their GP quickly.
We hope that, in combination, those two measures will lead more patients with potential symptoms to present to their GPs and lead to increased GP awareness of how best to deal with them. Through my work with friends of arthritis and musculoskeletal conditions in the Scottish Parliament, I have learned that the rheumatology unit in Fife, headed by Dr Jane Gibson, is regarded by those who are in the best position to judge as being one of the best designed in the UK, with its peripatetic services and speedy diagnosis and referral service. Dr Gibson’s team works in a different way from most others and has a much more holistic team approach that needs to be seen in action to be understood.
Step 2 is early diagnosis. We need to have particular regard to the Scottish inflammatory diseases and rheumatology industry group, which has produced some good research responses. If members wish to have further details of the excellent work that the group has done, I am happy to provide those.
I hope that members will join me in helping to raise this debilitating disease and other musculoskeletal conditions into a much higher priority for action by the Scottish Government, health boards and everyone who is involved in helping those who suffer from such conditions. I am most grateful for the debating opportunity this evening and pleased that colleagues have shown a willingness to support me. I thank each and every one of them for staying for the debate.
17:13
Presiding Officer, I am grateful to you for calling me early. I apologise to you, the chamber and, in particular, Helen Eadie for the fact that I will have to leave shortly after I have made my speech.
I was attracted to the motion above all else by the reference that it contains to psoriasis and its relationship to arthritis. I will speak about psoriasis for a couple of minutes. As many members know, psoriasis is and is not genetic. There is a linkage with arthritis; psoriasis does not necessarily lead to arthritis, but often it does. As far as we know—I am interested to hear what Dr Simpson says about the issue—psoriasis is linked to alcohol consumption and stress. Sadly, there is some evidence that there is a higher incidence of psoriasis in more northerly latitudes; in that respect, it is a bit like multiple sclerosis.
As members know, in psoriasis the immune system goes into overdrive and produces ugly skin loss. The condition can be treated effectively to a certain extent by steroids, ultraviolet light and sunlight. However, I want us to consider for a moment the people who suffer from psoriasis. In its most virulent form, the condition can be very unsightly, which can lead to considerable embarrassment on the part of those who suffer from it. In turn, that can lead to a form of loneliness, such that people are embarrassed to talk about or to reveal their condition. Psoriasis sufferers may be unwilling to go to a swimming pool or often to go on holidays abroad, because they do not want to be seen in the sun. That is extremely sad, and a particular sort of loneliness. Many other diseases have a similar effect, but it is true of psoriasis in particular. We should be concerned about that.
For many patients, psoriasis seems to be a one-way road: although there can be dramatic recoveries and the condition can be halted, for some people it does not get better but continues to get worse. Indeed, arthritic and rheumatoid conditions also seem to get worse along a steady road.
I have some suggestions to make. I am of course aware that budgets are incredibly limited, but I wonder whether some way of having dedicated nurses for psoriasis and similar conditions could be established without any additional resources being committed, perhaps within the existing financial envelope. New money had to be put in for MS nurses all those years ago. Perhaps something can be done nevertheless.
I have mentioned the loneliness that people can experience as they suffer from such conditions in silence. Perhaps it is a matter of getting people to talk about it more. I compliment the efforts that have been made in the Parliament as members have tried to highlight psoriasis. Perhaps, with the support of nurses, support groups could be set up, with people having the opportunity to share their experience of the disease.
Helen Eadie has suggested having an award for pharmaceutical companies that make advances in tackling arthritis and rheumatism—and perhaps, I submit, psoriasis too. That would be a tremendous encouragement. Ultimately, the way to tackle arthritic and rheumatic disorders, as Helen Eadie said, is through a drug regime and using the new treatments that we must develop. We must continue to develop them. If we do not, there is no hope for people who suffer from rheumatism, arthritis and related conditions. Above all else, it is our job to offer hope. I speak with some passion about the subject because I know some sufferers, and I know how debilitating such conditions can be.
Presiding Officer, from the bottom of my heart I congratulate Helen Eadie on bringing this excellent debate before us. I will not be with you in a year’s time, but I will remember debates such as this as being some of the finest offerings that we see in the Parliament.
17:17
I, too, congratulate Helen Eadie on securing the debate. I commend her for her unfailing interest in arthritis and other musculoskeletal diseases and for her contribution to raising their profile in the Parliament.
I note that more than 1 million people are estimated to have consulted a general practitioner or practice nurse in 2008-09 in relation to one of those conditions, although I would guess that that is a significant underestimate of the actual number of sufferers. I myself have been in the hands of a physiotherapist in recent weeks because of a back problem, and without going near my GP. I am sure that there are other people like me. Many more visit chiropractors on a regular basis for the treatment of back and joint problems.
From the helpful briefing notes that have been sent in by various organisations, it is clear that there needs to be an increase in awareness among GPs, particularly of rheumatoid arthritis, which is arguably one of the most serious of the conditions. Early diagnosis is vital if the reversible joint destruction and disability are to be avoided and if people are to continue in work.
I will focus on osteoporosis, the complications of which can cause very severe pain and disability. I have taken a particular interest in the condition as an MSP and am patron of the Aberdeen branch of the National Osteoporosis Society. Fragility fractures resulting from osteoporosis are common and they are very painful. Hip fractures are associated with high levels of mortality and are expensive to deal with. Many older women, in particular, develop osteoporosis. It is sad to see people such as my husband’s late stepmother, who was an active physical education teacher, walker and gardener in her younger days, in constant pain, shrunk in size and bent over from collapsed osteoporotic vertebrae.
With modern detection methods and the application of bone-protecting treatments, the fracture risk can be halved. It is now therefore recommended that all fracture patients over the age of 50 should be identified, assessed and treated where appropriate.
Osteoporosis affects not only older people. At the risk of this speech becoming a Milne family history, I will mention my son, who developed a degree of osteoporosis as a result of prolonged steroid therapy undertaken when a teenager. He was not aware that he had the condition but, fortunately, it was looked for and picked up during a routine check-up. Thanks to treatment, his bone density is back within the normal range, fortunately before he had any fractures—and despite his passion for downhill skiing.
The work of fracture liaison services is invaluable in detecting and treating osteoporosis, and the associated specialist nurses make an enormous contribution to the national health service. There is concern that posts could be at risk in some areas, given the current financial pressures on health boards. I hope that the minister will listen to pleas from the National Osteoporosis Society to protect threatened posts.
The NOS stresses that it is important that all hospitals that deal with fracture patients are linked to a comprehensive fracture liaison service and that incentives are given to primary care staff to improve prevention and treatment in relation to osteoporosis and fractures. I hope that the minister agrees with the NOS and I look forward to hearing her response.
I thank Helen Eadie for highlighting the importance of early diagnosis and treatment of the musculoskeletal disorders that are so common in Scotland.
17:20
Like Nanette Milne, I pay tribute to Helen Eadie, not just for securing this debate but for her work in helping to promote awareness of the issues that are mentioned in the motion. She is a tireless campaigner on a range of issues and it must be hard for her to keep track of everything that she is involved in. This evening she has secured a debate in which we focus on a set of medical problems that affect a huge number of people in Scotland. There can be barely any families who have not experienced the consequences of the conditions that are mentioned in the motion.
Nanette Milne and Jamie Stone talked about the personal impact of some of those conditions. It is hard to watch someone suffer. We often feel frustrated that so little can be done to ease pain. Tremendous progress has been made on drugs and a range of therapies and treatment is available, but sometimes we can only watch as people shrink before our eyes, as Nanette Milne said, and we can only witness the debilitating effects of severe arthritis. Osteoporosis and arthritis have affected members of my family, and it is tragic to see people suffer.
We all know about the litany of issues that affect our health in this country, such as diet and lack of exercise, but we cannot do anything about the climate. At this time of year, and even in a Scottish summer, when the weather worsens the pain starts, as I know from the experience of close family members. Medication is undoubtedly welcome, but there are long-term consequences to taking some of the significant drugs that are available. We need to be aware of that.
The organisations to which Helen Eadie referred do a fantastic job, not just in raising awareness but in campaigning for a better and more understanding approach. I worry that in the financial climate that we are entering into some services that can make a difference to people’s quality of life might be the first things to be dispensed with. I am thinking, for example, about the aids and adaptations that make a difference by enabling people to operate independently in their own homes. We must ensure that such assistance for sufferers is regarded as vital.
I ask the minister to reflect on an issue on which I have heard contradictory information and evidence. I am concerned about schoolchildren who carry extremely heavy loads to and from school. Heavy bags are often carried for a considerable distance. My intuitive response to seeing children carrying heavy loads is to wonder what will be the long-term consequences for their backs. I hope that we can undertake research into the long-term consequences of carrying excessive loads from an early age. If there is an issue in that regard on which we should be reflecting, let us do so.
In conclusion, I want to mention Helen Eadie’s idea about an award. I do not dispute the significance of giving awards to the companies that are doing the research, but they are often well rewarded when they come up with a product. If we do anything to recognise achievement, I like to think that we would recognise the achievements of those who, despite their illness and disability, contribute significantly to their families and to the community, and to those who help them. The untold good that is done by volunteers and sufferers of debilitating illnesses is immense, and I hope that, in some way, we can put on record our appreciation of what they achieve.
17:25
I start by saying how pleased I am that Parliament is discussing this issue today. I congratulate Helen Eadie on securing such an important debate, and on all the hard work that she has done on the issue over many years.
World arthritis day has been celebrated annually since 1996, allowing people around the world who suffer from arthritis to unite to raise awareness of a debilitating condition, to influence public policy in a way that is beneficial to sufferers, and to ensure that people who have arthritis, and the people who care for them, are aware of the vast amount of support that is available to them. Arthritis affects approximately 700,000 people in Scotland, and it is estimated that arthritis and other musculoskeletal conditions account for 48 per cent of all work-related illness in Scotland. The scale of the suffering is truly disturbing, and it is surely our duty as elected representatives to do everything in our power to ease that suffering by supporting people who have arthritis and their families and carers in any and all possible ways.
It should always be remembered that, although arthritis is commonly associated with old age, it affects many young people, which can have a huge impact on their careers and personal lives. Earlier this year, I met a young constituent who was being sponsored to walk the west highland way in aid of Arthritis Research UK. She was diagnosed with rheumatoid arthritis by her GP when she was aged only 23, but she manages her condition with painkillers and anti-inflammatory medication, and she lives a full and vibrant life. However, as she explained to me, that is because of early diagnosis by her GP, swift and excellent treatment from the NHS, and a full understanding of the support and services that are available to her.
Many people are not so fortunate: many of those who suffer from arthritis are unaware of the care and support that is available to them, and they may lose their independence and experience terrible pain, which is often needless. That is why the awareness that world arthritis day raises is so valuable.
Of course, world arthritis day is an annual international event, but it is important to remember that there are charities and other organisations in Scotland that work every day of the year to help the people who are affected by such conditions. The work that those organisations carry out and the expertise that they bring are invaluable and vital when we are forming health policy and providing services. Their unique position and constant dialogue with people who are affected by arthritis makes them the best-placed and most-informed organisations to advise Parliament.
For example, Arthritis Care Scotland has more than 50 branches throughout the country, an army of devoted volunteers, and it campaigns tirelessly for the changes that will benefit people who suffer from arthritis, their families and carers. The NHS must also be commended for its role in the fight against arthritis. Although there is no cure, its pioneering treatments help people to cope better and to live fuller lives with the condition.
Arthritis Care Scotland has also helped people to cope in their communities with their illness in simple but effective ways by, for example, altering traffic lights to allow people more time to cross the road. That is the kind of thing that we might take for granted, but through contact and dialogue with sufferers, Arthritis Care Scotland understands what people need and how to make positive changes to make things easier for them.
Jamie Stone talked about psoriasis. Twenty years ago, I worked for a company called LEO Laboratories Ltd, which brought out a revolutionary new treatment for psoriasis, called Dovonex. I was in my late 20s and I had never met anyone who had psoriasis but suddenly, when people realised that I worked for the company that made that drug, loads of folk came out of the woodwork and said that they had psoriasis. They were people I had known all my life; three members of my own family, including my mother’s sister. That was because there was a stigma around psoriasis: people wanted to keep it hidden and, of course, traditional treatments for it were quite horrible. I agree with Hugh Henry, but I am not convinced that rewards for pharmaceutical companies are really necessary as their reward comes through the bottom line, although certainly it would not do any harm.
I know that the Scottish Government is committed to tackling the problem of arthritis and that it gives significant grants to arthritis charities such as Psoriasis Scotland Arthritis Link Volunteers, which receives a three-year Scottish Government grant, but much more has to be done. I therefore hope that in the forthcoming weeks and months we as a Parliament can form a consensual national strategy to help to combat the crippling conditions that affect so many of our fellow Scots.
17:30
I join others in congratulating my esteemed colleague Helen Eadie on securing the debate, and I join them in recognising the work that she does in this area. It is an important issue that often does not get the attention that it deserves.
Although, as Nanette Milne did, I will focus mainly on osteoporosis, I will also refer briefly to rheumatoid arthritis and make a couple of points. First, the introduction of biologic drugs is crucial because they allow people to get back to work quickly. Far too often, we allow people to drift into situations in which they are imprisoned by their condition and it becomes, if not too late, at least much more difficult to treat them.
To do that, we need to establish a much more effective primary care part of the managed care network system. We need general practitioners who have a special interest in rheumatoid arthritis as part of networked practice groups within the community health and care partnerships, in order to ensure that the information is available. The average GP will not see many cases of rheumatoid arthritis and, frankly, is unlikely to have the sufficient knowledge to treat the condition, to diagnose it or even to make the specialist referral. That is not to cast aspersions on my GP colleagues; it is to recognise the reality that unless a practitioner sees cases pretty frequently, he or she will not keep fully up to date on the issues. We need a different approach, so I will be interested to hear what the minister has to say about that.
I will return to osteoporosis. As Nanette Milne said, fragility fractures that result from osteoporosis are painful and debilitating. Hip fractures are associated with high levels of mortality, are costly to treat and can be prevented by effective fracture liaison services. Health boards that implement a fracture liaison service will significantly reduce fragility fractures by up to 70 per cent, which will reduce the number of hip fractures and, in turn, reduce the costs of treating patients. Every low-impact fragility fracture should result in a proper assessment of risk through a fracture liaison service. That would create vital savings in the long run by reducing hip replacement costs, which can be up to £28,500 if we take all the costs involved, including the subsequent community costs.
We must do more to prevent falls among older people. For example, Falkirk Council has produced an award-winning scheme in association with Forth Valley NHS Board, with a falls prevention plan. The Falkirk project focuses on reducing the pattern of falls at the earliest stage. The service, which has been going for almost 10 years, has shown a dramatic drop in the number of falls. It has shown that 1,000 or so fewer falls happen per year, which is predicted to prevent some 50 fractures per year, with a saving of more than £1 million. That does not include the savings from other injuries that are associated with falls. As such significant savings can be made, why is that system not being rolled out throughout all the NHS?
Today, I had my staff ring round NHS boards to ask about the implementation of the falls report, which this and previous Governments have promoted, and to ask about whether we have taken the work forward. Every health board should now have a falls prevention co-ordinator, but in the phone-round we found that there is little clarity on whether boards have one. There was even a misunderstanding about what we meant: someone thought that we were asking about the chair of a committee that looks at the issue. NHS Lanarkshire said that it has two posts, but that they are both vacant—and we know what is happening to vacancy management in the current conditions. What is the Scottish Government doing to ensure that falls prevention is co-ordinated by every board?
The minister will not be surprised that I want to return to Forth Valley NHS Board. Forth Valley is let down from its participation in the excellent Falkirk initiative by the fact that it is the only health board that still does not have a full local osteoporosis service. I raised the point two years ago in debate, but we still do not have a service despite promises. I have been told that the service has been delayed again because of costs.
In funnel plots that have been presented to me, Forth Valley is one of the highest for where there is no medication on a second fracture and for patients who are not on medication pre-fracture, as in-patients and 120 days after admission. It is also one of the lowest on the funnel plot for nutritional assessment. That is an unacceptable position for my constituents.
An analysis of a number of hospitals shows the performance of Forth Valley NHS Board to be very poor. Only 6 per cent of all the patients there, during their total in-patient stay, had a falls nursing care plan—compared to 98 per cent at the neighbouring Queen Margaret hospital in Fife. Only 1 per cent of patients discharged to rehabilitation had a falls nursing care plan in both orthopaedics and rehab, and only 8 per cent had a falls nursing care plan in place in rehab. At Queen Margaret hospital, the figure was 100 per cent for the former. In Forth Valley, Only 2 per cent of patients discharged to rehabilitation had a nursing and allied health professional assessment in orthopaedics, and only 3 per cent of patients had a nursing and allied health professional assessment in orthopaedics and rehab. Again, the figures for Queen Margaret hospital were 100 per cent.
I have, so far, been unable to persuade the board, which is now delaying the matter again because it says that the cost would be £250,000 to £300,000. I say to the minister that the one area in Scotland that does not have a service must be required in accountability reviews to put in place a service.
17:36
I, too, congratulate Helen Eadie on her motion, which has given Parliament the chance to discuss the important subject of arthritis and musculoskeletal conditions. As the motion makes clear, that covers a wide range of conditions that place a real burden on the people who live with them, as well as on their families and carers. Those conditions also account for a significant proportion of NHS activity in spite of the stoicism with which many people face them. It is for those reasons that arthritis is mentioned in our long-term conditions action plan as an example of a common long-term condition.
The action plan is about helping people to live well with their condition and recognising them as leading partners in their own care. Self-management is one of the key elements in that work. Arthritis has been at the forefront in developing innovative and new approaches to self-management, and we have been able to draw on those in setting up the long-term conditions self-management fund, which is administered on behalf of the Government by the Long Term Conditions Alliance Scotland. Across the long-term conditions work, we very much value our partnership with the voluntary sector, and I echo the terms of the motion in acknowledging and appreciating the work of the various third sector organisations that it mentions.
Please excuse my coughing, but I have been talking too much today.
A fair amount is happening at the moment in relation to arthritis, which I hope to share. The Scottish intercollegiate guidelines network has revised its clinical guideline on the early management of rheumatoid arthritis, taking account of the new medications that have been developed. I hope that when it is published in December, the guideline will promote awareness of the benefits of treating the condition as soon as possible after onset. Implementation of the existing SIGN guideline has been assisted by the “Clinical Audit of Care in Rheumatoid Arthritis”—known as CARA—which NHS Quality Improvement Scotland published in December 2008. Its findings are being addressed through the web-based audit programme that is run by the Scottish Society for Rheumatology.
The revised guideline will also pave the way for the needs assessment of rheumatoid arthritis that we have commissioned from the Scottish public health network, which is about giving more impact to the needs assessment that was published more than 10 years ago. The network considered whether it should continue to focus on rheumatoid arthritis. There is no doubt that other types of arthritis should not be neglected, so the needs assessment will emphasise that rheumatoid arthritis work should promote benefits for people with those other types of arthritis, too.
All of that work could be drawn together effectively through the mechanism of managed clinical networks, which would give a strong voice to patients and the voluntary sector on the way in which services should be improved. Such networks promote multidisciplinary working with extended roles for nurses and AHPs, and they encourage the development of integrated care pathways across community and hospital care. They would use the SIGN guideline as their evidence base, and the findings of CARA would help them to work with boards in the most effective application of resources. We have, therefore, been exploring with NHS Greater Glasgow and Clyde the possibility of that board hosting a rheumatology MCN, and I am pleased to say that the board is now in the process of setting up such a network with some pump-priming funding from the Government. I hope that that will act as a demonstrator that other boards can follow.
Towards the end of last month, SIGN published a groundbreaking new guideline on psoriasis and psoriatic arthritis that should bring about improved diagnosis and treatment in primary care.
I also support the call in the motion for more research into these conditions, since stem cell therapy is still some way off. The chief scientist office is already supporting five research projects related to arthritis at a cost of £1.1 million, but it is always interested in well-constructed applications.
I am aware that there have been no new advances in the treatment of osteoarthritis in the past 25 years. The increasing recognition of the role that genetics plays will, I hope, help to change that position. It is also good that the musculoskeletal service model that is referred to in the motion will, in its first phase, have a focus on osteoarthritis.
We are developing the national MSK programme under the auspices of the delivery framework for adult rehabilitation. It focuses on early access to assessment and treatment by specialist practitioners based in primary care. They form part of a team that includes nurses, physiotherapists and podiatrists. People will be referred to the most suitable hospital service.
Since the motion mentions that arthritis and MSK conditions account for 48 per cent of all work-related illnesses in Scotland, it is important to mention that taking account of people’s work goals is an essential part of the model. Linking to employability services early in people’s rehabilitation journey will form part of their care plan—that is the point that Richard Simpson made. That ties in well with our revision of the healthy working lives strategy.
The model also integrates the work that our lead clinician for chronic pain has been taking forward in developing chronic pain pathways. Those are designed to direct people who are living with pain to the most appropriate service, whether that is provided by voluntary sector groups such as the Pain Association Scotland, in the community or in a specialist pain management clinic.
The MSK service model is being evaluated in two NHS boards. We have appointed a national lead to support the roll-out of the model, and a national programme board is being set up to oversee its implementation. The board has not yet been created, but I support what the motion says about the contribution that people living with MSK conditions would be able to make. I can, therefore, give assurance that the board will include patient representation.
A number of points were made in the debate. I will write to Richard Simpson about the latest position with regard to Forth Valley NHS Board, because I understand the points that he makes.
I hope that it will be clear from what I have said that the Government takes seriously the needs of the many people who are living with the conditions that have been mentioned tonight. I am confident that the work that is in hand will lead to earlier and more effective interventions that will markedly improve people’s quality of life.
Meeting closed at 17:42.