Tees Valley Spinal Unit
Phil Wilson (Opposition Assistant Whip (Commons); Sedgefield, Labour)
I want to highlight the work of the spinal unit at the University Hospital of North Tees and the charitable support group established in 1999 by patients who have used the spinal unit for surgery to relieve chronic back pain, allowing some patients to walk again and many others to get on with their lives pain-free. I speak with first-hand knowledge of the unit and its support group because of the major spine surgery performed on me in November 2008, after years of pain.
At a time of controversial change to the NHS, I want to put on record my belief that the spinal unit at the University Hospital of North Tees and the volunteer network that supports patients before and after treatment is a shining illustration of all that is good about the NHS, and should be an example of how other acute care and chronic pain services should operate elsewhere. Recent advances have made spine surgery safer and more effective and now there are safe and effective surgical options to treat back pain. It is no longer accurate to tell patients that nothing can be done and they just have to live with it. The North Tees spinal unit specialises in the holistic treatment of spinal pain—from physio to surgery, with surgery being the last option.
The spinal unit at the University Hospital of North Tees is in the constituency of my hon. Friend Alex Cunningham, who is a good friend of the hospital. It serves the Tees Valley and South Durham area, including my constituency, but its reputation has now reached far and wide, with patients travelling from all parts of the country for treatment. The spinal unit was set up in 1997 by consultant spinal surgeon Manoj Krishna, who operated on me. The unit was originally staffed by two spinal surgeons but is now staffed by three dedicated consultant spinal surgeons supported by associate specialists and middle-grade doctors, nurses, allied health professionals and other support services such as radiology. The unit offers a number of leading therapeutic, non-surgical and surgical procedures. My understanding of the procedures used is only surpassed by my complete inability to pronounce many of them, but they include lumbar disc replacement, neck surgery and other surgery on the spine.
The spinal assessment team’s specialist nurses carefully examine patients’ medical history to establish the best course of treatment for each case. Patients who require non-operative treatment are then channelled to the appropriate department and patients requiring surgery are referred for treatment in the spinal surgical unit. The unit’s consultants see about 2,000 new patients a year, usually from the musculoskeletal service but sometimes directly from GPs both in and out of the area. Patients come from as far as London and the south-west to have their surgery at North Tees. Fifteen major spinal operations are carried out in the unit each week. The average length of stay in the unit is two and a half days. The unit is a training centre for specialist registrar and spinal fellowship programmes. It is active in research and development, represented on the national and international stage.
I suffered from back pain for years. Initially, the periods between incidents of pain were long, lasting several months. Then the pain became constant. The by-election that I fought in 2007 was not pain-free, but was something that had to be coped with of necessity. One does learn coping techniques—for instance, exercise and physiotherapy are essential—but the more the pain intensified, the stronger the painkillers became. Heat wraps and ice packs were bought in abundance as a short-term remedy.
Coping mechanisms included wearing slip-on shoes because it was too painful to bend over to fasten shoelaces. Books, television remote controls and clothes would be left on the backs of chairs or on shelves at a particular height so it was not necessary to bend or stretch. Working in the office meant standing at the filing cabinet, using it as a desk, or walking around the room reading papers or documents. Sitting for any length of time could be torture. Standing in the this Chamber attempting to catch the Speaker’s eye would be a welcome relief for a few seconds, and speaking would be a relief in more ways than one. The pain would be in the legs rather than the back, because the damaged disc was catching the sciatic nerve.
My back was continuing to deteriorate. I was referred to Manoj Krishna, who treated me for about a year with physiotherapy regimes and epidurals that bathed the base of my spine with anaesthetic. All the treatments worked for a time, but the underlying problems caused by discs that were disintegrating meant that I needed surgery. The surgery meant removing the two offending discs and fusing the three vertebrae. Years ago that technique meant recuperating in hospital for many weeks, but in November 2008, when I had the operation, I hobbled into the hospital on a Wednesday morning and walked out on Thursday afternoon, less than 48 hours later. I have not looked back since. Nevertheless, surgery is not a silver bullet. People must continue to exercise, and must not take for granted the new lease of life that the operation has given them. Mr Krishna told me that I had an 80% chance of being 80% better, and I am, I think, more than 80% better. I experience the odd twinge, but the pain that I had before is gone.
My story is not unique; far from it. The cost to the individual, the family and the nation of chronic back pain is massive. Back pain is common in the UK. In any given year, about 30% of the population suffers from it, and 20% of the population—12 million patients—visit their GP with it. Between 3% and 4% of the population are chronically disabled by back pain, and 52 million work days a year are lost because of it. The chance of someone’s returning to work after being off work with it for two years is less than 5%. Research shows that, for the individual, sudden severe and then chronic back pain is debilitating and can result in low mood, loss of libido, disturbed sleep, poor appetite or weight loss, fatigue, feeling worthless, problems with concentration, and even thoughts of suicide.
Back pain can also threaten the stability of the sufferer’s family, possibly leading to marital and family breakdown. Because it often strikes during a person’s maximum earning period, it can threaten the economic survival of the family unit. A person’s back pain and associated side effects can become very draining for the family, as an inability to remain in one position for any length of time threatens normal daily activity as well as leisure.
The extent to which the whole family is affected when one of its members has back pain cannot be underestimated. The economic consequences to the nation are also apparent. The individuals concerned are often at the peak of their earning capacity, and months and years of not being able to work and to contribute to society add to their feelings of worthlessness.
For those reasons, I want to pay a special tribute not only to the work of the spinal unit at University Hospital of North Tees but, more specifically, to the voluntary workers of the Tees Valley spinal support group. In 1999 Victoria Fenny, a patient waiting for back surgery, approached Mr Krishna and asked what support there was for patients with this debilitating condition. She wanted to talk to someone who had been through the experience, but no support group existed, and as a result the Tees Valley spinal support group was formed. The group, which now attracts at least 100 people to its quarterly meetings at the hospital’s teaching centre, includes former patients and those awaiting surgery, and provides an invaluable source of learning and support for the hundreds of people who have back and neck surgery each year.
The feedback from the group is used to improve the service further. Health professionals attending the support group say they learn as much from the patients as they teach them about how quickly they can get back to normal after surgery. North Tees and Hartlepool NHS Foundation Trust supports the work of the charity by providing a counselling room for patients where they can meet volunteers and talk about their concerns, and rooms at the teaching centre where the quarterly support groups are held.
The Tees Valley spinal support group is a registered charity and it raises funds to support the work of the spinal unit. I have visited the support group on a couple of occasions and it is good to speak to people who have suffered from the same symptoms—people who coped by wearing slip-ons, used the filing cabinet as a desk and left the TV remote on the back of the chair. I would like to place on record my recognition of the voluntary work undertaken by Victoria, and also Linda Botterill, Claire Poulton, Peter Evans, Peter Allan and Gordon Marron.
In 2011 the support group held its first fun-walk to raise funds for educational equipment for the unit. I met former patients who had spent years in wheelchairs but can now walk. I agree with Mr Manoj Krishna when he says that it is no longer accurate to tell patients nothing can be done for their back pain and they have to live with it. The skills are there. The support is there too. What can the Government do to ensure the excellent example of the spinal unit and its support group can be replicated around the country so that the millions of our citizens who suffer from back pain can receive the treatment they need instead of being told they just have to cope with it?
Is the Minister aware that Britain has 18 spinal surgeons per 100,000 head of population, whereas the Netherlands has 30 and the USA has 76? Back surgery rates in the UK are 30 per 100,000 head of population, as against 52 in Sweden, 115 in the Netherlands and 158 in the USA. What more can be done to improve Britain’s position, because we obviously have the talent, skills and expertise to be world leaders in this area?
What will the Government’s proposed reorganisation of the NHS do to ensure that patients who need the treatment will get the treatment, especially as spinal surgery techniques are rapidly improving and becoming ever more sophisticated? Finally, will the Minister join me in congratulating the management and the surgical and nursing staff at the hospital on the work they are doing to ensure chronic back pain is being treated with such professionalism? In particular, will he join me in congratulating the volunteers who run the support group, and who ensure that the service provided is holistic in its approach and helps secure the good will of patients to help other patients, in order to give them hope and address their fears? All specialties in all hospitals would do well to have their own support groups. I know from personal experience how important they are.
Paul Burstow (The Minister of State, Department of Health; Sutton and Cheam, Liberal Democrat)
I congratulate Phil Wilson on raising this important set of issues. The subject is close to my heart as well, as a result of my previous experiences as a Back Bencher raising similar issues about how we can deal with chronic back pain and ensure that pain is not an afterthought and the forgotten issue in the NHS, given how much it can blight the lives of so many people. Before saying a little more about that, I want to do what the hon. Gentleman asked me to do at the end of his remarks and pay tribute to both the excellent work the NHS staff working in his area do, sometimes under trying circumstances, and the work Victoria and the other people he mentioned do through their contribution as volunteers and supporters of other patients.
The hon. Gentleman vividly described his own experiences, and in doing so he has helped to turn a spotlight on these important issues. We must keep in mind the excellent care and consideration he received—and has rightly praised so highly—from Mr Krishna and that team’s other specialists. Their work has made a difference to his life, as well as to the lives of many of his constituents and many other people. This is a clear example of the NHS at its best, and I join the hon. Gentleman in paying tribute to all concerned.
Often it is a patient asking how they can get involved that provides the spark that leads to the sort of voluntary activity the hon. Gentleman has described. I certainly have no difficulty in paying tribute to Victoria for asking that question of Mr Krishna, which became the spark that has ignited so much good work since.
I am aware of the hon. Gentleman’s ongoing engagement with the group since his surgery in 2008. His remarks again highlighted the value of patients who have finally found relief after long-term chronic back pain having the opportunity to talk to others who are still going through the misery of their condition, as that can reassure people about what can be done. The support group’s work shows the extraordinary value of having the voluntary sector and volunteers working within our NHS. He asked what we can do to strengthen that approach and replicate the idea further. The first question at last week’s Health questions was about what we can do better to support volunteering in the NHS. I said then, and I repeat now, that we are working closely with the association of hospital volunteer co-ordinators to make sure that NHS boards have the information they
need to make the right decisions about the investments they need to make to support voluntary organisations. These may be small investments, such as providing a bit of time or a room where people can provide the valuable emotional and other support that he describes. That approach is very much at the heart of the vision in our report on volunteering in the NHS. One way we can see that go further is by ensuring that local NHS organisations sign up to the compact agreements on the voluntary sector, so that they are fully engaging with their local voluntary and community sector and making full use of that way forward.
I understand that the Tees Valley spinal support group holds quarterly meetings and I am told that they are attended by hundreds of people, which, again, underscores how important these groups can be. Perhaps most important is the fact that charity volunteers who have received spinal surgery are available to talk about these issues, as that can be hugely reassuring. There is also enormous value in developing this whole area of hospital volunteer schemes. As the hon. Gentleman rightly said, this support group provides an excellent example, and I will want to use it to illustrate the benefits of such approaches. That is why I am keen to make sure that these volunteering opportunities go further.
I wish to reflect a little further on some of the points that the hon. Gentleman made, and there is broad agreement about many of them. He rightly highlighted the huge impact that back pain can have on people’s lives, saying that we can do better on treating and preventing it. This is a serious issue for the NHS, for the people affected and for the economy and our society as a whole, and it is not just about the most extreme cases where surgery proves necessary. He rightly says that surgery is no silver bullet, but when one rehearses the statistics, as he did, one finds that in the number of working days lost to illness, musculoskeletal conditions come second only to mental health problems, with a price tag for the economy of £5.3 billion a year. That occurs through lost work days, poor productivity and, in the most serious cases, people being shut out of work altogether and facing a lifetime of incapacity and difficulty.
In the shadow of the statistics that the hon. Gentleman has rehearsed there are hundreds of thousands, if not millions, of people who have to cope with chronic back pain for many years. As he has said, some of these people are not given the opportunities they need to get the right support and the right treatment at the right time, so he was right to talk about the impact on the individual and about his personal experience, but there is also an impact on families, on relationships, on mental health and on a person’s well-being. For me, that points to the fact that when we think about health and well-being, we need to think bigger. He talked about holistic services that have an impact on poor health and
tackle health conditions. That is very much part of what we are trying to achieve through some of the reforms to which he referred, so that improving mental health outcomes or issues to do with pain, for example, becomes not just about the Department of Health or the NHS but about what the Government, employers and many other organisations can do together. Occupational health is a key component of that.
I hope we can agree on some of the elements of the vision of what a society that actively promotes health and well-being looks like. Local communities, councils, the NHS and the voluntary sector, which has extraordinary power, should work together to begin to make a difference to the health and well-being of local people, and everything in the health system should point towards prevention. We should be able to say that the NHS is as good at preventing poor health as it is at treating it.
Let me say something about the need to ensure the integrated package of care mentioned by the hon. Gentleman. He listed some numbers and I would like to write to him about the numbers of spinal surgeons and so on, to give him a bit more detail on our thinking about how we can develop the NHS in respect of musculoskeletal conditions. There is a good story to tell and I want to set that out in more detail for him.
I also want to answer the hon. Gentleman’s important question about how reforms will support improvements in surgery services. In our view, the Health and Social Care Bill creates a number of the tools that will support continuous quality improvement in the service. The outcomes frameworks published for the NHS on social care and public health provide a greater opportunity for clarity and accountability and have been widely welcomed across the clinical community.
Let me answer the hon. Gentleman’s questions about what reform can do. Reform must allow much greater transparency so that we can see differences and variations in the service in different parts of the country. The publication of the health atlas is already driving commissioners to benchmark themselves against the best in the NHS. The use of tariffs will drive best practice in the services, too, and front-line staff will be empowered to use the clinical evidence—they know that this is the best practice—to deliver and commission the best possible services for their populations.
I thank the hon. Gentleman again for bringing this matter to the House tonight. He was right to want to praise the work of the spinal support group and the valuable contribution it makes to the lives of so many people in his community. I also praise the professionalism of the NHS staff who treated him and who treat his constituents. I am pleased to have the opportunity to put those remarks on the record and to endorse and underscore what he said.
Question put and agreed to.