Health Bill [HL]

I support the noble Baroness in her very well considered amendment. To my mind, there are three main problems here. First, we do not know precisely how many spinal cord-injured people there are each year. We know roughly, but we have no nationally collected data and, on the basis that what you cannot measure you cannot have a proper policy for, the first lesson from the noble Baroness is that we need to know the numbers. Secondly, there is a shortage of spinal cord injury beds. The spinal cord injury service in the UK has a total of up to 450 beds; the precise figure varies depending on how many beds are closed at any one time. They are located across eight NHS centres in England and one each in Northern Ireland, Scotland and Wales. Since 1980, the number of beds has fallen, while the proportion of people surviving spinal cord injuries has increased. Pressure on specialist beds has led to long-term spinal-injured people being admitted into non-specialist hospitals, where they are not offered basic spinal cord injury care requirements, and they often develop complications unrelated to the cause of their admission. Those complications increase rehabilitation time and reduce final outcomes. Thirdly, there is a lack of co-ordination, which is the sine qua non of enabling swift and appropriate referral. This is not a case of asking for more money to be spent on spinal injury care, but rather that the same amount of money should be spent in a different way. At present, many of those with spinal cord injuries are spending time being managed in non-specialist centres by people who lack the necessary competence. As a result, they develop complications, as I said, which result in longer stays and poorer outcomes. It has been estimated by the SIA that if every spinal cord injury patient were appropriately managed from the outset, the cost of treating each person would be less. That means that one could treat more people with the same amount of money. A survey was done last year by the SIA, which came out with some really quite alarming findings. Some 10 per cent of spinal cord injury patients did not receive any specialist care from a spinal cord injury centre. Some 21 per cent of new injuries did not get admitted within one month of their injury, and the average time from injury to referral was 28 days. It is salutary to read the brief that the SIA sent me, which says that for injuries sustained in rugby football, for example, two-thirds of those with complete spinal cord injury as a result of cervical dislocation who are looked after properly within four hours of injury make a full recovery. Only 5 per cent of those who are looked after properly after four hours will make a useful recovery and none will recover fully. It is rather like stroke, where you have to make certain that you go through a religious routine very swiftly after the incident has happened. If you do not do so, the results can be really very poor; the prognosis is poor. That is the background. I hope that the noble Baroness will not mind my setting it out for her amendment as I have. It is important that the Minister understands what we are talking about here; this is a really very important area of specialist care, which I do not think receives the attention that it deserves.