Health Bill [HL]

I strongly support this amendment, to which I have added my name, and I shall be reinforcing much of the background that the noble Earl has just given. I declare an obvious interest, as someone who was paralysed at university more than 40 years ago from a spinal cord injury to my neck, and as vice-chair of the all-party group for the condition. The number of Peers with spinal cord injury in this House misrepresents its incidence in the general population. Until Lady Darcy’s untimely death last year, there were three of us in a House of around 750 Peers, which far exceeded the estimated numbers of spinal cord injured people in the general population, which are seen to be low enough for spinal cord injury to be defined as a specialist condition under the Department of Health national definition set. Currently, under Sir David Carter’s Review of Commissioning Arrangements for Specialised Services, published in 2006, spinal cord injury is one of the conditions which should be commissioned at regional level of the health service by specialised commissioning groups, not at the national level. But this is patently not working, as we have heard described so graphically by the noble Baroness, Lady Masham. What is urgently needed is a single commissioning body, as proposed in this amendment, and a national bed bureau. What is the current position? The precise numbers of people with spinal cord injury in the country are not known and there is no easy means of establishing them. The most reliable estimate is that there are about 40,000 spinal cord injured people in the UK at any one time and around 700 new traumatic injuries each year. In percentage terms, these figures are small but, in terms of absolute numbers, 40,000 is still a significant group. There are also non-traumatic cases of spinal cord injury from a whole range of causes, such as viral infections, spinal tumours and so on. The incidence of these is thought to be substantially greater than for traumatic spinal cord injury, but, again, the precise numbers are unknown. There are an estimated 700 people who need emergency first-time admission to a specialised spinal cord injury centre each year. Admission needs to be as soon as possible after injury in order to minimise the damage and not cause additional and entirely unnecessary complications. As noble Lords will hear many times, the earlier a spinal cord-injured person is admitted to a spinal cord injury centre, the less will be the cost of their care and the better will be the outcome. But there is also a vital need for spinal cord injury centre beds for readmission of both elective and emergency spinal cord injury patients. There is enormous concern among the growing and ageing spinal cord injury population about the inability of district general hospitals to provide them with appropriate care for their existing condition, if they are admitted for non-spinal cord injury conditions such as a broken leg. Their concern is not about the hospital’s ability to treat the broken leg but about the lack of experience and knowledge to provide appropriate pressure care and bowel management. I had not needed to have any in-patient care for more than 35 years, because of my excellent speedy initial care, but I have been admitted twice overnight in the past few years for non-spinal-cord reasons to my local trust, which happens to be that of my noble friend Lord Darzi. Both times it was abundantly clear that staff had no knowledge or awareness that my spinal cord injury needs required attention. It was entirely up to me whether or not they were met. Over the past two years the Spinal Injuries Association has been conducting research with the spinal injury centres to try to establish the true situation in the country. As we have heard, it found that the average time from injury to admission to a specialist spinal cord injury centre for newly injured patients is 46 days—more than six weeks. This is the most crucial time for dealing with the trauma and preventing complications and can reduce the catastrophic effects of the injury. As a result of these serious delays, lengths of stay in specialist SCI centre beds are then greater than need be because the patients have complications that might have been avoided if they had been admitted more promptly. This in turn exacerbates the pressure on specialist beds and reduces capacity for specialist care. It is thought that at least 10 per cent of people with a spinal cord injury never receive specialist care from an SCI centre at all. What that means in terms of unnecessary complications, depression, increased life-long impairment and lack of rehabilitation is appalling. I turn to the issue of readmission capability for people with SCI. A study in 2000 of readmissions to SCI centres found that almost half—42 per cent—of established SCI patients did not gain admission to the specialist care centre that they needed. What capacity can the present SCI service offer to meet the needs of both new and existing SCI patients? A total of only 450 beds are distributed between eight NHS SCI centres within host NHS trusts in England and one each in Northern Ireland, Wales and Scotland. These centres developed in response to the Second World War and the needs of heavy industry and the coal mines, so they are generally not near contemporary centres of population. As a result, patients can be referred to centres hundreds of miles from their home and family and the scene of their accident, which can be for months, or even years on end. If you live in Cornwall and need specialist care for an SCI, you have to travel as far as Salisbury for the nearest SCI centre. A further complication is that the host trust will too often divert funds away from specialist SCI services for which they were intended to plug leaks elsewhere within the trust. Trusts also have a tendency to use specialist SCI beds for non-SCI patients if they are unoccupied. A national bed bureau for patients with SCI, as proposed in this amendment, would help to ensure that the existing bed capacity was used to its optimum level. It would help to address the current wasteful situation where SCI patients spend weeks waiting for referral in a district general hospital; as we have heard, they often develop additional complications, such as pressure sores, which take months for the specialist centre to eradicate, so filling a bed for much longer than anybody wants. The amendment would provide every A&E department with a systematic and coherent system for placing their spinal cord-injured emergencies in specialist care. What is more, it could heighten awareness of acute traumatic SCI in each A&E department, and so reduce the incidence of missed cases. Many Members of the Committee will have seen the article about Daniel James in the Sunday Times on 15 March. He was paralysed in a rugby accident, taken to a local hospital and moved unnecessarily many times, and then had to wait until the next day for an MRI scan. He was put last on the list for the scan because the hospital was not aware of his injuries. His hands and arms were moving when he first had his accident, but after having to wait for an ambulance, which arrived at about 10.30 at night, when he finally arrived at Stoke Mandeville he had lost all movement and feeling in his fingers, which he did not regain. As a result, he has the sad renown of being the youngest person to go to Switzerland for assisted suicide. Crucially, a national bed bureau would mean that we would start to get a true estimate of the level of spinal cord injury service that is required. As my noble friend Lord Darzi said in response to Amendment 35: ""Commissioning cannot be improved without high quality information".—[Official Report, 26/2/09; col. GC 178.]" With a firmer grip on the numbers, I hope that we can begin to reverse the current decline and ensure that there are no more cases of people waiting weeks for referral to the care and rehabilitation that they so desperately need.