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House of Lords

Wednesday, 26th November 1997.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Exeter.

ME: Diagnosis and Treatment

2.38 p.m.

The Countess of Mar asked Her Majesty's Government:

    What is the current advice upon which general medical practitioners base their diagnosis and treatment for the illness myalgic encephalomyelitis (ME) or, as known by some psychiatrists, chronic fatigue syndrome.

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, with the indulgence of the House, I first congratulate the noble Baroness on being the Peer of the year. I am sure that all noble Lords would like to join me in congratulating her on her extraordinarily successful work in so many fields of healthcare.

With all her expertise, I am sure that in relation to this Question the noble Baroness is aware that there is no single diagnostic test for ME. This means that diagnosis is often made by eliminating other possible conditions through a series of specific tests. The causes of ME are not fully understood, nor is there a generally agreed method of treatment. Treatment to relieve the wide variety of symptoms which may present and which patients can experience is therefore a matter for individual doctors to decide in consultation with their patients.

The Countess of Mar: My Lords, first, I thank the noble Baroness and the House for their support. The past five years have been a long, hard struggle for me and I appreciate the support that I have received from all parts of the House.

Is the Minister aware that most GPs and many health authorities rely on the report of the Royal Colleges, No. CR54, for diagnosis and treatment of ME, which not only causes a tremendous amount of ill health, pain and moral disappointment to patients with ME but also prevents them from receiving disability benefit? Will the Minister look once again at this report--I know she has been asked to do so many times--with a view to having it withdrawn?

Baroness Jay of Paddington: My Lords, I accept the noble Baroness's point that a number of people have received unsympathetic responses on first approaching their general practitioners about this condition. However, as she will be aware, both the report of the medical Royal Colleges and that of the national task force on CFS and ME--which was more of a

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voluntary-sector based activity--endorsed what I believe is generally known as the bio-psycho-social approach to diagnosis, which means that there is no polarised position between this being a psychological or a medical disease but that it is something which needs to be handled in a holistic way. As I said in reply to the noble Baroness's first Question, that means that there will be a variety of different treatments, depending on the patient.

The noble Baroness will be aware that entitlement to disability living allowance does not depend upon a particular illness or disease but upon the effects of disability on a person's life.

Earl Howe: My Lords, is the Minister aware that there are many hundreds of people suffering from this disability in one form or another? Can she tell the House what research is being undertaken into ME?

Baroness Jay of Paddington: My Lords, yes, we are aware of that. It is generally said that several thousand people have this unfortunate condition, in whatever manifestation it occurs. Through their research and development programme, the Government are funding research projects in this area, perhaps the most important and significant of which is looking at general practice in relation to the syndrome.

Lord Addington: My Lords, would it not be sensible to give guidance to doctors to the effect that they should examine patients to see whether there is a medical cause for the condition such as, for instance, organophosphate poisoning--which has been frequently referred to in the past--as opposed to a psychological cause? In other words, the medical condition should be looked at first. If a patient is misdiagnosed and psychological help is given to someone with a medical condition, that will not only waste considerable amounts of money but will inflict problem upon problem on those who are misdiagnosed.

Baroness Jay of Paddington: My Lords, I am sure that the noble Lord will not expect me to give a clinical judgment on this complicated condition. I can only refer to the previous answer I gave. My understanding is that the general guidance given to general practitioners is that this is not something which should be looked at as exclusively a medical or a psychological condition but that the best approach to therapy is a holistic one.

Lord Crickhowell: My Lords, I welcome the carefully balanced answer that the Minister has given. As one who has observed the serious nature of this illness in my family and among others, let me say how welcome it is that she accepts that not all these cases are psychiatric; there are undoubtedly many cases which have direct physical causes. One of the most important ways of dealing with the problem is thorough and careful diagnosis by the medical profession and, where possible, early treatment. There is clear evidence that where the problem is tackled early there is much more likely to be a cure.

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for underlining what he

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described as the balanced approach that we are attempting to take. As he says, different people in different places have recognised a variety of different conditions which they have related to CSF or ME over the past 35 years. It is important that people who fear that they may be suffering from the syndrome take medical advice early on. It appears that it is only prolonged fatigue that is generally recognised as a physical symptom of the illness.

Lord Monkswell: My Lords, can the Minister say whether, if a medical practitioner prescribes to a person a long period of bed rest, that person would qualify for disability living allowance?

Baroness Jay of Paddington: My Lords, once again I am being invited to suggest a clinical solution to this complicated problem. As I said in answer to the previous Question from the noble Countess, the question of disability allowance will be reflected in the mental and physical condition that the person exhibits when they make application. It is not related to the diagnosis of the specific illness.

Lady Kinloss: My Lords, is the Minister aware that the organisation Fighting for Truth has been asking her to receive a petition since July? As I understand it, it has not yet received an answer and we are wondering whether the noble Baroness received the petition. Is the Minister aware also that my noble friend Lady Mar will be presenting a petition containing 12,502 signatures to this House this afternoon?

Baroness Jay of Paddington: My Lords, I must confess that I am not aware of the petition to which the noble Lady refers. I shall ask the Department of Health to look into what happened to it.

Lord Blease: My Lords, is the Minister aware that figures have already been quoted stating that 200,000 people are suffering from this debilitating illness, around 5,000 of whom are in Northern Ireland? Can the Minister give a further explanation concerning the clinical diagnosis of the condition? Also, does she agree that there is an urgent need for general medical practitioners to receive help in referring patients for diagnostic treatment to hospitals under the National Health Service arrangements?

Baroness Jay of Paddington: My Lords, I am grateful to my noble friend for emphasising again that this is a widespread problem. I can only repeat that specific diagnosis is difficult to make. It is up to local general practitioners to use their best clinical efforts to deal with any patients who present to them. The point underlined by all the questions posed this afternoon is that there is a need for a better understanding of the

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condition. That is why the department is supporting the research I described, particularly in relation to general practice.

Traffic in London

2.46 p.m.

Lord Cledwyn of Penrhos asked Her Majesty's Government:

    What steps they have in mind to deal with the growing problem of traffic in London.

The Parliamentary Under-Secretary of State, Department of the Environment, Transport and the Regions (Baroness Hayman): My Lords, we are seeking to make the most efficient use of the existing road network and to develop new enforcement techniques to ensure that the network functions effectively. We are progressing the red route and bus priority networks and are looking to improve public transport and conditions for cyclists and pedestrians, thereby encouraging greater use of alternatives to the car. We are also developing a national integrated transport policy to deliver a clean, efficient, safe and reliable transport system.

The proposed greater London authority will assume overall strategic responsibility for transport in London and the implementation of a properly integrated transport policy for the capital.


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