Lord Londesborough (CB)
My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare my interest as a migraine sufferer.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the Government are committed to improving migraine care through the 10-year health plan. We are strengthening neurological services by expanding community-based care and community diagnostics for earlier identification, widening the availability of effective treatments, such as calcitonin gene-related peptide inhibitors, and enhancing the NHS app. NHS England’s neurology programmes are also expanding specialist capacity, reducing avoidable A&E attendances and helping people with migraine to remain in work and maintain their well-being.
Lord Londesborough (CB)
I thank the Minister for engaging on a subject that has been raised just once in this House since 1961—which is extraordinary, as we have 10 million migraine sufferers in the UK, more than half of whom have no diagnosis or access to preventive medication. Migraines cost the wider economy more than £10 billion per annum in lost productivity and tax revenues, with hundreds of thousands of capable people unable to work due to lack of treatment, so does the Minister agree that there is a compelling economic as well as compassionate argument for better GP training, more neurologists and including migraine in the NHS Pharmacy First scheme?
Baroness Merron (Lab)
I agree with the noble Lord. I appreciate the conversations we have had prior to this Question and acknowledge that he is one of the millions of people suffering from this condition. There is certainly a substantial economic and NHS impact from migraine. I am glad my department is working with the Department for Work and Pensions on a number of initiatives, including the WorkWell programme and the individual placement and support in primary care initiative, which are all focused on supporting those with migraine to stay in work and get back to work.
Baroness Winterton of Doncaster (Lab)
My Lords, the approach that my noble friend the Minister has outlined regarding migraine care is very welcome. The 10-year plan also talks about cholesterol management due to its links to cardiovascular disease, but the plan can quite often be confusing for the patient in terms of the care that is provided. A simple example would be suggesting that cheese is bad for cholesterol but good for osteoporosis. HEART UK has therefore raised the fact that there should be a holistic approach to the patient. Can my noble friend make sure this happens in the 10-year plan and the delivery of it?
Baroness Merron (Lab)
I can indeed say to my noble friend that a holistic approach is exactly at the core of the 10-year plan, as is the enhancement of care through expanded community diagnostics, better prevention and the use of personalised digital tools, including the NHS app. All these will be helpful in the way my noble friend seeks. The workforce plan, which we will see shortly to support the 10-year health plan, will also acknowledge the need to see people holistically and to staff up accordingly.
Lord Scriven (LD)
My Lords, there has been a more than 20% increase in the number of emergency hospital admissions since 2021 due to this condition. Will the Government include and fund migraine in the Pharmacy First scheme and empower pharmacists to prescribe for this high-volume condition?
Baroness Merron (Lab)
We constantly review and discuss with pharmacists the range of conditions they cover. It has been one of the highly successful ways of making community-based care available, and we certainly want to continue to work with pharmacists. It is also important to note that more modern treatments are available now on prescription, which will all also support people to manage their condition and will reduce unnecessary A&E admissions.
Baroness Manzoor (Con)
My Lords, as has already been mentioned, over 10 million people in the UK suffer from migraine, and it is highly prevalent in women. It is also linked to anxiety and depression. I welcome what the Government are doing in extending women’s health hubs and emphasising mental health in the 10-year plan but, unfortunately, there are no systematic gateways for migraine care in the 10-year plan. How can the Government address this in the light of the significant problem that there is? I am also sorry to hear that the noble Lord, Lord Londesborough, suffers from migraine.
Baroness Merron (Lab)
It is important that we acknowledge that this is a debilitating condition. The noble Baroness is right that it is one of the most common neurological conditions, affecting one in five women and one in 15 men. Indeed, it is a major cause of disability. The 10-year plan sets out the main pillars. For example, there will be an updated adult neurology service specification, which will come into being just next month. It was published in August, and I believe it will take account of the points the noble Baroness rightly raises.
Lord Hunt of Kings Heath (Lab)
My Lords, my noble friend the Minister, very welcomely talked in her first response about widening access to treatment. My understanding is that NICE guidelines can be very tight for some of those treatments. As part of the work she has put forward, can my noble friend ask NICE to review its guidelines to make sure they are absolutely up to speed?
Baroness Merron (Lab)
As I know my noble friend is well aware, the eligibility criteria are set independently by NICE. They are based on clinical evidence and cost-effectiveness, rather than being set by Ministers. However, it is worth saying that the introduction of oral CGRPs, which do not require specialist initiation, will significantly widen access through primary care and reduce the bottlenecks in the system. We are very keen that people can access effective drugs, and I take on board the point my noble friend made.
Lord Kamall (Con)
My Lords, I thank the noble Lord for the Question, because although many people think that migraines are just bad headaches, they are in fact a distinct, complex neurological condition. They are responsible for 43 million lost working days each year and are estimated to cost the UK economy up to £4.4 billion. The Minister rightly talked about calcitonin gene-related peptide therapies, but apparently only about 29% of trusts allow access to CGRPs. I welcome what the Minister said about increased access via primary care, but I note that these drugs prevent migraines by targeting a molecule involved in pain transmission. What specific steps is the Minister’s department taking to increase access to these treatments in addition to the primary care initiatives?
Baroness Merron (Lab)
We very much recognise the concerns that people may face unnecessary hurdles when trying to access CGRP treatments. NHS England is working with integrated care boards to ensure that the pathways being followed are consistent and timely. It would perhaps be helpful for me to mention some of the national tools, such as NHS RightCare’s headache and migraine toolkit and the Getting It Right First Time recommendations; they also speak to the clearer referral rates that the noble Lord called for and reduce variation. We want people to receive appropriate treatments; we do not want them to be delayed.
Lord Patel (CB)
My Lords, migraine as a symptom is a manifestation of a whole spectrum of different diseases, both neurological and vascular, and some are based on allergies. The important aspect of treating migraines is correct diagnosis, and advances in diagnostic techniques, including some of the treatments that the Minister mentioned, are now making that easier. Does she agree that, in addition to having a community-based service, it is important to train the right people to make the right diagnoses, so that patients can get the right treatment at the right time, no matter who dispenses or prescribes it?
Baroness Merron (Lab)
I certainly agree. NICE’s headache guidelines and the Royal College of GPs’ training modules support that better recognition and management.
Baroness Blower (Lab)
My Lords, speaking as a person who was identified as possibly prediabetic and having a significant heart and cholesterol problem, I can tell the House that, when I looked at the charts of what I might be able to eat from both of those sources, it seemed I was left with kale and cucumber. A holistic approach for this is very important, and I am pleased to say that I am very healthy and do not eat only kale and cucumber.
Baroness Merron (Lab)
I am sure your Lordships’ House is, like me, delighted to hear that about my noble friend.