This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.
  • The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK, and our mission is to transform the quality of life of people with musculoskeletal conditions. We have 33 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Arthritis News

by Sue Brown, CEO ARMA

I write this reflecting on my day yesterday, which was unexpectedly dominated by discussions on pain. Pain is, of course, something we all talk about a fair bit in the MSK health world, as it’s one of the shared factors that cuts across all MSK conditions. I’m increasingly realising it is something we don’t always deal with particularly well.

My day yesterday began with reading New Scientist on the train, including an article about UK doctors’ concerns that we will follow the US into an opioid crisis. The question raised in the article was: is there a risk we will take things the other way, so that when someone does need opioids, they won’t be able to get them? The day ended at a wide-ranging lecture by Simon Stevens, Chief Executive of the NHS, including a slide showing opioid prescription rates by region: a wide variation, with London the lowest, and the North East the highest.

My discussions throughout the day all touched on pain in some way, but with a much broader agenda. Pain is rarely a simple matter which can be solved by pills alone. Yet that’s the only option offered to so many people. ARMA promotes a person-centred, integrated, biopsychosocial approach for anyone who experiences chronic pain. The prevalence of chronic pain is highest in the North East of England, and lowest in London (43.1% vs 29.0%). There is something going on here which is not just physical. We know that there are strong links between physical and mental health, which is why ARMA recently organised a roundtable on mental health. It is clear from my discussions yesterday that this is crucial in the context of chronic pain.

My issue with the debates about opioids is that they are about opioids. It seems to me that this is starting in the wrong place. The question is not what can we do about the increase in opioid prescription but what can we do about the increase in chronic pain? We need a much more sophisticated discussion. If pain is complex and individual, then the solutions must be personalised and multidisciplinary. We need to be able to refer people for psychological support. That might be IAPT psychological services for people with MSK pain. It might be health psychology in the context of a specialist pain service. We need to have appropriate peer support and social prescribing offers. We need to look at the underlying causes of pain and treat those where possible. The best pain services in the world are not useful if what the patient really needs is joint replacement surgery or rapid access to physiotherapy. And we need appropriate prescribing, and clinicians confident to discuss the different options and engage in good shared decision making with their patients.

This is not an issue which can be addressed by one profession. Patients in chronic pain may need GPs, rheumatologists, surgeons, pharmacists, psychologists, physiotherapists and others, working together. As with so much else in MSK healthcare at the moment, this support doesn’t join up and in the case of psychological support, too often isn’t available at all. This is why ARMA has made mental health a priority for this year. Together with our members, we will be pushing for improved access to joined-up, multidisciplinary personalised biopsychosocial support for people in chronic pain. We’ve already had some webinars on the subject, including how to deliver an integrated pain service and how to integrate mental health into physical health services. We’ve held a roundtable and produced our report. Look out for more activity including webinars and our annual lecture in November that push this agenda forward.

Join with us in calling for action to provide comprehensive services which address chronic pain from all angles. Patients with chronic pain deserve nothing less.

NASS was delighted to launch the NASS Allies referral template, in conjunction with the Institute of Osteopathy and Royal College of Chiropractors, at the Primary Care and Public Health Conference on 15 and 16 May. The template was developed to help chiropractors and osteopaths in recommending referral for patients with suspected inflammatory back pain to rheumatology.

The template has been endorsed by the Royal College of GPs and Chartered Society for Physiotherapy. NASS is grateful to both the Institute of Osteopathy and Royal College of Chiropractors for their continued collaboration and wonderfully patient-centred approach.

Save Our Pools

NASS is working with a number of organisations, including several ARMA members, on developing a campaign to sustain and in some cases, save, hydrotherapy pools around the country. If you are interested in being involved, please email jill@nass.co.uk. Please also sign and share the petition to save the pool at Bedford Hospital.

 

Guest blog by Dr Jeanelle de Gruchy, President of the Association of Directors of Public Health

To its great credit, New Zealand has become the first country in the world to produce a “wellbeing budget” – a commitment to prioritise population wellbeing as the main mission of the government. A similar philosophy was adopted in Wales in 2015, with the Well-being of Future Generations Act requiring public bodies to think about the long-term impact of their policies on both people and places.

This is a bold and exciting approach for anyone living with a musculoskeletal condition or campaigning for change on their behalf – and for the wider public health community. It puts the highest value on quality of life when it comes to national policy and investment decisions. The Association of Directors of Public Health has long championed taking a whole system and long-term view of how we create and support the health and wellbeing of everyone in society.

What does that mean in practice?

The ADPH recently published updated versions of our life course policy position statements capturing the collective views of Directors of Public Health in local government. There are four documents covering: Best Start in Life, Living and Working Well, Healthy Ageing and Health Inequalities.

Our statement on Living and Working Well focuses on the ‘working age’ population – the approximately 63% of people between the ages of 16-64 – and how to promote healthy, happy and productive lives. We know that the biggest causes of poor health (‘morbidity’) in England are low back and neck pain.

Delivering change means putting a greater emphasis on improving the social determinants of health – such as housing, air quality, education, income and food – factors which overwhelming shape our health and driving down inequalities in how long we live in good health (‘healthy life expectancy’).

It means promoting good mental health by intervening early to prevent the adverse childhood experiences that can have a lifelong impact. We know that along with mental health, poor musculoskeletal health (like back and neck pain) accounts for the majority of sickness absence in the UK, making this an issue of concern beyond the health sector. As ARMA highlights in its policy paper Musculoskeletal and Mental Health, we need to understand the inter-relationship between MSK conditions and mental health rather than treating them in isolation.

It means enabling people into good work and creating healthy workplaces which prevent many musculoskeletal conditions arising, as well as supporting those with musculoskeletal conditions to thrive in work.

These are all areas that need to be addressed in the upcoming green paper on prevention.

Finally, more funding for public health is now critical. A spending review is expected at some point this year and there is a growing consensus that public health investment – in its widest sense – must be a priority. In February, ARMA – and many of its members – signed up to a public letter in the Times, coordinated by ADPH and supported by 54 organisations, setting out the case.

The government has the welcome ambition to improve healthy life expectancy so that, by 2035, we are enjoying at least five extra years of healthy, independent life, whilst closing the gap between the richest and poorest. If the public health funding gap continues to grow, this ambition will not be met, with the costs being borne by the NHS, the economy and individuals.

We look forward to working with ARMA in the months ahead to raise the voice of public health and echo the call recently made by the APPG on Wellbeing Economics for a spending review which walks the walk on wellbeing.

On 8 May, Versus Arthritis published a new policy report looking at the impact of home aids and adaptations for people with arthritis, and the barriers that people face when trying to access them. Read the full report here, which includes powerful stories from people with arthritis who benefit from aids and adaptations.

We found that aids and adaptations – from perching stools and grabbing tools, to grab rails and stair lifts – can help people with arthritis, and related conditions such as back pain, achieve a better quality of life and maintain their independence in the home.

60% of all people with arthritis, across all genders, ages, and severity of condition, used an aid or adaptation. Of those, 95% felt that these products had a positive impact on their lives. However, too few people are aware of the support available to them. 

The report makes recommendations to both local and central government that would help widen access to these vital services.

The Royal College of GPs (RCGP) has published a vision for general practice for 2030. It sees a very different place for general practice from the current model, with increased multidisciplinary working and a greater focus on prevention and well-being. This was developed with the involvement of patients, GPs and other stakeholders.

This is a response to the changing nature of health needs with more people presenting with complex and multiple conditions. The current primary care workforce is stretched and the numbers of GPs per 1,000 of population have declined by 5% in the last ten years.

The document sees general practice in 2030 remaining the first point of contact for most patients, but not focused on GPs, more on multidisciplinary teams, freeing up GPs to do what needs a GP. Practices should become well-being hubs addressing psychosocial needs of patients. They should host prevention, well-being and social action projects, and play a role in building strong resilient communities. They will provide links with secondary care. One example given is the potential for practices to run MSK clinics currently delivered from hospitals.

The document lists six enablers needed to deliver this:

  • Funding
  • Training
  • Workforce
  • Digital
  • Modern premises
  • Research and Innovation

The summary document contains many examples of practices already putting some of this into practice and more detail on each of the areas and enablers. Read it here.

Following a successful launch event at the British Society for Rheumatology Conference on 1 May, applications are now open for the Aspiring to Excellence award programme. The programme is designed to encourage and recognise service improvement in axial SpA (AS) care and is a strategic partnership between NASS, BRITSpA and sponsoring companies AbbVie, Novartis and UCB.

The deadline to apply is 31 July and all the application details can be found on the NASS website. For further information please contact annamcgilvray@nass.co.uk.

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Action is needed to tackle £646 million burden of bone, joint and muscle problems, a new ARMA report says.

construction-work-related-pieIndustry leaders called for action to tackle the huge burden of bone, joint and muscle conditions on people in the construction industry, in a report released today (30/05/2019). Physically demanding work means the construction industry has one of the highest rates of musculoskeletal disorders costing £646 million every year – accounting for over three-quarters of all occupational ill-health costs.

The report from the Arthritis and Musculoskeletal Alliance (ARMA) followed a roundtable meeting of industry leaders. The key issues identified were:

  • Prevention – requires proactivity and understanding people’s motivations to change behaviour.
  • Early support helps bone, joint or muscle disorders, but people first need to feel comfortable talking openly about them, not as a sign of weakness and without fearing job loss.
  • SMEs – In construction, small companies employ many workers, including transient workers. Solutions could include building control officers, who go on every site, flagging issues with smaller companies, or larger employers influencing supply chains to prioritise this.

report document coverAdrian Shah-Cundy from VolkerWessells UK, a speaker at the roundtable said,

VolkerWessels UK are proud to be lead sponsor on this initiative. We recognise the need to refocus efforts on the continued issue of MSDs in construction, as part of our responsibility to maintain a workplace free from injury and ill-health. This is a challenging subject due to the physical nature of our activities but, as the figures demonstrate, as an industry we still have a way to go to practically improve working practices and preventive measures. We welcome the opportunity to work with, and learn from, a diverse range of stakeholders for the betterment of health and wellbeing.

Industry leaders concluded that all employers needed:

  • a musculoskeletal disorders action plan, developing awareness of bone, joint and muscle problems beyond just manual handling;
  • awareness of MSDs and to encourage open conversations and support when employees are struggling;
  • routine monitoring of employee musculoskeletal health and wellbeing.

The full report, Musculoskeletal Conditions in the Construction Industry, is available here from 30 May 2019.

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Integrating Health Systems and Paradigms to Drive Culture Change

Tuesday 25 June 2019 at 18:00 – 20:00

Join the RSA Health, Care and Wellbeing Network for a conversation about the integration of health systems and paradigms to support sustainable health, hosted by Paul Hitchcock FRSA.

This event will be an opportunity to explore how the two approaches might be mutually supportive in driving the sort of culture change that we need.

This is a participative event: after an introduction from Paul there will be time to discuss the issues raised, and time for informal networking as well. There will also be an opportunity for anyone wishing to hold a similar event for the Health, Care and Wellbeing Network to discuss this, so please bring along your ideas.

This event is free to attend and open to Fellows, friends, and colleagues interested in supporting the work of the RSA. 
Visit the RSA website for more details.

Location: Dr Cross Room, Rawthmells, RSA, 8 John Adam Street, London, WC2N 6EZ.