This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

CEO Update

When people are scared they do one of two things – reach out for support and support others, or look after number one. We’ve seen lots of examples of both recently. ARMA members have chosen the first approach. They’ve been sharing information, working together to solve some common problems such as how to advise healthcare professionals working in private practice.

I take my hat off to our patient members organisations who have faced a huge increase in calls to helplines. As NHS services feel the pressure it is getting hard for them to provide their usual advice and people are turning to patient organisations for support. Many rheumatology patients are at higher risk and people need support to work out if they should be self-isolating or shielding, or need advice and reassurance about their medication. I hope that government will soon announce support for charities losing income during the outbreak, in the same way they have for businesses.

NHS England, Public Health England and professional bodies have been rapidly producing guidance on how to respond in a rapidly moving situation. It can sometimes be hard to keep track, or to find the document you want amongst the rest. ARMA has produced a page on our website that has links to the resources most relevant for our sector. This newsletter includes a much longer list of resources.

In the coming weeks we will do what we can to support everyone in the MSK community and deliver any of our core work that is appropriate. We held a webinar on Paediatric rheumatology: lived experience and psychological needs. The recording is now available to watch whenever you have time.

Just before Covid-19 took over our work, ARMA was planning a conference on November 30th, Working Together, focussed on multi-disciplinary and cross system working in MSK. It will be an exciting day and I look forward to seeing some of you there. Meanwhile we are all working together to get through this.

by Sue Brown, ARMA CEO

February has been a month of mixed feelings for me. On the downside I continue to hear of rationing of NHS services by CCGs going against NICE guidelines. More positively I’ve been hearing about some ambitious work to transform MSK services around the country. We need some of this bold thinking if we are going to achieve ARMA’s goal of high quality, appropriate MSK services for everyone who needs them.

This month I spoke to someone in a hospital about hip and knee replacement. They are commissioned by two CCGs. One follows NICE guidelines and refers patients they think would benefit from surgery so that the decision can be made on clinical grounds. The other restricts access and is about to reduce their BMI threshold still further. Surgeons have to check a person’s postcode before a conversation about surgery, and some patients who would benefit from surgery are denied it.

I’ve also heard about CCGs who restrict access to advanced therapies with patients being allowed to try three biologics and if one of these doesn’t work then further access is denied. In this case, ARMA members NRAS has successfully pressed for a statement from the NHS Regional Medicines Optimisation Committee that restricting access to NICE approved medicines is counter to the provisions of the NHS Constitution.

NHS England/NHS Improvement has an Evidence Based Interventions programme which aims to avoid unnecessary operations, and to free up clinical time by only offering interventions on the NHS that are evidence-based and appropriate. I’d love to see this programme also focus on ensuring that patients are not denied interventions which have been shown to be highly effective.

On a more positive note, I have spoken this month to many people working to improve MSK services. I attended the first graduation event for the Versus Arthritis MSK Champions programme. This supports MSK practitioners to develop their leadership skills so that they can be more effective in work to improve MSK services. I know that the 14 Champions I met this month will make a big difference to MSK in the coming years. It is an amazing programme and applications for the next cohort open later this month.

I’ve also spoken to a number of people doing some amazing work, multi-disciplinary and across systems, to transform the approach to MSK. I’ve heard about engagement with community and leisure services for prevention, patient led pain groups, improving links with rheumatology, CCGs, providers and third sector coming together to demolish blocks to patient centred care. I’ve heard about the involvement of stakeholders that are often forgotten such as admin staff and a focus on genuine patient involvement.

It’s exciting, but it’s also essential. We can’t solve the growing incidence of MSK conditions through ever tighter rationing. We need to think differently about prevention, about using the resources we have in the most effective way and getting the whole system to work together.

ARMA has a role in this. We want to showcase this innovation. Watch out for webinars and a conference later this year where you can find out how others are tackling this challenge. MSK is the biggest cause of years lived with disability in the UK. CCGs and local health systems can choose to respond to this in one of two ways: postcode lottery or transformation.

I’ve read a few things about how hard it is to get going after the festive break, or “blue Monday” part way through January, rumoured to be the most depressing day of the year. I’ve had a very different experience this year with a positive start to 2020. January has involved conversations and planning for our 2020 activities. Lots of positivity from members and stakeholders means I’m optimistic and looking forward to a successful year.

One of the things our members want to focus on is multidisciplinary working – how different MSK professionals can work better together, with each other and with patients. People with MSK conditions need us all, from skilled surgeons to support from others with the same condition. MSK health is all about teamwork. With the introduction of Primary Care Networks there’s a lot more focus on teamwork and networked services, so the wider NHS agenda is moving in the right direction. We just need to make sure that PCNs make MSK a priority.

One aspect of our work where multi-disciplinary working is vital is pain. One thing I’m proud of this month is the publication of the report from our roundtable on pain. Feedback so far has been very positive. ARMA has two angles on the subject of pain. We want to see people with chronic pain have access to biopsychosocial support. We also want to reduce the delays in treatment for conditions which cause pain, whether that’s timely access to joint replacement surgery or reducing delays in diagnosis of MSK conditions. Both sides of this will form part or our work plan this year.

We get very positive feedback about the resources we produce, especially this newsletter and our webinars. We are aware that there are many people working in MSK who don’t yet know about them. So if you know of colleagues who might benefit, please forward this newsletter, or share on social media. The more we come together, the stronger we become.

by Sue Brown, CEO ARMA

Happy New Year to all our readers. The start of the new year is a time to reflect on our successes in 2019 and to look forward to what can be done in 2020.

Some of my highlights from 2019 were the annual lecture on mental health and MSK, our roundtables on pain and on mental health and our webinars. The webinars have been very popular with thousands of people watching them live or in recording.

It was the final webinar in December that highlighted something about MSK health that we need to address in the coming year. The topic was care and support planning for MSK – it was an excellent practical session that I recommend to anyone who missed it. Year of Care and Versus Arthritis looked at how care and support planning (CSP) might be used for people with MSK conditions and found it was beneficial for both patients and healthcare professionals.

However, when a practice which had already implemented CSP for other conditions decided to offer it to people with MSK conditions they found that many of them had already been through the process as they also had other long-term conditions. Sadly, although CSP is supposed to include everything which is important to the person, MSK was not included in any of these plans. It seems that unless it is explicitly included, neither doctor nor patient will see an MSK condition as worth mentioning in the conversation. Yet again MSK health gets a lower priority than we at ARMA think it merits.

In December I attended a discussion about bone health by the Royal Osteoporosis Society. The closing words of the event were the need for people to understand that “bone health is as important as heart health.” That is so true, and not just in relation to osteoporosis. The ability to move, to remain socially engaged, to shop and prepare healthy food are essentials for long term health.

Every healthcare practitioner from whatever specialty needs to understand the importance of MSK and of pain to their patients’ ability to manage (and prevent) other long-term conditions. We will continue to press this point until it is inconceivable that a CSP conversation would not include a discussion of MSK pain and mobility. Until it is unthinkable for a local NHS body to plan for their population without thinking about their MSK health – MSK in the broadest sense, not just how to get hip and knee waiting times down (important though that is).

This vision will guide ARMA’s work in 2020. I know that you, the readers of this newsletter, are in a good position to help this. In 2019 I have met many people who have been inspired by ARMA’s work to do something – to ask their IAPT service to include IAPT-MSK Pain; to discuss MSK health with their social prescribing service; to look at introducing MSK into care and support planning; or to ask every person with an MSK condition about the impact on mood and quality of life. I hope that you will all resolve to join them and do one small thing in 2020.

Together we must say loud and clear: MSK health is as important as heart health.

CEO update by Sue Brown, ARMA

The general election is now in full swing. In amongst the Brexit debate, the NHS has been getting quite a bit of attention, albeit somewhat narrow in focus. I hope that after the election, whoever is in government, this debate will widen so that we can talk about health, not just the NHS, about more than hospitals, doctors and nurses.

One other thing an election brings is restrictions on what government bodies are allowed to do. For me that has meant lots of cancelled meetings, including one between the Minister leading on prevention and ARMA members. As soon as we know who will be responsible after the election, we will request the meeting is rescheduled. Prevention is more important in MSK than many people think, so we need to maintain its profile in this agenda.

There’s a lot going on in the NHS at the moment. At times it can feel difficult to keep up, but it also means there are lots of opportunities. Take the recent ARMA roundtable on pain (look out for the report coming soon). Some of those involved have been working on the issue for decades and during that time little has changed – in England at least; Scotland has made a bit more progress. Despite this, at the end of the afternoon there was a feeling of optimism, a feeling that some things in the NHS are moving in the right direction, that there are opportunities to get pain on the agenda in the right way.

I look forward to working with ARMA members to capitalise on these opportunities, not just around pain but also to drive MSK further up the NHS agenda until it has the profile it really deserves. MSK isn’t just doctors and nurses; it’s across the whole system. People with MSK conditions need support from a wide range of professionals, and they need them to work together effectively, even when not located in the same place or employed by the same person. Change is needed at every level – better public health and prevention services; support from primary and community health, and in hospital. People need this to join up seamlessly. They need everything from Primary Care Networks to transforming outpatients programmes to think MSK and put the patient at the centre.

The ARMA annual lecture is always a highlight of my November calendar. This year, as well as an excellent lecture on mental health from Brendon Stubbs, I had the privilege to use the opportunity to thank Peter Kay on behalf of the whole MSK community for his six years of hard work as National Clinical Director for MSK. In this time, he has worked tirelessly to drive MSK up the agenda, with a high degree of success. It’s in the NHS Long Term Plan, featured heavily in the Prevention Green Paper and there is now an MSK programme within Public Health England. Peter was a fantastic partner to ARMA and leaves a strong legacy for his yet to be announced successor.

However, there is still much to do. Whatever the political landscape after the election, I’m looking forward to working with ARMA members and a whole range of stakeholders to continue this drive for change. I’d like to thank our newsletter readers for your support in 2019. I hope you get a break at some point over the festive season, and I look forward to working with you all in 2020.

Bone and Joint Week is over for another year, and what a fantastic week it was, thanks to the support of our members and key stakeholders. It’s a one week blitz of MSK messaging on social media, raising awareness and prompting action. This year we had an even bigger reach than ever. But it doesn’t end there.

We need to keep raising the profile of MSK for the other 51 weeks of the year. During the week there were ARMA blogs on the NHS England and NHS Confederation websites explaining the importance of MSK health to the NHS. MSK health isn’t just about osteoarthritis, inflammatory arthritis, back pain, etc. It affects general health, prevents people being active, makes it harder for them to come home after being in hospital, means managing other conditions, taking medication are more difficult. The NHS might not count these costs as resulting from MSK, but they are; and it’s ARMA’s role, all year round, to keep reminding people of this fact.

We will keep talking about the importance of waiting times for joint replacement, the delays to diagnosis and effective treatment that many people with less common MSK conditions experience, the lack of mental health support and effective pain services. If you have diabetes, for instance, you will almost certainly have access to psychological support with anxiety and depression through an IAPT service locally. If you have an MSK condition, you probably won’t. Our recent webinar showed how to deliver a good IAPT-MSK pain service, presented by people who have done it, with lots of advice about how to go about it. If you don’t have one in your area, ask why not and signpost to the webinar.

ARMA is here to champion the cause of MSK health 52 weeks of the year. We can see it rising up the agenda – look at the profile of MSK in the Prevention Green Paper, for instance. There’s still a long way to go, but increasingly I find people are listening. The wide range of support for Bone and Joint Week and the increasing number of stakeholders who contact ARMA for advice or support is evidence that people are taking notice.

If you supported us in Bone and Joint Week, please keep supporting us. You can help make sure our resources, like our newsletter and webinars have a wide reach. You can keep talking about the importance of MSK in every forum. You can make sure no one forgets that there is no health without MSK health. Not just in Bone and Joint Week.

We are now very close to Bone and Joint Week, which begins on 12 October. It’s a chance to remind everyone of the fundamental importance of MSK health. Today I learned that there is some evidence that people with hip and knee arthritis who don’t receive treatment may die early due to cardiovascular conditions. It makes sense. If you are in too much pain to be active your general health will suffer. Add to this the impact of depression, isolation and loneliness, all of which also affects physical health. So, whilst the pain of the condition may not be fatal, the knock-on effects can be.

This is why we should all be paying more attention to long term MSK conditions like arthritis. The disabling impact of pain and reduced mobility is bad enough. But we must also remember the indirect impact when weighing up the priority to give to MSK health.

A lot of effective treatments exist. For severe osteoarthritis of hip and knee we know that joint replacement is an effective intervention. For rheumatoid arthritis, rapid access to the right therapies makes a big difference to long term outcomes. Being active, a good diet and maintaining a healthy weight will promote good MSK health for everyone.

So why does MSK get so little attention? It could be because we think it’s all about older people and only to be expected in later life. Not true. People of all ages get MSK conditions and ARMA is discussing what we might do to highlight the needs of children with MSK conditions. It could be because we think people can just take a painkiller and all will be well. Not true. The impact of MSK pain can be significant and disabling. Most of all I think it’s because we take MSK health for granted and don’t recognise it for what it is – the underpinning framework for all other health. There can be no health without MSK health.

This Bone and Joint Week ARMA members will work together to raise awareness of the importance of MSK. I am asking you to support us and do one thing to prioritise good musculoskeletal health.

CEO update by Sue Brown

One of the things I love about my job is the variety of things I get involved in. The wide scope of what is covered by musculoskeletal health and the variety of ARMA members, partners and stakeholders means no two days are ever the same.  August has been a month to prepare for the exciting variety of activity we have planned including our annual lecture, a roundtable on pain, an event on physical activity and more webinars.

Physical activity has been quite a theme this month, with the launch of the We Are Undefeatable campaign. I love the positive but realistic messaging which is so relevant to MSK conditions. This will help reinforce the messages from clinicians using Moving Medicine or the RCGP Active Practice Charter. My concern is that when people turn up at their chosen activity, be it a local leisure centre, gym or walking group, staff/volunteers won’t understand MSK and will be concerned about them taking part. This is the reason ARMA supports the parkrun Facebook group for people with MSK conditions, as it gives peer support and encouragement for people to be active in a way that works for them.

ARMA is planning an event for providers of mainstream activities to help them understand how to support people with MSK conditions to be active, and to include them in their activities. The emphasis of We Are Undefeatable is on self-management and being more active without medical supervision or special programmes, just like the parkrun initiative. I hope that we can help those motivated by the campaign to get a positive response wherever they choose to go.

The other big theme of my August has been pain. ARMA collaborated on some qualitative research around chronic pain which I presented at a Chronic Pain Policy Coalition event. It is clear that chronic pain is extremely common. It’s not all MSK related, but at lot of it is. The lack of services for chronic pain leaves patients and healthcare professionals alike struggling to know what to do for the best. That’s why we are promoting IAPT-MSK pain in a webinar later this month. It’s why we are holding a roundtable in October to look at how the situation can be improved. Look out for more from us in the coming months on this.

One thing that pain and physical activity have in common is complexity. There are a whole variety of barriers to people with MSK conditions being active and effective multidisciplinary pain services need to be available at every level from community peer support to specialist services. No one can solve either of these issues alone. Work together – then we might stand a chance.