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  • 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.

CEO Update

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.

Two things happened in July which will be significant for MSK services: the publication of the Prevention Green Paper Advancing Our Health, and the creation of over 1,200 Primary Care Networks (PCNs) across England. ARMA will be supporting members to engage with the Green Paper and to ensure PCNs deliver what is needed for MSK. We hope all our newsletter readers will get involved too.

I was pleased to see that Advancing Our Health gives plenty of profile to MSK. We’d like to see more focus on action and we’ll all be pushing for this in our responses. See the analysis of the content from an MSK perspective by our members in this month’s newsletter. It is a consultation document and anyone can respond online. I would encourage everyone to respond and encourage others to do the same. Government needs to hear that there is support for bold action to prioritise prevention and that the MSK sector is ready to collaborate to make a real difference.

Primary Care Networks were the subject of a presentation at our AGM this year. The Medical Director for Primary Care and Digital Transformation for London explained that GP practices will work collaboratively with each other and health, social care and voluntary partners to deliver services that can’t be delivered on a smaller scale. This animation explains how they are intended to work. PCNs will be important in providing MSK services, First Contact Practitioners and social prescribing. As with any collaboration, they will take time to establish and will take different forms in different areas. We heard worrying reports from members that PCNs weren’t giving it as much focus as is needed. Worrying given the profile for MSK in the Prevention Green Paper and in most CCGs priorities. We all need to work together to change that as the PCNs get established.

The AGM was also a chance to hear ARMA members views of what we should be doing. This year we have been working on some key priorities such as mental health, physical activity and what the NHS Long Term Plan means for MSK services. Members felt these are broadly the right priorities but that we should consider what we might be able to do about pain and about children and young people with MSK conditions.

Our webinar programme has taken a bit of break across the summer, but I’m pleased to say that we have two new webinars planned in September and available to book now. We also have plans for some exciting topics in October and November, so look out for those in future newsletters. Our webinars are a great way to learn from good practice and all the recordings are available to watch if you missed the live delivery.

We always like to hear from the commissioners, health care professionals, policy makers and others who make use of our information and materials. So if you love the newsletter, value our webinars or have thoughts on what we could do next to make a difference, do let us know by email or on twitter. The Green Paper and the PCNs give us opportunities which we must all engage with, because none of us can make the changes we need by ourselves.

Rheumatoid Arthritis (RA) is very much on my mind as I write this during RA Awareness Week. Yesterday I attended a roundtable discussing the NHS Long Term Plan (LTP) and RA. Rheumatology doesn’t get a specific mention in the plan, but there is plenty of content on related issues. There is mention of chronic pain, for instance, which is very relevant to ARMA and to RA. Access to integrated pain services is something ARMA members have identified as a priority following the publication of our mental health report last month, and by the time this is published I will have presented at a meeting of the Chronic Pain Policy Coalition.

MSK gets a number of mentions in the Long Term Plan but it’s easy to get the impression that this is all about osteoarthritis. ARMA is very clear that rheumatology is part of MSK, and just as important a part of our work as orthopaedics. I am part of an advisory group for the NHSE review of elective care access standards (waiting times in plain English) and I know that this is a vital issue for rheumatology. There are delays in patients recognising that their symptoms might be serious, and often further delays in GPs making a referral to rheumatology so, once referred, it’s vital that there isn’t a long wait to see a rheumatologist. But the roundtable heard that only 32% of RA patients are seen in a time recommended by NICE and almost 10% wait longer than the general waiting time target of 18 weeks.

The roundtable heard that three things impact on remission rates for RA and one of them is rapid access to specialist assessment.  Another is starting therapies quickly. The Long Term Plan talks about reducing delays in access to evidence based treatment. The example it gives is joint replacement surgery, but access to biologics in RA is another excellent example.

The final factor increasing chances of remission is a person centred holistic approach to care. The roundtable heard about unmet needs of RA patients, including pain, anxiety and depression. ARMA’s roundtable report on mental health and MSK has been well received in both MSK and mental health sectors. It’s very relevant to RA patients, and we will be pursuing the recommendations over the coming months.

After the meeting I was asked what would help rheumatology get the best out of the Long Term Plan. Part of my answer was that it needs to be clearly part of MSK, which is included in the plan. Which is why ARMA’s core offer for local NHS Plans includes rheumatology. Let’s be clear, no CCG, STP or ICS can say it is delivering good MSK services if it hasn’t included rheumatology, pain and mental health in their plans.