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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

by Sue Brown, ARMA CEO

MSK services seem to me to operate very like an ecosystem.  If any part of the system isn’t in balance, the pressures will be felt elsewhere. No ESCAPE-pain means surgeons spending time with people who don’t need surgery; poor understanding of inflammatory conditions in primary care means more pressure on GPs as people don’t reach the rheumatologist; no Fracture Liaison Service means more fractures and more pressure on hospitals. Always the result of the system being out of balance is a person, in pain, not getting what they need.

As this newsletter goes out, ARMA will be at the BSR conference in Birmingham. It’s a great opportunity to engage with a wide range of our stakeholders. Many of our patient member organisations exhibit there too and we have many supporters working with rheumatoid arthritis and other inflammatory conditions. Our stand always gets lots of interest. If you are at the conference, do drop by.

Last month we welcomed our latest member, BASRaT, who represent sports rehabilitators. How do they fit with an organisation that covers inflammatory conditions you might ask? My answer is that, even though individual MSK conditions may be very different, they all rely on an effective MSK health service. That service must work together as a seamless pathway, an ecosystem that supports people’s need holistically. Almost everyone sees a physiotherapist at some point in their journey. Everyone comes into the system through primary care. If your inflammatory condition damages your joints, then you may need a surgeon. We depend on radiologists to correctly interpret scans, specialist nurses to help people manage their conditions, pharmacists to assist with multiple medications. Many are supported to recover from or manage their conditions through exercise programmes, which is where BASRaT, and other ARMA members, come in.

nice iconThis ecosystem is wider still. Responding to a submission from ARMA, NICE included a recommendation to ensure seating is provided at regular intervals along footways that are key walking routes in their guidance on physical activity and the environment. It doesn’t matter if you need to rest because of osteoarthritis, rheumatoid arthritis, fibromyalgia or any other MSK condition. Those seats could be the difference between a short, slow walk, that will keep you moving and improve your health, and staying at home while someone else goes to the post office for you. The forthcoming prevention green paper is not just about older people and OA, it is a vital part of the MSK health ecosystem.

Our MSK core offer for local NHS plans expresses the breadth of that system. Our webinars show the range of topics that we cover, from physical activity and MSK to pregnancy and inflammatory conditions.

As I write this, Extinction Rebellion have been blocking roads in London for a week, demanding action on climate change to prevent imbalance in the ecosystem. Like climate change, the importance of MSK health has been ignored for too long. But this is changing and there is a growing understanding of how central MSK is to the nation’s health and economy. An effective MSK health offer must be at the centre of solving the problem of NHS sustainability; I hope we won’t need to bring London to a standstill with an MSK rebellion to put it there.

CEO update by Sue Brown

March has been a very impactful month for ARMA. My highlight was probably the ARMA roundtable on mental health. The statistics about incidence of mental health amongst people with musculoskeletal conditions don’t surprise me. It’s obvious why long-term pain and difficulty moving would go along with high levels of depression and anxiety. What surprises me is how little support people get with their mental well-being and that’s something ARMA is determined to change.

ARMA members will be discussing what they want to do next on mental health at this week’s members meeting. Personally, I’d like to see an IAPT service for MSK/pain commissioned in every area. I know that whatever we decide to focus on, we now have colleagues in the mental health sector who understand how vital this is and are ready to work with us.

The round table is an example of where ARMA works at its best, bringing people together to find common ground and collaborate. Another is our engagement with the Department for Health and Social Care on prevention. We have come together to identify our priority proposals for MSK prevention so that we can give a clear message to government. The clarity and cross sector support means we can make a much bigger impact than each of us working individually.

Our webinars continue to go from strength to strength. In March we delivered our most popular webinar ever on the National Back Pain Pathway. We’ve got a really interesting one at the start of April on supporting women with inflammatory conditions around pregnancy. See the ARMA webinar page to join or watch the recording. As you can see, we cover a range of topics, so if there’s a webinar you’d like to see us run, please let us know.

I always enjoy talking to members, large and small, about their work and how ARMA can support them. So, it was good to find out more about the priorities for the RCN Rheumatology Nursing Network. One of our smaller members, they have some ambitious plans for the next year. I’ve also been talking to a few new organisations who want to find out more about joining us.

ARMA is nothing without our members, and we value the contribution of everyone, large and small. We’ll be exhibiting at the BSR conference at the end of April, so if you are there do come and say hello. And if you know of an organisation that would benefit from collaborating on MSK heath, please suggest that they join us. There are so many opportunities to push things in the right direction for patients, and far more that unites us than divides us. The more of us we are, the stronger our voice can be.

Prevention seems to have been the theme of my February. The possibility that a lot of the pain and disability of MSK conditions might be prevented, and that this is being taken seriously is an exciting prospect. Even where the conditions can’t be prevented, good self-management support can make a big difference to the impact of the condition. The Government is clear that the future sustainability of the NHS depends on prevention, and that it wants to improve healthy life expectancy by at least five extra years, by 2035. With MSK conditions the largest cause of years lived with disability, this puts MSK centre stage.

There are two different debates and approaches to prevention. The first is what preventative services we can provide? There are lots of MSK examples – ESCAPE pain, Fracture Liaison Services, Strength and Balance programmes, yoga for healthy backs, weight loss support. Then there is a much broader, whole system approach to prevention. Our health is determined not just by our genetics and personal lifestyle decisions. It’s also about the environment we live in; the food we see advertised; our housing; social networks; how easy it is to walk to the shops if you need to sit down half way to rest; the support you might get from your employer to remain in work; your doctor making it easy for you to find peer support for your condition from a patient group. Public health is everyone’s business.

A physiotherapist speaking at one of the Public Health England regional meetings spoke of his experience of first encountering public health. He had been working in an “NHS Bubble”, unaware that the local authority had staff looking at prevention through a different lens, but with the same objectives. This disconnect is replicated up and down the country. I think the NHS long term plan and the prevention green paper give us an opportunity to join them up. If local government, not just public health, but also planning, housing, transport and environment, aren’t included, we will still be fighting against the wider determinants of health. I think there is a real opportunity with the new Primary Care Networks (PCN), to bring this together. At the moment, the remit of the PCNs is joining up primary, secondary and community healthcare. I think they are also in a great position to also bring in local government and address population health more widely. Smaller than an STP/ICS, they should be more able to look at local relationships and bring together all those who influence the systems that determine our health.

ARMA will be engaging with the implementation of the NHS Long term plan and the development of the Green Paper. We need both approaches for good population MSK health – services and a whole system approach. But the gains could be enormous, both for the NHS and individuals. This is everyone’s business. Let’s work together and see just how big a difference we can make.

As I sat down to write this, NHS Chief Executive Simon Stevens was on the radio talking about plans to increase the ability of patients to see pharmacists and physios rather than a GP as their first point of contact in the NHS. Ensuring we have the right workforce to meet the growing health needs of an ageing population is a real challenge. ARMA’s different professional members have a lot to contribute, as I discovered when I spent a day at the Royal College of Chiropractors conference.

Not all speakers at the conference were chiropractors. A rheumatologist spoke about the way chiropractors are often important partners in patient’s pathways for both diagnosis and management. A bold statement from another speaker, a physiotherapist: “chiropractors can help to save the NHS”. The chiropractors speaking all focused on how to improve practice, to increase skills in psychological and social aspects of health, taking a public health approach and making every contact count. It was the non-chiropractor speakers who challenged the delegates to step up to a leadership role. Based on my conversations in the breaks, I think there were plenty of delegates ready to rise to that challenge.

As CEO of an alliance, this is the sort of thing I love. Not professional rivalry (which I see too often) but professional collaboration. Yes, take a pride in your own skills and training, but do so with an understanding of what you have to offer to a multidisciplinary team. As the musculoskeletal patient population gets older, more complex and more likely to have other co-existing long-term conditions, no profession can act alone. The best surgeon can’t get good patient outcomes if rehabilitation is poor. The best rheumatologist can do nothing for the patient who wasn’t referred because no-one recognised the severity of their condition. Health is a system, not isolated episodes of care.

ARMA members include a whole range of professions who could contribute to the musculoskeletal health of the nation. The NHS Long-term plan presents us all with an opportunity. Benjamin Ellis of Versus Arthritis, another rheumatologist speaker at the conference said: “If the MSK community doesn’t get on the bandwagon, it will go without us.” We need to get on that bandwagon, with pride in what we can all offer, together as a community. That’s exactly what ARMA is here to facilitate.

NHS logo

by Sue Brown, CEO ARMA

The NHS Long-Term plan was published earlier this week. I was pleased to see quite a bit about musculoskeletal health throughout the document. There has been lots of immediate reaction, positive and negative. I think now is the time to focus on the positive, so here are my highlights.

The first reference to musculoskeletal health comes early on, (para 1.17) but seems to be mostly about frailty and older people. Great, I thought as I read this, but MSK isn’t just about older people. Read on.

The chapter on care quality focuses strongly on the major killers such as cancer and heart disease, and this is what got all the media coverage. But it also talks about the biggest disablers of our population. This is important because the fact that we are all living longer in poor health is just as important as tackling killer diseases. The plan “affirms the importance of therapies and planned surgical services for conditions that limit independence and affect quality of life.” In case you thought that MSK wasn’t included in this, the section includes increasing the use of First Contact MSK Practitioners and expanding access to the on-line version of ESCAPE-pain. There is also recognition in the appendix that MSK conditions are a big cause of sickness absence and that rapid access to treatment is important in reducing this.

NHS sickness chartCrucially the plan recognises that capacity for surgery such as joint replacement hasn’t grown fast enough, and that short waits are important. “Joint replacements and other planned surgery all help people stay independent and yield important quality of life gains.” This is great, although waiting times are a blunt measure and we also need to see a reduction in the hidden waiting list of people who need surgery but are being denied it on grounds with no clinical basis, such as BMI thresholds. But this recognition that joint replacement is important in helping people stay independent will help us make this case.

There is a tendency for the NHS to focus on the common MSK conditions such as osteoarthritis or back pain. Less common conditions such as Ankylosing Spondylitis also limit independence and affect quality of life. The first hurdle for these conditions is often the length of time it takes to get a diagnosis. If the plan is to tackle rapid access to treatment for these conditions it must address this delay in diagnosis.

Increased funding for community and primary care, greater emphasis on more person-centred care, expanding the number of AHPs, these are all things which will benefit people with MSK conditions. The plan also includes a commitment to expanding the IAPT (Increasing Access to Psychological Therapies) programme to people with long term conditions (para 3.91), and also includes a case study on a living well with back pain course which integrates physical and psychological support. This is encouraging as ARMA works to see the recommendations in our mental health position paper implemented.

Inevitably there are omissions in the plan, but for now I’d prefer to focus on the opportunities it delivers and make the most of them. For now, the plan is just words on a page. It’s what happens next that’s important.  Every area is now expected to set out a local plan to deliver the commitments (para 7.3). We need to work to make sure that people with MSK conditions are included in every local plan. The MSK community is ready to engage and make things happen – in the end, that’s what will make the difference.

Happy New Year to all our readers.

As I write this, everyone is talking new year’s resolutions and I’m thinking about resolutions for ARMA and the MSK community.

ARMA is seeing the new year in with the start of a new strategy. We’re resolving to use this to make our work more focused and more effective, with an emphasis on collaboration and engagement. We hope that you will resolve to collaborate and engage with us. Our strength is in our membership, supporters and stakeholders – it’s by working together that we can bring about change.

I’d like to suggest a few new year’s resolutions for others.

NHS England – to recognise the importance of musculoskeletal health for the NHS, patients and the economy and work to ensure it gets the priority it deserves.

Public health – everyone involved in prevention and public health in the NHS, local government and the voluntary sector to engage with the Public Health England MSK programme, because MSK health underpins every other aspect of health.

CCGs – to stop rationing joint replacement surgery according to criteria with no clinical bases, such as BMI thresholds and pain scores.

Clinicians – to do more to address the mental health needs of patients, especially during January.

Why especially January? Many of your patients will have struggled over Christmas. There is pressure to get in the festive spirit, shop for presents, cook elaborate meals, smile, laugh, enjoy yourself. I spent time with several people experiencing pain and long-term conditions over Christmas, so I know how much of a challenge this can be, how easily it can lead to feelings of guilt or inadequacy.

That’s why in 2019 ARMA will be focusing on mental health and what can be done to improve support for people with long term MSK conditions. We’ll be working to get some of the recommendations in our position statement on mental health implemented.

January is a month when we can all feel a bit down, but it’s even harder if you had an MSK condition. So, let’s all resolve to think more about mental health and MSK.

There’s no health without MSK health, and no MSK health without mental health.

I’m looking forward to working with you all to make a difference.

November has been a very active month for ARMA. Not just in the sense that we are doing a lot but also that a lot of it has been about physical activity, which seems to be exciting and uniting the MSK community.

The ARMA lecture featured three speakers with different perspectives on the subject. A wide range of people attended, bringing GPs into conversations with public health professionals, parkrun with sport therapists, pain specialists with the DWP, Sport England with Healthwatch. These are the sort of connections that happen at an ARMA event and the discussions continued long after the lecture was over. The following week we had a webinar on physical activity, with practical tools to help people with MSK conditions be more active. It proved the most popular webinar we have ever delivered.

There’s a lot of excitement around ARMA at the moment, not just about physical activity. We have a new strategy developed by the membership. It is clearer and more focused which should mean it delivers more impact. There’s a desire to focus on issues where we can be more effective working together than alone. We’ve had interest from potential new members, funders and people who want to work in partnership with us, so there will be no end of opportunities for us to collaborate in 2019.

We’re developing our workplan for next year, putting the strategy into action. It will be a balance between capitalising on opportunities and setting our own agenda. We will be working with NHS England and Public Health England, where MSK is now higher up the agenda, making sure the voice and expertise of all our members is heard. We will also be pursuing our own issues, one of which will be physical activity.

In my almost two years at ARMA I don’t think I have felt so much positivity. Policy change is slow, difficult and often frustrating. Collaboration can be the same. We often feel that things aren’t moving as fast as we’d like, that MSK doesn’t get the priority we know it deserves. Please do watch the lecture and the webinar. They express precisely how ARMA members’ activity, combined with that of external stakeholders, can make their different contributions, and work together to deliver something special.

I’m looking forward to working with you all in 2019. I hope to return after the Christmas break feeling as positive as I do now. There will be some exciting collaborations ahead and I can’t wait to see what we can achieve.

Get involved and help us find out.

CEO imageThere seems to have been a lot of mental health in my work in recent weeks. I’m pleased for two reasons. Personally, as someone who used to work for Mind it’s a subject that remains dear to my heart. But also, because this increase in mental health related activity is a sign that the mental health sector is focusing increasingly on the needs of people with long-term conditions. At the moment that’s focusing much more on conditions like diabetes or cardiovascular disease. ARMA is here to make sure that musculoskeletal conditions are included.

National Voices recently held an event on mental health and long term conditions that showed just how much of a priority it is across long term conditions. There is increasing evidence about the relationship between mental health and MSK conditions. A recent survey by Arthritis Action found that around half of those surveyed (49%) said that their pain often or always makes them feel down or depressed. And NRAS have published a report which found that 2 out of 5 respondents with rheumatoid arthritis have never been asked about emotional wellbeing, despite NICE guidelines stating that all patients should be checked for depression.

Clearly there is a long way to go. An additional £2 billion was allocated for mental health services in the recent budget, and ARMA will be working to ensure that some of this goes towards offering timely mental health support for people with MSK conditions. Last week I heard a presentation from someone delivering an excellent mental health service, integrated into clinics for long term conditions. Sadly, not musculoskeletal, but the principles would work just as well in an MSK clinic. One of the benefits of her approach is that it gives clinicians treating physical health conditions the confidence to address mental health. Look out for a webinar next year on this.

Look out for more activity on this from ARMA and from our members in the coming months. Our conversations with the mental health sector show that there is an increased awareness of the needs of people with MSK conditions. It feels like a good time to seize the opportunity and drive improvement, the MSK sector and the mental health sector together. As always, ARMA is all about collaboration. This is an area where this could really make a big difference.