Arthritis and Musculoskeletal Alliance
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.

Health Policy

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.

The National Institute for Health and Care Excellence is inviting comments on the consultation of a new version of the principles that guide the development of NICE guidance and standards. The consultation will run until 11 February 2019.

The document brings together existing statements of the way NICE practices, in particular the principles set out in our Social Values Judgements document. It also links to, and is consistent with, the legislation that establishes NICE in its current form, the NICE charter, and other legal, ethical and technical considerations that relate to decisions about how to allocate fixed resources in health and social care.

The consultation may be in interest to anyone involved in developing NICE’s guidance and standards and to anyone else who would like to know more about how NICE goes about its work.

The consultation details are available on the NICE website.

by Sarah Duncan, Head of Clinical Policy, NHS England

An interview on the news recently about stem cell research into cartilage replacement for osteoarthritis, made me reflect on the phenomenal pace of change and progress in the relatively short time of my career. As a new physiotherapist in the mid-1980s we used short wave diathermy; long flexible heated tubes wrapped around a patient’s knees, to help with the pain of arthritis. Although patients really enjoyed the heat, it made little difference to their ongoing pain and mobility.

At that time, every orthopaedic ward housed patients on traction for spinal pain. Attached to heavy weights via tape stuck to their legs, patients were on bedrest for 6 weeks. It would be the physio’s job to get them standing up for the first time. Many people would nearly faint as their cardiovascular system tried to cope with being vertical again. I often thought the subsequent manoeuvres to get them flat again must have reversed the alleged benefits of the bedrest. This was a time when there were treatment regimes for everything and the main individualising factor was the surgeon’s preference.

I was working in Somerset when I came across a different approach to chronic pain management, led by Dr Alf Collins, now Personalised Care Group Clinical Director at NHS England. His approach for people living with persistent pain was to help them understand and come to terms with their pain, and adopt strategies which enabled them to lead as fulfilling and independent lives as possible. Physiotherapists ran education and exercise groups, which also enabled people to share their experiences with others who understood and could empathise. This approach really worked for many people, supporting both their mental and physical health, and they were empowered to take control of their condition. I learned that managing pain was less about giving a treatment to a passive recipient and more about collaborating and working with them.

Fast forward 30 years and I’m in a national clinical policy role, which includes the Musculoskeletal (MSK) Conditions programme. Digital technology, genomics, stem cell research, and advances in surgery are all enabling progress to be made, beyond anything imaginable in the ‘80s. This progress also includes the evidence-based personalised care approach that the membership organisations of ARMA have long supported and developed. In partnership with ARMA, NHS England has developed the MSK Knowledge Hub enabling the MSK community to debate innovative ideas, share learning and celebrate success. The NHS Long Term Plan published yesterday, has a whole chapter on personalised care building on the  Five Year Forward View, which recognised the need for better integration of services, and connection with the voluntary sector, to enable a more personalised approach.  The NHS Long Term Plan aspires to a fundamental shift in approach to deliver more person-centred care, including for musculoskeletal conditions.

We must continue to develop the focus on people as individuals amongst the high-tech treatment options, and ensure people are properly listened to. People with MSK conditions should have choice and control over the way their care is planned and delivered, based on what matters to them and not only on what’s the matter with them. I’m encouraged to see that the Long Term Plan for the NHS will build on the evidence and examples to show how personalised care could, and should be, business as usual across the health and care system.

Tracey Loftis, Head of Policy and Public Affairs Versus Arthritis, attended the Lords Economic Affairs Committee on Tuesday 4 December 2018 to talk about social care and the needs of people with arthritis, alongside colleagues from Mencap and the Alzheimer’s Society. 

In a wide-ranging session, Tracey highlighted Versus Arthritis’ research on aids and adaptations, the positive impact they have on the lives of people with arthritis and the challenges people still experience when trying to access them. Members of the Committee were particularly struck by the numbers of people affected by musculoskeletal conditions and the massive impact arthritis has on their lives. 

The Lords session also covered multi-morbidity, social care funding models, care workers, unpaid carers and the impact of Brexit. We are very much looking forward to publication of the Lords Economic Affairs Committee report and hearing their thoughts on social care.

The House of Lords session is available for viewing here:
https://www.parliamentlive.tv/Event/Index/51406006-0dad-4843-9c4c-ac2c38214e85  

Despite improvements in life expectancy, England lags behind other countries on many key health outcomes. A new report from the Kings Fund argues that to address this, we need to move away from a system just focused on diagnosing and treating illness towards one that is based on promoting wellbeing and preventing ill health.

Population health is an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population. The King’s Fund’s vision is to reduce inequalities and achieve health outcomes on a par with the best in the world by focusing on population health locally, regionally and nationally. Whilst the report does not focus upon it directly, we know MSK health underpins all other aspects of health, as ARMA has always argued. The vision cannot be successful unless MSK health is part of it.

The report outlines a framework for population health and calls for action at national, regional and local levels. This should include: ambitious and binding national goals to drive progress; a cross-government strategy for reducing health inequalities; stronger political and system leadership; greater clarity on the roles and accountability of national bodies and local organisations; and increased investment in prevention, public health and spending that supports population health.

Guest blog by Suzanne Rastrick, Chief Allied Health Professions Officer, NHS England

As I look back on 2018 it has been a great year for AHPs and for the NHS. 2018 has seen acknowledgement of ‘the Brilliance of AHPs’ by Simon Stevens, the Chief Executive of NHS England and development of a number of work areas which have highlighted how AHPs can support the challenges faced by the Health and Social care system in England. AHPs are a diverse group of practitioners recognised for their autonomy with proven ability to apply innovative solutions to the challenges facing communities across health and social care, but also in wider settings such as education, the military, justice, independent and voluntary sectors. AHPs have repeatedly evidenced their ability to take on new roles and step outside traditional boundaries; I view them as 14 jewels each with a unique skill set that can be applied to address the challenges facing communities today.

An excellent example of how AHPs can support current system challenges has been the development of the First Contact Practitioner (FCP) model for people with musculoskeletal conditions. The FCP model has been developed to enable people to access prompt, timely, specific advice and management for their musculoskeletal condition, be that through seeing an Osteopath, Physiotherapist or Podiatrist. Without FCP, people are required to see a GP first to access appropriate management. Access to the right care will support individuals to manage their condition and continue with activities important to them, be that work or leisure.

My first priority for any service development that includes AHPs, is the provision of safe and effective care for citizens, the publication of The Musculoskeletal Core Capabilities Framework for first contact practitioners’ has supported this aim. ARMA delivered this work programme in partnership with NHS England, the National Clinical Director for MSK services and the Elective Care Transformation Programme. The outcome is a document detailing the knowledge, skills and behaviours deemed essential for First Contact Practice. The provision of guidance in this area will ensure consistency and effectiveness of first contact services. The implementation of first contact services for people with MSK conditions, where AHPs with expertise in MSK are very much part of the general practice and primary care team, will improve access to person-centred musculoskeletal care and support.

It was a pleasure to be involved with the development of this framework. Delivery of this model is being rolled out nationally, as a person-centred approach, enabling shared decision making and acknowledging that appropriate management can be achieved for people with MSK conditions without the need for involvement of the GP or a practice nurse, freeing their clinical time to manage people who require their specific skills and expertise.

The Work Foundation’s Health at Work Policy Unit  has published its latest report: Who cares? The implications of informal care and work for policymakers and employers.

The number of informal carers in the UK is substantial and growing. Between 2001 and 2011, their number rose significantly (outstripping population growth) from 5.8 million to 6.5 million. Most carers are women (around 60%) and the vast majority (around 4.1 million) are of working age. Furthermore, the majority of working age carers (2.6 million) combine work with their caring responsibilities.

Read the full report or executive summary.

Due to several factors, in particular the ageing population and declining investment in social care services, the number of informal carers is expected to rise. Estimates suggest they will number 9 million by 2037. The economic value of their contribution is huge – and the UK’s health and social care system is heavily and increasingly reliant on it.

This paper outlines some of the implications associated with the growing number of informal carers in the UK, the health and social care system’s increasingly unsustainable reliance on them, and what Government and employers can do about it. This is informed by the academic and grey literature, as well as a workshop we hosted in 2017 (in partnership with Simplyhealth) , which was attended by over 30 expert stakeholders from government and non-government bodies, individual carers, carers charities, think tanks, and businesses.

The Who Cares? paper is the third in the Health at Work Policy Unit series, Gender, sex, health and work, which explores the issue of health and work through a ‘gendered’ lens. This series focuses on areas where gender and sex have a significant impact on work and/or health outcomes. Other papers in the series include:

For more information, see the Work Foundation’s background paper and accompanying infographics.

Please feel free to contact the report’s author, Dr James Chandler, for more information.

 

In England alone, approximately 4.6 million people have had both a long-term physical health condition and mental health problems. People with long-term physical health conditions are two to three times more likely to experience mental health problems. For the working age population in the UK, musculoskeletal and mental health conditions are the most common health conditions. 35.2% of all working aged disabled people in the UK experience musculoskeletal conditions only; 20.2% experience mental health conditions only; and 17.2% experience both.

In policy directives and in practice, these conditions are often dealt with separately, although we are beginning to see some change now. The reality for people is that there is a relationship between their mental health and musculoskeletal conditions. However, the delivery of care for people is still often built around the individual conditions, rather than the way the person experiences them.

This policy position paper on musculoskeletal and mental health identifies a number of areas where patient, professional and research organisations and experts in mental and musculoskeletal conditions felt that there is particular scope for improvement. Commissioners, clinicians, providers, professional and training bodies can use these areas to identify where there are significant opportunities for positive change.

The Arthritis and Musculoskeletal Alliance (ARMA) works in partnership with its members, CEOs, directors, policy and communication professionals. This policy position paper on mental and musculoskeletal health is part of a programme of activity, including a round-table event and the flagship ARMA annual lecture for 2019.

Please get in touch if you would like to work with us to promote this paper, round-table or 2019 lecture or would like us to write a blog or article for your publication or are interested in other collaboration.