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

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. 

 

by Dr Hamish Reid, Consultant in Sport and Exercise Medicine, Moving Medicine design and development lead

Moving Medicine is an exciting new initiative by the Faculty of Sport and Exercise Medicine in partnership with Public Health England and Sport England. It is dedicated to spreading best practice, research and advice to clinicians and patients to create a healthier, happier and more active nation. On the 16th October 2018 the initiative was formally launched by the Honourable Matt Hancock, Secretary of State for Health and Social Care, headlining the flagship set of resources to support high quality conversations on physical activity across a broad range of chronic diseases including musculoskeletal pain.

Why is it important?

The UK is currently suffering epidemic levels of physical inactivity in keeping with global trends. This inactivity causes a heavy burden of morbidity and mortality. This burden, In contrast to communicable disease, can be prevented and effectively treated through moving more. In no areas is this more important that musculoskeletal conditions.

At the heart of intervention in healthcare lie conversations between healthcare professionals and members of the public. These conversations provide a unique opportunity to interact with the least active members of society, but many healthcare professionals currently lack the skills, knowledge and systems to deliver impactful conversations on physical activity.

How has it been developed?

The ‘prescribing movement’ resources have been developed by a large team of Sport and Exercise Medicine doctors in consultation with 300 medical specialists, general practitioners, researchers and patients. The foundations of the content lie in robust reviews of the literature on physical activity in specific diseases and differ from other resources summarising the evidence base on physical activity as the structure has been designed by clinicians for clinicians to use in practise. A knowledge into action framework, Delphi study and behavioural change framework have underpinned this iterative development process. The result enables the user to dig as deep as they want to into the evidence base, embedded in a time-based framework to support good quality conversations based on established behavioural change techniques and motivational interviewing theory.

What does this mean for musculoskeletal care?

The Moving Medicine musculoskeletal pain resource has been designed with experts in musculoskeletal care in partnership with many ARMA members. Due to the exceptional input from the ARMA network this resource has been developed to fulfil an unmet need in the excellent resources available. It is a practical resource to support and inform clinical staff in routine practice and has been designed to support conversations.

We encourage everyone to use and share the resources. If you are keen to find out more or contribute to the Moving Medicine to get in touch with us at contactus@movingmedicine.ac.uk, join our Facebook ambassador group or follow us on twitter @movingmedicine – we would love to hear from you.

Visit the website at www.movingmedicine.ac.uk.

Prevention is in the news this week as Health and Social Care Secretary Matt Hancock announced that prevention must be at the heart of the NHS long-term plan, with more spending on community services.

This is welcome news and something ARMA and our members have long called for.

The new prevention vision aims to ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest.

ARMA will continue to call for this to include a focus on MSK conditions. As the leading cause of years lived with disability, MSK health is essential to independent living and managing your health. There can be no health without MSK health.

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.

Over the last few months ARMA has been working with members on a new strategy, setting out more clearly what we work on and how we work in collaboration with our members. We will work in those areas where collaboration will have bigger impact than any single organization working alone. Through greater clarity and focus we expect to achieve greater impact. If you are reading this and thinking that your professional body or patient organisation isn’t a member but really should be part of this, encourage them to join.

ARMA is an umbrella body representing the breadth of musculoskeletal conditions and professions.  

Our vision for musculoskeletal (MSK) health: 

  • The MSK health of the population is promoted throughout life; 
  • Everyone with MSK conditions receives appropriate, high quality interventions to promote their health and well-being in a timely manner. 

 

We engage with: 

Public Policy 

Desired impact:  

  • Integrated approaches to MSK are included in all policy. 

 

Services (commissioning)

Desired impact: 

  • Evidence-informed MSK pathways are in place 
  • MSK health is recognised and prioritised. 

 

Policy delivery and practice 

Desired impact:  

  • Evidence based Interventions are being delivered 
  • Person-centred, integrated MSK care is being delivered. 
  • There is an improvement focus, with innovation, spread and quality improvement at the heart of provision. 

 

Taking place on Wednesday 21 November 2018 at 6pm in London.

Hear and debate three perspectives on physical activity at the Annual ARMA Lecture, this year in partnership with Versus Arthritis. Three outstanding speakers, Nick Pearson, CEO parkrun, Michael Brennan, Physical Activity Programme Manager, Public Health England and Claire Harris, Physiotherapist speak to the theme: More people, more active, more often: three perspectives on physical activity and musculoskeletal health

Physical activity is good for promoting musculoskeletal health and helps alleviate the symptoms of musculoskeletal conditions. Yet nearly a quarter of adults in the UK are physically inactive. Getting people active is an obvious way to reduce the costs of MSK conditions to individuals, the NHS and the economy. If activity brings such benefits, why is this so difficult? How can we overcome the barriers people face in getting more active? And what additional barriers are faced by those who have an MSK condition? How can we harness the powers of statutory, voluntary, private sectors and communities to tackle this?

The evening will begin with a drinks reception and the lecture will conclude with a question and answer session, with questions taken from an audience of leading health and public health professionals, policy makers, commissioners, patients, and representatives of professional bodies.

Tickets are available here

A report by Public Health England has been published in the World Health Organization’s European journal, Public Health Panorama.

“Developing partnerships and a whole-system approach for the prevention of musculoskeletal conditions in England”

Abstract: This case study reviews the experience of PHE in developing and implementing a public health approach to the prevention of and early intervention in MSK conditions. We reflect on key elements of the approach, and the essential role of galvanizing and supporting partnerships, as well as achievements and lessons learnt so far.

Achievements: Since 2013, through investment in people and partnerships, evidence synthesis, development of support tools and communications, we have built a strong foundation for MSK public health in England. Important relationships have formed and policy direction and commitment established for health improvement, work and health, health intelligence, local planning and delivery, the public health workforce and embedding MSK health in the work of Public Health England.

Lessons learnt and recommendations: Significant progression of the MSK conditions prevention agenda in England has been possible because of strong partnerships based on a clearly articulated common vision and a shared narrative for a public health approach. On this journey, we have adopted dynamic reflection and review as a critical part of our growth as a partnership and network. Ultimately, only a whole-system approach to MSK health can substantially reduce the burden on those affected, their families and carers, public health and care services, the economy and the wider society. Flexible, committed partnerships, when combined with sustained political will and leadership for change, can bring this about.

Click here to open and download the report in PDF.

The BOA is nearing the end of our Centennial year and reflecting on 100 years of developments in orthopaedic surgery. While innovation in surgical techniques has dramatically improved patient care, the changing nature of healthcare delivery systems, rationing and access to care mean that many patients are still struggling with the day-to-day impact of MSK conditions.

During our Congress last week we heard powerful stories from patients on the impact of waiting for surgery. From a patient waiting for carpal tunnel release who was struggling to deal with basic daily tasks such as handling money, preparing food or getting dressed to another describing his wait for knee surgery, in huge amounts of pain with increasingly reduced mobility impacting on overall fitness and the ability to enjoy life.

It is undoubtedly a challenging time for MSK patients in the NHS. There is chronic under supply of resources for NHS services, and huge increases in the numbers of people waiting longer for surgery in many parts of the UK. In April this year we issued a press statement to highlight the situation in England, and shockingly, at the time of the release, there were still some trusts that had not resumed elective operations after the winter moratorium. The number of people who had waited over 18 weeks was at its highest level for many years and the graph below shows that this has been progressively deteriorating for several years (source: Waiting times data).

The number of people waiting over a year has also increased markedly in England, while the situation in Northern Ireland is even more stark, and we are speaking to the Chief Medical Officer there about this next month (see graphs below – source: Waiting times data).

The figures overall are stark:

  • The number of people in England waiting over a year for T&O surgery reached a high of 978 in June 2018, which compared to 375 a year earlier (a 260% increase).
  • The number of people waiting more than 18 weeks reached a peak of 81,663 in April 2018; the highest level since reporting began November 2010.
  • A BOA survey of hospitals in England received 84 replies from BOA Link people and 31 % of these had experienced winter closures of 3 months or more.

These delays have also had a major impact on orthopaedic trainees, who are losing opportunities to learn. This impacts the future workforce and is a situation we are continuing to monitor closely.

At our Congress we discussed access to Elective Care in further detail. The HSJ recently reported our concerns about Sussex CCGs policies that patients for hip surgery meet the requirement of: “uncontrolled, intense, persistent pain resulting in a substantial impact on quality of life … which have failed a reasonable period of conservative treatment of at least 6 months.” (HSJ article) We highlighted the BMJ coverage of growing numbers of Individual Funding Requests for hip and knee replacement as a result of more restrictive CCG policies. (BMJ article).

During the year we’ve done as much as we could to get our messages out to the media and speak out on behalf of our patients about the restrictions on access to care. Besides the articles above, have received coverage in the Telegraph, Times, and Daily Mail among others. We are making plans to develop relationships with key decision makers, both through ARMA, but also directly. We also continue to promote and highlight the joint position statement from ARMA.

Most recently we have been working with four specialist societies (BESS, BSSH, BASS and BASK*) to respond to the latest attempt to limit seven orthopaedic operations through the Evidence Based Interventions consultation. We as a profession agree that there are some operations where this is appropriate, but for others we have raised issues about the proposals, the consultation and the data it is based on. Our full response was posted online last week, here in our News section.

The BOA is very aware that our concerns are shared right across the ARMA community and are pleased to be part of this alliance, working together to shine a light on these important issues as part of our continued commitment to be “Caring for Patients, Supporting Surgeons”.

(*British Elbow and Shoulder Society – BESS, British Society for Surgery of the Hand – BSSH, British Association of Spine Surgeons – BASS and British Association for Surgery of the Knee – BASK.)