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Health Policy

State of Health reportState of health and care: The NHS Long Term Plan after COVID-19

A new report from IPPR shows the extent to which the coronavirus pandemic has disrupted progress on the NHS Long Term Plan. The report looks at cancer, mental illness, cardiovascular disease and multiple long term conditions, but the findings are equally relevant to MSK services.

The report argues that COVID-19 should not become an excuse for low ambition, and that world-class healthcare must remain the overall goal. To achieve this, the report recommends a package of six ambitious changes designed to do three things:

  • Ensure the pandemic does not cause lasting damage to healthcare services for future generations.
  • Bring in areas – like social care and public health – that are not covered in The NHS Long Term Plan, but which are integral to healthcare.
  • To capture the innovations that occurred during the pandemic.

The six recommendations are:

  1. Ensure a sustainable workforce: a new deal to catalyse recruitment and retention – including a pay rise, a new wellbeing offer, and improved training and progression.
  2. Fund the NHS to deliver and sustain transformation: funding to meet the elective care backlog and rise in mental illness to avoid a trade-off between transformation and the pandemic care backlog.
  3. Empower integration from the bottom up: through system focussed regulation, reformed financial incentives and permissive legislation.
  4. Upgrade the digital NHS: providing internet access as a basic public service, understanding patient preferences and investing in the NHS’s digital infrastructure.
  5. Fund and reform social care: including free personal care for everyone aged 65 and over, improving the quality of social care, better pay for care workers, and immigration rules that do not lead to catastrophic shortages.
  6. Level up the nation’s health: a public health cabinet committee to co-ordinate policy functions across Whitehall, and greater devolution of funding and powers to local government to tackle the primary determinants of health.

Read the full report on www.ippr.org.

by Sebastian Rees, Researcher, Reform.

At Reform, we’ve long advocated for prevention to be central to any proposals for building a healthier Britain. Tackling the drivers of ill health early reduces demand on health care services further down the line, easing pressures on our already strained system. Far more importantly, averting or delaying the development of preventable conditions allows people to live for longer in better health. If the goal of our health system is to help people build happier, healthier lives, prevention must remain a priority. 

Earlier this year, we partnered with MSD to produce A New Deal for Prevention, an essay collection on how preventative medicine can be put back on track and accelerated after the COVID-19 pandemic. Expert contributors detailed how preventative approaches had helped virtually eliminate new cases of HIV and HCV in the community, how vaccination programs remain the single most effective tool for preventing infectious illness and how new technologies are helping us identify communities at higher risk of contracting non-communicable diseases, allowing us to detect and intervene early and drastically improve patient outcomes.

Prevention is central to meeting increases in healthy life expectancy and reducing the costs of treating life threatening non-communicable diseases. Yet our ambitions for prevention must stretch more widely. Preventing the onset of conditions that see people live in unnecessary pain for prolonged periods, such as musculoskeletal (MSK) conditions, must be given adequate attention by the public health community.

Arthritis and musculoskeletal conditions affect over 17 million people across the UK. As with other long-term non-communicable conditions, a strong economic case has been made for prevention and early intervention in relation to of MSK conditions. Each year, NHS England spends more than £5 billion on treating MSK conditions, constituting the third largest NHS programme budget. Joint work by ARMA and NHS England in 2017 revealed that as much as 40 per cent of these costs could be prevented by tackling risk factors that lead to MSK conditions.

Acting early and alleviating known risk factors is essential to improving the experience of those living with MSK conditions. Many feel their quality of life and independence has been significantly undermined by their condition and over half of people (57 per cent) living with arthritis say that they experience pain every day. As ARMA’s position paper Musculoskeletal and Mental Health makes clear, living with MSK conditions can lead to a range of mental health challenges- depression is four times more common for those living with persistent pain than without.

Preventing the onset of MSK conditions and providing support for those living with them early can make a world of difference to patients and their families. ARMA’s policy paper on prevention provides a road map for doing just that: by promoting lifelong good musculoskeletal health, tackling risk factors such as obesity and inactivity, and treating conditions early, needless disability can be avoided, pain intensity reduced and quality of life drastically increased.

The links between prevention and improved health outcomes are undeniable and increasingly recognised at the highest levels of government. The Government’s decision to replace Public Health England with a new Office for Health Promotion offers an opportunity to rethink the ways in which preventative health care is organised and delivered. But pressure must remain on the Department of Health and Social Care to ensure that prevention remains at the heart of reorganisations of the public health landscape. If prevention is truly better than cure, the right structures and funding mechanisms must be put in place to give it the attention it deserves.

The launch of NHS England’s Best MSK Health programme gives the population’s musculoskeletal health in England a focus and priority like never before, and much needed in the wake of the COVID-19 pandemic. 

NHS England waiting times data shows people with serious MSK conditions needing diagnosis and treatment by rheumatology and elective care services are waiting much longer. The same is true for community MSK services and treatment. At the other end of the spectrum, for people who previously had no long-term conditions, the lockdown effect on mental well-being, exercise and weight-gain are significant obstacles to their musculoskeletal health now and into the future. All of these challenges can impact long-term health and employment.

[Click image to expand view of full chart in PDF]

Diverse and dynamic workforce is key

A multidisciplinary, diverse and dynamic NHS workforce will be key to supporting people to good musculoskeletal health especially in an era when COVID-19 fast-tracked collaboration, working with and across boundaries and along pathways based upon the needs of the person. As NHS national and local, place-based, systems seek to address population needs for musculoskeletal services, the Arthritis and Musculoskeletal Alliance (ARMA) ‘Workforce planning chart for MSK’ aims to support workforce planning by setting out the breadth of healthcare professionals specialising in musculoskeletal health and available to support musculoskeletal services.

This will be key in the wake of the COVID-19 pandemic, and with the opportunities that the new NHS Best MSK Health programme offers, along with NHS reforms outlined in the Government’s recent White Paper: Integration and innovation: working together to improve health and social care for all, which supports wider integration and breaking down barriers.

Planning the workforce, having the right people with the right skills, in the right place at the right time is vital to enabling delivery of musculoskeletal health and care services.

Access the Workforce planning chart for MSK.

Open Consultation

Arthritis and long-term musculoskeletal conditions in adults

Consultation ends 30 July 2021

The Welsh Government has released a consultation document: Arthritis and Long-term Musculoskeletal Conditions in adults. This guidance is currently being developed to replace the Welsh Government’s Service Development and Commissioning Directives for Arthritis and Chronic Musculoskeletal Conditions [2006].

The new consultation seeks views on the proposed direction of the draft guidance and closes on 30 July 2021.

Please see the links below to the consultation documents:

The document provides definitive models of access and advises health boards on designing, planning and managing person-centred services for adults living with arthritis and long-term musculoskeletal conditions. Using a whole-system approach, the framework directs healthcare professionals to appropriate guidance and advises them on the most appropriate service and support available.

Responses can be made by email or post.

For any queries please contact MSKConsultation@gov.wales.

As I write this, the sun outside my window is shining and swathes of blue and yellow crocuses bloom in the local parks. As if that were not enough to lift the spirits, last night saw the launch of NHS England’s Best MSK Health programme. ARMA has worked for many years to raise the profile of MSK health. We have made some progress, often in very specific areas, such as the introduction of First Contact MSK Practitioners a few years ago. Now we have a step change in the profile and priority given to MSK in England.

You can read more detail on the programme in this newsletter and watch the launch event. The programme aims to be integrated across all aspects of MSK, coproduced and collaborative. The launch event was filled with references to things ARMA has long campaigned for – integrated biopsychosocial care. Healthcare of value to all, including social value. The importance of MSK health to enabling people to live independent active lives.

The delivery of this programme will happen as the NHS starts thinking about new structures in response to the NHS White Paper. Aiming to break down some of the boundaries within the NHS and integrate more with wider stakeholders, this could be really helpful in implementing Best MSK Health. I wrote this about the importance of those wider stakeholders. Local authorities and communities need to be an integral part of promoting health as opposed to treating illness.

These are just green shoots. I am excited about the possibilities of Best MSK Health. The programme is right at the start, appointing the workstream leads and establishing ways of working to ensure it is joined up. The hard work is yet to come. Getting not just a work programme but good implementation locally will be a harder task. And that’s where you come in.

There is an amazing vision of personalised, high-quality integrated MSK care, of coproduction and collaboration. That can’t be done by a small number of people involved in workstreams at a national level. It will be become a reality through the contributions of everyone – professionals and those with lived experience. So please, get involved, help shape this, nurture those green shoots and together let’s create a garden.

Public Health England has released new media resources to promote their coronavirus campaign, ‘COVID-19 Response: Spring 2021.’ These include the ‘Road map’ steps, and an animation explaining the government’s latest social contact rules.

You can access imagery and material from the new ‘Let’s Keep Going’ campaigns, including: ‘Stay Home, Protect the NHS, Save Lives.’

NHS England has launched a new programme with the aim of sustaining the delivery of evidence-informed, personalised, high-quality integrated healthcare of value to all. This new initiative, part of the Pathways for Better Health Programme, significantly increases the resource to support MSK service delivery.

The programme covers the breadth of MSK including orthopaedics, rheumatology and pain, spanning primary secondary and community services. You can watch the launch event here.

The programme has ten workstreams, each led by a relevant clinical specialist:

  • Diagnostics
  • Orthopaedics
  • Rheumatology
  • Primary and Community MSK Provision
  • Spinal Services
  • Falls, Fragility Fractures and Osteoporosis
  • Data, Validation and Coding
  • Communications and Developing MSK Networks
  • Supporting those with Long Term MSK Conditions
  • Outpatients

There is the intention to ensure that the programme is coproduced involving the range of stakeholders including people with lived experience and patient organisations. The aim is to support local system leads to deliver MSK services in line with the programme, rather than to mandate a specific service model.

BestMSKHealthThe primary and community workstream, led by Chris Mercer, will be vital to the success of the programme overall. The other workstreams all depend on effective support in primary and community services. Having all the pieces of work in one programme will enable co-ordination. At the launch event Chris talked about the potential for the new White Paper to start breaking down some of the boundaries in the NHS and the need for MSK leadership across all levels of the system.

Summing up, Andrew Bennett, National Clinical Director for MSK, encouraged everyone to engage with the programme as it develops. The work has only just begun. This will not be a top-down initiative. It will be based on collaboration and coproduction.

Look out for updates in future ARMA newsletters and on twitter using #BestMSKHealth.

The Office for National Statistics is consulting on a new measure for health in England, recognising that the nation’s health is an asset – as important to the economy and wider society as it is to the individual. The proposed health index not only measures how healthy people are today but also looks at the wider social and economic circumstances that will influence our – and the next generation’s – ability to live healthy lives in the future. Tracking these indicators over time provides the opportunity to finally look beyond GDP as a sole measure of national success.

The proposed index includes three areas:

  • Healthy people – includes MSK conditions
  • Healthy lives – includes many of the determinants of MSK health such as physical activity and obesity
  • Healthy places – includes access to green spaces, distance to services including leisure and sport facilities

Tracking these indicators over time provides the opportunity to finally look beyond GDP as a sole measure of national success. 

The consultation is open until 3 March 2021.

This webinar from the Health Foundation explains more about the background and how such a measure might be used.