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

Guest blog by William Pett – Senior Policy Advisor, NHS Confederation

As people grow older, health conditions often become both more complex and chronic. Evidence shows that rates of those living with multimorbidity rise significantly with age; a recent study revealed that 30% of adults aged 45 to 64 years report at least two chronic conditions, increasing to 65% of adults aged 65 to 84 years and more than 80% for those above 85 years old.

For older people living with multimorbidity, musculoskeletal conditions are common. Organisations such as Versus Arthritis have drawn attention to this in recent years, highlighting that among those over 45 who report living with a major long-term condition, more than 3 out of 10 also have a musculoskeletal condition.

Yet, as those who have lived with comorbidities may tell you, the NHS has not historically dealt well with patients with multiple conditions. The health system has traditionally been focused around episodic care – one provider contracted to treat for one condition, another contracted to treat for a second condition. This in turn has made care pathways somewhat arduous for patients, requiring them to go to different locations for different conditions – especially problematic, of course, if you are older and less mobile.

Fortunately, things are beginning to change. The NHS Long Term Plan, which builds on the principles of the Five Year Forward View, looks to break down silo working across the health system and sets out how integration of services will improve outcomes for patients. There are likely to be several beneficiaries of more integrated working – including not just patients but also clinicians and the tax-payer – but it may well be those with multiple conditions who benefit most.

For those with musculoskeletal conditions specifically, care pathways are being made easier and more direct for patients through direct access to First Contact Practitioners (FCPs). Recognising that musculoskeletal conditions account for 30% of GP consultations in England, FCPs will allow those with conditions such as arthritis to see a physiotherapist at a local surgery straight away, without the need to go through a GP.

More broadly, the old model of GPs referring patients out to different specialist and community services is being streamlined through Primary Care Networks (PCNs). These will bring together GP practices and community services in neighbourhoods across England, with the aim of achieving fully integrated community-based health care. A key feature of PCNs will be multidisciplinary teams, comprising a range of staff from pharmacists to district nurses to physiotherapists, as well as those from the social care and voluntary sectors. Someone living with multimorbidity will therefore be able to have a single comprehensive care plan that recognises the complexity of living with multiple conditions at community level.

We are, however, in the very early stages of the new integrated world. Clinical directors leading PCNs are still settling into roles that didn’t exist a year ago, within networks that didn’t exist a year ago. There are multiple expectations being placed on PCNs and many clinical directors are beginning to feel overwhelmed. This is where the NHS Confederation comes in. The Confederation has launched NHS Primary Care, which will act as the voice of PCNs as they develop and begin to deliver against new service specifications. Crucially, if the ambitions of the Long Term Plan are to be achieved – and if care is to improve for those living with comorbidities – then it is vital that new integrated care models are given the time and resources they need to succeed.

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.

by Ellie Davies, Acting Project Manager, Falls and Fragility Fracture Audit Programme (FFFAP)

The challenge:

520,000 cases of fragility fracture occur every year amongst those (primarily over-50s) suffering with the bone-weakening disease known as osteoporosis. That is 520,000 broken bones caused by as little as slipping in the shower, stepping off a curb even. This is not only a huge economic burden on the NHS, approximately £5.25 billion, but an epidemic that has lasting physical and emotional repercussions for sufferers. It is upsetting to learn that 42% of older people say that osteoporosis has made them feel more socially isolated.

And it’s going to get worse. For as life expectancy steadily increases, it is estimated that there will be 25% more fragility fractures by 2030, and with that a 30% rise in healthcare costs that the NHS is simply not equipped to meet. A sobering prospect yes, but a crucial reminder nonetheless that now is the time to target improvement.

The solution:

Of course, eradicating the occurrence of fragility fractures altogether is the ultimate goal. However, given that any such fracture approximately doubles the risk of another, most likely within two years, focusing on secondary prevention is an effective starting point. Rapid assessment and timely treatment post index (first) fracture could avoid thousands of secondary cases.

Fracture Liaison Services (FLS): what are they and why are they so important?

A fracture liaison service (FLS) is an NHS service which aims to reduce the risk of subsequent fractures by systematically identifying, treating and referring all eligible patients aged 50 and over who have suffered a fragility fracture to appropriate services. A FLS is a proven approach, recommended by the Department of Health, for targeting these high-risk groups and improving secondary fracture prevention.

Fracture Liaison Service Database (FLS-DB): Our mission

According to the Fracture Liaison Service Database: Commissioner’s report 2019, there are significantly fewer fracture liaison services (FLSs) available for older patients in some parts of England and Wales than others. The Fracture Liaison Service Database (FLS-DB) is not only working towards improving the care provided by existing services but making these preventative services available more widely and avoid approximately 50,000 life-altering fractures in the process.

Dr Kassim Javaid, RCP clinical lead for the FLS-DB said “Those suffering broken bones are often the most vulnerable in society and it is unacceptable that such variation exists in service accessibility depending on where in the country they live. Fracture liaison services are proven to reduce the risk of experiencing further fractures, reducing the impact on older patients, and save the NHS millions of pounds. I implore all Clinical Commissioning Groups to ensure that FLSs are commissioned in their areas so that millions of older people receive the care they deserve.

What can you do?

  • Watch and share our short animation with information about fragility fractures and the care that should be provided
  • Read and share our guide to strong bones after 50 to help reduce the occurrence of fragility fractures
  • Find out about the data available for healthcare professionals and academic institutions for research and analysis
  • Follow us on twitter @RCP_FFFAP to find out more about the FLS-DB and other related audits.

 

NICE guideline: Safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal

The final scope and equality impact assessment for this NICE guideline have now been published, along with all the stakeholder comments that were received during consultation and our responses to these comments.

NICE identified ARMA as a stakeholder for this topic and ARMA is able to comment on the draft guideline when it is available. Please contact us should you have an interest in this topic and are a member.

 

Workplace health: long-term sickness absence and capability to work

NICE published this final guideline on the NICE website. You can also find the supporting evidence, tools and resources as well as all the stakeholder comments NICE received during consultation and the responses to these comments.

The recommendations from this guideline have been included in the NICE Pathway on Managing long-term sickness absence and capability to work, which brings together everything NICE said on Workplace health: long-term sickness absence and capability to work in an interactive flowchart.

If you have any further queries, please contact workplacehealthLTSUpdate@nice.org.uk.

Medical Devices Regulation from 2020

On 26 May 2017 the Medical Devices Regulation (MDR 2017/745) was published, with the aim of replacing the current Medical Devices Directive (MDD 93/43/EC). Following a transition period of three years, this regulation will be applied in full from 26 May 2020.

The BOA has recently published its position statement on the MDR. They welcome the drive to improve the rigour and regulation of novel devices and procedures for the benefit of patients. However, the BOA raises some particular concerns with regard to legacy devices, regulation of different types of device, value of registry data in evaluating devices and long term monitoring. The BOA’s position statement is available here.

NHS England waiting times for elective surgery

NHS England waiting times for September 2019 were published and showed the worst performance this decade for several metrics. It is now a full five years since the waiting time targets were last met for the Trauma & Orthopaedic specialty, and over 90,000 people had been waiting over eighteen weeks for treatment.

The BOA published a statement highlighting their concerns at the growing problem, which can be found on the BOA website, here.

Versus Arthritis have made available their responses to recent consultations and governmental health proposals.

In particular, you can read November’s response to the HM Government consultation ‘Advancing our health: prevention in the 2020s’, and the joint submission document, sent alongside other charities and health organisations, to highlight the urgent need for increased, sustainable public health funding.

Visit the Versus Arthritis Consultation Responses page.

Draft Scope Consultation

The National Institute for Health and Care Excellence (NICE) has been asked to consider an appraisal of guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs ID1658.

NICE invited organisations to take part in the consultation to discuss the draft remit and scope. The organisations selected as stakeholders are listed here and the draft scope that is being consulted on can be found here.

The consultation closes on Wednesday 18 December 2019. If you have any queries regarding this scoping exercise or would like to be involved you can contact Michelle Adhemar, Scoping Project Manager at scopingta@nice.org.uk