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Health Policy

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  

NASP logoOctober saw the launch of a new National Academy for Social Prescribing (NASP), to champion social prescribing and the work of local communities in connecting people for wellbeing. Its objectives include exploring new ways of sourcing statutory and non-statutory funding and brokering relationships between different sectors. Given the prevalence of MSK conditions, it is important that social prescribing has something to offer for MSK.

The NHS Long Term Plan includes plans to recruit over 1,000 trained social prescribing link workers by 2020 to 2021, with the aim of 900,000 people being referred to social prescribing schemes by then. In some parts of the country, patients with long-term conditions who have had access to social prescribing link workers have said they are less isolated, attended 47% fewer hospital appointments and made 38% fewer visits to A&E.

The Chair of the NASP is Helen Stokes-Lampard, who as a GP will be all too aware of the importance of MSK conditions to the NHS. ARMA will be working to raise MSK so that link workers understand the importance of MSK and the types of community support, including peer support from patient groups, which can help.

More information on the NASP website.