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Health Policy

by Laura Boothman, Senior Policy Manager, Versus Arthritis

The Government is inviting views on how we can live longer, healthier lives. There are some positive proposals for people with arthritis – but Versus Arthritis will continue to demand more action to help people look after their musculoskeletal health. 

In 2018, the Government set a mission to ensure that by 2035, people can enjoy at least five extra healthy, independent years of life and to narrow the gap between the richest and poorest in the country. On 22 July 2019, ‘Advancing our health: prevention in the 2020s’ was released. This official green paper sets out the Government’s suggestions to tackle preventable ill health and invites people to give their views. So what does this mean for people with arthritis? 

Recognition of the impact of arthritis

The green paper highlights that, for the last 30 years, musculoskeletal conditions that cause problems with joints, bones and muscles have been the most common reason for years lived with disability in England. We know that too often arthritis is simply dismissed or overlooked, so this recognition by Government is important. However, we were also expecting concrete actions that would make a real difference and help people to look after their musculoskeletal health.

Action to tackle musculoskeletal conditions in workplaces

We know that people with arthritis often want to work but can find this difficult. That’s why Versus Arthritis is actively campaigning so that people have better support to be in work. VA welcomes proposals in the paper that the Government will bring together experts to review guidance for employers, develop a package of tools for employers to use to support their employees, and how these can be better promoted and used. These ideas, alongside proposals to address job loss due to ill-health are a start, though more needs to be done to put suggestions into practice and to build understanding of the impact arthritis has on people’s working lives.

Other areas for action

Several other proposals are promising for people with arthritis, including:

  • A call for evidence on musculoskeletal conditions, including priority areas for action such as awareness raising, physical activity, behaviour change programmes and links between mental and musculoskeletal health. Government is also interested in what data should be routinely collected about musculoskeletal conditions;
  • A digital design challenge for strength and balance exercises, focused on people with health conditions;
  • Work with charities and Sport England on a new physical activity campaign; and
  • A ‘Home of 2030’ design competition to explore how more energy efficient, accessible and adaptable homes can be designed.

What happens next?

The consultation runs until mid-October and Versus Arthritis’ policy and public affairs team will be working to ensure that views of people with arthritis are heard by Government through this process. VA does not accept that these proposals are enough and will demand more to tackle the pain, fatigue and isolation that arthritis causes. Add your voice and campaign with Versus Arthritis.

NASS logoby Jill Hamilton, Professional Engagement Manager, National Ankylosing Spondylitis Society

On 22 July 2019, the government quietly published their green paper Advancing our health: prevention in the 2020s. There has been a lot of commentary in the media, although it has been hugely overshadowed by activity in Westminster and the appointment of a new Prime Minister.

What is a green paper?

A green paper is a consultation document. This means that this isn’t the final version and so people both inside and outside parliament are able to comment on policies being proposed.

Relevance axial SpA (AS)

Many people may read the title of the paper and think to themselves ‘this has nothing to do with AS, you can’t prevent it from happening’, and they would be right about axial SpA (AS) not being preventable, but not that this paper has nothing to do with people living with the condition.

Musculoskeletal (MSK) conditions are problems with bones, joints and muscles, and axial SpA falls into this broad category. MSK conditions are mentioned a significant amount in the paper, particularly when it comes to the amount of disability caused by MSK conditions. Axial SpA (AS) is not specifically mentioned.

There are many areas of the paper which can be directly applied to axial SpA (AS), including a very heavy emphasis on physical activity, mental health, access to work and social prescribing.

The paper is also asking for evidence on musculoskeletal conditions including:

  • raising awareness of MSK conditions among the public
  • the role of physical activity
  • population-level behaviour change programmes
  • action to support staff in the workplace
  • links between mental and MSK health
  • What data should be routinely collected on MSK conditions


Is it slightly disappointing that awareness of MSK conditions amongst health professionals is not a focus, as is the lack of recognition of the role of the voluntary sector, which NASS will include in their response. You can read the open letter from National Voices members, including NASS, which was published in The Guardian a few weeks ago in anticipation of this paper being published.

NASS plan of action

The consultation is running from now until 22 October. During this time, NASS will put together a comprehensive response to the paper, ensuring that people with axial SpA (AS) and the Medical Advisory Board are consulted on their views before the submission of a final version. The response from NASS will be very specific to the AS community. NASS will also work with the Arthritis and Musculoskeletal Alliance (ARMA) on a joint response from the whole MSK community which will be more general.

APPG for Axial SpA

The All-Party Parliamentary Group for Axial Spondyloarthritis will also be working to prepare a response to the consultation, led by NASS and will look to ask parliamentary questions on the paper when parliament reconvenes in the autumn.

This new resource looks at how Allied Health Professionals can be involved with social prescribing, not just AHPs who work in the NHS but also those in private practice. The framework sets out four ways AHPs can engage with social prescribing, from active signposting, to involvement in the development of social prescribing and gives examples of how different AHPs might do this.

Social prescribing improves outcomes for people by giving more choice and control over their lives. It is effective at targeting the causes of health inequalities and is particularly useful for people who need more support with their mental health, have one or more long-term conditions, are lonely or isolated, and/or have complex social needs that affect their wellbeing.

The framework includes a range of AHPs, including those who are ARMA members such as physiotherapists, dieticians, osteopaths, and occupational therapists. It explains why AHPs should be interested in social prescribing and how to approach the different roles they might play:

  • Active signposting
  • Refer to a link worker
  • AHP as prescriber
  • AHPs promoting, growing and developing social prescribing


The framework is accompanied by a policy report giving recommendations for AHPs and for system leaders to ensure the maximum benefit from what AHPs have to offer.

All AHPs:

  • To continue to embed holistic care into their roles and to use social prescribing as part of this.
  • To connect with their local link workers to build a picture of social prescribing opportunities applicable for their users.
  • To champion social prescribing and share good practice examples.


AHP leaders and managers:

  • To connect with their local system to articulate how AHPs can support social prescribing, whether that is through provision of services, pathways development, training, supervision or advice.
  • To champion social prescribing as part of effective service delivery.


System leaders:

  • To draw on the skills and expertise of AHPs as they develop pathways, support and quality assurance frameworks around social prescribing.
  • To explore opportunities to develop directories of services, through applications such as MECC to support active signposting by a range of professionals.


23 July 2019

The Arthritis and Musculoskeletal Alliance, an alliance of prominent health charities, professional and research bodies, welcomed the publication of the Advancing our health: prevention in the 2020s consultation document from the UK Government.

The Green Paper recognises that for the last 30 years, problems with joints, bones and muscles have been the most common cause of years lived with disability in England and the Green Paper’s proposition includes increasing the join-up across mental and physical health services. It includes ensuring businesses are equipped with the knowledge and tools they need for musculoskeletal health, convening a reference group on this. The document also recognises the scale and cost of MSK conditions – to individuals and the economy – and the need to take further action.

We are pleased to see the importance placed on musculoskeletal health in the prevention green paper as there are effective ways to prevent many musculoskeletal conditions, which is why Public Health England recently published a strategic framework for musculoskeletal prevention. However, there also needs to be sustained financial and political commitment if we are going to improve health outcomes in the long term.

Guest blog by Andy Bell, Deputy Chief Executive, Centre for Mental Health

Having a musculoskeletal condition increases your risk of having a mental health problem, and people with a mental health condition are more likely to have a range of MSK problems. Yet the way services for both are organised and the ways professionals in each are trained offers little recognition of the overlaps between them.

Mental health and MSK conditions share some common traits and challenges. Both are complex and diverse. Many are poorly understood. And neither has traditionally been afforded priority status within the NHS.

Nonetheless, both are finally gaining recognition by policymakers as causes of long-lasting distress, pain, poverty and disability. The NHS Long Term Plan, for example, includes a welcome focus on improving mental health support, including an extension of psychological therapy provision for people with long-term physical conditions. And a new five-year MSK strategy sets out a range of actions that statutory bodies such as Public Health England and charities including Versus Arthritis and ARMA will take to prevent MSK conditions and improve support for those living with them.

The MSK strategy specifically notes the links with mental health, citing a fourfold higher risk of depression among people living with chronic pain and a 50% higher risk of back pain among people with depression [1]. It goes on to note that integrated working may therefore help to support people with co-occurring needs more effectively, though gives little detail about what that might mean in practice.

Centre for Mental Health is now working with partners in both mental and physical health to highlight the often neglected physical health needs of people living with long-term mental health conditions such as schizophrenia, bipolar disorder or personality disorders through a collaborative called Equally Well [2]. Having a severe mental illness is known to cut short life expectancy by 15-20 years. But for many it also comes with chronic pain and disability. And too often people’s physical symptoms are ignored or overshadowed by their mental illness.

We want to change that by ensuring that people working in and using mental health services have a bigger focus on physical health, and that those working in physical health can work equally well with someone who has a mental health diagnosis as they can with someone who does not. For MSK professionals, this may mean being more aware of the nature and impact of mental health conditions, and being able to work in trauma-informed ways [3]. Building links with mental health professionals and service users can help to ensure people get timely help where possible to prevent MSK problems and whenever necessary to offer the right help and support to people who need it.

Some services, for example Sussex MSK Partnership [4], understand the importance of ‘no health without mental health’ (one of its three core values) and the value of people who use services being recognised as equal partners in designing and delivering this sort of support [5].

It is vital that people living with long-term mental health conditions get the same recognition for their physical health needs, with MSK professionals available to meet their needs in ways that they find helpful and convenient (including for those who may be in hospital for their mental health).

Achieving equal health for people with mental health conditions requires the whole health and care system to work differently. But ultimately, it is about the interactions professionals have with people day to day. And through Equally Well we hope to work with ARMA and colleagues across the MSK sector to enable people to bring about change at every level of the system and to ensure no one is left without the support they need for their physical and mental health.



NICE are inviting organisations to register as a stakeholder for the guideline: ‘Safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal’.

Registered stakeholders will have the opportunity to comment on the draft scope and guideline during consultation and all comments received from registered stakeholders will be considered and responded to individually. You will also be privy to an embargoed release of the guideline prior to publication in the public domain.

To register as a stakeholder, please complete the online form from the NICE website, and you can find more information about NICE’s guideline work here.

Rheumatoid Arthritis (RA) is very much on my mind as I write this during RA Awareness Week. Yesterday I attended a roundtable discussing the NHS Long Term Plan (LTP) and RA. Rheumatology doesn’t get a specific mention in the plan, but there is plenty of content on related issues. There is mention of chronic pain, for instance, which is very relevant to ARMA and to RA. Access to integrated pain services is something ARMA members have identified as a priority following the publication of our mental health report last month, and by the time this is published I will have presented at a meeting of the Chronic Pain Policy Coalition.

MSK gets a number of mentions in the Long Term Plan but it’s easy to get the impression that this is all about osteoarthritis. ARMA is very clear that rheumatology is part of MSK, and just as important a part of our work as orthopaedics. I am part of an advisory group for the NHSE review of elective care access standards (waiting times in plain English) and I know that this is a vital issue for rheumatology. There are delays in patients recognising that their symptoms might be serious, and often further delays in GPs making a referral to rheumatology so, once referred, it’s vital that there isn’t a long wait to see a rheumatologist. But the roundtable heard that only 32% of RA patients are seen in a time recommended by NICE and almost 10% wait longer than the general waiting time target of 18 weeks.

The roundtable heard that three things impact on remission rates for RA and one of them is rapid access to specialist assessment.  Another is starting therapies quickly. The Long Term Plan talks about reducing delays in access to evidence based treatment. The example it gives is joint replacement surgery, but access to biologics in RA is another excellent example.

The final factor increasing chances of remission is a person centred holistic approach to care. The roundtable heard about unmet needs of RA patients, including pain, anxiety and depression. ARMA’s roundtable report on mental health and MSK has been well received in both MSK and mental health sectors. It’s very relevant to RA patients, and we will be pursuing the recommendations over the coming months.

After the meeting I was asked what would help rheumatology get the best out of the Long Term Plan. Part of my answer was that it needs to be clearly part of MSK, which is included in the plan. Which is why ARMA’s core offer for local NHS Plans includes rheumatology. Let’s be clear, no CCG, STP or ICS can say it is delivering good MSK services if it hasn’t included rheumatology, pain and mental health in their plans.

In the run up to the publication of the Government’s Green Paper on prevention, the IPPR has published a report Ending the blame game: The case for a new approach to public health and prevention. The UK has made significant progress on prevention in the past, IPPR says, but we appear to have ‘hit a wall’ with limited progress since 2010. They call for the government’s prevention green paper to deliver a paradigm shift in policy from interventions that ‘blame and punish’ to those that ‘empathise and assist’.

Meanwhile Public Health England’s Health matters: Prevention – a life course approach guidance published last month focuses on taking a life course approach to the prevention of ill health and signposts to evidence-based interventions and tools, as well as to evaluation and monitoring techniques.

It looks at addressing the wider determinants of health that will help improve overall health by helping to improve the conditions into which people are born, live and work. Unlike a disease-oriented approach, which focuses on interventions for a single condition often at a single life stage, a life course approach considers the critical stages, transitions, and settings where large differences can be made in promoting or restoring health and wellbeing.