This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Health Policy

One major criticism of the NHS Long Term Plan was the lack of any detail on workforce. This detail has begun to emerge with the publication of the Interim People Plan for the NHS. It looks at the need to transform the way the entire workforce, including doctors, nurses, allied health professionals (AHPs), pharmacists, healthcare scientists, dentists, non-clinical professions, social workers in the NHS, commissioners, non-executives and volunteers, work together. It works on the basis that multi-professional clinical teams will be the foundation of the future workforce, rather than treating the workforce as a group of separate professions.

This new multi-professional way of working will be essential for MSK services, where there are high levels of multimorbidity and good person-centred care is rarely the responsibility of one professional.

The plan has 5 themes:

  • Making the NHS the best place to work
  • Improving the leadership culture
  • Tackling the nursing challenge
  • Delivering 21st century care
  • A new operating model for workforce

A full, costed five-year People Plan will be developed later this which will build on the vision and actions in this interim Plan. This will set out in more detail the changes to multi-professional education and training, career paths, skill mix and ways of working needed and quantify in more detail the full range of additional staff needed for each of the NHS Long Term Plan service priorities.

There are accompanying documents setting out the vision for the future workforce for allied health professionals and psychological professions; dental; healthcare science; medical; and pharmacy.

Public Health England has published two documents related to MSK prevention. The first is a whole-system strategic framework for prevention of musculoskeletal conditions across the life-course. The purpose is to provide stakeholders and system collaborators with a clear statement of PHE, NHS England and Versus Arthritis’ commitments to promote MSK health and to prevent MSK conditions. Each collaborating organisation, including ARMA, has identified what they will be contributing, and in some cases, leading on.

The document contains information about a range of MSK prevention activities and links to resources and tools to help prevention activity.

Alongside this is an MSK prevention logic model which provides an overview of the programme vision: help maintain and improve the musculoskeletal health of the population in England (across the life-course), supporting people to live with good lifelong MSK health and freedom from pain and disability which will be delivered by system partners and collaborators within 5 years.

The ARMA Alliance with Versus Arthritis and the British Orthopaedic Association voiced its concerns previously about rationing of joint replacement surgery for people with MSK conditions. ARMA published a position paper on this in 2017.

So what does the latest data tell us about hip surgery? In June, Deborah Ward and Lillie Wenzel from the policy team at The King’s Fund published a blog post: ‘A new trend in elective hip surgery’. They examine the trend in hip replacements, health gain and health gain reported by patients and interpret these trends. Are the trends symptoms of a service under pressure?

Read their article in full via the King’s Fund website.

NICE published its quality standard NICE Physical activity: encouraging activity in the community on the NICE website in June.

The NICE quality standards team have prepared a summary of the consultation report and the full set of consultation comments on its website.

Guest blog by Dr Jeanelle de Gruchy, President of the Association of Directors of Public Health

To its great credit, New Zealand has become the first country in the world to produce a “wellbeing budget” – a commitment to prioritise population wellbeing as the main mission of the government. A similar philosophy was adopted in Wales in 2015, with the Well-being of Future Generations Act requiring public bodies to think about the long-term impact of their policies on both people and places.

This is a bold and exciting approach for anyone living with a musculoskeletal condition or campaigning for change on their behalf – and for the wider public health community. It puts the highest value on quality of life when it comes to national policy and investment decisions. The Association of Directors of Public Health has long championed taking a whole system and long-term view of how we create and support the health and wellbeing of everyone in society.

What does that mean in practice?

The ADPH recently published updated versions of our life course policy position statements capturing the collective views of Directors of Public Health in local government. There are four documents covering: Best Start in Life, Living and Working Well, Healthy Ageing and Health Inequalities.

Our statement on Living and Working Well focuses on the ‘working age’ population – the approximately 63% of people between the ages of 16-64 – and how to promote healthy, happy and productive lives. We know that the biggest causes of poor health (‘morbidity’) in England are low back and neck pain.

Delivering change means putting a greater emphasis on improving the social determinants of health – such as housing, air quality, education, income and food – factors which overwhelming shape our health and driving down inequalities in how long we live in good health (‘healthy life expectancy’).

It means promoting good mental health by intervening early to prevent the adverse childhood experiences that can have a lifelong impact. We know that along with mental health, poor musculoskeletal health (like back and neck pain) accounts for the majority of sickness absence in the UK, making this an issue of concern beyond the health sector. As ARMA highlights in its policy paper Musculoskeletal and Mental Health, we need to understand the inter-relationship between MSK conditions and mental health rather than treating them in isolation.

It means enabling people into good work and creating healthy workplaces which prevent many musculoskeletal conditions arising, as well as supporting those with musculoskeletal conditions to thrive in work.

These are all areas that need to be addressed in the upcoming green paper on prevention.

Finally, more funding for public health is now critical. A spending review is expected at some point this year and there is a growing consensus that public health investment – in its widest sense – must be a priority. In February, ARMA – and many of its members – signed up to a public letter in the Times, coordinated by ADPH and supported by 54 organisations, setting out the case.

The government has the welcome ambition to improve healthy life expectancy so that, by 2035, we are enjoying at least five extra years of healthy, independent life, whilst closing the gap between the richest and poorest. If the public health funding gap continues to grow, this ambition will not be met, with the costs being borne by the NHS, the economy and individuals.

We look forward to working with ARMA in the months ahead to raise the voice of public health and echo the call recently made by the APPG on Wellbeing Economics for a spending review which walks the walk on wellbeing.

The Royal College of GPs (RCGP) has published a vision for general practice for 2030. It sees a very different place for general practice from the current model, with increased multidisciplinary working and a greater focus on prevention and well-being. This was developed with the involvement of patients, GPs and other stakeholders.

This is a response to the changing nature of health needs with more people presenting with complex and multiple conditions. The current primary care workforce is stretched and the numbers of GPs per 1,000 of population have declined by 5% in the last ten years.

The document sees general practice in 2030 remaining the first point of contact for most patients, but not focused on GPs, more on multidisciplinary teams, freeing up GPs to do what needs a GP. Practices should become well-being hubs addressing psychosocial needs of patients. They should host prevention, well-being and social action projects, and play a role in building strong resilient communities. They will provide links with secondary care. One example given is the potential for practices to run MSK clinics currently delivered from hospitals.

The document lists six enablers needed to deliver this:

  • Funding
  • Training
  • Workforce
  • Digital
  • Modern premises
  • Research and Innovation

The summary document contains many examples of practices already putting some of this into practice and more detail on each of the areas and enablers. Read it here.

Integrating Health Systems and Paradigms to Drive Culture Change

Tuesday 25 June 2019 at 18:00 – 20:00

Join the RSA Health, Care and Wellbeing Network for a conversation about the integration of health systems and paradigms to support sustainable health, hosted by Paul Hitchcock FRSA.

This event will be an opportunity to explore how the two approaches might be mutually supportive in driving the sort of culture change that we need.

This is a participative event: after an introduction from Paul there will be time to discuss the issues raised, and time for informal networking as well. There will also be an opportunity for anyone wishing to hold a similar event for the Health, Care and Wellbeing Network to discuss this, so please bring along your ideas.

This event is free to attend and open to Fellows, friends, and colleagues interested in supporting the work of the RSA. 
Visit the RSA website for more details.

Location: Dr Cross Room, Rawthmells, RSA, 8 John Adam Street, London, WC2N 6EZ.

governemnt logoFor the first time since Public Health England (PHE) came into being, musculoskeletal conditions have been mentioned in the Government’s remit letter to PHE. PHE is the national body with responsibility for the nation’s health and wellbeing and tackling health inequalities. Each year the Government sends them a set of instructions about their priorities. In 2019/20 this specifically includes ‘work-focused musculoskeletal prevention activity’.

In 2018, PHE made musculoskeletal conditions one of its priority programmes, and so it’s great that these conditions are now taking their place on the national agenda. This summer, PHE will publish their 5-year prevention plan for musculoskeletal conditions, which Versus Arthritis has been working in partnership on.