What is the roadmap for improving musculoskeletal health in London?
Personal view from Ian Bernstein, Clinical Director for Musculoskeletal Health, NHS England and NHS Improvement, London Region.
The Best MSK Health collaborative at NHS England brings together providers and people with lived experience to “enable best MSK health for all”.  The programme formally launched in February 2021 as we were riding the second COVID wave; and the timing is significant. We have known for many years that musculoskeletal problems are the largest cause of years lived with a disability in the UK.  COVID sadly shone a spotlight on the ‘unfair and unjust’ health inequalities for people with musculoskeletal conditions and co-morbid mental health conditions.  In the lull before the second COVID wave, Amanda Pritchard (now our new Chief Executive of NHS England) outlined the NHS’s operational priorities for the winter of 2020-21.  One small sentence in this letter galvanised resources for our National Clinical Director for Musculoskeletal Conditions, Andrew Bennett, “to maximise recovery [of non-COVID services]… …[for services with the] greatest opportunity for improvements: ophthalmology, cardiac services and MSK/orthopaedics.”
The Best MSK Health aim is: “Through NHS system recovery improve the quality and value of provision to enable best MSK health for all [children, adults and older people].”  The national collaboration brought together the Getting it Right First Time, Outpatients Transformation and Patient Experience programmes. The collaboration stakeholders include NHS England, Public Health England, Health Education England, NHSX (digital transformation), professional and charitable stakeholders including ARMA and clinical champions from the seven NHS regions and people with lived experience. The focus is on system recovery including reducing waiting lists for surgery, outpatients and diagnostics as these are clinically important, easily measurable and consequently politically sensitive. The national team cleverly used this impetus to drive a wider suite of initiatives to support self-management, improve care and outcomes in primary and community settings, foster collaboration with mental health services and social care, and importantly improve population health. The latter is pivotal to sustainability in the longer term due to the triple whammy of population growth, an ageing population and rising obesity.
The provider networks at place or borough level along with larger providers at integrated care system level have to deliver the vision. A new cadre of musculoskeletal clinical champions in the NHS Regions will act as connectors between the national vision and local delivery. These champions will act as ‘translators’ inspiring clinical colleagues at the coal face whilst understanding the language and aspirations of programme directors and drivers for operational managers in the NHS. In order to inform this bi-directional dialogue, it is important to identify clinical leads at all levels in the NHS: regionally, integrated care system, place or borough and primary care networks. New musculoskeletal clinical networks will develop and finesse local strategy and members will hold each other to account for the delivery of improved care and outcomes for our patients.
In my role as clinical director for musculoskeletal health for the London region, I will be working with our programme director and colleagues to offer support to nascent clinical networks, foster co-production of new and improved services, facilitate progress with delivering our regional priorities, and ensuring alignment with the national vision. Our new MSK Board in London agreed the following deliverables to support system recovery at regional level:
- Improving waiting times
- Ensuring optimal referrals
- Improving access and supporting self-management
Running through these three objectives will be a golden thread to address health inequalities. As we move towards more integrated services it is important to keep our patients’ perspectives as the organising principle, to ensure fruitful and productive collaboration. 
Personal views of Ian Bernstein, 13 August 2021