by Sarah Duncan, Head of Clinical Policy, NHS England
An interview on the news recently about stem cell research into cartilage replacement for osteoarthritis, made me reflect on the phenomenal pace of change and progress in the relatively short time of my career. As a new physiotherapist in the mid-1980s we used short wave diathermy; long flexible heated tubes wrapped around a patient’s knees, to help with the pain of arthritis. Although patients really enjoyed the heat, it made little difference to their ongoing pain and mobility.
At that time, every orthopaedic ward housed patients on traction for spinal pain. Attached to heavy weights via tape stuck to their legs, patients were on bedrest for 6 weeks. It would be the physio’s job to get them standing up for the first time. Many people would nearly faint as their cardiovascular system tried to cope with being vertical again. I often thought the subsequent manoeuvres to get them flat again must have reversed the alleged benefits of the bedrest. This was a time when there were treatment regimes for everything and the main individualising factor was the surgeon’s preference.
I was working in Somerset when I came across a different approach to chronic pain management, led by Dr Alf Collins, now Personalised Care Group Clinical Director at NHS England. His approach for people living with persistent pain was to help them understand and come to terms with their pain, and adopt strategies which enabled them to lead as fulfilling and independent lives as possible. Physiotherapists ran education and exercise groups, which also enabled people to share their experiences with others who understood and could empathise. This approach really worked for many people, supporting both their mental and physical health, and they were empowered to take control of their condition. I learned that managing pain was less about giving a treatment to a passive recipient and more about collaborating and working with them.
Fast forward 30 years and I’m in a national clinical policy role, which includes the Musculoskeletal (MSK) Conditions programme. Digital technology, genomics, stem cell research, and advances in surgery are all enabling progress to be made, beyond anything imaginable in the ‘80s. This progress also includes the evidence-based personalised care approach that the membership organisations of ARMA have long supported and developed. In partnership with ARMA, NHS England has developed the MSK Knowledge Hub enabling the MSK community to debate innovative ideas, share learning and celebrate success. The NHS Long Term Plan published yesterday, has a whole chapter on personalised care building on the Five Year Forward View, which recognised the need for better integration of services, and connection with the voluntary sector, to enable a more personalised approach. The NHS Long Term Plan aspires to a fundamental shift in approach to deliver more person-centred care, including for musculoskeletal conditions.
We must continue to develop the focus on people as individuals amongst the high-tech treatment options, and ensure people are properly listened to. People with MSK conditions should have choice and control over the way their care is planned and delivered, based on what matters to them and not only on what’s the matter with them. I’m encouraged to see that the Long Term Plan for the NHS will build on the evidence and examples to show how personalised care could, and should be, business as usual across the health and care system.