Coordinate musculoskeletal care to help the NHS make significant savings, says Vicky Chamberlain.
Everyone working in the NHS is aware of the need to make savings while still providing high-quality, safe services. The sweeping reforms to the health service have added to the pressure.
The treatment and good management of long-term conditions offers one of the best opportunities for reducing costs within the NHS. Some conditions have already been highlighted and focus has been, quite rightly, on areas such as diabetes and ischaemic heart disease.
Yet the treatment of musculoskeletal conditions places a huge burden on the NHS. In 2011-12 it was the fourth largest area of spending at a cost of £5.06bn. The musculoskeletal framework published in 2006 identified that 30% of all GP consultations are for musculoskeletal conditions.
Where possible, we should be looking to prevent conditions developing. This feeds into the public health priorities of reducing obesity, increasing exercise and reducing smoking and alcohol intake. This would require coordinated health and social services to involve local government, the food and drink industry, employers, many other organisations and local communities, embedding healthy lifestyles into society as a whole.
Early diagnosis and treatment are crucial in reducing the burden of long-term conditions on society. In 2009, the National Audit Office found that people with rheumatoid arthritis were not being treated in a timely manner, and delays in treatment were resulting in poorer outcomes. We should be aiming to treat people promptly so they can stay in work. A population that can contribute to the economy by working and paying taxes, rather than needing benefits, has got to be better, not only for the individual but also for the economy as a whole.
People with long-term conditions become experts in their conditions. Initiatives, such as expert patient programmes, need to be more widely available to promote this aspect of care.
Encouraging patients to manage their conditions can improve outcomes and reduce the pressure on health services. People with the skills to self-manage achieve a better quality of life and are more productive and independent, again reducing the strain on health and social care services as well as the benefits system. Unfortunately, not all providers of musculoskeletal care are willing to fund these initiatives.
Coordinated services provided by a multi-professional team are core to the provision of high-quality, cost-effective care. There is a need to ensure that individuals receive the right treatment, in the right place, at the right time. This seems like a simple enough premise but it does not appear to be that easy.
The Arthritis and Musculoskeletal Alliance (ARMA) is an umbrella organisation, consisting of professional groups, patient groups and research charities. ARMA is working to develop a model for a musculoskeletal clinical network with the aim of supporting commissioners in the commissioning of coordinated musculoskeletal care, developing pathways and ensuring access to training and expert support. This is intended to help clinicians diagnose, treat and refer those with musculoskeletal conditions more effectively.
By making musculoskeletal care a priority, the government and NHS can make significant savings in healthcare as well as for the economy. It is time to bring these conditions and the people who live with them to the forefront of health policy to enable better management and outcomes as well as much-needed financial savings.
Vicky Chamberlain is rheumatology nurse specialist at Central Manchester University Hospitals Foundation Trust and chair of the Royal College of Nursing Rheumatology Forum
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