On 10th July 2017, NICE issued a new Technology Appraisal (TA) for bisphosphonates which links the recommendations for drug treatments to advice on fracture risk assessment outlined in their earlier guidance. The TA is not intended to provide treatment thresholds but offers recommendations on cost-effective use of bisphosphonates when using fracture risk assessment as described in their guideline www.nice.org.uk/guidance/cg146.
For the first time, these recommendations will apply to men as well as women.
The TA says that provided an individual meets the criteria for fracture risk assessment there should be no financial barrier to them receiving bisphosphonates if they have a fracture risk of ...
Guest Blog by Lesley Giles, Director, Work Foundation
I am delighted to contribute to this edition of the Newsletter in my new role as Director at the Work Foundation. I think after 6 months I can probably just about still call myself new, not least as time has flown by in a whirlwind. It’s one of those roles that really is a great privilege to do. What is there not to like? I have the opportunity to research and promote something I am passionate about – the importance of good work! The importance of more positive working lives, creating meaningful ...
The Next Steps on the NHS Five Year Forward View document was published on March 31st 2017 as an update to the original Five Year Forward View published in October 2014.
Next Steps sets out the NHS’ main national service improvement priorities over the next two years, “within the constraints of what is necessary to achieve financial balance across the health service”.
This blog post sets out why MSK is so important for the delivery of the next steps and the role ARMA and our members have to play.
Putting forward models of care and examples of practice for the NHS is a large part of how Sport and Exercise Medicine (SEM) is influencing the MSK landscape. The Faculty of Sport and Exercise Medicine’s Fresh Approach in Practice NHS information document remains useful and relevant when communicating what works and how SEM can improve outcomes and make real cost savings in MSK care.
Members and Fellows of the FSEM are now putting forward their evidence for SEM-led MSK services to help provide much needed examples. Recently featured in the FSEM’s response to the Scottish Preventative Agenda Inquiry was NHS Tayside ...
After the success of our first three MSK pathway events I’m pleased that planning for the next three has begun. The North West event will be in Merseyside on May 16th and is shaping up to be every bit as inspiring as the others. Two events are being planned for the South region, with the first in Exeter in July. More details should be available in our next newsletter.
I have been reading the pledge forms completed by people at the first three events and they show the commitment of people to create change in services. There’s lots of talk ...
Last Friday, March 31st, NHS England published a significant document about the future of the NHS: Next Steps on the NHS Five Year Forward View. The original NHS five year forward view set out why and how the NHS should change to address three issues: the health gap, the quality gap and the financial sustainability gap. The next steps updates on progress and sets out future plans.
Musculoskeletal conditions account for a major part of the workload of the NHS, 40% of which is due to potentially preventable risk factors. The NHS spends £5 billion a year treating them. Yet ...
Gout: No Laughing Matter
The UK Gout Society held a parliamentary reception at the House of Commons on 28th March 2017 to launch #shoutaboutgout – a social media campaign to raise awareness about gout, a musculoskeletal disorder which now affects one in 40 people in the UK. Nearly 60 MPs, peers and other stakeholders in the MSK space, including many ARMA members, attended the event.
Jim Shannon, MP for Strangford (Northern Ireland) and DUP Spokesperson for Health, who sponsored the event, stated: “It’s time we put the facts on the table and told people the truth about gout.”
The George Nuki, Emeritus Professor ...
It's been a very busy month for the HMSA with the release of new EDS nosology. We've prepared some material for people unsettled by these developments in classification: a letter which can be printed and given to medical professionals explaining what the changes mean, and an update for clinicians that contains a simplification of the changes for people working in the MSK field. Both can be found on our website sidebar, appended to an interview with our HSD Ambassador, Hannah Ensor, here: hypermobility.org/hsdandme.
Our major fundraising campaign this summer is in the hands of Keith Diaper, who is completing 52 middle ...
March has been a busy month for ARMA. I have enjoyed meeting so many ARMA members, finding out more about what you do and how ARMA fits with your current priorities. I really welcome the level of support you have offered me in my new role as I begin to get an understanding of the priorities of the MSK community.
The highlight of the month must be the three joint ARMA/NHS England regional events. These have been a huge success. All three events were over-subscribed, showing the high level of interest in improving musculoskeletal services locally. A range of speakers, including ...
The Government’s Mandate to NHS England for 2017-18 has been published. This sets out annual deliverables against the seven objectives to 2020. All of these objectives are relevant to musculoskeletal services, but one has been added which makes specific reference to MSK data. This is in relation to the Government’s goal to reduce the disability employment gap and says the NHS should:
“Work with Government to identify opportunities for regular collection of data about incidence, prevalence, clinical activity and outcomes of musculoskeletal patients and services in England.”
ARMA will be looking at how the MSK community can support the implementation of this ...
Arthritis Care’s response to the Budget welcomed the announcement of £2 billion of additional funding for social care in England as a step in the right direction, but argued that it falls far short of what is needed. We also blogged about what we wanted from the Budget here, calling for long-term solutions to the health and care crisis in England and an end to benefit cuts.
Judi Rhys appointed as Non-Executive Director of Public Health Wales
Judi Rhys, Chief Executive of Arthritis Care, has been appointed as the Third Sector Member (Non-Executive Director) at Public Health Wales. This complements her ...
At a recent meeting of the World Federation of Chiropractic in Washington, founder of World Spine Care, Scott Haldeman MD, DC, reported on the latest developments.
The WSC is a collaboration of people working in MSK care, a charity dedicated to improving the lives of those suffering from spine related conditions in communities underserved by health care. Desmond Tutu and Elon Musk have put their names to WSC.
Work goes on in India, Ghana, Botswana and the Dominican Republic. Besides facilitating and funding clinicians’ work in these countries, the WSC also funds college education for future chiropractors from these countries.
The Global Spine ...
Debbie Cook, Chief Executive at NASS, has been a member of the Guideline Development Group working with NICE for over two years, particularly giving the patients’ perspective. The NICE Guideline for Spondyloarthritis was issued at the end of February 2017.
NASS welcome this Guideline. We will be working hard to promote it and to ensure the recommendations contained within it are taken on board. You can read it in full on the NICE website.
Dr John Hunter, Consultant Rheumatologist at NHS Greater Glasgow and Clyde
NASS launched our first ever Patients' Choice awards in 2016 to mark our 40th anniversary.
Our Members voted for the health professionals ...
RA Awareness Week is coming soon…19-25 June 2017.
Awareness packs will be sent out in early April and you can request your copy by emailing email@example.com today.
Over 30 charity CEOs write to DWP about changes to Personal Independence Payment (PIP)
On 15th March, the Chief Executives of over 30 charities and organisations (including NRAS) wrote an open letter to Minister for Disabled People, Health and Work, Penny Mordaunt, urging her not to proceed with damaging changes to Personal Independence Payments. You can read the letter here.
ARMA worked with Public Health England and Business in the Community to develop a new toolkit for employers in the workplace, which launched at the Health and Wellbeing at Work Conference in the NEC today (7 March 2017). Musculoskeletal conditions are an important consideration for businesses as they are a leading cause of pain and disability in the UK, affecting many employees.
The toolkit draws together information for employers to support staff in the prevention, early identification, management and adaptation for people affected by musculoskeletal conditions. The musculoskeletal toolkit is a simple step-by-step guide dealing with back, neck, muscle and joint ...
by Kate Gilbert, PhD, Project Lead for PMRGCAuk’s Rheuma Research Roadshows
I’m writing this on a train on a February evening, feeling worn out but excited, a state of mind familiar to any development worker who has just launched a major project. In this case, the PMRGCAuk team have just held the first of our Research Roadshows, funded by a grant from the Wellcome Trust, focusing on Giant Cell Arteritis and Polymyalgia Rheumatica. The roadshows are going to take place at research hubs around the country. To be honest, there aren’t many of them. Sites of special scientific interest – ...
On the 21st February, Arthritis Research UK hosted a drop-in event in Parliament as part of our Work Matters to Me Campaign. The event was a great success with 53 MPs and one Peer in attendance, including the Minister for Disabled People, Penny Mordaunt, the Shadow Health Minister, Barbara Keeley, the SNP Health Spokesperson, Martyn Day, and the Deputy Speaker of the House of Commons, Lindsay Hoyle.
Our campaign calls for the Government to better support people living with long-term conditions such as arthritis, so that they can find and remain in suitable work. We are asking MPs to write to the ...
Shared decision making pilot
Arthritis Care has expanded our unique service into South Tees. The local CCG has commissioned a pilot, recently launched, which uses a shared decision making tool to help people with arthritis considering knee and hip replacements to explore their options and learn about self-management techniques.
Green paper response
In our response to the Work, Health and Disability Green Paper, Arthritis Care welcomed the focus on musculoskeletal conditions but urged the government not to force people to engage with employment support if they are not well enough.
Our response is available here.
You & Yours
Arthritis Care has recently ...
Sport and Exercise Medicine and its Relevance to Work, Health and Disability
The Faculty of Sport and Exercise Medicine (FSEM) UK submitted a response to the Work, Health and Disability Consultation focused on the specialty’s ability to provide service delivery in MSK Medicine. Key points from the response included:
Sport and Exercise Medicine has the skills and knowledge to lead clinical vocational multi-disciplinary teams which can improve health and employment outcomes in the community.
Early assessment for musculoskeletal (MSK) conditions is key, via a community-based Sport and Exercise Medicine (SEM) team who can provide functional analysis of limitations and abilities and decide on ...
Our response to the UK Government consultation
ARMA welcomes the recognition in the Improving Lives: The Work, Health and Disability Paper of the need to address musculoskeletal conditions and work.
Musculoskeletal conditions are among the commonest causes of people’s inability to work and, as evidenced in the Global Burden of Disease study (2015), are the single biggest cause of pain and disability in the UK. Less than two-thirds of working age people with musculoskeletal conditions are in work. MSK conditions are the leading cause of sickness absence, resulting in 30.6 million working days lost each year and one in five visits to ...
Whole System MSK Regional Events to help transform MSK care outcomes and Quality of Care.
Working in partnership with ARMA, the NHS England Long Term Conditions (LTCs) Unit, are sponsoring a series of regional launch pad events that supports a joined up approach to transforming musculoskeletal (MSK) care.
The practical events will bring together regional and national leaders and organisations including RightCare and GIRFT, patient groups and local MSK stakeholders to focus on what the regions are most challenged by and potential solutions by sharing examples of best practice and evidence including national tools and resources and agree local priorities and actions ...
In 1968, the Beatles topped the charts with Hey Jude. That's the same year the medical exemption list for Prescription Charges was written up. Treatments for RA, JIA and other long-term conditions have come on a lot in that time but other than the addition of Cancer in 2009 the list hasn't changed.
Many of you know that campaigning for all long-term conditions to be added to the exemption list is one of NRAS’s campaign priorities for the year. We're pleased to have stepped up to join Parkinson’s UK and Crohn’s & Colitis as co-chairs of the Prescription Charges Coalition. In ...
Joint release from: British Society for Rheumatology and National Rheumatoid Arthritis Society
Rheumatology and arthritis societies raise concerns for arthritis services in Wales and call for more support to improve long-term patient outcomes.
The number of patients referred to rheumatology departments in Wales has increased by 66% since 2012, but resources for treatment are not keeping up with the demand, say patients and clinicians. As a consequence, new patients are waiting longer to be seen and treated and existing patients are struggling to secure follow up appointments and self-management advice.
These findings are important as there are 25,000 ...
The Faculty of Sport and Exercise Medicine (FSEM) UK welcomes new rules by the Committees of Advertising Practice (CAP) to ban the advertising of high fat, salt and sugar food and drink products in children’s media and supports both the Obesity Health Alliance (OHA) and the Children's Food Campaign in their responses to the measures, calling for loopholes to be closed.
The FSEM, as part of the OHA, is calling for a sustained increase in regular physical activity, according to UK Chief Medical Officer guidelines, to be part of all children's daily routines to prevent and manage obesity, alongside measures to reduce the consumption of ...
NICE’s updated guideline on low back pain and sciatica recommends exercise in all its forms - for example stretching, strengthening, aerobics or yoga - as the first step in managing the condition.
The guideline also recommends encouraging people to continue with normal activities as far as possible. However the guideline says massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone.
The updated guideline has been expanded to include people with sciatica, a painful condition typically caused by irritation or compression of the nerves which run from the ...
What is a good outcome?
We’re two years into delivery of the Five Year Forward View, the document heralded as a blueprint for bridging the gaps in finance, quality and prevention. Chapter Two of that seminal document sets out a vision for a ‘new relationship with people and communities’…
But what does that actually mean?
The Realising the Value programme has spent 18 months seeking to turn those words into a more deliverable reality. It is an important body of work delivered by Nesta, the Health Foundation, National Voices, Regional Voices, NAVCA, Volunteering Matters and others.
The team behind the programme have examined the ...
On 2nd November, NRAS held its 5th Healthcare Champions awards ceremony in Portcullis House, Westminster, with the kind permission of the Prime Minister and NRAS Founding Patron, the Rt. Hon Theresa May MP.
The event was a resounding success with over 80 NRAS Members, healthcare professionals, MPs and special guests attending.
The awards provide the opportunity to celebrate the dedication, professionalism and excellent care given by those healthcare professionals that go ‘the extra mile’ to provide the best possible outcomes for the many people living with RA and JIA, whilst also working in a challenging environment of NHS reforms and financial cuts.
Between 20 and 30% of a GP caseload is made up of patients with musculoskeletal (MSK) conditions; by expanding the availability of physiotherapy in general practice, GP time is freed up and patients are put in the driving seat, receiving the right care from the right professional. Physiotherapists are experts regarding MSK issues and have the same high safety record as GPs.
There are already examples of experienced physiotherapists working alongside GPs as the first point of contact for MSK patients. These examples show high patient and GP satisfaction rates, decreased x-ray, MRI and orthopaedic referrals.
The CSP has produced a suite ...
Fracture Liaison Services hold key to addressing crisis in osteoporosis, attendees at National Osteoporosis conference hear
The growing crisis in osteoporosis causing 300,000 debilitating fractures and costing the NHS £1.9bn every year can be effectively addressed by implementing and improving Fracture Liaison Services throughout hospitals and clinics across the UK, attendees at the National Osteoporosis Society conference in Birmingham heard in November.
Dr Kassim Javaid, Consultant in Metabolic Medicine at the Oxford University Hospitals NHS Trust - who spoke about Fracture Liaison Services at the conference - said: “The enormous personal cost of the often debilitating fractures caused ...
National Voices has published 'Involving patients and citizens: I Statements for research and innovation'.
The document was developed with voluntary sector organisations and people with lived experience as part of the recently published Accelerated Access Review.
“Health policy across the world has ignored diseases which affect the quality of lives and independence of people living with them and focused on those with high mortality such on cancer, heart disease and diabetes. Now with people living longer it is time for priority to be placed on dealing with this enormous burden from arthritis, back pain and other musculoskeletal conditions to prevent unnecessary pain and disability and enable people to keep independent.’’
Professor Anthony Woolf, Chair of the Bone and Joint Decade (BJD) International Co-ordinating Council, from the Royal Cornwall Hospital, Truro
The Global Burden of Disease study 2010, researched by the Institute for Health Metrics and Evaluation, is the first comprehensive study of the impact of all diseases and risk factors worldwide. The GBD data referring to the UK points to musculoskeletal conditions as being responsible for nearly one third of the entire national burden of disability.
Health Policy in the Media
Articles posted on external websites.
Prioritising Musculoskeletal Disorders
“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.’’
Musculoskeletal disorders are very broad and do not always fit neatly into our current, biomedically-dominated approach to delivering, and measuring outcomes in, healthcare. They are often complex, are associated with many co-morbidities and many of them tend to fluctuate.
Federico Moscogiuri and GP Dr Tom Margham, lead for primary care at Arthritis Research UK, co-author an article in GP Online which interprets the findings of the Global Burden of Disease report.
Musculoskeltal disorders can be managed effectively in primary care
Early diagnosis, prompt referral and specialist intervention is essential for some inflammatory forms of arthritis, for example rheumatoid arthritis. But many people with MSDs, the vast majority of whom have osteoarthritis, can be managed effectively in primary care, if the care they receive includes a strong element of self-management and support to remain independent.
Dr Alan Nye and Federico Moscogiuri, our director, co-authored this article on shared-decision making, spending variation and consultant-led pathways. It was published in gponline.com.
Is back, neck and muscle pain hurting the UK economy?
Almost 31 million days of work were lost in 2013 due to back, neck and muscle problems, according to the Office for National Statistics (ONS). The Labour Force Survey found that musculoskeletal conditions accounted for more prolonged absences than any other ailment.
Every time you get people in health to talk about the big issues facing the sector, you can be sure that the issue of joined-up working and joined-up care will come up. And when you start talking about joined-up working, you’re not far from talking about networks.
Read this post by ARMA’s Federico Moscogiuri on the National Voices website.
Health Policy Presentations
“How do we get policy makers to take musculoskeletal health and conditions seriously?”
This chart is taken from a fascinating, illustrative PowerPoint presentation document by Professor Anthony D Woolf, of the Bone and Joint Decade.
“Domain 2: Enhancing the quality of life for people with long-term conditions.”
Dr. Martin McShane, NHS Commissioning Board lead for Domain Two (Improving the quality of life for people with long-term conditions) was our guest speaker at the 4th annual ARMA Lecture. It took place on 21 November 2012 at the Royal College of Obstetricians and Gynaecologists.
Click the video image to see the slides and hear his presentation. The video should open with Windows Media Player (25 minutes, slides+audio).
In early August, ARMA has published a Policy Position Paper titled: ‘Rationing’ Access to Joint Replacement Surgery and Impact on People with Arthritis and Musculoskeletal Conditions [document opens in pdf] It deals with the damaging nature of thresholds and scoring tools, the problems of waiting times and restricted access to surgery, and how patients with …Read More
On Tuesday 5 July, Arthritis Research UK held a parliamentary reception which more than 60 MPs attended. The reception had a range of activities for MPs including speaking to people living with arthritis, trying our interactive station, as well as learning how many people in their local area may have the condition. In advance of …Read More
One thing I have been really struck by since starting this role is just how much musculoskeletal conditions impact across the breadth of a person’s life, and just how much unaddressed MSK conditions impact other parts of health services. This month’s blog highlights how MSK conditions impact the ability of NHS staff to do their …Read More
On 10th July 2017, NICE issued a new Technology Appraisal (TA) for bisphosphonates which links the recommendations for drug treatments to advice on fracture risk assessment outlined in their earlier guidance. The TA is not intended to provide treatment thresholds but offers recommendations on cost-effective use of bisphosphonates when using fracture risk assessment as described in …Read More
AMs in the National Assembly for Wales voted overwhelmingly in favour of a motion calling for a full multidisciplinary paediatric rheumatology service to be developed in Wales. Despite Cabinet Members abstaining, 27 AMs voted to support the motion, with nine abstentions and none against. There is now significant pressure on the government to take action. …Read More
By Chris Graham, Chief Executive, Picker Institute Europe Arguments about the pressures on the NHS at a system level are well rehearsed; rising demand, financial restraint, and challenges around staffing numbers are well reported. But what of the impact of caring on healthcare professionals as people? The NHS Staff Survey is an annual survey that …Read More
What a difference a month makes. When I last wrote an introduction to the ARMA newsletter we were in the run up to an election. I’m not sure anyone expected the result to go quite the way it did. Instead of increasing their majority the Government now has no majority at all and will have …Read More
Guest blog by Liz Lingard, NHS RightCare Delivery Partner Over the past 3 months I have joined the ‘Whole System MSK events’ that ARMA and NHS England have organised as the RightCare speaker. This was an opportunity to clarify the RightCare approach to everyone working across the system and how they can apply this in …Read More