by Adrian Bradley, CEO, Arthritis and Musculoskeletal Alliance (ARMA)
I welcome the new report from Arthritis UK and Deborah Alsina’s powerful blog. It shines a clear light on an issue ARMA and our members have raised consistently: access to care must be based on clinical need, not arbitrary thresholds.
For people living with musculoskeletal conditions, this is not an abstract policy debate. It is about pain, function and the ability to live a full life. When joint replacement is delayed or denied, people don’t just wait. They lose mobility, independence, and often their ability to work and participate in society.
The persistence of BMI thresholds in some systems shows where policy has drifted away from both evidence and equity. Variation between systems creates a postcode lottery and risks compounding inequalities, particularly in communities where need is greatest and access to wider support is limited.
This matters even more in the context of changes underway across the NHS. As systems reshape and neighbourhood models develop, there is an opportunity to get this right. Decisions should be grounded in shared decision making, supported by clinicians, and aligned with National Institute for Health and Care Excellence guidance.
We also need to look upstream. Supporting people to manage their weight, stay active and build confidence in their own health is essential. Medication alone will not deliver this. It requires sustained wraparound support, physical activity, pain management and supported self-management.
Getting this right is not only about access to surgery. It is about building a system that prevents avoidable deterioration, reduces inequalities and enables people to live well for longer.