by Sue Brown, ARMA CEO
February has been a month of mixed feelings for me. On the downside I continue to hear of rationing of NHS services by CCGs going against NICE guidelines. More positively I’ve been hearing about some ambitious work to transform MSK services around the country. We need some of this bold thinking if we are going to achieve ARMA’s goal of high quality, appropriate MSK services for everyone who needs them.
This month I spoke to someone in a hospital about hip and knee replacement. They are commissioned by two CCGs. One follows NICE guidelines and refers patients they think would benefit from surgery so that the decision can be made on clinical grounds. The other restricts access and is about to reduce their BMI threshold still further. Surgeons have to check a person’s postcode before a conversation about surgery, and some patients who would benefit from surgery are denied it.
I’ve also heard about CCGs who restrict access to advanced therapies with patients being allowed to try three biologics and if one of these doesn’t work then further access is denied. In this case, ARMA members NRAS has successfully pressed for a statement from the NHS Regional Medicines Optimisation Committee that restricting access to NICE approved medicines is counter to the provisions of the NHS Constitution.
NHS England/NHS Improvement has an Evidence Based Interventions programme which aims to avoid unnecessary operations, and to free up clinical time by only offering interventions on the NHS that are evidence-based and appropriate. I’d love to see this programme also focus on ensuring that patients are not denied interventions which have been shown to be highly effective.
On a more positive note, I have spoken this month to many people working to improve MSK services. I attended the first graduation event for the Versus Arthritis MSK Champions programme. This supports MSK practitioners to develop their leadership skills so that they can be more effective in work to improve MSK services. I know that the 14 Champions I met this month will make a big difference to MSK in the coming years. It is an amazing programme and applications for the next cohort open later this month.
I’ve also spoken to a number of people doing some amazing work, multi-disciplinary and across systems, to transform the approach to MSK. I’ve heard about engagement with community and leisure services for prevention, patient led pain groups, improving links with rheumatology, CCGs, providers and third sector coming together to demolish blocks to patient centred care. I’ve heard about the involvement of stakeholders that are often forgotten such as admin staff and a focus on genuine patient involvement.
It’s exciting, but it’s also essential. We can’t solve the growing incidence of MSK conditions through ever tighter rationing. We need to think differently about prevention, about using the resources we have in the most effective way and getting the whole system to work together.
ARMA has a role in this. We want to showcase this innovation. Watch out for webinars and a conference later this year where you can find out how others are tackling this challenge. MSK is the biggest cause of years lived with disability in the UK. CCGs and local health systems can choose to respond to this in one of two ways: postcode lottery or transformation.