In ten years’ time, two-thirds of adults will be living with multiple long-term conditions leaving them twice as likely not to be in work. In 2025, 2.4 million people are already out of work due to long-term sickness. The new Labour government has made fixing Britain’s worklessness crisis a key priority, as is building an NHS “fit for the future”. Both missions will require a comprehensive, joined-up approach which considers the needs and experiences of the 17 million people living with musculoskeletal (MSK) conditions like arthritis.
The NHS’s ten-year health plan is a vital opportunity to do this. Due to be published before the summer, the plan will lay out exactly how the new government intend to revitalise the NHS; transforming it from a service in “critical condition” as diagnosed by last year’s Darzi report to one which offers quick diagnosis, access to the right treatment and universal rehabilitation.
The New Statesman, the charity Versus Arthritis and the Chartered Society of Physiotherapy brought together a group of experts to discuss how the ten-year health plan can benefit people living with long-term health conditions. The roundtable discussion was held under Chatham House rules, meaning individuals and organisations are not named. The conversation has been summarised for length and clarity.
The discussion began by pointing out the lack of a clear strategy for dealing with MSK conditions, and that arthritis is costing the health service time, money and resources. “Around 30 per cent of GP consultations are on an MSK issue,” said one participant, “and we have over a million cases waiting for elective trauma and orthopaedic treatment (like hip and knee replacements) across the UK.” But under the current system, the diagnosis and care of these conditions is not given the priority it deserves, despite being a major issue across the health system. “Nobody outside of this room thinks about MSK when you say long-term conditions,” said one panellist, “we absolutely need to keep saying long term conditions and MSK to ensure it is prioritised.”
Primary care is often where MSK conditions and arthritis are diagnosed and managed by GPs, and increasingly other professionals such as specialist physio-therapists working in first contact roles. “If I could only do one thing, I would put all the money into primary care and make it work properly again with personalised care for patients,” said one participant.
Another agreed, adding: “We’re still stuck in a cycle of treating people when they are ill and when they present to the system rather than being able to anticipate and think about how to proactively avoid crisis.” The panel agreed that there needs to be a gearshift in how the government tackles and approaches healthcare challenges away from a predominant focus on hospital care and toward a more holistic “prevention is better than cure” model. “We need to move from treating people when they get sick, to supporting them to manage their long-term conditions on a sustainable basis.”
The panel noted that, concurrently with this, there needs to be a wider effort across the system – which must be included in the long-term plan for health – to consider patients as people. Housing, employment, mental health and other determinants must be looked at. One panellist explained: “If public services are not there for people, if society is not there to work for people, if people don’t have a basic standard of living, everything else is tinkering around the edges.” They added: “The classic patient I think of is the patient with an MSK condition who has damp housing: she’s working three jobs on a zero-hour contract, she’s got a teenage daughter with ADHD. These are the elephants in the room, and we don’t talk about them enough.”
Rehabilitation is another crucial part of ensuring better outcomes for patients. Yet, as one panellist said, “we treat rehabilitation as an add-on. This must change.” Instead, it should be seen as a vital part of the process, with adequate funding and resources. This must be reflected in the government’s long-term plan for health.
All panellists agreed that any ten-year plan that truly works for those living with long-term conditions must improve data collection and sharing. This is important for two reasons: it improves the experience of the patient, offering them more holistic and joined-up care, but it also gives the system more evidence and courage to take risks around treatment. One panellist explained that data “in community services or outpatients is diagnostically coded” making it difficult to separate out overlapping conditions. Another suggested that the ten-year plan might include a primary care MSK audit, to assess the gaps in care and create a more well-rounded and holistic system. Better data sharing and connectivity can enable more effective management of patients, better planning of services, and more incentives for further clinical research into diagnosis and new treatments. One panellist said: “I think the fear of risk is the biggest barrier for all of us. We need to be bold, and we need to have the outcome data to do that.”
Bringing the discussion to a close, all panellists agreed that the ten-year plan must make clear where responsibility for MSK and arthritis treatment and diagnosis sits. “It’s about responsibility,” one panellist said, “the ten-year health plan needs to make it clear what individuals are responsible for.” Another added that properly funding primary care is crucial if we are to be able to intervene in patients’ journeys and conditions at the right time to prevent their condition deteriorating. “Primary care is the cornerstone of all this… [responsibility] needs to be devolved there because GPs are the ones who know their patients. They know the types of patients they have in practice,” one panellist said.
Overall, it was noted that MSK and arthritis must be given the attention and significance they deserve within the health service and that tackling them should become more of a priority. The panel agreed that this should be an essential aspect of Labour’s mission to fix the NHS and its inclusion in the government’s ten-year health plan is essential.