Arthritis and related musculoskeletal (MSK) conditions affect 20 million people in the UK, with one in six people (or more than ten million) living with arthritis itself. Aside from the great personal toll, data shows it comes at great cost to the NHS and wider health service, and to the economy. One in three GP visits relates to MSK conditions, and it is the second-most-recorded reason for people being off, or out of, work.
Though they mostly affect bones and joints, the overall impact of these illnesses can have a far greater reach – affecting patients’ ability to work, their physical and mental health and well-being and their overall experience of life. Contrary to popular belief, arthritis can be diagnosed in childhood, or indeed at any age, as people navigate education, build careers and raise families.
Health Secretary Wes Streeting has set out stridently on his mission to reduce NHS waiting lists and improve overall care, abolishing NHS England and taking more direct control of the health service himself. Arthritis and MSK conditions are often lost in the noise around tackling the crisis in healthcare in the UK, but a crucial part of Streeting’s mission will be to develop a more holistic and long-term plan for the treatment of these conditions given the depth and breadth of their impact. As the leading cause of disability in the UK, having a plan to tackle the impacts of arthritis and MSK needs to be an essential part of the government’s plans for the NHS and for its mission to get more working-age adults in the UK into employment.
Deborah Alsina, the chief executive of Versus Arthritis, the UK’s largest charity dedicated to supporting those living with arthritis and other MSK conditions, told Spotlight that arthritis has a huge impact in “three distinct ways”. They are: “the impact on people, the impact on the NHS and the impact on the economy”. Alsina explained that the way these conditions impact the individual are through “pain, fatigue and limitations in mobility and dexterity”. She added: “Pain and fatigue are huge issues for people with arthritis and that can fluctuate. They come in and out; they’re not just one thing all the time.” Alsina pointed out that people living with arthritis and other MSK conditions are often “also living with other long-term conditions as well”. For example, if you have osteoarthritis – a degenerative joint disease that leads to cartilage breaking down – you are 60 per cent more likely to live with diabetes and three times as likely to develop cardiovascular disease.
Alsina is clear that the government and the health service therefore need to think more holistically about arthritis and MSK conditions to reduce other major conditions. “If we want to reduce the risk of cardiovascular disease, maybe we need to go a bit more upstream and think about how we reduce osteoarthritis or treat it more effectively,” she told Spotlight, “because some research suggests it can be causative for cardiovascular disease.”
She also pointed to the considerable impact that living with arthritis and MSK can have on individuals. Not being able to exercise the full range of motion you once could, feeling like a burden to family or carers, or being unable to engage in certain activities, can all weigh heavily. As the country’s leading cause of disability, it can also keep people out of work, with one in four people not working living with an MSK condition.
“If you’re living with severe pain, it has a huge impact on your mental health,” Alsina said. Versus Arthritis runs a helpline for patients living with these conditions. Alsina explained that there have been “quite a lot of people who phone our helpline with suicidal ideation because they can’t stand it any longer. It’s all very interconnected.”
So, there is a challenge here; not only to deal with arthritis and MSK conditions as they currently present themselves within the NHS but also to tackle some of the key causes of these conditions. They need to be viewed as long-term conditions in and of themselves and be tackled as such. Alsina explained that health inequalities can have a large bearing on a patient’s likelihood of developing arthritis or another form of MSK condition.
“If you are living in a deprived part of the UK, you are likely to develop arthritis or an MSK condition ten to 15 years earlier than if you’re living in an affluent area,” Alsina said. It is also more likely that those living in deprived areas have one or two other long-term conditions too.
Tackling this will require a programme of action from the government that goes wider than immediate healthcare. “We have to have a much tighter way of thinking about all the things that are social determinants of health,” Alsina said. “That means poor housing, lack of employment, being in a food desert; all of those different things have an impact on people.”
With a Labour government, the next few years could present an opportunity, a clean slate. What else would Alsina and Versus Arthritis like to see? A crucial ask is for the NHS. “We want to see permanent, sustainable MSK leadership in the NHS,” Alsina said, reflecting that efforts to date to improve MSK health have been piecemeal. “It needs a budget, so that it can do much more in terms of coordination,” added Alsina, who was clear this sustainability should not only be a priority at the national, Whitehall level, but must be
at a “local level as well”.
A crucial area of focus must also be diagnosis. “At the moment, diagnosis is patchy,” Alsina explained. “For example, if you have suspected rheumatoid arthritis, there are some brilliant early diagnosis clinics, but they’re not available everywhere consistently.”
Therefore, more work needs to be done to improve consistency of diagnosis across the country, so those in more deprived areas who are more at risk of arthritis or MSK can be caught earlier. This was underlined in a report in February by the National Confidential Enquiry into Patient Outcome and Death, which found that a lack of awareness of childhood arthritis among health professionals was resulting in children “bouncing around the NHS”, with swift diagnosis “too often based on luck”.
Part of this is in the training given to healthcare professionals. Alsina added: “In order to aid diagnosis, we need to ensure frontline health staff are given the training they require… we need to make sure we’re using the full workforce.”
Streeting clearly has his work cut out for him. What would Alsina’s advice to the Health Secretary be? “Don’t make the error of ignoring arthritis and musculoskeletal conditions,” she said. “Good musculoskeletal health underpins our lives and our ability to move, to work, to do our thing as humans… it requires focus and attention to ensure that we can all live the lives we choose. In short, what we need is an MSK action plan to help deliver on the government’s long-term ambitions to transform health in the country.”
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