We recently published a joint blog between the Social Care and Musculoskeletal (MSK) Special Interest Groups at the Faculty of Public Health.

We said our next blog would include ideas for how public health professionals can influence health and care systems; how better data can help us understand population need; and lastly, the importance of innovative community-focused programmes. In this blog, we also advocate for the role of prevention in improving quality of life and reducing demand.

To influence systems, we (in Public Health) need to understand and articulate the context and issues for MSK health and adult social care. Evidence shows that women, older people, people experiencing socioeconomic deprivation, and those from some minority ethnic groups (including Black people and those from Pakistani and Bangladeshi ethnic backgrounds) are most at risk of chronic pain , and therefore may be in particular need of support in order to maintain quality of life and independence.

Worsening musculoskeletal problems and chronic pain are often experienced together with other long-term conditions and can be the ‘tipping point’ that robs people of their ability to continue working until retirement age, which consequently can affect mobility and financial security in later life. 

What action should be taken to turn the tide on these issues?

Firstly, data is a powerful tool to drive action and improvement and underpins effective public health plans and interventions.  In our previous blog, we pointed to the lack of data on MSK problems. Public Health should work with Adult Social Care, and wider partnerships, to bring about improvements in collection, analysis and use of need and service data so we can identify suitable targets and metrics for knowing about and improving MSK conditions and services. This could be across a range of geographical UK footprints, such as integrated systems, health boards and local authorities. There is a need to bridge the gap between clinical metrics which are used by the NHS and person-centred ‘activities of daily living’ metrics as used by Adult Social Care, to find a common language and basket of indicators to monitor progress across the health and care system. This is something that could be researched, with a view to an analysis of need along these lines being included in public health population profiles.

Secondly, a focus on prevention is the best way to ensure a healthy population and reduce demand on clinical and social care services. MSK practitioners, Public Health and Adult Social Care teams should be advocating for primary prevention, including an increased focus on physical activity, which is extremely beneficial in preventing many MSK conditions. Moving more (and getting stronger) can improve physical function and reduce pain too.

As people develop MSK symptoms, steps should be taken to reduce or slow the risk of progression. Support must be made available, with a focus on understanding and meeting the needs of underserved or more vulnerable communities, to address stigma and the ‘nothing-can-be-done’ myth. We would argue that these issues require further research so we can understand and act on the lived experience of people and ensure services (both Adult Social Care and NHS services) meet people’s needs.

Culturally sensitive tertiary prevention can help those most affected to manage their conditions, through rehabilitation, self-care, peer support, and ensuring that people are aware of their entitlement and are receiving services – including disabled facilities’ grants, community equipment and other support. Underpinning this, must be a strengths-based approach to mapping the services, communities, networks and resources that are already available to promote MSK health and wellbeing. Engaging individuals and communities in managing their own health to reduce future demand was identified as critical back in 2002 in the Wanless Report and this need still exists.

Some exciting examples of innovative initiatives that are meeting community needs, whilst also reducing waiting lists,  include Community Appointment Days being tested in Sussex, South East London and Lincolnshire. People with musculoskeletal problems are invited to attend these events held in local venues, which connect people with a wide range of services. People are supported to identify their needs and preferences, and then to engage with the NHS, social care, educational and voluntary sector services that they think will be helpful to them.

To conclude, progress on improved data, a greater focus on prevention, targeting of existing resources and encouraging innovative community-based approaches could be achieved through an integrated, collaborative approach across Public Health, Adult Social Care, and NHS services.  The outcome we are seeking is an improvement in overall wellbeing, as well as a reduction in demand for NHS and care services.

Benjamin Ellis, Elaine Rashbrook, Eugenia Cronin and Sebastian Baugh
Members of the FPH Public Health & Adult Social Care SIG and FPH Musculoskeletal Health (MSK) SIG