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The Adjournment Debate

Article featured in Fibromyalgia Focus.
Arthritis and Musucloskeletal Alliance (ARMA) is the umbrella body ARMA logoproviding a collective voice for the arthritis and musculoskeletal community in the UK. Fibromyalgia is classed as a musculoskeletal disease (MSD). Together, ARMA and its member organisations work to improve quality of life for more than 9.6 million people in the UK with these conditions.

ARMA has 34 member organisations representing a broad range of interests across service user, professional and research groups working in the field of musculoskeletal conditions. FMA UK is a member of ARMA and an active supporter of the work it undertakes.

Recently ARMA has been successful in a number of lobbying initiatives to make the government aware of the difficulties being faced by people with MSDs. The fibromyalgia community is well aware of the difficulties with diagnosis, treatment and support for FM, but this applies to many other MSDs as well, as ARMA proved when it conducted a survey of Primary Care Trusts (PCTs) and their implementation of integrated treatment plans.

With the proposed changes to the NHS and benefit system it is important that the new ministers are aware of the difficulties that had already been highlighted to those responsible in the previous government.

On July 4th an End of Day Adjournment Debate was held concerning the current situation of MSD recognition and action.

This was lead by Graham Stringer, Labour MP for Blackley and Broughton, who first outlined the reports and surveys presented during the previous 2 years, which resulted in a debate in Westminster Hall on 19 January 2010. The plea then was that there was an outcome strategy that improved the outcome for people suffering from musculoskeletal disorders. “In many ways, in spite of those four reports and the debates that have taken place since, the situation nationally remains much the same,” he said. “In terms of costs, the magnitude of the issue is that one visit in every four to a general practitioner concerns musculoskeletal disorders and 10.8 million working days are lost because of such disorders.”

Nic Dakin, Labour MP for Scunthorpe added to the debate saying that: “Early intervention is good not only for the patient, because they can recover faster or get to grips with the condition, but also for the economy, because the person is more likely to be able to continue active employment, and for the health service because early intervention is likely to cost less in the longer term.”


Graham Stringer went on to point out, “The quality and outcomes framework contains no indicator for musculoskeletal conditions………and only two of the National Institute For Health and Clinical Excellence (NICE) policy standards announced so far relate to musculoskeletal conditions—for hip fractures and osteoarthritis—out of the vast range of some 200 conditions covered by this generic term.

ARMA is calling for an outcomes strategy as a vital first step in addressing the current failures in provision of treatment and care for people with these disorders.”

He also went on to underline the importance of patient involvement: “The useful slogan, ‘no decision about me without me’, should also be a guiding factor, enabling patient involvement and shared decision making at all points in the patient pathway and, in particular, encouraging better self-management and at the same time improving general public awareness of musculoskeletal conditions.”

Paul Burstow, the Minister of State for the Department of Health replied: “Let me make it clear from the outset that the Government fully recognises the impact that musculoskeletal disease has on individuals and society as a whole and that, although there are excellent services in some parts of the country, there is still far too much variation in the availability of services and the outcomes they secure for people.”

In response to the request for a specific outcome for MSDs he said: “The Government believes that a focus on outcomes is key to how we can drive improvements in the NHS. It is also how we can hold the NHS to account. That was why we published the NHS outcomes framework, to which the honourable Member for Blackley and Broughton referred, in January. It has five key domains that are populated by measures that will be used to judge outcomes. They are: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm.

The second domain, improving the quality of life of people with long-term conditions, is clearly the most relevant to the debate. It includes an instrument known as EQ-5D, which is to measure people’s quality of life in a number of respects including mobility, pain and the ability to carry out the usual activities of daily living. The inclusion of that measure was the result of feedback from the public consultations last year on the outcomes framework. It is clear from the analysis done by the department’s economists that almost half the total burden of disease, as measured by that instrument, is due to musculoskeletal disease.

In other words, the inclusion of that instrument in the NHS outcomes framework highlights clearly the importance of musculoskeletal conditions to the population, and why commissioners and clinicians need to focus their efforts on designing and delivering care pathways of the type outlined in the framework in 2006. It shows how that can have a significant impact on the aggregate score in the outcomes framework on enhanced quality of life for people with long-term conditions. It will not be possible to achieve success, as set out in the framework, without making progress in that way. There is a powerful new lever in the system as a consequence of the outcomes framework.”

He also added: “We are looking at the scope for the development of a quality standard in pain management,” which will be of particular relevance to FM.

This debate certainly showed that MSDs have been highlighted and that the minister for the Department of Health is hopeful that improvements will come about as a result of the changes planned. However it will depend on the services at a local level which will mean making sure MSDs are represented on local commissioning and Local Authority monitoring boards to ensure this happens.

 By Pam Stewart

Article featured in Fibromyalgia Focus. Subscribe here. 

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