Arthritis and Musculoskeletal Alliance

Bride House 18-20 Bride Lane, London EC4Y 8EE

Tel +44 (0)20 7842 0910 Fax +44 (0) 20 7842 0901






The Arthritis and Musculoskeletal Alliance (ARMA) - the umbrella organisation for the musculoskeletal community - welcomes the Public Accounts Committee's investigation into services for people with rheumatoid arthritis (RA).

The National Audit Office (NAO) report highlights a number of limitations in current services for people with RA and identifies range of improvements that could be implemented to improve both the efficacy and cost effectiveness of care for people with RA. These include complex solutions aimed at better delivery of care in appropriate settings (e.g in primary care where possible and secondary care where necessary), and better integration of health and social care services


These limitations in the planning and delivery of RA services are not however peculiar to RA alone and ARMA, along with its 34 member organisations believes that the inefficiencies uncovered by the NAO are representative of musculoskeletal services as a whole. We contend that the current situation is the consequence of a lack of direction and a poor prioritisation of musculoskeletal conditions at the national level. We believe that the Department of Health could readily address this lack of national direction and ensure that all musculoskeletal services, including those for people with RA, are organised more effectively and efficiently for the benefit of patients.


ARMA has uncovered a large body of evidence to suggest that musculoskeletal conditions are being delivered without effective planning. Earlier in 2009, for example, ARMA audited every single Primary Care Trust (PCT) in England to ascertain its progress in implementing the Department of Health's musculoskeletal services framework (MSF) of July 2006. The complete findings of our audit are contained in our report, Joint working, attached. Key findings from the audit include:  


1. More than one in five (21%) PCTs do not operate a Clinical Assessment and Treatment Service (CATS) for musculoskeletal conditions, despite this being described as the 'keystone' of the Government's policy in this area. There is a huge degree of confusion within the NHS over the best location, purpose and staffing arrangements of CATS


2. Only 16% of responding PCTs had mapped their current resources and their use by people with musculoskeletal conditions


3. Patients are still experiencing delays in obtaining an accurate diagnosis of a long-term musculoskeletal condition. One cause of this - a lack of awareness amongst GPs - is being exacerbated because less than half (43%) of PCTs offer education to GPs on how to manage patients with inflammatory arthritis


4. 40% of PCTs do not work with voluntary and community organisations expert in the delivery of care to patients with musculoskeletal conditions


5. Over half (57%) of PCTs have not made links with their local Pathways to Work scheme


6. A review of the provision of NHS and social care rehabilitation services initiated by the Department of Health in 2006 is yet to be completed


7. 60% of PCTs have not audited the outcomes of patients with musculoskeletal conditions. Of those that had, a variety of outcome indicators are used. The lack of nationally validated outcome measures is cited by a number of PCTs as a reason for not doing so


ARMA has also uncovered evidence of widespread variations in the amount of funding provided to each person with a musculoskeletal condition, ranging from 204 per patient in Camden PCT to 632 per patient in Gateshead PCT. This analysis is attached. 


In order to address the varied implementation of the Musculoskeletal Services Framework and the unjustifiable variations in spending between different PCT areas, ARMA is calling on the Government to appoint a National Clinical Director for Musculoskeletal services. More than 10 million people in the UK are living with musculoskeletal disorders and more than 9.5 million working days are lost as a direct consequence of these conditions. With an ageing population and increasing levels of obesity these figures will continue to rise. The appointment of a National Clinical Director would provide for the first time, clear leadership for musculoskeletal services, a line of communication between the musculoskeletal community and government and a mechanism for developing a coherent strategy to maintain the musculoskeletal health of the UK population as effectively and efficiently as possible..  


We would be happy to discuss our work further with you if this would be of assistance.



Yours sincerely



Ros Meek









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