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Standards of Care for People with Back Pain
What is ARMA?
ARMA is the Arthritis and Musculoskeletal Alliance, a consortium of 28 national organisations concerned with
the quality of life for the more than 8.5 million people with musculoskeletal conditions. For a complete list,
go to
www.arma.uk.net.
What are musculoskeletal conditions (MSCs)?
Musculoskeletal conditions are conditions that affect the bones, joints and ligaments, such as arthritis of all
kinds, connective tissue diseases, back pain, osteoporosis, soft tissue rheumatism and regional and widespread
pain. The most common musculoskeletal conditions are arthritis (including rheumatoid and osteoarthritis),
back pain and bone disease. More than 8.5 million people in the UK are affected by these conditions, which are
the single largest cause of physical disability in the UK; symptoms include pain, joint deformation and impaired
mobility. The number of people living with these conditions is set to rise as the population ages.
Why do people with musculoskeletal conditions need standards of care?
The post-code lottery of NHS service provision means that a reasonable standard of care is unavailable for
the vast majority of people with MSCs. The Government has said that both the National Service Framework (NSF)
for older people, and the coming NSF for long term conditions, would meet the needs of people with MSCs.
But apart from osteoporosis, the NSF for older people doesn't have any focus on MSCs. The forthcoming NSF for
long term conditions has a strong focus on neurological conditions and is not expected to have any focus on
MSCs. In the meantime, people with MSCs are continuing to be failed because they can't get the help they need.
ARMA and its member organisations therefore decided to develop their own standards of care for policy makers,
health professionals and people with MSCs.
What's in the standards of care?
The standards of care have been drawn up by a working group made up of clinical experts, representatives of user
groups and people with MSCs, which first met in the summer of 2003. Six sets of standards are being produced,
one for each of the main groups of musculoskeletal conditions. We are now seeing the launch of the first three,
for inflammatory arthritis, osteoarthritis and back pain. The core aims of the standards of care are to:
- Improve the quality of life for more than 8.5 million people with MSCs;
- Identify the care and treatment people with MSCs can expect;
- Enable the NHS to improve resource management by preventing avoidable disability, so reducing return GP and hospital appointments;
- Promote consistent, evidence-based approaches to advice, prevention and treatment;
- Improve productivity and reduce the benefits bill, where appropriate, by supporting people to remain economically active.
What would be the practical impact of implementing standards of care?
Many NHS professionals do not have the tools they require to deliver good services. The standards provide a
framework for people to develop the tools they need, and a basis of sharing the good practice. Examples
include nurse-led chronic pain management services to ensure people living with persistent pain get the
support they need; group exercise classes provided in the community, helping people stay more mobile; triage
services to ensure people get referred to the right health professional without delay; and support and
information to help people get back to work. In areas that already have services that are like these, we can
see that patients are getting correct, timely treatment. This means that they are receiving better information
about how to manage their own condition now, and in the future, and their wider health needs are being met.
Will this solve the problem?
The standards of care highlights the key mechanisms to ensure people with MSCs get the best healthcare they can,
but also touch on some of the other social and environmental factors which affect people with MSCs, such as
social care, the impact on the family and access to their local community. The standards of care are not a
panacea, but will help ensure people get what they need, and deserve, from the health service.
Is there a cost to implementing the standards for the NHS?
ARMA believes implementing the standards need not cost a fortune - in many cases it will be a case of
reconfiguring existing services. We know there are examples of health services out there which already meet the
standards. These examples show how early investment in getting the services right can lead to less
complications and deterioration in people's conditions and could help reduce the costs of surgery, such as
joint replacements.
So there is a cost of not implementing the standards. MSCs already have a major impact on the health service
and the economy. With the population aging, there will be more and more people living with these conditions
into their old age; we cannot afford not to invest in treating this group of people more effectively.
In addition, of course, there's the economic impact of helping people with MSCs remain in or return to work.
ARMA estimates that more than half a million claimants of incapacity benefit do so as a result of MSCs - the
idea that MSCs only affect older people is a myth.
ARMA - November 2004
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