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Musculoskeletal disease (MSK) - London Borough of Hounslow
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Transcript of Musculoskeletal disease (MSK) - London Borough of Hounslow
Factsheet : Musculoskeletal disease (MSK)
Joint Strategic Needs Assessment 2016/17
In England over 9.6 million adults and around 12,000 children have a musculoskeletal condition.
Musculoskeletal conditions such as osteoarthritis, back pain and fragility fractures owing to
osteoporosis have a considerable impact on quality of life1.
The prevalence of the most common form of osteoarthritis (knee osteoarthritis) ranges from 15% to
21% of people across England2.
In 2015/16 Stress, depression or anxiety and musculoskeletal disorders accounted for the majority
of days lost due to work-related ill health, 11.7 and 8.8 million days respectively3.
The average days lost per case for musculoskeletal disorders (16 days) was the second highest
after stress, depression or anxiety (24 days) 2.
An ageing population combined with growing levels of obesity and physical inactivity, will result in
an increase in the number of people living with musculoskeletal conditions.
Musculoskeletal conditions are the largest contributor to the burden of disability in the UK4.
1
1Kammerling M. Pickin M. Gilchrist K. MSK Needs Assessment. NHS Sussex. October 2011.2Arthritis Research UK and Imperial College (2014) The Musculoskeletal Calculator. Available from www.arthritisresearchuk.org/mskcalculator3 Heath & Safety Exactive, “Work related stress, depression and anxiety GB-2016”, [Online], available from:
http://www.hse.gov.uk/STATISTICS/causdis/stress/stress.pdf4Source: Labour force survey-Office for National Statistics. Available from: http://www.hse.gov.uk/statistics/dayslost.htm
What have we got, what are we doing?
MSK covers individual services like:
• Orthopaedics
• Rheumatology
• Chronic Pain
• Physiotherapy
CCGs in North West London have implemented two strategies
to provide care closer to a patients home where possible,
‘Shaping a Healthier future’ and the ‘Out of Hospital’
programme.
There is currently a mixed provision for MSK services within the
North West London CCGs comprising of hospital based
services, community run services and practice based services.
The provision of MSK services in the community has significant
benefits in terms of being able to treat patients at home where
the service is appropriate and treating the most complex MSK
patients in secondary care. The majority of patients would also
prefer to access services at a local site closer to their home.
2
Clients are referred into the MSK service for a wide range of conditions; Once referred a fully qualified state registered
physiotherapist provides an assessment. Together with the therapist the patient will agree on the most appropriate
management and plan a course of treatment. Treatments and pathways offered may include:
• Spinal/joint mobilisations
• Pilates
• Exercise rehab
• Referral to orthopaedic, neurosurgical or
rheumatology outpatients.
• Education
• Joint manipulation
• Pain management
• Referral for diagnostics e.g. MRI
scanning.
• Acupuncture
• Massage
• Splinting
There are three groups of musculoskeletal conditions.
1. Inflammatory conditions such as rheumatoid arthritis, where
the immune system attacks and destroys the joints. Treated
by rheumatology specialists in hospital and with drugs.
2. Musculoskeletal pain such as osteoarthritis and back pain.
In osteoarthritis there is painful wear and degeneration of
joints. These conditions are normally treated by GPs in
primary care, with management usually involving physical
activity and pain management. Severe cases of
osteoarthritis can result in joint replacement.
3. Osteoporosis and fragility fractures, commonly following a
minor trip or fall. Fragility fractures affect large numbers of
people and are commonly caused by osteoporosis where
bones weaken with age. Identification of those at risk of a
fragility fracture takes place mainly in primary care where
treatments, including medication, can be prescribed. Long
term pain and loss of independence are common, and older
people may not survive the trauma of a major fracture.
How are we getting on, any key gaps?
3
0
1000
2000
3000
4000
5000
6000
7000
8000
65+ yrs 65-79 yrs 80+ yrs
Hounslow London
Hospital admissions for Injuries due to falls in people aged 65 and over.
2014/15. DSR per 100,000 residents
Source: PHOF extracted February 2017
Falls are a major cause of disability and the
leading cause of mortality resulting from
injury in people aged over 75 in the UK
(Scuffham & Chaplin, 2002). They account
for half of all accident related hospital
admissions, up to a quarter of ambulance
callouts, and have been estimated to cost
the NHS in England more than £2bn a year
in direct healthcare costs alone.
Osteoporosis is a condition that affects
bone strength and over a third of women
and one in five men in the UK have one or
more bone fractures because of
osteoporosis in their lifetime (NOS, 2013).
Women lose bone material more rapidly
than men, especially after the menopause
when their levels of oestrogen drop.
• Falls and osteoporosis are inextricably linked, both in their consequences and in the patient group who most suffer these
outcomes. Approaches to fracture prevention must address both the force of the fall, the incidence of falling and bone
fragility. Source: Cryer and Patel, 2001.
• In Hounslow the rate of admission to hospital because of a fall is significantly higher than the London rate. It is a particular
issue for residents over the age of 80. (DSR per 100,000 PHOF 2014/15)
• The rate of years of life lost due to mortality from accidental falls in Hounslow is 64.5 which is significantly higher than the
5 best most similar CCGs value of 36.6. (DSR per 100,000 Primary Care Mortality Database, HSCIC 2011-13)
How do our performance and services compare
with other areas?
Comparing Hounslow CCG against statistically similar CCGs indicates that the prevalence of Osteoporosis in
Hounslow is the second lowest out of 10 CCGs.
4
Source: NHS Digital, Quality and Outcomes framework, [online] available from: http://www.content.digital.nhs.uk/catalogue/PUB22266
[last accessed: 04 April 2017)
How do our performance and services compare
with other areas?
Comparing Hounslow CCG against statistically similar CCGs indicates that the prevalence of Rheumatoid Arthritis in Hounslow
is in line with the 10 most demographically similar CCGs.
5
Source: NHS Digital, Quality and Outcomes framework, [online] available from: http://www.content.digital.nhs.uk/catalogue/PUB22266
[last accessed: 04 April 2017)
How do our performance and services compare
with other areas?
6
The NHS England Right Care Programme identifies that the total NHS spend on MSK conditions in Hounslow is lower than the
best of the 5 most similar CCGs. The total per 1000 population in Hounslow was £30,246, compared to an average of £33,726
in the best of the 5 most similar CCGs. However within this the non elective (emergency admissions) spend for MSK related
conditions is higher than the best of the 5 most similar CCGs to Hounslow. The difference in the levels of expenditure is mostly
in relation to the higher length of stay in hospital experienced by Hounslow residents than residents from the 5 best, most
similar CCGs. For example in 2014/15 for Rheumatoid and Inflammatory arthritis the average length of stay was 16 days,
compared to 5 days for peer CCGs. For Osteoporosis and fragility fractures the average was higher at 13 days, compared to 9
days, but not to a statistically significant level. (Source: CFV Where to look packs May 2016)
Rheumatoid and Inflammatory arthritis
PHE-NHS, RightCare-Hounslow CCG. “NHS RightCare Commissioning for Value Focus Pack, Musculosketal conditions; Trauma and Injuries –
May 2016” [online] available from: https://www.england.nhs.uk/rightcare/intel/cfv/data-packs/ [Last accessed 04 April 2017]
Future plans, what will this mean for local people?
1. Musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, back pain and fragility fractures owing
to osteoporosis have a considerable impact on quality of life. The incidence of osteoporosis increases with
age, and particularly for women, the osteoporosis may contribute to the high incidence of falls in Hounslow.
Raising awareness and assessing the risk for falls in the community are integral parts of the community MSK
service.
2. The MSK service was redesigned in September 2016 this means:
• For routine physiotherapy referrals, patients are being offered an appointment within 4 weeks for a
minimum of 80% of patients. This rises to 100% within 6 weeks of referral. This has changed from the
8 weeks target previously.
• For pain management referrals, patients are being offered an appointment within 6 weeks for a
minimum of 80% of patients. This rises to 100% within 8 weeks of referral.
3. Roll out of the joint injections service within the community commissioned by Hounslow CCG. The joint
injections were previously administered via secondary care within acute hospitals.
4. Adoption of standard templates when referring into the MSK service with particular reference to making sure
that patients are fit for any potential surgical procedures and that critical clinical information is included.
7
Summary information and data sources
Rate (%) by Age group and Gender
Hip osteoarthritis, by age group and gender and BMI, Hounslow, London
and England, 2010
Numbers by Age group and Gender, Hounslow
0%
2%
4%
6%
8%
10%
12%
14%
16%
45 - 64 65 - 74 75 plus 45 - 64 65 - 74 75 plus
Male Female
Hounslow London England
2,166
587360
3,695
1,092886
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
45 - 64 65 - 74 75 plus
Male Female
Arthritis Research UK, 2017. ‘Data and Statistics‘ [online] available from: http://www.arthritisresearchuk.org/arthritis-information/data-and-statistics.aspx
[Last accessed 04 April 2017]
8
Summary information and data sources
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Healthyweight
Overweight Obese Healthyweight
Overweight Obese
Male Female
Hip osteoarthritis, by gender and BMI, Hounslow, London and England, 2010
Hounslow London England
9
Arthritis Research UK, 2017. ‘Data and Statistics‘ [online] available from:
http://www.arthritisresearchuk.org/arthritis-information/data-and-statistics.aspx [Last accessed 04 April 2017]
Summary information and data sources
Rate (%) by Age group and Gender
Knee osteoarthritis, by age group and gender and BMI, Hounslow, London and England, 2010
Numbers by Age and Gender, Hounslow
0%
5%
10%
15%
20%
25%
45 - 64 65 - 74 75 plus 45 - 64 65 - 74 75 plus
Male Female
Hounslow London England
4480
1206
693
5397
15901208
0
1000
2000
3000
4000
5000
6000
45 - 64 65 - 74 75 plus
Male Female
10
Arthritis Research UK, 2017. ‘Data and Statistics‘ [online] available from: http://www.arthritisresearchuk.org/arthritis-information/data-and-
statistics.aspx [Last accessed 04 April 2017]
Summary information and data sources
0%
5%
10%
15%
20%
25%
30%
35%
Healthyweight
Overweight Obese Healthyweight
Overweight Obese
Male Female
Knee osteoarthritis, by gender and BMI, Hounslow, London and England, 2010
Hounslow London England
11
Arthritis Research UK, 2017. ‘Data and Statistics‘ [online] available from:
http://www.arthritisresearchuk.org/arthritis-information/data-and-statistics.aspx [Last accessed 04 April 2017]