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]