Musculoskeletal health and work – why is this important?
Musculoskeletal conditions are the greatest cause of years lived with disability in the UK. These conditions affect over 20.3 million people, are responsible for over 28.4 million working days lost each year, and care for these conditions accounts for the third largest area of NHS programme spend at £5 billion.
There's an 'employment gap' in relation to people with musculoskeletal conditions, in that fewer people with these conditions are in work, compared to people with no condition or disability. The employment rate for people with musculoskeletal conditions (62.4%) is almost 20% lower than the employment rate of people with no condition or disability (81%). Over half (53%) of working-aged people with arthritis report that their condition has a negative impact on their working life. One in four people (25%) with arthritis report retiring earlier from work than they otherwise would have. To understand and then address the underlying determinants, we need better routine data about the health and work experiences of people with musculoskeletal conditions.
However, there's a lack of high-quality data needed to understand population health needs and to be able to plan for how these issues can be met. This includes work on health promotion and prevention, as well as for the delivery of health and care services. National and local data about services activity and health outcomes:
- allows evaluation of policy changes
- highlights unwarranted variation
- supports innovation, better integration and quality improvement activity.
In an effort to address this, an opportunity was included in the Government’s mandate to NHS England.
What is the Government’s mandate to NHS England?
The Improving Lives: the Work, Health and Disability Green Paper was published by the Department for Work & Pensions and the Department of Health in October 2016. The Green Paper highlighted the health and work barriers experienced by people with arthritis.
The paper highlighted, "…a lack of detailed information about what kinds of musculoskeletal services are currently commissioned, and the extent to which the services meet local need. The government will therefore work with NHS England to identify opportunities for regular collection of data about incidence, prevalence, clinical activity and outcomes of musculoskeletal patients and services in England."
Following the Improving Lives: Work, Health and Disability Green Paper, the Department of Health published the NHS Mandate 2017 to 2018 in March 2017. As part of the objective to support research, innovation and growth, included in the Health and Work commitments, the mandate featured a commitment on data collection for musculoskeletal conditions – "to work with Government to identify opportunities for regular collection of data about incidence, prevalence, clinical activity and outcomes of musculoskeletal patients and services in England".
What has the Musculoskeletal Data Advisory Group done?
To support NHS England in responding to this, Arthritis Research UK created an advisory group, bringing together professional and patient organisations, policymakers and researchers. The group aimed to prioritise 3 to 5 opportunities for data collection that will be both trackable and impactful, and lead to higher value services and better outcomes for people with musculoskeletal conditions, with the intention that these could be rapidly piloted and evaluated. The terms of reference for the group and membership can be found in the full report, Response to The Government’s mandate to NHS England for 2017/18, Annex 7.3. From the Musculoskeletal Data Advisory Group (PDF, 962 KB).
The group met regularly in the second half of 2017, recommending that six data items be prioritised by NHS England for collection.
What are the recommendations?
The advisory group’s recommendations fall into three categories:
- Impact on Health (recommendations 1–2)
- Impact on Work (recommendations 3–5)
- Support Needs (recommendation 6)
At the heart of these are data items relating to work, particularly improving data from fit notes about work absence, but also collecting new data about work participation and work interference. Sitting beneath this, there must be a foundation of high-quality data about musculoskeletal conditions and their impact. Without this foundation being addressed, it will be difficult to make full use of the other data items. Finally, higher quality data on the support people receive for work should help drive improvements in the care and services they receive.
Individually each of these data items will be valuable. They will be most powerful when brought together, and ultimately all will be required to produce an accurate assessment of work and musculoskeletal health.
|What we want to know||Data item||Immediate next steps|
|1||How many people are presenting with MSK conditions?||Nature of presenting musculoskeletal conditions among people aged 16–75 years.||IMPLEMENTATION
Include "type and site" data in Community Services Dataset (CSDS)
|2||Of those presenting with an MSK condition, what is the impact on their health?||Health status of people aged
16–75 years presenting with an MSK condition (e.g. MSK-HQ)
Include outcome measure, such as MSK-HQ, in CSDS
|3||Of those presenting with an MSK condition, how many are in paid work?||Employment status of people aged 16–75 years presenting with an MSK condition||PILOTING
Link to existing Joint Work and Health unit activity to pilot questions in CSDS
|4||Of those presenting with an MSK condition who are in work, what is the impact on their work?||Proportion presenting with an MSK problem reporting current work interference||PILOTING
Pilot collection of Work Productivity and Activity Impairment Questionnaire (WPAI) in CSDS
|5||What proportion of work absence of a week or more is attributable to MSK conditions?||Improved MSK health data collection and coding in fit notes||IMPLEMENTATION
Improve data quality, e.g. agree standardised and consistent nomenclature for MSK problems
|6||What support are those presenting with an MSK condition who are struggling to work, or who are out of work, receiving?||Capture any support received to remain at or return to work||RESEARCH
Commission research to develop a new instrument validated and piloted in NHS settings
What are the next steps?
The Community Services Dataset (CSDS) electronically collects data from Community Services that are funded and/or provided by the NHS or local authorities. Substantial numbers of people with musculoskeletal conditions are seen by the allied health professionals in community settings, such as physiotherapists, podiatrists, and occupational therapists. Allied health professionals are increasingly accustomed to recording and reporting data such as patient reported outcome measures (PROMs) which are often required for contractual purposes. As a relatively new dataset for adults, CSDS is being actively improved, and there is room for development including inclusion of survey tools.
There is therefore a substantial and immediate opportunity to prioritise improved musculoskeletal health and work data through CSDS.
The NHS England mandate for 2018/19 will include mention of the implementation needed to support the recommendations made in the Improving lives: the future of work, health and disability white paper, including the work of the Data Advisory Group. Both strategic and technical conversations now need to take place between NHS England, NHS Digital and the Joint Health and Work Unit to make the recommendations a reality.
For more information, download the Response to The Government’s mandate to NHS England for 2017/18, Annex 7.3. From the Musculoskeletal Data Advisory Group (PDF, 962 KB).