Musculoskeletal Conditions

Tuesday 17th December 2024 Westminster Hall

11:00

[Clive Efford (in the Chair)]

I understand that Sonia Kumar has agreed that another hon. Member can make a contribution. I will then go straight to the Minister. As is the convention with half-hour debates, there will be no opportunity for the mover to sum up at the end.

[Sonia Kumar (Dudley) (Lab)]

I beg to move,

That this House has considered the diagnosis and management of musculoskeletal conditions.

I am grateful for the opportunity to have this debate. As chair of the all-party parliamentary group on osteoporosis and bone health, and as an advanced practice physiotherapist and first-contact practitioner, musculoskeletal health is my speciality. I am here to discuss the provisions needed to improve the diagnosis and management of MSK conditions.

My experience as an advanced practice physiotherapist is very much autonomous. I do not think many people know that physiotherapists work from paediatrics all the way to elderly care—from nursery all the way to palliative care. Most people do not know the work of a first-contact practitioner, which is a new service in which physiotherapists work with GPs to diagnose, assess and refer to secondary care, if needed. I was part of that vital service at Dudley Group hospitals, so I declare my interest as working on the bank there.

MSK physiotherapists work not only across hospitals and primary care but also in tertiary care. They work in fracture clinics, rheumatology, pain management and A&E. Not many people realise what we do. MSK physiotherapists are the specialists and experts in musculoskeletal diagnosis. That could include referring people for X-rays to look for suspicion of fractures or for MRI scans to look for sinister pathology, a differential diagnosis, masqueraders that look like Pancoast tumours, metastases or spinal or multi-joint cysts. Along with ultrasounds, guiding injections and prescribing, the scope of physiotherapists has expanded year on year, to a point where they are now specialising and moving their practice on to do simple surgeries, such as carpal tunnel releases.

I look not only from a diagnostic point of view but at the importance of managing MSK conditions, including in respect of rehabilitation.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate. There have been some worrying trends in the press in the last six months, in relation to children as young as 11. Does she agree that the NHS plan for change over the next five years is necessary, given that children as young as 11 are being diagnosed with arthritis? We need help and guidance for those whose lives might be impaired from an early age right through to older life, and who need coping mechanisms. The importance of this debate cannot be underlined enough.

[Sonia Kumar]

I agree with the hon. Gentleman. I have worked in paediatrics where many patients get diagnosed late and suffer with late onset. That affects their whole life from the beginning, including their ability to get involved with physical activity and to build relationships, or their mental health and sleeping patterns. Getting an early diagnosis is one of the solutions I want to put forward. I would like the Minister to consider involving physiotherapists from early on, at nursery stage, to find out why we are not picking up MSK conditions from a really young age so that we can provide health and wellbeing from day one.

[Dave Robertson (Lichfield) (Lab)]

I hear my hon. Friend’s point about early intervention and making sure that we diagnose MSK conditions as soon as possible. A member of my extended family suffers from pregnancy-related osteoporosis, which needs to be picked up as soon as possible so that appropriate treatment can be put in place and mothers supported through it. A new charity has been set up specifically for pregnancy-associated osteoporosis, and it is pushing for the #MeasureThatMum campaign to make sure that midwives are trained to pick up the condition at that point, as early as is physically possible. Does my hon. Friend support that?

[Sonia Kumar]

Of course. One of the things MSK physiotherapists look at is spinal fractures, 70% of which happen in the thoracic spine, generally in older women who have had poor bone health. It is essential to look after bone health from a really early age, while women are in their 40s, so that when they are older, in their 50s, 60s, 70s and 80s, they are on the right medication and doing bone health exercises to help for the future. For MSK conditions and osteoporosis, physiotherapists are essential. Spinal fractures are very often undiagnosed, and those who suffer spinal fractures as they get older are more likely then to have a hip fracture, after which the mortality rate becomes really high. My hon. Friend makes a very good point.

Let me explain why MSK physiotherapists and MSK care are so important. By 2035, two thirds of the population are expected to have two or more long-term conditions, which include MSK conditions. Versus Arthritis reports:

“Arthritis and related musculoskeletal conditions affect 20.3 million people in the UK.”

That means that one in six people has arthritis, which is a staggering amount. MSK conditions cost the NHS £5 billion a year, accounting for one in five GP appointments, 1.6 million hospital admissions and 30 million prescriptions a year. People with low confidence who feel that they cannot manage their conditions are more likely to attend hospital, while those who are most confident with long-term conditions have 38% fewer hospital admissions.

That is what we can do for the economy, but this issue is also about first-contact practitioners, as I mentioned at the beginning. With first-contact practitioners, we can save so many GP appointments. It is part of the long-term plan, which has been created to improve the impact on GP care and allied health professions that work in general practice. Working adults with MSK conditions are twice as likely to be economically inactive compared with those with long-term conditions. Of the people who are economically inactive due to ill health, 21% report having MSK conditions. It is about not just health but the economy and the wellbeing of the society that we are hopefully building together now that we are in government.

It is really important that we look at this issue in a holistic way. MSK conditions affect not just affect somebody’s mental health but their relationships and how they build them. They affect whether they can get into bed and sleep well, as well as their sleep hygiene. Perhaps a person eats poorly because they cannot get out, so they put on lots of weight. A person’s emotions, self-esteem and ability to work can be affected. I do not believe there is a silver bullet or that if we manage MSK conditions it will just fix one part. It has to be effective in respect of all the facets of somebody’s general wellbeing. We cannot tackle waiting lists and return people to work without that, and we need a strong workforce to plough back into the economy. It is incredibly important for people to understand that it is about holistic management and how we can improve health literacy and self-efficacy for people with MSK conditions.

I came to this debate to talk about solutions, as I am a solution-led person. We need to recognise the allied health professions in the NHS and build a workforce for MSK physios. That includes not just MSK physios but paramedics, podiatrists and every single person in the 14 allied health professions, all of which help to build resilience in the NHS, reduce waiting lists and build a healthier society.

MSK assessments need to happen from day one in nursery. We cannot expect paediatrics or care to be delivered well if we wait until the future, look back and say, “We should have done a better job when that person was younger.” If we looked at MSK conditions from day one—early in a child’s development and in their early years of support—there would not be a massive impact on society later in that person’s life because of having to do delayed diagnosis with multiple appointments and to look after their general wellbeing.

We also need to embed into society notions of what good health looks like from day one. That includes keeping active, going to classes and going to rehabilitation. We need a bigger awareness campaign about what being well looks like. It should not just be that the person leaves school and that is it; it needs to be lifelong. In the same way that people do continuous professional development, they should learn what looking after their body entails, and that should be translated into health policy.

We also need to increase the scope of physiotherapists’ practice. At the moment, they do not do DEXA scans, but they look at bone health in every other way. We look at X-rays, and work in fracture clinics, rehabilitation and trauma orthopaedics, but we do not look at the full picture of bone health. Will the Minister consider inputting that in future?

We need to increase the roll-out of community appointment days. We must provide same-day services for patients, including assessments, advice, health promotion and rehabilitation, and the community and volunteer sectors should provide support in a non-medicalised environment. If somebody has shoulder, knee or back pain, there should be a one-stop shop where they can be assessed appropriately, and they can then move on and get the right care at the right time.

We also need to put community care services on high streets and in places of worship. There are people who are not getting access, and there are massive health inequalities, so how do we promote care and health in difficult-to-reach communities? I would love to see care being put into places of worship and other locations people do not normally think of. I very much welcome the fact that the Government are already moving away from hospital care.

We also need to increase the number of first-contact practitioner places. A consultation with an FCP physio is £30 cheaper than the traditional GP-led pathway. MSK issues are one of the most common reasons to visit GPs, accounting for about 20% to 30% of appointments. Will the Minister meet me to discuss more of the solutions that I think need to be put forward to manage MSK issues? Would he be happy to visit my constituency to look at our fracture liaison service? I hope we will continue to fund that and that the service will be rolled out nationally.

[Clive Efford (in the Chair)]

I call Lizzi Collinge.

11:12

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

I was told that I would not be able to speak today, and that I could merely intervene, but I am happy to speak if you allow it, Mr Efford.

[Clive Efford (in the Chair)]

I was told that it had been arranged for you to speak.

[Lizzi Collinge]

Excellent news. It is a pleasure to serve under your chairship, Mr Efford. I apologise for the confusion.

Musculoskeletal conditions are very serious, particularly when looked at through the lens of the health and social care workforce. In Morecambe and Lunesdale, 27% of the sickness rate in the health and social care workforce is caused by musculoskeletal conditions. It is clear that if we want to fix our health and social care workforce, we must fix the prevention, diagnosis and treatment of musculoskeletal conditions.

As my hon. Friend the Member for Dudley (Sonia Kumar) pointed out, the conditions do not just have a physical impact, affecting mobility and the ability to work, but can have a particularly serious effect on people’s mental health, relationships and ability to live their life to the full. I believe that health and social care and public health should be framed around allowing people to live their absolute best lives. They need to focus on enabling individuals, whether or not they have long-term health conditions, to work, socialise and have a good family life.

I am passionate about preventing ill health as much as possible. We must prevent musculoskeletal conditions, which can cause a lot of pain and discomfort. I welcome the proposals set out by my hon. Friend, and I look forward to hearing from the Minister about the Government’s plans.

11:14

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

It is a pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Dudley (Sonia Kumar) for securing this really important debate, and for bringing her professional expertise to the House. I also thank my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge), who showed that she can think on the spot and turn an intervention into a short speech.

It is important that we acknowledge just how significant the impact of musculoskeletal conditions can be on both individuals and their loved ones. Poor MSK health can severely impact every aspect of a person’s life. It also has a significant impact on the NHS and the wider economy. Pain, stiffness and limited movement all affect quality of life and independence, including the ability to work. MSK conditions are the leading cause of years lived with disability in England. They are responsible for up to 30% of GP consultations, and MSK community services have the longest waiting lists of all community services in England, as of September this year. MSK conditions are also one of the leading causes of sickness absence, with approximately 23.4 million working days lost due to MSK conditions in 2022 in the UK.

That is why the Government are committed to improving care for the 17 million people living with MSK conditions in England, and ensuring that they receive support and access to the latest treatments. Improving health and work outcomes for people living with MSK conditions also forms a key part of the Government’s missions to build an NHS fit for the future, and to kickstart economic growth.

Turning first to the health mission, my Department recently announced plans to develop a 10-year NHS plan. It will consider what actions are needed to improve patient access and reduce waiting times. It will set out a bold agenda to deliver the three big shifts needed. Those are moving healthcare from the hospital to the community, from analogue to digital, and from treatment to prevention. We recognise that there is much more we can do to support earlier diagnosis and management for people with MSK conditions, and the need for timely and comprehensive care that starts at home. We know that many people with MSK conditions can be diagnosed and well managed in the community, which is why we are making a start by exploring how best to support MSK primary and community service improvement, helping to give MSK conditions greater parity with other conditions.

I will certainly take away the suggestions made by my hon. Friend the Member for Dudley on physiotherapists, AHPs more generally, and other issues. They could play a vital and important role in getting the better outcomes we want to see. She spoke rightly about how we deal with children. The Government want to create the healthiest generation of children ever. We must ensure that we have the services to diagnose bone conditions at an earlier stage and get children the appropriate treatment.

My hon. Friend also talked about communities that are difficult to reach. I have a row with my officials because I do not accept that any community is difficult to reach—we have just not tried hard enough. It is precisely the kind of suggestions that she set out that will ensure, on a whole range of health conditions including MSK, that we do better at identifying where those people and health inequalities are, and get access to services into the places where those people are so we can get them on to the treatment pathways.

With NHS England, we are considering a range of options to identify the most effective ways of improving the quality of and access to the fracture liaison service model, and the interventions that that model provides. For MSK conditions such as rheumatoid arthritis, early diagnosis is the key to preventing joint damage and improving quality of life. The Government are investing £1.5 billion in capital funding in 2025-26 for new surgical hubs and diagnostic scanners, to build capacity for over 30,000 additional procedures and over 1.25 million diagnostic tests as they come online.

I turn now to the growth mission. The “Get Britain Working” White Paper highlighted the issue of spiralling economic inactivity, with 2.8 million people, which is equivalent to the population of Greater Manchester, being locked out of work because of long-term sickness. Tackling economic inactivity caused by ill health will play an important part in realising our ambition of having an 80% employment rate.

To support that ambition, the Further Faster 20 scheme will be delivered by NHS England’s Getting It Right First Time programme. Further Faster 20 will operate in 20 areas of the country that have high levels of economic inactivity, with the aim of reducing waiting times and enabling people to return to work. Actions will include improving secondary care interfaces with primary and community services.

We will also launch a set of place-based trailblazers in eight areas in England and Wales to run during 2025-26. These trailblazers will be at the forefront of developing joined-up approaches to support people with work, health and skills. Three trailblazer areas will be funded to become health and growth accelerator sites, in order to build evidence of the impact of targeted action on the main health conditions driving economic inactivity, and I assure the House that those conditions include MSK conditions.

I also say to my hon. Friend the Member for Dudley that I am more than happy to meet her to discuss these issues further. If we can squeeze it in somewhere in my diary, I am also more than happy to visit the fracture liaison services in her area.

I want to reassure my hon. Friend the Member for Morecambe and Lunesdale that we take very seriously the impact of MSK conditions on the NHS workforce itself. As part of our workforce planning, we need to get better at identifying NHS employees who have MSK conditions and ensure that we provide them with the appropriate support, so that they can carry on working in our health and care systems.

To conclude, once again I thank my hon. Friend the Member for Dudley for securing this important debate. I hope that she is reassured by some of the measures I have outlined today. In addition, I will take on board the very important points she made about how we can do better on those issues and ensure that they are fed back through my team to those working up our policies on fracture liaison and MSK more generally.

I hope that my hon. Friend recognises that MSK is a priority for this Government. I absolutely recognise that we must go further, but today I will close by reaffirming this Government’s commitment to supporting the millions of people in the UK living with an MSK condition, to ensure that they receive the support they need, including improved diagnosis and management, and to ensure that we drive down waiting times and waiting lists, identify conditions earlier, get people into treatment as quickly as possible, and have the happier, healthier and more prosperous country that we have all been elected to this place to help deliver, which would be the consequence of having a healthier, happier workforce and a healthier and happier population.

Question put and agreed to.

11:25

Sitting suspended.