The Adult Social Care SIG and the Musculoskeletal SIG got together to explore where our agendas overlap, using as a starting point the 2023 Chief Medical Officer for England’s report on population health in an ageing society. Its focuses on maintaining independence and delaying disease onset provide useful themes for our two-part blog.
We were curious about musculoskeletal (MSK) conditions and their impact on adult social care (ASC), and how we as public health professionals might raise awareness of both the challenges and the potential solutions.
The likelihood of having an MSK condition increases with age. In the UK, just under 1 in 3 in people aged 35-44 have an MSK condition. This increases to almost 2 in 3 people for those aged 65 and over.
MSK conditions can have a serious impact on people’s daily lives and are one of the leading causes of morbidity. 21% of years lived with a disability are attributed to MSK conditions in the UK.
As well as morbidity due to MSK conditions themselves, these problems often co-exist with others. Among people aged 45 and over living with a long-term condition, more than three out of 10 also have an MSK condition. And the co-morbidity is often with a mental health condition. Primary care data in England reveals there is a 40% increase in the odds of a self-reported mental health condition among people with an MSK condition.
With the over 65 population in England and Wales set to rise from 11 million to 13 million in the next ten years, the burden of these issues are only going to increase, and will have a significant impact on health care and social care systems.
Given the prevalence statistics above, we can imagine the impact on individuals in their daily lives and on health care systems, but what about adult social care? The answer is – it’s very hard to quantify.
A diverse range of adult social care services are offered by local authorities. However, there is little specific data about the services that people with musculoskeletal conditions access, or those that are provided, at either a local or national level.
However, some recent research indicates that adults with chronic MSK pain report significant social care use. In the study of over 900 participants across the UK with chronic pain, 54% received formal social care support and 74% received informal support. Authors do not report how many participants stated that they needed help. The study also found that the likelihood of social care being provided increased by 50% for each additional chronic disease reported. The authors point out that social care use is ‘frequently not considered when assessing the overall cost (both financial and societal) of MSK morbidity’, and they conclude that understanding the relationship between MSK diseases and social care may allow better design of social care services in this context, as well as opportunities to develop prevention strategies.
We would argue that in the current context of massively stretched adult social care budgets and rising thresholds for eligibility, we are missing an understanding of the relationship between population MSK need, ‘what works’ to prevent and improve these conditions in the social care context, and the design of programmes of support.
Reaching a place where we understand these dynamics and are able to formulate prevention strategies may be undermined by a number of features of adult social care which perhaps set it apart from health care systems. Research published in 2019, which sought to develop a framework for evaluation for prevention in adult social care prevention efforts, found challenges in data collection including a lack of longitudinal data and a short-term approach to evaluation. Authors suggested there may also be a lack of appetite to invest in data gathering and analytical capabilities, particularly in times of budget restrictions.
Public health data on musculoskeletal health is patchy, at least in England, with the latest prevalence figures in Fingertips being from 2012, and 2016/17. The limitations of public health data – and in fact the lack of recognition of MSK conditions as a public health priority – had been noted in 2011 in the England CMO’s report.
So, in concluding this first part of our joint blog, the impact of MSK conditions on adult social care will no doubt be great, but being able to say more than that is hampered by a lack of information. This has a significant impact on our ability to put in place prevention strategies and evidence-based interventions to address the needs of this population. We haven’t looked exhaustively at all the literature, including grey literature produced in the four UK nations, so please do get in touch with us if you can shed light on any of the issues highlighted.
The second part of our joint blog will focus on innovative community-focused programmes for responding to and preventing MSK conditions, and some ideas for how public health professionals can influence health care and social care systems to make a difference, including addressing the lack of data available to understand the needs of this population.
Sebastian Baugh, Eugenia Cronin, Benjamin Ellis & Elaine Rashbrook
Comments to: benjamin.ellis@nhs.net and elaine.rashbrook@dhsc.gov.uk
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