Version October 14

DRAFT:

Musculoskeletal health – a view from Whitehall

Sir Mark Walport, Government Chief Scientific Adviser

13 October 2014

Hammersmith Hospital

The rheumatology clinic

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The broader medical perspective

Surrogate for physical health as a whole.

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• Bad prognostic feature• 45% global increase in

DALYs (1990 to 2010)

• Ageing population• rising burden of

osteoarthritis

• Link to comorbidities• mental health and

wellbeing• obesity Factors comprising good musculoskeletal health

Source: Arthritis Research UK - musculoskeletal health, a public health approach http://bit.ly/1vT3zIB

The medical challenge

In the UK:

• 10 million with long-term pain

• Each year 20% of people visit their GP with musculoskeletal-related complaints

• NHS England spends £5 billion a year on treatment – includes 150,000 joint replacements

• >4.5 million people with osteoarthritis of the knee –could nearly double by 2035

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Bull World Health Organ vol.81 n.9 Genebra Sep. 2003

Multiple impacts across society

• Single largest cause of years lived with disability in the UK

• Workplace

– A third of days lost to illness are due to musculoskeletal conditions

• Social care and inclusion

– Barrier to independent living

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Source: Arthritis Research UK – musculoskeletal health

The Lancet, Volume 381, Issue 9871, Pages 997 - 1020, 23 March 2013

Wellcome Trust

“To foster and promote research with the aim of improving human and animal health”

Wellcome trust

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Origins of Bone and Cartilage Disease

Systematic skeletal phenotyping of knockout mouse lines to identify mutants with structural and functional abnormalities affecting bone and articular joints.

MRC’s research priorities

• resilience, repair and replacement

• tissue disease and degeneration

• life course perspective on health and disease

• lifestyles affecting health

• securing impact from medical research

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MRC’s musculoskeletal research is being prioritised including:

Research challenges

• To understand why our bones, joints and muscles function less well as we age

• To identify the role of nutrition

• To understand risk factors

• To identify and test approaches to detect and monitor age-related changes in musculoskeletal tissues

• To understand how these processes may be ameliorated or prevented to help preserve mobility and independence

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• Wellbeing, health, resilience & security

• Knowledge translated to economic advantage

• The right science for emergencies

• Underpinning policy with evidence

• Advocacy and leadership for science

Government’s Chief Scientific Adviser

A Precision Medicine Catapult• Part of a world-leading network of technology and

innovation centres• Bridge the gap between businesses, academia,

research and government• Long-term investment to transform the UK’s ability to

create new products and services• Open up global opportunities for the UK and

generate sustained economic growth for the future• Being established and overseen by the Innovate UK

• Focus on a number of areas including inflammatory diseases

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• Imagination

• Innovation

• Entrepreneurship

• Business Skills

• Manufacturing, branding, marketing and distribution

We are good at these …

….and our science base is first rate

Knowledge to Growth

What can we do to:• Promote innovation led growth• Build on existing expertise

The Foresight Programme:The Future of Demography

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15

2033

1992

Figure: Projected percentage of UK population aged 65 and over by local authority 1992 & 2033

The Foresight Programme:The Future of Ageing

• Economic competitiveness• Governance• Climate change• Technology• Sustainability – energy, waste• Resilience• International competition• Network of cities• Demography – ageing population

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HOUSEHOLD INCOME PER WEEK, ENGLAND AND WALES (GBP)

What are the key enablers of success for different cities?What are their most important decisions in preparing for the future?

The Foresight Programme:The Future of Cities

How will musculoskeletal diseases be affected?

How should cities be adapted to provide attractive living and working environments for the elderly and people with musculoskeletal disease

image: Patrick Vale, RIBA (2013)

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The Internet of Things

Smart Energy

Transport

Physical Object +

Controller, Sensor and Actuators +

Network +

Data Analytics =

The Internet of Things

Healthcare

Internet of ThingsHealthcare and wellbeing

£8-14bn Potential savings in UK healthcare from digitisation (NHS, 2014)

20 Genomics England and the power of DNA data

From data to knowledge to societal benefit

Health data and public opinion

• An overwhelming majority of the British public - 85% - want any healthcare professional treating them to have secure electronic access to data from their GP's record.

• But 85% (in a different survey) oppose government selling their health records commercially.

• Mention of safeguards increases support for data sharing from 33% to 51%.

In the USA, preventable medical errors are the third leading cause of death (440,000 per year –Journal of Patient Safety, 2013). Data analytics can identify and address the underlying causes.

Countries all around the world are currently wrestling with the same issue of how to share medical data while protecting privacy.

We need to be more open with people on how their data may and may not be used, and communicate the benefits.

On care.data…

“This information helps us identify the causes of cancer and heart disease; it helps us to spot side-effects from beneficial treatments, and switch patients to the safest drugs; it helps us spot failing hospitals, or rubbish surgeons; and it helps us spot the areas of greatest need in the NHS. Numbers in medicine are not an abstract academic game: they are made of flesh and blood, and they show us how to prevent unnecessary pain, suffering and death.”

Ben Goldacre, Guardian 21 February

The challenge of communicating the benefits: care.data

Global Perspective

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The work of the Bone and Joint Decade (BJD) in 2012-15 is focused on the following priority areas:

• Trauma and the care of the injured through education in prevention and outcome-based interventions

• Healthy ageing through improved access to supportive information and education in self-care

• Musculoskeletal health in the workplace through education in awareness and prevention

• Sustained advocacy for equal priority with other significant non-communicable diseases (NCD’s) by raising awareness of the burden of musculoskeletal diseases (MSD’s) and awareness of the advances in prevention and control

• Health care provider training programme to train mid-level providers in developing countries in the detection, diagnosis and management of MSD’s, being piloted in East Africa