Latest / MSKMag OutLoud / The Biggest Wins in the NHS are Cheap

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The Biggest Wins in the NHS are Cheap · MSKMag OutLoud

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  SPEAKER_00: The biggest wins in the NHS are cheap.
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  SPEAKER_00: A look at why we keep starving the highest leveraged pathway in healthcare by Luke Callaway.
• 0:10
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• 0:12
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• 0:19
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  SPEAKER_00: A community pilot reduced musculoskeletal waiting lists by 20%,
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  SPEAKER_00: and its reward was a national budget smaller than the pilot itself.
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  SPEAKER_00: The announcement,
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  SPEAKER_00: stripped of its press release Gloss,
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  SPEAKER_00: identifies an initiative that reduced community musculoskeletal waiting lists by
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  SPEAKER_00: a fifth that is now going national.
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  SPEAKER_00: The reward for that success is a grand total of £3.225 million,
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  SPEAKER_00: which I had to read twice as I was expecting more zeros.
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  SPEAKER_00: The pilot that improved the model in the first place cost 3.5 million.
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  SPEAKER_00: So the reward it has earned,
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  SPEAKER_00: namely the budget to do exactly the same across every health system in England,
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  SPEAKER_00: is somehow smaller than the pilot that produced it.
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  SPEAKER_00: A bit of a black drop before we get to the outrage.
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  SPEAKER_00: Because the scale of it really does matter.
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  SPEAKER_00: Ill health now costs the UK economy somewhere in the region of $212 billion a year.
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  SPEAKER_00: A figure published in last Ultima's Keep Britain Working review and worth roughly 7% of GDP.
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  SPEAKER_00: And my dear old friend MSK sits second only to mental health among the drivers of that bill.
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  SPEAKER_00: MSK mag readers will know
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  SPEAKER_00: that musculoskeletal conditions affect nearly 18 million people in England
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  SPEAKER_00: and account for somewhere between a fifth and a third of GP appointments,
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  SPEAKER_00: depending on whose figures you happen to trust.
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  SPEAKER_00: They also make up a third of the largest area of NHS spend at around £5 billion
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  SPEAKER_00: a year,
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  SPEAKER_00: so when you set the national rollout against that £212 billion,
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  SPEAKER_00: you land at roughly 0.0015% of the problem,
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  SPEAKER_00: which is a rounding error for the Treasury.
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  SPEAKER_00: Let's be clear, none of this is a criticism of the work itself, which is genuinely very good.
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  SPEAKER_00: Get It Right First Time's MSK Community Delivery Program cut 18-week community
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  SPEAKER_00: weights by 20% across 17 integrated care boards between December 2024
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  SPEAKER_00: and March 2025.
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  SPEAKER_00: It did so with deeply unglamorous ingredients,
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  SPEAKER_00: namely community clinics,
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  SPEAKER_00: local clinical leadership and one-stop appointment days that bundle assessment,
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  SPEAKER_00: treatment,
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  SPEAKER_00: mental health support and physical activity into a single visit,
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  SPEAKER_00: rather than scattering them across four separate letters and four separate days off.
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  SPEAKER_00: There is no miracle buried in any of this,
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  SPEAKER_00: it's just a sensible,
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  SPEAKER_00: joined-up pathway run by the right people, close to where patients actually live.
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  SPEAKER_00: I have a bit of skin in this game because I spent years involved
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  SPEAKER_00: in one-stop initiatives in orthopaedics and rheumatology,
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  SPEAKER_00: the very kind that Get It Right First Time now references.
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  SPEAKER_00: Their simplicity was a key ingredient in why they worked,
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  SPEAKER_00: with patients seen,
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  SPEAKER_00: assessed,
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  SPEAKER_00: imaged and started on a plan inside a day,
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  SPEAKER_00: instead of bouncing around the system for the better part of a year.
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  SPEAKER_00: The point worth holding on to is that the model is genuinely repeatable and translatable.
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  SPEAKER_00: Which is to say it's not a clever local fluke that it happened to work because
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  SPEAKER_00: of one brilliant clinical lead.
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  SPEAKER_00: It is a method and methods can be copied and scaled.
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  SPEAKER_00: Which is exactly where it grates because the 17 area pilot cost 3.5 million and
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  SPEAKER_00: a second cohort of 6 more areas took another 2.2 million.
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  SPEAKER_00: In effect,
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  SPEAKER_00: the model has now been proved twice across 23 systems and rewarded with
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  SPEAKER_00: a national budget of 3.225 million to cover the entire country.
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  SPEAKER_00: England has 42 integrated care boards where the pilot areas received up to £300,000 each.
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  SPEAKER_00: The national rollout funding works out closer to £77,000 each per area,
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  SPEAKER_00: which is roughly a third of what the trailblazers got to do precisely the same job.
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  SPEAKER_00: The unspoken brief reads something like, guys,
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  SPEAKER_00: can you do the same again at scale for less money than you spent the first time?
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  SPEAKER_00: Anyone who has ever run a service will recognise both the request and
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  SPEAKER_00: the quiet despair this ignorance tends to produce.
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  SPEAKER_00: The deeper problem sits underneath the budget line, in the workforce.
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  SPEAKER_00: And I talk about this a lot on my various channels because the gap is real and it is widening.
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  SPEAKER_00: Becoming a physiotherapist today means obtaining near-perfect grades,
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  SPEAKER_00: no meaningful tuition concession of the sort we used to offer,
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  SPEAKER_00: a brutal job market the moment you qualify and a salary that flattens inside
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  SPEAKER_00: a decade.
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  SPEAKER_00: Being good is no longer enough and there is constant pressure to specialise or
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  SPEAKER_00: to extend scope simply to stay relevant and enjoyable.
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  SPEAKER_00: We have quietly turned,
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  SPEAKER_00: in my opinion,
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  SPEAKER_00: the single most cost-effective profession in healthcare into one of
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  SPEAKER_00: the least attractive to enter and then we act faintly surprised when
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  SPEAKER_00: the workforce pipeline starts to thin.
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  SPEAKER_00: The opportunity here is enormous and it is worth being specific about why.
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  SPEAKER_00: The 20% reduction was on the community list,
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  SPEAKER_00: the smaller and earlier queue,
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  SPEAKER_00: which is precisely what makes it exciting rather than marginal.
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  SPEAKER_00: Treat and mobilise people earlier in the community and you take pressure off
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  SPEAKER_00: the trauma and orthopaedics list further downstream,
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  SPEAKER_00: which remains the single largest elective queue in the country.
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  SPEAKER_00: Keeping patients moving,
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  SPEAKER_00: at work and off surgical waiting lists will reduce expensive problems in years
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  SPEAKER_00: to come,
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  SPEAKER_00: and those who do still need surgery will arrive in better physical and mental shape,
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  SPEAKER_00: which is a precursor for faster recovery,
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  SPEAKER_00: less time spent in hospital, and less cost to the system on the way through.
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  SPEAKER_00: The model also does something rather neat, which deserves more credit.
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  SPEAKER_00: By pulling movement and mental health into the same visit,
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  SPEAKER_00: it chips away at the two biggest contributors to that £212 billion bill at
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  SPEAKER_00: the same time and movement.
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  SPEAKER_00: Psst, it's rather good for the brain as well as the body.
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  SPEAKER_00: The link has been known for years,
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  SPEAKER_00: but we simply do not commission or broadcast it as though we believe it.
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  SPEAKER_00: If the system were serious,
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  SPEAKER_00: and by system I mean something rather more durable than a revolving door
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  SPEAKER_00: of health secretaries, it would do four fairly obvious things.
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  SPEAKER_00: One, it would fund the workforce in the tens of millions rather than the low single figures.
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  SPEAKER_00: It would treat compliant hybrid digital msk pathways as a genuine clinical priority
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  SPEAKER_00: where the whole population can access at the front door.
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  SPEAKER_00: It would build in-house rather than reflexively buying off-the-shelf products to fill the gap.
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  SPEAKER_00: This is not complex tech and return on investment multiplies
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  SPEAKER_00: when there is no license fee going to the external developers.
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  SPEAKER_00: It would actually scrutinise what it has already bought because a surprising amount
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  SPEAKER_00: of tech has never been shown independently to do very much at all.
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  SPEAKER_00: Don't get me started on
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  SPEAKER_00: a medical device's defined intended use versus how it is being deployed in
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  SPEAKER_00: the system.
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  SPEAKER_00: So here is where I keep landing as this issue travels a long way beyond MSK.
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  SPEAKER_00: We consistently mistake cost and complexity for value.
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  SPEAKER_00: The expensive,
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  SPEAKER_00: complicated,
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  SPEAKER_00: heavily-branded intervention feels serious, so it gets the money and the contract.
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  SPEAKER_00: Meanwhile,
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  SPEAKER_00: the cheap,
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  SPEAKER_00: simple, effective solutions are overlooked, as it cannot possibly be the answer.
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  SPEAKER_00: Pilots happen, credit ensues, yet the budget to achieve impact at scale never materialises.
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  SPEAKER_00: For me, simple good physiotherapy is affordable, effective and scalable.
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  SPEAKER_00: Its only real crime is that it is not shiny.
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  SPEAKER_00: So I will leave you with the same question I opened with because I'm yet to see
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  SPEAKER_00: a satisfying answer.
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  SPEAKER_00: If a pilot scheme can knock a fifth off the waiting list on a shoestring
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  SPEAKER_00: and proven its effectiveness across 23 areas,
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  SPEAKER_00: why on earth are we not throwing cash at it?