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Comments on the Green Paper ‘Advancing Our Health – Prevention in the 2020s’

The Faculty of Sport and Exercise Medicine UK welcomes the Government’s overall aspirations for the prevention of ill-health outlined in this Green Paper and strongly supports the role of prevention in improving the health of the nation.

However, we believe that there must be much more emphasis in this Green paper on physical activity in the management and primary and secondary prevention of illness and disability.

In addition, there needs to be recognition of the importance of properly trained, consultant-level medical expertise in the evidence-based management of musculo-skeletal conditions, which have a massive impact on the health and occupational outcomes of the nation. The Faculty sets the standard for training of Fellows and Members in MSK medicine and Exercise Medicine – which will be critical to the prevention and management of disease and injury.

Physical Activity

Physical activity is a cheap, sustainable and highly effective mechanism for the management and prevention of illness. The benefits far out-weigh the risks and the implementation of an effective physical activity strategy is wholly consistent with policy in other areas of government, including aspirations towards sustainability in healthcare.

Physical activity will help society in many ways:

  • In the prevention of disease
  • In the treatment of disease
  • by the reduction of the complications of disease
  • by the improvement of functional outcomes after disease and injury – rehabilitation

To improve outcomes, we need to make greater efforts to develop an infrastructure which supports physical activity in the community

We believe this will require central government funding and encouragement to improve local authority planning decisions to promote active lifestyles. This will allow people, from the earliest age, to make positive decisions to adopt active behaviour which will improve their health.

It is absolutely critical that government recognises that investment in this approach brings with significant in-year and recurrent cost-benefits. Investment in this area is not another cost-sink which will (hopefully) improve health – it will bring with significant financial benefits to society from:

  • Reduced morbidity and consequent costs of health treatment
  • Reduced social dependence and social care costs
  • Reduced disability
  • Reduced use of drug costs
  • Improved emotional and physical well-being of British society.

Healthcare professionals will play an important role as a conduit for advice and clinical delivery of the physical activity agenda. We know that every healthcare contact counts and this Faculty is providing the tools to do this through the Moving Medicine initiative with PHE and Sport England support. This will be critical to the adoption of movement as an effective clinical treatment. The ‘Active Hospitals’ pilot at Oxford University Hospitals Trust is demonstrating the importance of embedding physical activity in the patients and staff of a large NHS hospital and will be rolled out to other hospitals later this year.

Musculo-skeletal Conditions

The Faculty is pleased that the Green paper acknowledges the significant impact that MSK conditions have on the total years lived with disability and number of working days lost.

We would welcome a rational approach to the care of people with musculo-skeletal conditions which does not just focus on maximising the effectiveness of surgical interventions. The Faculty would like to emphasise that the effective management of musculo-skeletal disorders requires expert doctors trained in their diagnosis and effective, evidence-based treatment for which Members and, especially Fellows, of this Faculty are uniquely trained.

Physical activity guidelines

The Faculty welcomes the new CMO physical activity guidelines.

Social prescribing

FSEM welcomes social prescribing as a key part of health care particularly for those at high risk of falling or loneliness. It is essential however to understand the characteristics, training and scope of social prescribers. FSEM believes that additional value could be gained from this key resource if they were trained in motivational interviewing and had an understanding of the importance of physical activity in frailty. Our Moving Medicine active conversations resource would be of potential benefit to this group. The impact of social prescribing needs better data particularly in relation to their level of training, where there is currently little data.

Digital Design Challenge

There are opportunities in digital delivery of healthcare systems but it cannot be seen as a panacea for a lack of clinical and personnel resource. The Green Paper targets older people, those living with health conditions and people on low income, in deprived areas. It needs to be recognised that these groups may be the least likely to be influenced by a digital approach.

Strength and balance is critical to injury prevention and the amelioration of MSK conditions but this cannot purely be delivered through digital services and thought must be given to a dialogue with the Faculty and specialist exercise professional groups.

Moving Health professionals forward programme

FSEM welcomes this programme and the leadership it has bought to the physical activity agenda in the NHS. Sustainability of this programme is important to keep the momentum going on this vital work.

Work

We welcome the focus on improving access to and retention in work – particularly in the area of MSK conditions. There must be much more focus on the timely and expert management of MSK conditions in the workplace. Early treatment interventions and occupational health advice have shown to be effective in reducing working days lost and improving work satisfaction in the private sector and the military, but those lessons do not seem to be transferred to the NHS or public sector. MSK treatment is not prioritised in the NHS and priority cannot be given for occupation under the terms of the NHS constitution. This needs to be reviewed.

The Faculty would wish to be part of any MSK expert reference group convened to review existing guidance about what could be improved in this area

Data

There is very little data recorded on the outcomes or non-surgical management of MSK conditions by CCG’s or the NHS and no data on exercise-based rehabilitation. There is limited data on commissioning structures for MSK services. We cannot effectively plan these services without these data.

Call for Evidence

The Faculty does not believe that there needs to be stronger evidence of the social and economic value of physical activity. The evidence is overwhelmingly positive. We are concerned that a further call for the review of data will lead to delayed implementation of evidence-based policies. Where evidence needs to be improved is in a better understanding of the translation of current evidence into clinical practice.

We would support the call for better data on

  • The influence of physical activity in the prevention and treatment of specific conditions
  • Population-level physical activity behaviour changes
  • Help to support the working population
  • The links between mental and MSK health
  • Impact of social prescribing particularly in relation to level of training.

Raising Awareness

We are uncertain of the value of raising awareness of MSK conditions among the public as there limited and stretched resources for non-surgical treatment of these conditions.

Conclusion

This Green Paper has many positive aspects but this Faculty believes that a greater focus on physical activity and the effective management of MSK conditions – through expert medical services – will have a major influence on the health and well-being of this nation.