Professor Oliver FitzGerald:

What are MSDs? MSDs include, most commonly, regional musculoskeletal pain. The patients who present are people who complain of back pain, work-related upper limb disorders and hip and knee pain. It is remarkably common, with virtually all people experiencing an episode of musculoskeletal pain during their lifetime. The second commonest condition is osteoarthritis, which is estimated to affect more than 500,000 people in Ireland. This is followed by rheumatoid arthritis, a condition the committee will have heard of. It is a severe deforming arthropathy that affects up to 40,000 people in the country. Children can be affected by arthritis and an estimated 1,000 children are affected in Ireland. Finally, spondyloarthropathy is a group of disorders commonly involving the spine and the joints outside the spine. It includes conditions such as ankylosing spondylitis and psoriatic arthritis.

Broadly speaking, these are the diseases under discussion and, in each case, early intervention is central. Early intervention has been shown to result in better health outcomes, prevention of joint damage and preservation of function, including ability to work. It has been shown that the longer a patient is out of work with a MSD, the less likely he will be able to return to work. For example, if a person is out of work with back pain for more than a year, the chances of his returning to work are negligible.

Many of these patients are referred to rheumatology and orthopaedic outpatient services. Unfortunately, there are lengthy waiting lists for such services throughout the country. The waiting list is up to three years in some units, and many of these people are sitting on waiting lists. Last year, the HSE rheumatology and orthopaedic programmes appointed 24 highly trained specialist musculoskeletal physiotherapists. During 2012 more than 10,000 patients with regional musculoskeletal pain were seen by these physiotherapists and diagnosed and treated. Fewer than 20% of those patients needed to see a consultant - they could be managed effectively by the physiotherapist - and fewer than 10% required surgical intervention. We estimate that in 2013 a further 24,000 patients will be removed from the orthopaedic and rheumatology outpatient waiting lists. In time we expect that the rheumatology and orthopaedic outpatient waiting lists will become more manageable and that physiotherapists will be able to work more at the interface between primary and secondary care. This will allow us to address some of the issues related to regional musculoskeletal pain in a more expedient manner. Across the spectrum of health in both primary and secondary care, we need to target getting back to work as a clinical outcome. That is something we need to focus on.