The Rise And Fall Of MSKReform
Jack Chew is the sort of friend who I recommend, before picking up the phone to him, you have a few household chores lined up because you’re about to have a significant amount of time on your hands while he bends your ear.
In one 2017 conversation though, I had to interrupt his flow. Looking up from the pristine bathroom and three loads of washing I’d accomplished in the conversation so far, I said “Sorry, you want to call this project ‘The Big Arse’?”
Turns out, that project was actually ‘The Big Rs’ representing the Reasoning, Responsibility and Reform of practice that we were starting to hear MSK clinicians call out for online.
Fast forward to Autumn 2019 and as I clip-clopped around west London in a pair of heels and my smartest coat in an against-the-clock search for an HDMI cable, my phone rang. Was it Lord Sugar with another Apprentice-style mission? No, it was Jack again. This time he was calling from the Houses of Parliament. We had descended on the capital for a Parliamentary reception marking the launch of MSKReform’s Manifesto for Reform, which pulled together months of work from our Working Groups into the chapters of Evidence, Governance, Education, Excellence and Influence, stemming from those original Big Rs.
Fast forward one last time to 2024. Unfortunately MSKReform can’t come to the phone right now. Why?
Oh, because it’s dead.
The Big Rs
2017. The UK’s biggest chart hit was Ed Sheeran’s Shape of You, Harry and Meghan got engaged, and the news was full of ‘Article 50’. The Physio Matters Podcast was in its heyday and a conversation was happening online. MSK clinicians were seeking knowledge and perhaps even different models of working, certainly different models of understanding. We were starting to hear more too from those who used our services as patients who were noticing variations in the level of care they received for MSK conditions. Reasoning, Responsibility and Reform seemed to be the best three words to sum up what was lacking.
The launch event for #TheBigRs was held in a large conference room in Birmingham in November 2017 but no one was headlining. Instead, the day was about multiple round-table discussions between fifty invited clinicians, educators and those who receive MSK care. The event was funded by Connect Health; the founder of which, Andrew Walton called out Jack the year prior by saying “We’ve heard your analysis. What would you do about it?”
Jack admits: “They gave me an inch and I took a mile!”
In May 2018, we needed twice the amount of round tables at our follow up event for 100 invited guests that focussed more on how it might be possible to implement some of the suggested changes to the MSK industry.
MSKReform
Later in 2018, our working groups under the topics of Evidence, Governance, Education, Excellence and Influence were headed up by Emma Salt, Paula Deacon, Reena Patel (later joined by Ann Green), Matt Wyatt and Ash James respectively. The movement was now taking shape as MSKReform, or MSKR and it made sense to create a structured, not-for-profit organisation.
Each Group Lead spoke and held panel discussions at the 150-strong, two-day Reforming MSK Conference in Manchester. I remember that event well, and not just for the doughnut wall that the venue provided at the end of the second day. It truly felt like a buzz was building and that so many people in MSK were aligned. Was there unanimous agreement? Of course not – alongside calls for consistency in clinical education standards, protected time for development and improved targeting of media misinformation, one of MSKR’s proposed policies was increased appraisals and tighter regulation. Some policies would need costly buy-in from businesses, education institutes and professional bodies but it felt like something was brewing. I was asked to join Jack as MSKR’s Deputy Director and I, a chronic people pleaser already working part time in my own private practice, part time in occupational health and part time for The Physio Matters Podcast, of course signed up. None of us received any payment for our roles in MSKR, which we knew would be the case, but the hope was that it would generate an income for its contributors in the future.
Manifesto for Reform
The Manifesto for Reform was the product of months of effort between the Working Group Leads and the wider group of volunteer clinicians, patients, educators, researchers and policy makers who met to create each chapter between April and October 2019. This was a huge piece of work that compiled all the groups’ policies. While there were some ‘easy win’ policies, we knew there would be aspects that would be challenged or met with resistance. As Jack is quoted in the document: ‘If we were looking for signatures from people who agreed with 100% of this Manifesto’s policies, we wouldn’t even get mine.’ However, the big question posed in the introduction was ‘if we were to enact these policies, would MSK practice improve?’
That brings us to October 2019 and our Westminster Parliamentary Reception for the finished Manifesto. The HDMI cable was eventually sourced, the presentation was given and the document was toasted by its contributors, supporters and a collection of MPs.
MSKReform was now a registered non-profit company; a think tank with members now reaching wider than the original working groups, who would vote for which policies they felt were priorities to best improve MSK care. We sought to work with forward-thinking organisations who believed in and were willing to invest in the project: Connect Health, AHP Suffolk CIC, IPRS and BASRaT deserve praise for their vision and faith at this stage.
Of course, MSKR had its detractors. Some camps described MSKR as a wild, utopian pipe dream whilst others conversely felt it was too broad and too similar to what they or others were already doing. Insert puzzled emoji here.
Probably the number one question we were asked about the project was ‘what do the CSP think?’ A very valid question given that Physiotherapists form the largest MSK profession and more than 90% of UK Physios are CSP members. The logical stance of many when hearing about MSKR, an organisation with improvement of MSK care at its core, was ‘aren’t I already paying fees to a professional body for this?’ On Valentine’s Day 2020, we headed to London again to find out. Jack, Matt Wyatt, Ann Green and I met Natalie Beswetherick, then CSP’s Director of Practice and Development, alongside Gill Rawlinson and Ruth Ten-Hove, where we talked about the common goals of the CSP and MSKR. It felt like a big win when we saw that later that day, Natalie had tweeted ‘Very positive meeting with MSKR leads today discussing shared priority areas…more collaboration to follow.’ I guess we’ll never know whether collaboration would have followed or whether this was an exercise in temporarily appeasing an emergent, decentralised movement because of the global events that then unfolded.
The Pandemic
When the first lockdown was announced and MSK clinicians country-wide were either closing their doors or being redeployed into more acute care areas, we had just come to the end of voting for our members’ policy priorities via our fancy new online portal. Suddenly, everyone’s priorities were very different – not least our own. Jack and his wife Charlotte had had twins in December 2019 and were running a new private clinic hit by the restrictions. My own clinic was closed too but I had four other jobs at this point - some of them were even paid. Everyone had their own challenges. Some were sick and some were worried sick. We felt worried that people had paid their annual membership fee and perhaps now we weren’t doing enough because the doors we’d been in the process of carefully unlocking were suddenly jammed shut. We allowed everyone a free six months on their membership and perhaps naively hoped that things would look different by then.
We were hearing regularly from MSK clinicians who wanted to help the crisis emerging within the NHS. As you won’t have forgotten, those were unprecedented times and perhaps time for unprecedented actions. We collected details from over 7000 qualified MSK professionals of various stripes who were willing to work with the NHS to help with the rehab and discharge aspect of patient care whilst existing NHS staff were redeployed, overwhelmed, or shielding at home. This however proved slightly too innovative for NHS England who wondered out loud in a meeting whether MSK professionals might actually be better placed to offer manual handling training for the staff currently log-rolling on ICU to prevent back injury. Yes, you read that right.
I was in awe of the creativity and sway of the MSKR Working Group Leads in the realms of clinical practice, research and education. As we sat in regular Zoom meetings, I listened to Emma describe her work on an AI-led patient outcome measure database, Paula’s work on the kitemark of best clinical practice, Reena and Ann’s work with HEIs on regulating placements and clinical educators, Matt’s passion to make Chartership mean more than ‘monthly fee payer’, and Ash’s work on MSKR.info – the peer-reviewed and contemporary patient education site that we launched during lockdown.
But of course, even as we moved into 2021 and beyond, when we looked around, the landscape had changed. Services were backlogged, education institutes were behind on teaching face to face skills and healthcare staff were stretched to the limit.
I feel no shame in admitting that MSKR and policy influencing wasn’t my strength. Now back in clinic and juggling four other work roles, I stepped down as Deputy Director in October 2021.
It was May 2023 when I heard from Jack about the future of MSKR. The plan post-pandemic had been to relaunch the project using the popular MSKR.info patient-facing website and a campaign against MSK misinformation. The three commercial partners who were to be involved in the funding and development had all backed out two weeks prior for one big reason: AI. Artificial Intelligence and all the data it can access made their endeavours suddenly far quicker and cheaper without the need for MSKR’s involvement. That, in combination with being stretched personally and professionally as a dad of twin toddlers whilst simultaneously running a clinic, led to the crux of the message: MSKR would be wrapped up and was subsequently recognised by Companies House as being dissolved on 12th December 2023.
One last Big R: Reflection
I, a millennial woman and consumer of mental health Instagram and antidepressants, have of course not got to this point of the story to label all the efforts described above a failure.
As part of writing this article, I looked over the Manifesto for Reform for the first time in years with eyes that are in some ways fresh and in others more weary. In my opinion it remains a brave document stuffed full of optimism, compassion for the people who receive our care and the professionals who deliver it, and an overwhelming sense that we can do much, much better as an industry.
And I strongly suspect the appetite to do so is still there – I read Jo Turner’s article in Issue 1 of MSKMag ‘This Was About More Than Just A Few Revised Standards…’ and was intrigued though not surprised to read that during the time Jo was seeking clarity on last year’s new HCPC standards, she found many clinicians were actually looking for ‘tighter regulation and more robust audit’. There’s a paragraph of Jo’s that I’d love to have added to the Manifesto of 2019: ‘Good governance and regulation need not be the enemy of innovation but in fact the framework that frees creative individuals up to experiment and take risks, safe with a clear understanding of what constitutes current best practice’. You can’t see me but I’m on my feet, hands in the air, yelling ‘louder for those in the back!’
I imagine the people in our care would also be delighted t
o know that somewhere between graduation and retirement, there were processes in place to appraise the quality of service we provide to the general public. As things stand, its sounds like a bad Christmas cracker joke to ask:
Q: When you go to see an MSK professional, how do you know we are up to standard?
A: You don’t.
At the time, the buzz quote of MSKR was this:
‘Because if not us, then who?
And if not now, then when?’
Maybe the answer wasn’t MSKReform and maybe the time wasn’t then. Maybe the answer to ‘who?’ is still a very broad ‘us’. But as for ‘when?’ – I can only hazard a guess. Perhaps when the professional bodies and organisations are ready to dare greatly. The MSK industry waits for their call.