Clinical Innovation Hub 2026

I’m looking forward to speaking at the Clinical Innovation Hub on the 3rd March 2026 where we will be discussing innovative solutions to improve our organisations’ operational efficiencies. Excited to network, discuss and strategise with my colleagues and peers in attendance. To view further information on the forum and how to attend please visit: Clinical Innovation Hub

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EQ-5D or MSK-HQ: A commissioning decision

The EQ-5D and the MSK-HQ are both tools used to measure health outcomes, but they serve different purposes and have distinct characteristics. From a commissioner’s perspective in the UK, understanding the key differences between these two instruments is crucial for making informed decisions about healthcare provision and evaluation.

The EQ-5D is a standardised instrument used to measure general health-related quality of life. It is designed to be applicable to a wide range of health conditions and treatments. The EQ-5D includes five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. It also includes a visual analogue scale (VAS) for the patient to rate their overall health.

Advantages of the EQ-5D include its versatility, being applicable to a wide range of diseases and health states, not limited to any specific condition. It allows for comparison across different diseases and treatments, generates utility values that can be used in health economic evaluations including cost-utility analysis, and is widely accepted and used in clinical trials, health surveys, and economic evaluations globally. However, its generic nature might not capture condition-specific details and nuances, and it may be less sensitive to changes in specific conditions such as musculoskeletal disorders compared to condition-specific instruments.

On the other hand, the MSK-HQ is a condition-specific questionnaire designed to measure health outcomes in patients with musculoskeletal (MSK) conditions. It focuses specifically on MSK conditions, including back pain, arthritis, and other musculoskeletal disorders. The MSK-HQ includes 14 items covering pain, physical function, physical activity, sleep, fatigue, emotional well-being, and social participation.

The MSK-HQ’s advantages include its condition-specific focus, which captures the specific issues and outcomes relevant to patients with musculoskeletal conditions. It is more sensitive to changes in health status related to MSK conditions, allowing for more detailed tracking of patient progress and outcomes. Developed with input from patients and clinicians, it ensures coverage of the aspects most important to those with MSK conditions. However, its limited scope makes it unsuitable for use with non-MSK conditions, limiting its applicability in a broader healthcare context. It is less useful for comparing across different types of diseases and treatments outside of MSK conditions, and it does not generate utility values for economic evaluations, limiting its use in cost-utility analyses.

From a commissioner’s perspective, the key differences between the EQ-5D and the MSK-HQ are clear. In terms of applicability, the EQ-5D is suitable for a broad range of health conditions, making it useful for general health assessments and comparisons across different patient groups. The MSK-HQ, however, is specifically designed for musculoskeletal conditions, providing more detailed and relevant information for this patient population. In terms of sensitivity and specificity, the EQ-5D may lack sensitivity for specific conditions, potentially missing important changes in health status in patients with MSK conditions, whereas the MSK-HQ is more sensitive to changes in musculoskeletal health, providing more precise information on patient outcomes in this area.

For economic evaluations, the EQ-5D generates utility values that are essential for cost-utility analysis and economic evaluations in healthcare. In contrast, the MSK-HQ does not provide utility values, limiting its use in economic evaluations. In terms of use cases, the EQ-5D is ideal for broad applications, including public health surveys, clinical trials, and general health assessments. The MSK-HQ is best suited for clinical settings focused on musculoskeletal conditions, rehabilitation programs, and MSK-specific patient monitoring.

Considering patient-centred outcomes, the EQ-5D is more general and may not capture all patient-specific concerns related to musculoskeletal conditions. The MSK-HQ, being developed with direct input from patients and clinicians dealing with MSK conditions, addresses the most relevant aspects of health and quality of life for these patients.

From a commissioner’s perspective, the choice between the EQ-5D and the MSK-HQ depends on the specific needs of the health service being provided. If the goal is to measure health outcomes across a broad range of conditions and perform economic evaluations, the EQ-5D is more appropriate. However, if the focus is on musculoskeletal health, the MSK-HQ provides more detailed and sensitive information that can better inform clinical decisions and patient care strategies.

The EQ-5D and the MSK-HQ are both tools used to measure health outcomes, but they serve different purposes and have distinct characteristics. From a commissioner’s perspective in the UK, understanding the key differences between these two instruments is crucial for making informed decisions about healthcare provision and evaluation.

The EQ-5D is a standardised instrument used to measure general health-related quality of life. It is designed to be applicable to a wide range of health conditions and treatments. The EQ-5D includes five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. It also includes a visual analogue scale (VAS) for the patient to rate their overall health.

Advantages of the EQ-5D include its versatility, being applicable to a wide range of diseases and health states, not limited to any specific condition. It allows for comparison across different diseases and treatments, generates utility values that can be used in health economic evaluations including cost-utility analysis, and is widely accepted and used in clinical trials, health surveys, and economic evaluations globally. However, its generic nature might not capture condition-specific details and nuances, and it may be less sensitive to changes in specific conditions such as musculoskeletal disorders compared to condition-specific instruments.

On the other hand, the MSK-HQ is a condition-specific questionnaire designed to measure health outcomes in patients with musculoskeletal (MSK) conditions. It focuses specifically on MSK conditions, including back pain, arthritis, and other musculoskeletal disorders. The MSK-HQ includes 14 items covering pain, physical function, physical activity, sleep, fatigue, emotional well-being, and social participation.

The MSK-HQ’s advantages include its condition-specific focus, which captures the specific issues and outcomes relevant to patients with musculoskeletal conditions. It is more sensitive to changes in health status related to MSK conditions, allowing for more detailed tracking of patient progress and outcomes. Developed with input from patients and clinicians, it ensures coverage of the aspects most important to those with MSK conditions. However, its limited scope makes it unsuitable for use with non-MSK conditions, limiting its applicability in a broader healthcare context. It is less useful for comparing across different types of diseases and treatments outside of MSK conditions, and it does not generate utility values for economic evaluations, limiting its use in cost-utility analyses.

From a commissioner’s perspective, the key differences between the EQ-5D and the MSK-HQ are clear. In terms of applicability, the EQ-5D is suitable for a broad range of health conditions, making it useful for general health assessments and comparisons across different patient groups. The MSK-HQ, however, is specifically designed for musculoskeletal conditions, providing more detailed and relevant information for this patient population. In terms of sensitivity and specificity, the EQ-5D may lack sensitivity for specific conditions, potentially missing important changes in health status in patients with MSK conditions, whereas the MSK-HQ is more sensitive to changes in musculoskeletal health, providing more precise information on patient outcomes in this area.

For economic evaluations, the EQ-5D generates utility values that are essential for cost-utility analysis and economic evaluations in healthcare. In contrast, the MSK-HQ does not provide utility values, limiting its use in economic evaluations. In terms of use cases, the EQ-5D is ideal for broad applications, including public health surveys, clinical trials, and general health assessments. The MSK-HQ is best suited for clinical settings focused on musculoskeletal conditions, rehabilitation programs, and MSK-specific patient monitoring.

Considering patient-centred outcomes, the EQ-5D is more general and may not capture all patient-specific concerns related to musculoskeletal conditions. The MSK-HQ, being developed with direct input from patients and clinicians dealing with MSK conditions, addresses the most relevant aspects of health and quality of life for these patients.

From a commissioner’s perspective, the choice between the EQ-5D and the MSK-HQ depends on the specific needs of the health service being provided. If the goal is to measure health outcomes across a broad range of conditions and perform economic evaluations, the EQ-5D is more appropriate. However, if the focus is on musculoskeletal health, the MSK-HQ provides more detailed and sensitive information that can better inform clinical decisions and patient care strategies.

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The Benefits of Community-Based Musculoskeletal Interface Services in the NHS: A Patient’s Perspective

Living with a musculoskeletal (MSK) condition can significantly impact a patient’s quality of life. MSK conditions, which affect muscles, bones, and joints, are common and can range from acute injuries to chronic syndromes like fibromyalgia. For NHS patients, the integration of community-based MSK interface services has been transformative.

1. Accessibility and Convenience

Community-based MSK services are designed to be closer to home, reducing travel time and providing easier access to care. This is especially beneficial for patients with mobility issues or chronic pain, as it alleviates the stress and fatigue associated with long journeys to hospitals. Additionally, local clinics often offer more flexible appointment times, better accommodating work and personal schedules.

2. Timely Care and Reduced Waiting Times

A significant benefit of community-based services is the reduction in waiting times. Traditional hospital-based MSK services often have long waiting lists, causing delays in diagnosis and treatment. In contrast, community-based services streamline the process with quicker initial assessments and faster referrals to specialists if needed. This timely intervention can prevent conditions from worsening, leading to better outcomes and a quicker return to normal activities.

3. Personalised and Holistic Care

Community-based MSK services tend to adopt a holistic approach to patient care. Practitioners in these settings often have the time to engage more deeply with patients, understanding their personal circumstances and tailoring treatments accordingly. This patient-centered approach ensures that care plans are not only medically appropriate but also practical and achievable for the individual’s lifestyle.

4. Integrated Multi-Disciplinary Teams

Community MSK services are typically staffed by a multi-disciplinary team of healthcare professionals, including physiotherapists, occupational therapists, GPs with a special interest in MSK conditions, and sometimes mental health specialists. This integrated team approach ensures that patients receive comprehensive care that addresses all aspects of their condition. For instance, physiotherapists can provide exercises to improve mobility, while occupational therapists can suggest modifications to everyday activities to reduce pain and strain.

5. Enhanced Patient Education and Self-Management

Empowering patients with knowledge about their conditions and involving them in their treatment plans is a cornerstone of community-based care. These services often provide educational resources and self-management support, teaching patients exercises and strategies to manage symptoms independently. This not only improves patient outcomes but also reduces dependency on healthcare services, fostering a sense of control and confidence in managing one’s health.

6. Stronger Community Connections

Receiving care within the community fosters a sense of belonging and support. Patients often benefit from peer support groups and local resources that offer additional help and encouragement. Knowing that others in the community are going through similar experiences can be incredibly reassuring and motivating, aiding in mental and emotional wellbeing.

7. Cost-Effectiveness

From a broader perspective, community-based MSK services are cost-effective for the NHS. By reducing the burden on hospital services and preventing the progression of conditions through early intervention, these services help manage healthcare resources more efficiently. This, in turn, ensures the sustainability of the NHS and the continued provision of high-quality care for all.

Conclusion

For patients, the shift to community-based MSK interface services has been overwhelmingly positive. The combination of accessibility, timely care, personalised treatment, integrated support, patient education, and community connection creates a robust framework for effectively managing musculoskeletal conditions. These benefits underscore the importance of continued investment and expansion of community-based MSK services within the NHS, ultimately enhancing patient experiences and outcomes.

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The Premier League’s response to the COVID-19 pandemic

During the COVID-19 pandemic, the Premier League undertook extensive measures to manage its operations amidst unprecedented challenges. Initially, the league swiftly suspended all matches in March 2020 following the outbreak of COVID-19 and subsequent positive cases among players and staff. This decision was made in alignment with government guidelines and public health recommendations.

As the situation evolved, the Premier League embarked on “Project Restart,” a meticulous plan aimed at resuming the season safely. This initiative involved developing rigorous health and safety protocols in collaboration with health authorities and government bodies. Protocols included regular COVID-19 testing for players, coaching staff, and match officials, alongside strict hygiene measures, social distancing guidelines, and the establishment of biosecure bubbles for teams.

The season eventually resumed on June 17, 2020, with matches played behind closed doors and without spectators to minimize the risk of virus transmission. The absence of fans, while essential for public health, presented challenges and required adjustments to maintain the integrity and atmosphere of matches. Efforts were made to enhance the broadcast experience for fans, including innovative camera angles and virtual fan engagement initiatives.

Financially, the Premier League provided significant support to its clubs to mitigate the economic impact of the pandemic. This included advances on merit payments and solidarity payments to ensure clubs remained financially stable during the uncertainty. Additionally, clubs and the league engaged in various community support efforts, such as donating funds to local charities, supporting food banks, and collaborating with the NHS to provide essential resources.

To accommodate the physical demands on players due to the condensed schedule, the Premier League temporarily permitted teams to make up to five substitutions per match instead of the usual three. This measure aimed to reduce the risk of injuries and fatigue among players navigating a congested fixture list.

Throughout the pandemic, the Premier League maintained close communication with stakeholders, including clubs, players, fans, and government authorities. Regular updates were provided on evolving circumstances, health protocols, and the league’s response strategy. Collaborative efforts with health authorities ensured adherence to public health guidelines and facilitated a coordinated approach to managing the crisis.

Recognising the mental health challenges faced by players and staff during this period of uncertainty, the Premier League prioritised mental health support. Resources and services were made available to support the psychological well-being of players and staff, including access to counseling and mental health professionals.

In conclusion, the Premier League’s comprehensive response to the COVID-19 pandemic underscored its commitment to prioritising health and safety while maintaining the continuity of the sport. By implementing stringent health protocols, providing financial support to clubs, and fostering community engagement, the league navigated the challenges posed by the pandemic with resilience and unity.

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You Are Not Done at 50

If you’re over fifty, this is not the end.
You are not past your prime, nor past your time.
You are not too late for anything.
You are not stuck.

You’ve lived. You’ve learned.
Not from books, not from screens—
But from doing, from trying, from failing, from rising.
You carry the scars, and with them, the stories.
You have wisdom carved from years of experience.

Thirty years of work? That’s thirty years of lessons.
Every grey hair is a medal, hard-earned.

Now…
You have a voice.
You have a platform.
You have knowledge the world needs.

Don’t keep it locked away.
Don’t be the silent sage.
Pick up your phone, speak your truth,
Share what you know.

Because you are not done.
Not even close.

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Back pain | When is the right time for an MRI scan?

What is an MRI scan?

Magnetic Resonance Imaging (MRI) allows health professionals to look inside a patient’s body.

It is considered a very safe way of producing images that can help diagnose medical conditions.

The scanner uses a high-strength magnet, radio waves and computers to create images that can by your healthcare professional.

What does it show?

  • MRI scans are extremely sensitive and, unlike X-rays which only show bones, MRI scans show bones and soft tissues such as muscles, ligaments and discs.

BUT

  • Research has shown that many of the findings on MRI scans are often found in people without pain.
  • It is normal to have an element of wear and tear or changes to some of the muscles, ligaments or discs as we get older.
  • One study found that up to 90% of healthy people over the age of 60 were reported to have changes to their spinal discs on MRI. It is not an indication that there is something wrong with the spine.
  • While MRI provides excellent pictures of your body structure, it may not be able to pinpoint the specific source of your pain.

When do I need a scan?

MRI for spinal pain should only be used when:

  • A serious condition is suspected. Less than 1% of all back pain is due to serious disease or injury.
  • If symptoms of numbness and weakness in the legs or arms are getting worse despite treatment.
  • If the results of the scan are likely to change your options for treatment.

Thorough examination can determine the best course of management and whether you require a scan.

Is something seriously wrong?

  • Spinal pain is very common, with 80% of people experiencing pain in their backs at least once in their lifetimes.
  • Most new spinal pain will get better on its own within 12 weeks.
  • Less than 1% of all back pain is due to serious disease or injury.
  • Research suggests there is no relationship between the level of pain you feel and the severity of your condition.
  • Health care professionals such as osteopaths, physiotherapists and doctors are specifically trained to identify spinal pain from serious causes.
  • Special questions and a thorough physical examination are very effective for identifying serious causes of back pain.
  • Sometimes blood tests can be a helpful part of the examination process.

Surely I need a scan to tell me what’s wrong with my long standing back pain?

  • The information we get from MRI scans is often unhelpful in treating long standing pain (pain that has persisted for longer than 3 months).
  • Musculoskeletal health care professionals are trained to recognise patterns of pain which indicate when an MRI scan may be useful.
  • Scans tell us nothing about how fit, tight, weak and sensitive our body’s tissues have become. These are often reasons for ongoing pain.
  • Even with modern techniques and knowledge there is often no immediate cure for chronic pain. However, there are many ways to help manage the condition.
  • Your health care professional can discuss techniques, strategies and resources that maybe useful to help manage your problem.
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