We are supporting better care for patients with arthritis through the Getting It Right First Time Programme (GIRFT) for Rheumatology. The GIRFT rheumatology programme is supporting the National Health Service to deliver care more equitably across England and closer to patients’ homes and improve services nationally.

As part of the GIRFT Musculoskeletal (MSK) Delivery Programme, GIRFT teams are working with health system leaders to reduce MSK community waiting times, including for patients with arthritis, and improve referral pathways to wider support services.

As part of a major transformation of the NHS under the 10-Year Health Plan, patients with MSK conditions, such as arthritis, will also soon be able to directly access community services, including physiotherapy, pain management, and orthopaedics, in the NHS App. The landmark change will deliver faster treatment for the flare up of existing conditions, including arthritis, back pain, and joint pain, while enabling general practitioners to focus on more complex cases, reducing pressure on hospitals, and freeing up general practices.

National Institute for Health and Care Excellence (NICE) guidelines are informed by clinical expertise, are evidence-based, and represent best practice. While NICE guidance is not mandatory, the Government expects commissioners and service providers to take them fully into account in designing services that meet the needs of their local population and to work towards their implementation over time.

Librela Solution for Injection for Dogs is an authorised injectable veterinary medicinal product containing the active substance bedinvetmab. It is indicated for the alleviation of pain associated with osteoarthritis in dogs.

We continue to actively monitor the reported adverse events in dogs that have been administered Librela.

DSIT funds medical research through UK Research and Innovation (UKRI) and the Department of Health and Social Care funds research through the National Institute for Health and Care Research (NIHR).

UKRI’s Medical Research Council (MRC) supports the best scientific research to improve human health, with work ranging from molecular level science to public health medicine. MRC plays a key role in funding underpinning research which may not be attributable to a specific disease but will benefit medical research more generally. As part of this, UKRI funds research on immunology which is relevant to all of these diseases and will not be categorised per disease.

Details of UKRI and NIHR funding on specific areas is provided in the table below:

The Department does collect information on Access to Work applicant’s primary medical condition, however we do not hold information to the level required to identify people with the specific conditions requested. Therefore, we are not able to make an estimate of the number of people that have applied for, or been approved, for support through the Access to Work scheme.

Information on Access to Work volumes for approvals and recipients by primary medical condition are published annually in the official statistics found here.

The information is not available in the format requested. Data on waiting lists is not collected by age breakdown.

Clinical commissioning groups (CCGs) are primarily responsible for commissioning services to meet the requirements of their population, including the obese and smokers. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence and take into account national guidelines.

The evidence suggests that major surgery poses higher risks for severely overweight patients who smoke. CCGs are therefore right to ensure these patients first get support to lose weight and try and stop smoking before their operation. Reducing obesity and cutting smoking not only benefits patients but also saves money for the National Health Service and taxpayers.

This does not and cannot mean blanket bans on particular patients such as smokers or overweight people getting operations, which would be inconsistent with the NHS Constitution.

There are no current plans to review the ’10 year rule’ with respect to the prescription for osteoarthritis of the knee for specific mining occupations.

I am advised on matters relating to the Industrial Injuries Scheme by the Industrial Injuries Advisory Council (IIAC). IIAC keeps all occupational diseases under continuous review, including osteoarthritis of the knee, and is always ready to receive and consider robust scientific evidence from any source.

Information concerning the number of people diagnosed with osteoarthritis on an annual basis is not collected and the Department has made no specific estimate of the cost of osteoarthritis to the NHS. Although some relevant costing data are captured, such as those relating to hip fracture, total costs are not available, as additional costs are incurred out of hospital and in other services where data are not available.

Information concerning the number of people diagnosed with osteoarthritis on an annual basis is not collected and the Department has made no specific estimate of the cost of osteoarthritis to the NHS. Although some relevant costing data are captured, such as those relating to hip fracture, total costs are not available, as additional costs are incurred out of hospital and in other services where data are not available.

The National Institute for Health and Care Excellence clinical guideline ‘Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children’ published in 2006, makes recommendations on the treatment of obese patients. The guideline outlines that patients who are overweight or obese should be assessed for a number of conditions, including osteoarthritis.

No assessment has been made of the advice given by healthcare practitioners to patients with knee osteoarthritis. In 2008, the National Institute for Health and Care Excellence (NICE) published ‘Osteoarthritis: the care and management in adults’, which sets out best practice on the diagnosis treatment, care and support of patients with this condition, including patients suffering from osteoarthritis of the knee.

Healthcare practitioners in the National Health Service are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not replace the knowledge and expertise of practitioners, who should make decisions on a case by case basis, taking into account the individual circumstances of each patient.

The NICE Osteoarthritis clinical guideline was updated and replaced in February 2014 and can be found on the NICE website at the following link:

www.nice.org.uk/guidance/cg177/resources/guidance-osteoarthritis-pdf.

This information is not available. Although some information on post-operative complications experienced by osteoporosis patients following surgery of the hip and knee is available via the Health and Social Care Information Centre’s Patient Reported Outcome Measures (PROMs) data collection, this only covers hip and knee replacement, and not the full range of surgical interventions. In addition to this, as PROMs is a voluntary reporting system the data published does not reflect the total number of osteoporosis patients having complications for all hip and knee replacements. More information on PROMS data can be found at the following link:

www.hscic.gov.uk/proms

Public Health England has considered the link between obesity (including morbid obesity) and osteoarthritis.

The role of obesity as a strong risk factor for the development of knee osteoarthritis is well documented^{1,2. There is less evidence on the relationship between obesity and osteoarthritis of the hip or hand.}

A recent meta-analysis found that obese people were almost four times more likely to develop knee osteoarthritis than those with a healthy body weight^{2, 3}.¹ Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology. 2012 Apr;20(2):53-8.² Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010;18(1):24-33.³ Muthuri SG, Hui M, Doherty M, Zhang W. What if we prevent obesity? Risk reduction in knee osteoarthritis estimated through a meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2011 Jul;63(7):982-90.

Information is not available in the format requested.

Information on the number of weeks waited for finished admission episodes with a joint replacement as the main operative procedure for patients with a diagnosis of osteoarthritis resident in the former East Lancashire Teaching Primary Care Trust (PCX) area from 2009-10 to 2011-12 is shown in the following table:

Through our Mandate to the NHS, we have asked NHS England to make measurable progress towards making our health service among the best in Europe at supporting people with ongoing health problems, such as osteoarthritis, to live healthily and independently/with much better control over the care they receive. The

NHS Outcomes Framework contains the indicators that will be used to hold NHS England to account for making progress.

One of NHS England's objectives is to ensure the NHS becomes dramatically better at involving patients and their carers, and empowering them to manage and make decisions about their own care and treatment. Achieving this objective would mean that by 2015; the 5 million carers who look after friends and family members will routinely have access to information and advice about the support available, including respite care.

It is for clinical commissioning groups (CCGs) in partnership with local stakeholders, including local government and the public to assess the needs of their local population and to commission services accordingly. CCGs will work closely with public health colleagues in this assessment to address local needs within the health community including physiotherapy.

Local authorities are now responsible for commissioning weight management services. Public Health England will work with and support local authorities to tackle obesity and is currently developing its work programme to do this. The programme will include support to local authorities to commission weight management services in England.

Through our Mandate to the NHS, we have asked NHS England to make measurable progress towards making our health service among the best in Europe at supporting people with ongoing health problems, such as osteoarthritis, to live healthily and independently/with much better control over the care they receive. The

NHS Outcomes Framework contains the indicators that will be used to hold NHS England to account for making progress.

One of NHS England's objectives is to ensure the NHS becomes dramatically better at involving patients and their carers, and empowering them to manage and make decisions about their own care and treatment. Achieving this objective would mean that by 2015; the 5 million carers who look after friends and family members will routinely have access to information and advice about the support available, including respite care.

It is for clinical commissioning groups (CCGs) in partnership with local stakeholders, including local government and the public to assess the needs of their local population and to commission services accordingly. CCGs will work closely with public health colleagues in this assessment to address local needs within the health community including physiotherapy.

Local authorities are now responsible for commissioning weight management services. Public Health England will work with and support local authorities to tackle obesity and is currently developing its work programme to do this. The programme will include support to local authorities to commission weight management services in England.

Through our Mandate to the NHS, we have asked NHS England to make measurable progress towards making our health service among the best in Europe at supporting people with ongoing health problems, such as osteoarthritis, to live healthily and independently, with much better control over the care they receive. The NHS Outcomes Framework contains the indicators that will be used to hold NHS England to account for making progress.

It is for clinical commissioning groups (CCGs) in partnership with local stakeholders, including local government and the public to assess the needs of their, local population and to commission services accordingly.

CCGs will work closely with public health colleagues in this assessment to address local needs within the health community including physiotherapy.

Local authorities are now responsible for commissioning weight management services. Public Health England (PHE) is actively engaged in exploring ways in which the new public health system can support older people with long-term conditions and disabilities to maximise their health and wellbeing. PHE will work with and support local authorities to tackle obesity and is currently developing its work programme to do this. The programme will include support to local authorities to commission weight management services in England.