As Simon Stevens put it in his very first speech in his NHS England post
“If like me you believe in a tax-funded NHS, you’ll want the Health Service to play its part in growing our nation’s economy, precisely so we can sustain public health services for generations to come.” 
No single specialty is in a position to make a bigger contribution to this agenda than rheumatology. Musculoskeletal disorders (MSDs) represent the single biggest cause of sickness absence in the UK, accounting for more than 30 million sick days taken in 2013. 
We know that much sickness absence due to MSDs is avoidable. Provided with appropriate advice and support, many people could return to work. Giving such support will however require a change in the mindset of healthcare professionals in two important ways.
Firstly, the misguided belief that work is somehow incompatible with long-term conditions needs to be fundamentally challenged. There is a growing evidence of the therapeutic benefits of work in general and for those with MSDs. In many cases, staying active and remaining in work not only bring physical benefits but can also make a world of difference to individuals’ self-confidence, self-esteem and mental wellbeing.
Secondly, work needs to become a clinical outcome for patients of working age. Rheumatologists endeavor to return patients to functional capacity – for many this can and should include work. Rheumatologists need to ensure that work-related issues feature throughout the clinical episode. Patient surveys tell us that the issue of work comes up in conversations with healthcare professionals all too seldom. This has to change.
The management of MSDs can be a complex and expensive endeavour. If we want investment to be made in new diagnostics, treatments and workforce, we in the rheumatology community must also find ways to demonstrate return on that investment.
The inclusion of work in consultations does not cost much. Yet if implemented at scale, this small adjustment in the way that rheumatologists approach their conversations with their patients could make an enormous difference, not only to the health of the British workforce but to the British economy as a whole.
Dame Carol Black
Expert Advisor on Health and Work to the Department of Health & Principal of Newnham College Cambridge