Four in every five patients with early inflammatory arthritis are at risk of long-term disability and reduced life expectancy due to delays in NHS treatment.
2nd annual report – National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis
Up to a million Britons are at risk of preventable, long-term disability and reduced life expectancy due to delays in referrals to specialist advice and treatment services, according to the most comprehensive audit of rheumatology services carried out across England and Wales.
The report by the British Society for Rheumatology reveals that nationally just 20 per cent of patients who see a GP with suspected rheumatoid and early inflammatory arthritis are referred to specialist services within the three-day limit recommended by the National Institute for Health and Care Excellence (NICE). For some health providers, this wait is over 20 weeks for a quarter of their patients. Nationally, fewer than half of patients who are referred are seen by a specialist within the three-week time limit recommended by NICE. For some providers, a quarter of patients are waiting more than 12 weeks.
The report reveals considerable differences in achievement rates for the standards across England and Wales. A ‘postcode lottery’ means that depending on where a patient lives, they are far more or less likely to access treatment at an early stage and hence prevent the disease becoming more advanced and life-shortening. For example, patients in Wales are half as likely to see a specialist within three weeks as those living in London.
The audit data points to several reasons for the delays in accessing services including the overall number of rheumatology specialists needed to diagnose and treat the disease. The BSR calculates that consultant levels are 21% below Royal College of Physicians recommended levels, and the number of additional consultants needed is likely to increase as the demand for rheumatology services increase. The latest report also shows a link between numbers of specialist nurses and an ability to commence treatment in a timely manner and achieve treatment targets.
Other findings include:
- 68% of patients were treated with disease modifying drugs within 6 weeks of referral (NICE Quality Standard 3), up from 53% in year 1; there was a strong correlation between nurse staffing levels and timely initiation of treatment.
- 95% of patients agreed that they had a good experience of specialist care, up from 78% in year 1. 1% of patients disagreed, which is an unchanged statistic from year 1 even with the increase in sample size.
- Data from the audit is being used to facilitate discussions with commissioners with a view to delivering better patient care.
There are significant personal and society costs linked with inflammatory and rheumatoid arthritis. These are some of the most common debilitating medical conditions in the UK. Around 10 million people have a form of arthritis, of which almost 700,000 have rheumatoid arthritis. Around 12,000 children suffer from juvenile idiopathic arthritis, the childhood equivalent disease. The arthritis can be so severe that those with the disease cannot bathe or dress themselves or perform simple tasks such as walking a short distance. Rheumatic conditions do not only damage joints but can also damage vital organs, including the lungs, heart, nervous system, kidneys, skin and eyes if not adequately treated.
One third of sufferers will have stopped working within two years of onset, and half will be unable to work within ten years. Rheumatoid arthritis is a major cause of sickness absence and unemployment, and this is estimated to cost around £1.8 billion per year. It has been estimated that reducing work limitations and loss of work, can save the UK economy around £31 million a year for rheumatoid arthritis alone. Patients are twice as likely to experience depression and have similar risks of cardiovascular disease as patients with diabetes.
The audit’s recommendations include:
- Increase awareness amongst the general public of the symptoms of inflammatory arthritis and the need for quick treatment to prevent it progressing
- Increase GP’s awareness of the varied symptoms and in particular the need for referral within the NICE guidelines in order to maximise the efficiency of treatment programmes and prevent the disease progressing into more serious, later stages.
- Analyse and understand variation in performance against the key standards
- Review the adequacy of specialist nurse provision, given the strong association between staffing levels and timely delivery of intensive treatment.
- Support national audit data collection.