By Ailsa Bosworth, CEO of the National Rheumatoid Arthritis Society

In November 2011 the then Minister for Long Term Conditions, Paul Burstow MP, commissioned health officials to conduct a scoping exercise into early diagnosis across the health service to understand the extent of delayed diagnosis and its impact on patients. At around the same time the Coalition Government launched a national dementia awareness campaign to encourage people to spot the early signs of the disease and earmarked £10 million for dementia memory services to improve early diagnosis and treatment of the condition. Since 2012 the Government has also piloted and run a number of ‘be clear on cancer’ campaigns and promoted National HIV testing week amongst other things.

Ailsa-blog-icon1These initiatives deserve rich praise. The links between early diagnosis and cancer are particularly well established and predictions about the unabated impact of dementia on future health and care services are simply frightening. The case of cancer and dementia is demonstrative of proper evidenced-based policy: presented with the facts the Coalition Government has formulated a response to try and maximise health gain and head off a looming crisis.

It is therefore slightly frustrating to see the Government’s focus on the overall importance of early diagnosis and long term conditions slipping slightly. More than two and a half years on from Burstow’s original announcement and the results of the scoping exercise on early diagnosis do not appear to have been released into the public domain. The current Minister for Long Term Conditions, Norman Lamb, a person for whom I have a huge amount of respect, has also not made any further, wider pronouncements since his appointment.

One of the most widely cited statistics about the NHS is that long term conditions account for 70% of expenditure on health and social care in England. Clearly, not every long term condition will respond to early diagnosis, but improving rates of early diagnosis for a particular range of long term conditions could make a sizeable dent into this area of expenditure.

Rheumatoid arthritis (RA) is one example where definitive evidence of the importance of early diagnosis exists. Patients diagnosed and started on appropriate treatment within 12 weeks of symptom onset are much more likely to have a better quality of life – staying in work and making a positive contribution to the economy. Moreover, the Public Accounts Committee estimates that doubling the number of people with RA that are early diagnosed from the current level of 10% to 20%, could result in productivity gains for the economy of £31 million over 5 years.

Section 2.11 of the latest NHS Mandate on ‘Enhancing quality of life for people with long term conditions’ already contains a specific objective on ensuring timely diagnosis of dementia. My suggestion is that the Government and NHS England simply extend this objective further to include other long term conditions that can present substantial supporting evidence.

Of course, introducing a commitment in the NHS Mandate will not solve the problems over night, but it is symbolic and it may help to overcome some of the present log-jam and help refocus on the need for a national approach. Persuading each individual CCG of the need to undertake a public awareness campaign around RA (or inflammatory arthritis) would take an unfathomable amount of time and resource which neither we, nor the NHS can afford.

Such is the urgent need for action, given the NHS’s diminishing resources and need to reduce service demand to sustainable levels, I believe the Government could do a lot worse than to announce a Long Term Conditions Challenge to try and set out a clear road-map for action and dedicate a work stream to early diagnosis. I use the terminology of Long Term Conditions Challenge deliberately to separate it from the idea of a National Strategy for Long Term Conditions, which the Government has already moved away from and align it more to the much publicised Dementia Challenge. Later this year the Bone and Joint Decade will also hold an international summit. A public declaration about the importance of early diagnosis by this global alliance would also help to send the right signals to policymakers.

Such a Challenge might involve Government working with stakeholders from the long term conditions sector and, using the best available clinical evidence, start to draw up a list of those conditions that respond most critically to early diagnosis, where there is compelling evidence of delay in presentation to GPs and onward referral. Once agreement is reached, objectives could then be drawn up in relation to pooling resources across Government, industry and the third sector and developing coordinated activity with community pharmacy and GP surgeries, as well as the media.

As momentum towards the next general election builds, NRAS wants to work with our 3rd sector and professional partners in the Arthritis and Musculoskeletal Alliance to try and move the subject of early diagnosis back up the agenda of political parties.

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