2 Supporting people to live with rheumatoid
10. People with rheumatoid arthritis may suffer
unbearable pain as a result of a flare-up of their condition,
and when this happens they may not get access to the services
they need promptly and easily.
There are gaps in the support and information available to help
people with rheumatoid arthritis manage their condition. For example,
59% of people with the disease strongly agreed that a named person
they could turn to when they had a flare-up would help them manage
their disease better. The Department accepted that there were
shortcomings in access to services to help manage flare-ups, particularly
to specialists and at night.
As part of its programme for all people with chronic diseases,
it had given people with complex rheumatoid arthritis access to
a case manager, but that this would not be both day and night.
11. The Department recognised that better planning
and organisation of services could help with the management of
flare-ups by releasing the time of consultants in the acute sector
where patients currently seeing a specialist do not necessarily
need to do so. It
envisaged a combination of services, with patients seeing both
GPs and specialists and with a mixture of pain relief and anti-rheumatic
drugs as the way forward.
Although there were examples where primary and community services
worked effectively with specialists, the Department recognised
that good practice in looking after patients to manage flare-ups
in a systematic way was not widespread enough.
12. The focus on implementing an 18 week 'referral
to treatment' standard for new patients had meant that patients
already in the system had had problems accessing the services
they needed and had received slower or deficient treatment.
In its census of acute trusts, the National Audit Office found
that two- thirds of acute trusts were not able to provide follow-up
services to all people with rheumatoid arthritis who need them.
The Committee was concerned about instances where people needed
to be referred again by a GP when they needed follow-up appointments
or had suffered a flare-up and needed to see a specialist. The
Department did not recognise this problem but agreed to look into
13. Primary Care Trusts lack good information
on the extent and costs of rheumatoid arthritis in their local
populations which meant that the services they commissioned could
be limited and deficient. The Department accepted that the effect
of the National Institute for Health and Clinical Excellence guidelines,
the National Audit Office Report, and the Commissioning Pathway
for Inflammatory Arthritis would be to make Primary Care Trusts
re-examine the services they were delivering and where they could
14. While it did not recognise that existing
patients were receiving a deficient service,
the Department acknowledged that services could be better planned,
managed and delivered to make more efficient use of existing capacity
and to deliver improvements in quality.
This meant improving commissioning so that primary and community
services and hospitals worked more closely together in order to
provide more effective management in the community, such as by
making better use of specialist nurses in GP practices for the
review and monitoring of people with rheumatoid arthritis.
15. Evidence from the National Rheumatoid Arthritis
Society suggested that there were variations in spending on rheumatoid
arthritis between Primary Care Trusts ranging from £5.68
per head in Bexley to £17.58 per head in Gateshead, with
an English average of £10.97.
The Committee was concerned that these spending variations could
contribute to variations in service quality, and the risk of a
In its census of acute trusts, the National Audit Office had found
different levels of access to multidisciplinary services.
It also found that policies for funding new drugs for the treatment
of rheumatoid arthritis varied across Primary Care Trusts.
The Department said it would investigate whether there was any
correlation between levels of spending and service quality.
16. An example of particular concern to the Committee
was the variations in access to psychological services. Although
depression is common amongst people with rheumatoid arthritis,
just one in seven acute trusts provided access to psychological
services for people with rheumatoid arthritis who needed help
The Department acknowledged that the relationship between physical
and mental health had not been well understood nor supported in
the past, but said that 75% of Primary Care Trusts now had access
to psychological therapy services and that its 'Access to Psychological
Therapy' programme would be introduced across the whole NHS. It
also expected the forthcoming clinical guidelines from the National
Institute for Health and Clinical Excellence to reinforce the
importance of psychological therapy for people with rheumatoid
34 Qq 10, 21 and 24 Back
Qq 11 and 65 Back
Q 11 Back
Q 65 Back
Q 10 Back
Q 65 Back
Qq 19, 20, 63 and 64 Back
C&AG's Report, para 4.6 Back
Q 21 and 22 Back
Q 57 Back
Q 64 Back
Qq 61, 62 and 65 Back
Qq 34 and 65 Back
Ev 18 Back
Qq 67 and 70 Back
C&AG's Report, para 3.16 Back
C&AG's Report, para 3.8 Back
Q 69 Back
Q 8 Back
Q 8 Back