Services for people with rheumatoid arthritis - Public Accounts Committee Contents

2 Supporting people to live with rheumatoid arthritis

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.[34] 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.[35] 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.[36]

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.[37] 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.[38] 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.[39]

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.[40] 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.[41] 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 it.[42]

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 be improved.[43]

14.  While it did not recognise that existing patients were receiving a deficient service,[44] 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.[45] 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.[46]

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.[47] The Committee was concerned that these spending variations could contribute to variations in service quality, and the risk of a postcode lottery.[48] In its census of acute trusts, the National Audit Office had found different levels of access to multidisciplinary services.[49] It also found that policies for funding new drugs for the treatment of rheumatoid arthritis varied across Primary Care Trusts.[50] The Department said it would investigate whether there was any correlation between levels of spending and service quality.[51]

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 with depression.[52] 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 arthritis.[53]

34   Qq 10, 21 and 24 Back

35   Qq 11 and 65 Back

36   Q 11 Back

37   Q 65 Back

38   Q 10 Back

39   Q 65 Back

40   Qq 19, 20, 63 and 64 Back

41   C&AG's Report, para 4.6 Back

42   Q 21 and 22 Back

43   Q 57 Back

44   Q 64 Back

45   Qq 61, 62 and 65 Back

46   Qq 34 and 65 Back

47   Ev 18 Back

48   Qq 67 and 70 Back

49   C&AG's Report, para 3.16 Back

50   C&AG's Report, para 3.8 Back

51   Q 69 Back

52   Q 8 Back

53   Q 8 Back

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Prepared 23 February 2010