Amyas Morse, the head of the National
Audit Office, said today: "Patients with this debilitating and
distressing disease are not identified or treated quickly enough
and this dramatically affects long-term outcomes and people’s
ability to remain in work. The National Health Service (NHS) should
take a more co ordinated approach to identifying people with
symptoms of early rheumatoid arthritis, so that they get access to
specialist care quickly and receive support and advice to help them
manage and live with the disease. This would provide better value
for money, better outcomes for patients, and lead to productivity
gains for the economy. Some of the systemic improvements needed to
manage and control this disease also apply to other long-term
conditions requiring specialist-led
care."
Too many people with rheumatoid arthritis are
not being diagnosed or treated quickly enough, and some services
for people with the disease are not coordinated enough, according
to a report published today by the National Audit Office. Delay in
treatment is detrimental to patients’ health, their quality of life
and, with three quarters of people of working age when diagnosed,
the economy. The estimated cost to the economy of sick leave and
work-related disability for people with rheumatoid arthritis is
£1.8 billion a year.
Rheumatoid arthritis costs the NHS an
estimated £560 million annually. The National Audit Office
estimates that approximately 580,000 adults in England currently
have the disease with a further 26,000 new cases diagnosed each
year. Better coordinated services would lead to earlier
identification of new cases, productivity gains for the economy,
and improved outcomes for patients. The NHS does not consistently
provide support for people with the disease to remain in, or get
back into, work, with a lack of local links between the NHS and
Jobcentre Plus services.
Early diagnosis is the key to the successful
treatment of rheumatoid arthritis (ideally within three months of
symptom onset), but public awareness of the disease is low. Between
half and three quarters of people with rheumatoid arthritis delay
seeking medical help from their General Practitioner (GP) for three
months or more following symptom onset and around a fifth delay for
a year or more. The disease is difficult to diagnose and requires
specialist knowledge; and few GPs have the specialist expertise
required to diagnose rheumatoid arthritis which can lead to further
delays, with patients on average visiting their GP four times
before being referred to a specialist for diagnosis and treatment.
The average length of time from symptom onset to treatment is nine
months, compared to the clinically recommended period of three
months, and this has not improved in the past five years.
There is inconsistent coordination of the
roles and activities of staff in different parts of the NHS: for
example between GPs and hospital specialists. Furthermore, many
patients do not have sufficient access to psychological services
even though depression is common for people with rheumatoid
arthritis; and the provision of quick response appointments in the
event of a flare up is inconsistent. Current services also do
not always match the Government’s vision of a “systematic
patient-centred approach” and the majority of Primary Care Trusts
are not commissioning as effectively as they could as they do not
know the numbers of people in their area with rheumatoid
arthritis.