Press Release - Services for people
with rheumatoid arthritis
15 July 2009
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 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 PCTs are not
commissioning as effectively as they could as they do not know the
numbers of people in their area with rheumatoid
arthritis.
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 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."
Notes for Editors
-
Rheumatoid arthritis is an autoimmune
condition in which the immune system attacks the tissue within the
joint, leaving it painful and inflamed. If left untreated,
the joint can lose its shape and alignment and can eventually be
destroyed completely. Unlike osteoarthritis, which affects
only the joints, rheumatoid arthritis can also cause inflammation
of other parts of the body, such as tear glands and salivary glands
and it can also damage the lining of the heart and lungs.
-
Severe rheumatoid arthritis can shorten life
expectancy by six to ten years – this is equivalent to the impact
of diabetes, stroke or coronary heart disease. Depression is
common amongst people with the disease. The disease is
incurable, but there are a range of treatments which can slow
damage to joints and there is increasing evidence that aggressive
treatment very soon after the onset of symptoms can lead to
remission.
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The NAO’s economic modelling shows that if an
additional 10 per cent of people with rheumatoid arthritis (around
2,600 patients) were treated within three months of symptom onset,
this earlier treatment could result in productivity gains of £31
million over five years for the economy due to reduced sick leave
and lost employment, with a cost to the NHS of £11 million.
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An international comparison report on services
for people with rheumatoid arthritis, surveys of GPs, people with
arthritis and patient groups, a census of acute trusts, a UK and
international literature review, and two economic models are
published on the NAO website.
-
Press notices and reports are available from
the date of publication on the NAO website, which is at
www.nao.org.uk. Hard copies can be obtained
from The Stationery Office on 0845 702 3474.
-
The Comptroller and Auditor General, Amyas
Morse, is the head of the National Audit Office which employs some
900 staff. He and the NAO are totally independent of
Government. He certifies the accounts of all Government
departments and a wide range of other public sector bodies; and he
has statutory authority to report to Parliament on the economy,
efficiency and effectiveness with which departments and other
bodies have used their resources.
Press Notice 40/09
All enquiries to Sarah Farndale, NAO Press
Office:
Tel: 020 7798 5350
Mobile: 07985 274 421