Services for people with rheumatoid arthritis
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.
"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."
Amyas Morse, the head of the National Audit Office
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.
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.
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.