Improvements to rheumatology services recommended

The National Rheumatoid Arthritis Society (NRAS) has reported that it is delighted that the Public Accounts Committee (PAC) has endorsed the recommendations of the National Audit Office and their own recommendations for improvements to rheumatology services that will improve patient outcomes and make better use of public resources.

The PAC has called for Government led initiatives to improve training for GPs on rheumatoid arthritis (RA), launch a public awareness campaign about the symptoms of RA to improve chances of earlier diagnosis and direct programmes to get people with RA back into work.

The PAC report ‘Services for people with Rheumatoid Arthritis', is the Committee's response to the National Audit Office report of the same name, published in July 2009.

The PAC has made vital recommendations on how services for RA patients can be made more equal, supporting the conclusions of the Kings Fund report into RA services, published in January 2009 in conjunction with the Rheumatology Futures Group of which NRAS CEO Ailsa Bosworth is Joint Chair.

Evidence provided to the PAC by NRAS showed a threefold difference between the highest and lowest levels of spending by PCTs on RA services in England. (See Notes to Editors) The Committee has recommended that the Department of Health set national benchmarks for PCT spending and that SHAs should hold them to account for local variations. NRAS believe that this is a necessary step in providing fairer access to the best RA care for all patients.

NRAS works tirelessly to help educate and empower people with RA to help them manage their condition more effectively. They have recently partnered with the EPPCIC (Expert Patients Programme) to develop a self management programme which was successfully piloted in 3 locations in England at the end of 2008. Three further pilots will run over the next 2-3 months. NRAS were therefore delighted that the PAC has recommended that the Department of Health produce an action plan by March 2010 on improving access to flare up and pain management services for RA patients.

Responding to the PAC report, NRAS founder and Chief Executive Ailsa Bosworth said: “NRAS wholly support the Public Accounts Committee's recommendations. It is vital that resources are targeted on education and awareness for patients and clinicians to ensure that patients seek help at an earlier stage when they experience symptoms and are referred rapidly to specialist care for diagnosis and commencement of treatment. Early intervention is vital to prevent the progression of RA and disability later in life so that people are able to remain in work. NRAS and the Rheumatology Futures Group look forward to working with the Department of Health to help implement the Committee's recommendations.”

‘Services for people with Rheumatoid Arthritis': KEY STATS

Lack of GP awareness

· NAO reports that people with RA visit a GP on average four times before being referred to a specialist.

· 18% of patients visit more than eight times before being referred.

· This costs the NHS £6 million a year in unnecessary, repeated visits.

Lack of public awareness

· The NAO identified that between half and three quarters of people with RA delay seeking medical help from their GP for three months or more following the onset of symptoms.

· A fifth of patients delay seeking help for a year.

· The NAO has identified that this could be addressed by increasing the number of people diagnosed with RA in the first three months from the current 10% to 20%.

· This increase in earlier treatment could result in productivity gains of £31 million for the economy due to reduced sick leave and lost employment.

Inefficient use of resources in musculoskeletal care

· In 2008/9 NHS expenditure on musculoskeletal conditions increased from £3.5 billion to almost £4.1 billion – an increase of over 15%. (Department of Health, Programme budgeting data 2007-08, 16 July 2009) but this did not result in improvements in outcomes.

Local variations in RA spending

· NRAS has undertaken an analysis of the level of spending on rheumatoid arthritis services in each PCT area. Spending varies from £5.68 per head in Bexley PCT to £17.58 per head in Gateshead PCT with an England average level of £10.97 per head.

· The NAO report revealed that 71% of PCTs had not carried out a local needs assessment for rheumatology services overall and 73% had not undertaken any assessment to establish the number of people with RA living in the locality.

Employment Support

· The NAO estimated that for the cost to the economy of sick leave and work-related disability for people with RA is £1.8 billion a year.

· Only 20% of those surveyed by the NAO stated that they had received sufficient information about employment issues.

· Only 12% of GPs surveyed offered people diagnosed with RA information on staying in work.

· NRAS research has shown that once on Incapacity Benefit (Employment and Support Allowance) 80% of people with musculoskeletal conditions never return to work.

The National Rheumatoid Arthritis Society (NRAS) was launched in October 2001 and is now established as the campaigning voice in the UK for people with Rheumatoid Arthritis. NRAS provides a total one-stop-shop with support, information and advocacy for all people in the UK with RA, their carers and families.

NRAS has a national volunteer network, a group of people with the disease who provide peer to peer support and provide additional resource to help NRAS in many different ways.

For more information about NRAS go HERE

Spending on rheumatoid arthritis services per head of population in 2007-08

(Calculation by NRAS)

Primary Care Trust	Expenditure on musculoskeletal services in 2007-08 (£000s)	Estimated expenditure on rheumatoid arthritis (£000s)	Total population	Estimated expenditure on rheumatoid arthritis services per head of population (£)
Bexley Care Trust	£8,268	£1,197	210,846	£5.68
Camden PCT	£9,596	£1,389	232,476	£5.97
Luton PCT	£8,311	£1,203	185,044	£6.50
Ealing PCT	£14,614	£2,115	320,247	£6.60
Hounslow PCT	£10,367	£1,501	220,839	£6.79
Barking and Dagenham PCT	£7,867	£1,139	165,224	£6.89
Brent Teaching PCT	£13,354	£1,933	279,831	£6.91
City and Hackney Teaching PCT	£10,523	£1,523	220,479	£6.91
Richmond and Twickenham PCT	£8,385	£1,214	172,967	£7.02
Redbridge PCT	£11,764	£1,703	239,977	£7.10
South West Essex PCT	£19,575	£2,833	397,364	£7.13
Hammersmith and Fulham PCT	£8,409	£1,217	169,996	£7.16
Westminster PCT	£12,072	£1,747	234,500	£7.45
Wandsworth PCT	£14,873	£2,153	280,145	£7.68
Kensington and Chelsea PCT	£10,187	£1,474	190,514	£7.74
Bradford and Airedale PCT	£26,670	£3,860	497,635	£7.76
South East Essex PCT	£17,948	£2,598	333,348	£7.79
Solihull Care Trust	£11,131	£1,611	206,552	£7.80
Mid Essex PCT	£19,364	£2,803	356,281	£7.87
Leicester City PCT	£17,147	£2,482	308,699	£8.04
Bedfordshire PCT	£23,096	£3,343	411,716	£8.12
West Hertfordshire PCT	£30,332	£4,390	536,390	£8.18
Kirklees PCT	£22,372	£3,238	391,969	£8.26
Wakefield District PCT	£19,045	£2,757	333,186	£8.27
Berkshire East PCT	£22,056	£3,192	384,225	£8.31
Blackpool PCT	£8,173	£1,183	140,104	£8.44
Telford and Wrekin PCT	£9,516	£1,377	160,910	£8.56
Islington PCT	£11,079	£1,604	187,275	£8.56
Calderdale PCT	£11,877	£1,719	200,421	£8.58
Suffolk PCT	£34,858	£5,045	587,972	£8.58
Leeds PCT	£45,813	£6,631	767,081	£8.64
Croydon PCT	£20,313	£2,940	335,142	£8.77
Portsmouth City Teaching PCT	£12,231	£1,770	199,522	£8.87
East and North Hertfordshire PCT	£34,163	£4,945	549,793	£8.99
Buckinghamshire PCT	£30,897	£4,472	496,622	£9.00
Kingston PCT	£10,842	£1,569	172,013	£9.12
Southwark PCT	£16,413	£2,376	258,245	£9.20
Medway PCT	£16,975	£2,457	265,207	£9.26
Cambridgeshire PCT	£36,949	£5,348	577,074	£9.27
Havering PCT	£15,276	£2,211	237,212	£9.32
East Riding Of Yorkshire PCT	£19,703	£2,852	304,296	£9.37
Doncaster PCT	£19,016	£2,752	293,143	£9.39
Hull PCT	£18,187	£2,632	280,044	£9.40
West Kent PCT	£43,203	£6,253	662,250	£9.44
Manchester PCT	£32,085	£4,644	485,511	£9.57
North Tyneside PCT	£13,504	£1,955	204,085	£9.58
North Lincolnshire PCT	£10,542	£1,526	158,259	£9.64
Liverpool PCT	£29,696	£4,298	443,988	£9.68
Greenwich Teaching PCT	£15,423	£2,232	230,462	£9.69
Lambeth PCT	£19,502	£2,823	289,747	£9.74
Enfield PCT	£18,076	£2,616	267,869	£9.77
Darlington PCT	£6,631	£960	98,203	£9.77
County Durham PCT	£34,556	£5,002	509,491	£9.82
Sheffield PCT	£36,525	£5,287	534,251	£9.90
Hampshire PCT	£85,266	£12,341	1,235,910	£9.99
Berkshire West PCT	£31,766	£4,598	455,101	£10.10
Derbyshire County PCT	£48,630	£7,039	692,696	£10.16
Stoke On Trent PCT	£18,211	£2,636	258,117	£10.21
South Staffordshire PCT	£41,309	£5,979	583,057	£10.25
West Essex PCT	£18,563	£2,687	261,656	£10.27
Worcestershire PCT	£38,780	£5,613	545,377	£10.29
Harrow PCT	£14,239	£2,061	198,505	£10.38
Bristol PCT	£30,762	£4,452	428,124	£10.40
North East Lincolnshire Care Trust	£11,853	£1,716	163,551	£10.49
Sutton and Merton PCT	£27,511	£3,982	377,654	£10.54
North Yorkshire and York PCT	£55,919	£8,094	767,344	£10.55
Rotherham PCT	£17,781	£2,574	243,888	£10.55
South Birmingham PCT	£25,331	£3,666	347,014	£10.57
Torbay Care Trust	£10,211	£1,478	139,121	£10.62
North East Essex PCT	£23,355	£3,380	317,972	£10.63
Great Yarmouth and Waveney PCT	£16,281	£2,357	220,674	£10.68
Lewisham PCT	£18,996	£2,749	257,419	£10.68
Haringey Teaching PCT	£17,792	£2,575	240,403	£10.71
Bromley PCT	£22,622	£3,274	303,504	£10.79
Cornwall and Isles Of Scilly PCT	£39,395	£5,702	525,942	£10.84
Tower Hamlets PCT	£16,073	£2,326	214,523	£10.84
Northamptonshire PCT	£50,287	£7,279	660,508	£11.02
Bournemouth and Poole PCT	£24,842	£3,596	321,235	£11.19
Bury PCT	£14,086	£2,039	182,116	£11.20
Wiltshire PCT	£33,732	£4,882	434,921	£11.23
Nottingham City PCT	£23,709	£3,432	305,234	£11.24
Brighton and Hove City PCT	£20,263	£2,933	259,100	£11.32
Barnet PCT	£26,126	£3,781	331,471	£11.41
East Lancashire PCT	£29,537	£4,275	373,519	£11.45
Isle of Wight NHS PCT	£10,947	£1,584	137,985	£11.48
Herefordshire PCT	£13,871	£2,008	174,778	£11.49
Peterborough PCT	£11,884	£1,720	149,603	£11.50
South Gloucestershire PCT	£19,257	£2,787	242,175	£11.51
West Sussex PCT	£61,650	£8,923	773,856	£11.53
Sandwell PCT	£24,054	£3,482	301,397	£11.55
Bassetlaw PCT	£8,517	£1,233	106,594	£11.56
North Staffordshire PCT	£16,342	£2,365	204,101	£11.59
Warwickshire PCT	£41,377	£5,989	516,157	£11.60
Leicestershire County and Rutland PCT	£51,892	£7,511	645,279	£11.64
Coventry Teaching PCT	£25,972	£3,759	322,771	£11.65
Walsall Teaching PCT	£20,099	£2,909	249,756	£11.65
Northumberland Care Trust	£25,165	£3,642	311,274	£11.70
Birmingham East and North PCT	£32,196	£4,660	398,186	£11.70
Heywood, Middleton and Rochdale PCT	£16,539	£2,394	203,963	£11.74
Gloucestershire PCT	£47,058	£6,811	579,098	£11.76
Warrington PCT	£15,740	£2,278	192,778	£11.82
Waltham Forest PCT	£18,725	£2,710	228,251	£11.87
Oxfordshire PCT	£50,412	£7,297	612,823	£11.91
Dudley PCT	£24,837	£3,595	301,297	£11.93
Lincolnshire PCT	£58,350	£8,446	698,635	£12.09
Halton and St Helens PCT	£25,512	£3,693	304,194	£12.14
Surrey PCT	£90,124	£13,045	1,072,388	£12.16
Swindon PCT	£16,195	£2,344	192,541	£12.17
Shropshire County PCT	£24,050	£3,481	285,158	£12.21
Norfolk PCT	£61,094	£8,843	723,638	£12.22
Hillingdon PCT	£20,365	£2,948	240,291	£12.27
Dorset PCT	£32,906	£4,763	382,266	£12.46
Wolverhampton City PCT	£20,463	£2,962	237,535	£12.47
South Tyneside PCT	£13,037	£1,887	150,957	£12.50
Trafford PCT	£18,223	£2,638	210,704	£12.52
Central and Eastern Cheshire PCT	£38,943	£5,637	445,787	£12.64
Tameside and Glossop PCT	£19,835	£2,871	225,259	£12.74
North Tees PCT	£16,689	£2,416	188,522	£12.81
Middlesbrough PCT	£12,781	£1,850	144,105	£12.84
Bolton PCT	£23,404	£3,387	262,529	£12.90
Blackburn with Darwen PCT	£13,512	£1,956	151,187	£12.94
Heart of Birmingham Teaching PCT	£25,502	£3,691	282,156	£13.08
Stockport PCT	£25,502	£3,691	281,488	£13.11
Devon PCT	£66,378	£9,608	732,201	£13.12
Newcastle PCT	£23,711	£3,432	260,861	£13.16
Derby City PCT	£24,729	£3,579	271,023	£13.21
Newham PCT	£23,604	£3,416	254,504	£13.42
Sefton PCT	£25,640	£3,711	270,639	£13.71
Hartlepool PCT	£8,662	£1,254	91,132	£13.76
Eastern and Coastal Kent PCT	£68,302	£9,886	715,899	£13.81
Sunderland Teaching PCT	£26,183	£3,790	273,990	£13.83
Cumbria PCT	£48,141	£6,968	502,103	£13.88
North Somerset PCT	£19,373	£2,804	201,811	£13.89
Knowsley PCT	£14,653	£2,121	150,286	£14.11
North Lancashire PCT	£31,912	£4,619	326,341	£14.15
Nottinghamshire County PCT	£62,796	£9,089	638,935	£14.23
Western Cheshire PCT	£24,205	£3,503	245,689	£14.26
Central Lancashire PCT	£43,959	£6,363	438,711	£14.50
East Sussex Downs and Weald PCT	£32,783	£4,745	326,732	£14.52
Milton Keynes PCT	£23,346	£3,379	232,448	£14.54
Redcar and Cleveland PCT	£13,359	£1,934	132,813	£14.56
Salford PCT	£22,473	£3,253	222,861	£14.60
Hastings and Rother PCT	£18,137	£2,625	171,398	£15.32
Oldham PCT	£23,714	£3,432	222,362	£15.44
Barnsley PCT	£24,698	£3,575	231,551	£15.44
Bath and North East Somerset PCT	£19,883	£2,878	186,018	£15.47
Plymouth Teaching PCT	£26,830	£3,883	250,297	£15.52
Ashton, Leigh and Wigan PCT	£32,870	£4,758	301,596	£15.77
Somerset PCT	£56,685	£8,205	513,108	£15.99
Wirral PCT	£34,407	£4,980	309,821	£16.07
Southampton City PCT	£27,679	£4,006	245,611	£16.31
Gateshead PCT	£23,570	£3,412	194,043	£17.58

ENGLAND AVERAGE				£10.97