joint replacementThe treatment of rheumatoid arthritis, which costs the NHS £560m annually, is not given a high enough priority according to a new report. It calls for a more collaborative approach, with National Health Service England taking a more strategic role in supporting local commissioning decisions.

RAising the Game: translating national policy into local action for rheumatoid arthritis services, is from the Association of the British Pharmaceutical Industry Rheumatology Initiative, and makes six recommendations. It was supported and reviewed by the patient charity, the National Rheumatoid Arthritis Society and the medical body, the British Society for Rheumatology.

In a joint statement in the report they said that the planning and prioritisation for musculoskeletal (MSK) diseases including RA remains “disgracefully low” given the amount of time taken up by GP appointments and the high impact on the quality of life of sufferers. They added: “Whilst these initiatives are positive steps, the report identifies a number of challenges, including the incoherent nature of the reforms to date, which may compromise their effectiveness.”

Professor Peter Taylor, Norman Collison Chair of Musculoskeletal Sciences at Oxford University said: “It is essential all Clinical Commissioning Group’s start to think actively about the needs of this group of patients and the particular needs of the population they serve. There is compelling evidence that the best long-term outcomes achievable are associated with early and optimal treatment intervention. We cannot yet prevent RA but by speedier diagnosis and treatment we can optimise outcomes and mitigate its impact on individual patients, the wider society and the NHS. We can reduce comorbidities and the need for surgical intervention, preventing disability and maintaining employment status and independence.”

There are 580,000 RA suffers in England alone. RA is a chronic and progressive autoimmune disease. It results in a great deal of pain and disability associated with the swelling of joints, particularly the hands, feet and wrists. It can also lead to damage of internal organs including the heart, eyes and lungs. However, people with RA often experience delays in referral, diagnosis and treatment which can cause their condition to worsen unnecessarily, causing long-term damage that may have been prevented. Late diagnosis also increases the economic burden on the NHS.

The costs of poor clinical outcomes are not just borne by the patients themselves. Families, carers, friends, work colleagues, the NHS and society all pay a heavy price, says the report. The National Audit Office estimates that RA costs the NHS £560 million a year and total costs which include the NHS, carers, nursing homes, private expenditure, sick leave and work related disability amount to £3.8-4.75 billion each year. 40% of sufferers lose their jobs within five years due to their condition and 4 in 5 do not have a care plan.

There have been various initiatives to improve the care of people with RA including:

  • NICE published a quality standard for RA in June 2013, designed to encourage the quick referral of patients with suspected RA to rheumatology units.
  • The Best Practice Tariff (BPT) was introduced countrywide in 2013 to provide a financial incentive to providers to deliver high quality services across the country.

In addition, the Secretary of State for Health has also identified long term conditions as a priority area of the NHS because of the strain they place on the health service. The report makes six key recommendations:
  • The National Audit Office should revisit its 2009 report, “Services for people with rheumatoid arthritis” and the subsequent recommendations made by the Public accounts Committee.
  • NICE and NHS England (NHSE) should take steps to improve awareness of RA and use of existing commissioning tools.
  • Local commissioners should take steps to assess the burden of disease associated with RA and prioritise accordingly.
  • The Department of Health (DH) and NHSE should work in partnership with the Health and Social Care Information Centre (HSCIC), the Healthcare Improvement Partnership and Right Care to improve the quality of data and develop national indicators for RS.
  • NHSE should review its systems for measuring performance for RA under the overarching improvement area of the NHS Outcomes Framework (NHS OF).
  • The DH’s Payment by Results team should review the payment threshold for the BPT, working to ensure that the barriers to implementation identified in this report are minimised