Continued lack of local prioritisation of rheumatoid arthritis services in the UK, reveals new research

Five years ago, the UK’s National Audit Office recommended widespread action to improve services for people with rheumatoid arthritis. But a new report states that progress at a local level has been limited, and where national initiatives do exist, they lack the necessary incentives to foster local action.
Key findings from RAising the game: Translating national policy into local action for rheumatoid arthritis services are that:
• Local prioritisation of rheumatoid arthritis in planning documents is worryingly low; only 5% of joint strategic needs assessments mention the condition;
• Poor data makes it difficult for commissioners to identify rheumatoid arthritis as a problem and prioritise accordingly;
• Awareness and implementation of the NICE quality standard for rheumatoid arthritis has been limited;
• National initiatives such as the best practice tariff for inflammatory arthritis and the national clinical audit for rheumatoid arthritis are welcome but these systems need to adapt in order to have a greater impact.
Almost 580,000 people in England have rheumatoid arthritis, a debilitating disease that has significant resource implications for the NHS and the wider economy.
The total cost of rheumatoid arthritis in the UK, including indirect costs and work related disability, is around £3.8–4.75 billion each year. Yet the condition can be managed effectively with early diagnosis and appropriate treatment.
“The success of initiatives must be measured by the degree to which they have an impact on the ground,” explains Prof Peter C Taylor, chair of musculoskeletal science at the University of Oxford. “[The new report] argues that it is not sufficient for these policies to exist, they must be actively taken up by local clinicians and commissioners alike. The ABPI RI’s research indicates that this is not always the case.
“In a cash-strapped NHS, any initiatives that support greater prioritisation of rheumatoid arthritis on a local level must be welcomed. We cannot yet prevent rheumatoid arthritis but by speedier diagnosis and treatment we can mitigate its impact on individual patients, the wider society and NHS by optimising outcomes, reducing comorbidities, the need for surgical intervention thus preventing disability, maintaining employment status and independence.”
The analysis was undertaken by the ABPI RI with support from the National Rheumatoid Arthritis Society and British Society for Rheumatology, and was based on an assessment of local planning documents and engagement with Clinical Commissioning Groups and rheumatologists. Key recommendations are:
1. 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.
2. NICE and NHS England should take steps to improve awareness of rheumatoid arthritis and use of existing commissioning tools.
3. Local commissioners should take steps to assess the burden of disease associated with rheumatoid arthritis and prioritise accordingly.
4. The Department of Health and NHS England should work in partnership with the Health and Social Care Information Centre, the Healthcare Improvement Partnership and Right Care to improve the quality of data and develop national indicators for rheumatoid arthritis.
5. NHS England should review its systems for measuring performance for rheumatoid arthritis under the overarching improvement areas of the NHS Outcomes Framework.
6. The Department of Health’s Payment by Results team should review the payment threshold for the best practice tariff for early inflammatory arthritis, working to ensure that the barriers to implementation identified in this report are minimised.