Lack of NHS resources in Wales causing delays to Inflammatory arthritis diagnosis and treatment

Published: 6 Dec 2016

Rheumatology and arthritis societies raise concerns for arthritis services in Wales and call for more support to improve long-term patient outcomes.

The number of patients seen by Wales’ rheumatology departments is increasing, referrals are up 66% on 2012 levels, but resources for treatment aren’t keeping up with the demand say patients and clinicians. New patients are waiting longer for their rheumatology appointment and existing patients are struggling to secure follow ups and self-management advice. 

Such findings are important as there are 25,000 individuals with rheumatoid arthritis (RA) in Wales, with 12% of adults based in Wales identifying themselves as having some form of arthritis. This is almost the same number of people who identified as having a mental illness (13%) and significantly higher than those with diabetes (7%).

The findings are taken from a new reportfrom the British Society for Rheumatology (BSR) and the National Rheumatoid Arthritis Society (NRAS) Rheumatology in Wales: The State of Play which is released today. The report is part of a series of reports that investigate how rheumatology services are coping in the UK. When looking at service levels for new patients the report discovered:

  • The number of patients receiving a rheumatology appointment within 6 weeks of GP referral has declined over the last year to just 39% as of June 2016.Patients 22% of patients in Wales with RA in 2016 were being seen within three weeks, compared to the England and Wales average of 37%.*
  • Wales has the lowest number of Early Inflammatory Arthritis (EIA) Clinics compounding the service delays.
  • Wales is the best performing region of the UK for GP referrals within 3 days* of first presentation, 46% compared to the UK average of 20%.

Rheumatoid Arthritis (RA) patients already within the system also face problems, for example:

  • Four in ten patients reported that intervals between appointments were too long to keep their condition under control, and a third found it difficult or very difficult to get an appointment with their consultant.
  • Only 52% of patients in Wales received education and self-management for RA within one month of diagnosis compared to a national average of 67%.
  • 35% of NRAS’ survey respondents stated they were not given information on services or organisations who could give them further support, and 30% indicated nobody had spoken to them about the emotional impact of their condition.  

Early diagnosis, treatment and management of inflammatory arthritis conditions is crucial to avoiding long-term damage and disability, both of which commonly lead to unemployment and further burden on health and welfare support services.

Peter Lanyon, BSR President, commented: “Both feedback from our membership, the NRAS survey and the National Clinical Audit indicate variation in care across Wales for people living with inflammatory arthritis. We hope that this report should stimulate action across Wales to provide rheumatology services, and the professionals working within them, with the support they require to deliver consistently high quality care to their patients with rheumatic and musculoskeletal disorders.”

Rich Flowerdew, Welsh Ambassador for NRAS, said “These results are worrying and show that NHS Wales and Local Health Boards need to support rheumatology services to meet quality standards for the treatment of RA. It is abundantly clear that patients are not being seen enough within the 12-week window of opportunity of diagnosis. If patients are seen to within this window, their longer-term outcomes are better.”

The report incorporated a number of data sources which included an NRAS survey of 257 people with RA to gain greater understanding of their experience of health and care in Wales. In addition, BSR consulted many of its professional members, which consist of health professionals such as consultant rheumatologists, GPs, physiotherapists and specialist nurses who work in Wales. The report also includes the data from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis of which BSR was a key partner.

This report forms part of a series the BSR has produced starting with The State of Play in Rheumatology: Insights into service pressures and solutions in 2015, which highlighted the status of rheumatology services throughout the UK, followed by Rheumatology in Scotland: The State of Play. The fourth report in this series, planned for 2017, focuses on services in Northern Ireland and will enable us to explore similarities and differences in provision of care across the UK.

*Key service quality standards from the National Institute for Health and Clinical Excellence

Go to report