Friday, January 23, 2009

How arthritis sufferers are let down by NHS targets

Thousands of rheumatoid arthritis sufferers are being let down by 'unacceptably wide variations' in care by GPs and hospitals, says a report. It claims the postcode lottery is being made worse by Government targets that are causing delays in appointments to see specialists and receive treatment. Patients already diagnosed with the disease are having to wait longer to be seen - or the NHS ends up paying more than double to treat them as a 'new' patient, says the report from the independent King's Fund think-tank.

Around 420,000 Britons have rheumatoid arthritis, with more women than men affected. It causes pain, swelling and inflammation in the joints and also puts sufferers at higher risk from strokes and heart attacks. The report shows:

Geographical variations in the standards of care for sufferers;

Knock-on effects of the Government's 18-week referral target;

Poor understanding and lack of support among GPs;

Haphazard management of flareups which can cause pain and joint damage unless treated urgently;

Some patients having to wait years for a diagnosis.

The report, commissioned by the Rheumatology Futures Project Group, analysed the views of more than 900 patients and 500 medical professionals and NHS staff. Some patients said they received 'no support' from specialist teams supposed to be co-ordinating their care and were just 'left on the sidelines'. The time between seeing a GP and seeing a specialist ranged from less than six months to more than three years.

But rheumatology experts are most concerned that the Government's 18-week target for referring new patients to specialists is having 'knock-on effects' for existing patients. This can leave those with long-term disease unable to get follow-up appointments because clinics are under pressure to reserve slots for new patients.

Professor David Scott, chief medical adviser of the National Rheumatoid Arthritis Society, said: 'Some GPs end up re-referring existing patients as "new patients" which costs their primary care trusts almost 250 pounds in payment by results instead of 99 as a follow-up appointment.' Professor Scott said he was not talking about his own trust but the experiences of many specialists nationwide. He said: 'Some patients are taking longer to get back to hospital than if they were a new patient, or under the old system. 'One problem is that rheumatoid arthritis is perceived to be a disease of old people and it's not. It can affect patients of any age but they struggle to get the care they need.'

Ailsa Bosworth, joint chairman of the Rheumatology Futures Project Group, said: 'Much needs to be done to raise awareness of the seriousness of this condition with the general public and to address the lack of clinical knowledge about rheumatoid arthritis in primary care.'


Dreamy NHS constitution sets out responsibilities for patients and staff

Any attempt to enforce it would be amusing -- and futile

A written constitution for the NHS - a bill of rights and responsibilities for patients and staff - will be officially signed by Gordon Brown and ministers at Downing Street today. A draft version has already been put out to consultation and the Government has tabled legislation to compel the health service to adhere to the final document. The constitution will effectively become a bill of rights for patients and was introduced by ministers as a major reform - comparable to Mr Brown giving the Bank of England control of interest rates when he was chancellor. The constitution sets out responsibilities linked to people's entitlement to free NHS care, including that they should take some personal responsibility for their own health.

But doctors and campaign groups say that the draft consisted of "optimistic pledges" that would not make any difference to patient care.

Alan Johnson, the Health Secretary, said yesterday that measures to tackle obesity would be included in the document but that it would not threaten to withhold treatment from those who were overweight through over-eating. It would not involve "broccoli police" to check up on people's eating habits. The constitution was intended to be "one concise, clear document that told people what their rights were, what their responsibilities were and what was expected of the staff," he said.

"We never intended this to change the way the NHS works, which is, if you have a health problem we will deal with it. "We have got a section in there on personal responsibilities but it's not something that's backed up by law and [therefore] you'll not have the broccoli police come round if you are having a fry-up. "It was never meant to be something that changed the health service and made it less acceptable to people and made it more problematic. "There are other ways of talking about the dangers of alcohol or getting your nutrition right than stating it in a constitution."

But Katherine Murphy, director of the Patients Association, said "We do not expect this document to make any difference to the care patients are receiving. The time for words like safety, quality, choice and, in this case, constitution to have the meaning they have elsewhere in life is long overdue."

National Voices, an association of charities and patients groups, said that the document had "huge potential". "We need a service that listens and responds to the needs of the people it serves."


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