Committee of Public Accounts


Publication of the Committee's 10th Report, Session 2009-10

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

"It is not widely known that damage to joints as a result of rheumatoid arthritis can be limited by prompt early diagnosis and treatment. Applied as early as possible but certainly within three months of the onset of symptoms, appropriate treatment can lead to remission, prevent pain and disability and help people with the condition to continue working.

"What is so frustrating is that, since 2003, the average time from the first appearance of symptoms of rheumatoid arthritis to diagnosis and first treatment has remained constant at around nine months. Such delay can have enormously serious consequences for the patient: such as disability, damage to heart and lungs, inability to work and a significantly shorted life expectancy.

"The root of this delay is a widespread lack of knowledge. People with symptoms do not recognize that they might be suffering from the disease or what the consequences of delaying going to a doctor might be. And GPs themselves are not well-informed about the disease and so not adept at picking it out from the hundreds of other musculoskeletal conditions they see, leading to repeat visits from patients and delay in referring them to a specialist for a diagnosis.

"The Department of Health should launch a public education campaign this year, emphasising the symptoms of rheumatoid arthritis and how important it is to seek medical attention without delay. And GPs need more training on the disease, highlighting possible symptoms and the importance of promptly referring patients to a specialist where rheumatoid arthritis is suspected."

Mr Leigh was speaking as the Committee published its 10th Report of this Session which, on the basis of evidence from the Department of Health, examined the following issues: identifying and diagnosing cases of rheumatoid arthritis sooner; providing better support for people living with the disease; and how the NHS can work more effectively to improve services for people with rheumatoid arthritis.

Rheumatoid arthritis is a lifelong, progressive, musculoskeletal disease that causes severe pain, swelling and inflammation of the joints, and can lead to reduced joint function and disability. An estimated 580,000 people in England have the disease, with 26,000 new cases diagnosed each year. Annual healthcare costs to the NHS are £560 million, with costs to the economy of £1.8 billion in sick leave and work-related disability.

Too many people with the disease are not diagnosed early enough and, once diagnosed, they do not always get the services they need to help them live as well as possible with the disease. Starting treatment within three months can stop the disease getting worse and yet the time between experiencing symptoms and receiving treatment is typically nine months, unchanged since 2003. The barriers to gaining early treatment arise from people's low awareness of the disease, causing them to delay seeking medical help, and from GPs failing to spot the early symptoms and refer quickly enough for diagnosis by a specialist. People with rheumatoid arthritis visit a GP on average four times before referral, and a fifth visit a GP eight or more times before referral.

People don't always get the services they need once they have been diagnosed and, as for many long term conditions, there may be a postcode lottery of care. There are big variations in spending on rheumatoid arthritis across Primary Care Trusts and access to the range of services needed to manage rheumatoid arthritis varies. There are differences in the quality and breadth of services available, in particular significant gaps in access to psychological services. People also find it difficult getting timely access to help when they experience a flare-up.

Not diagnosing the disease early enough makes it harder for people to remain in work. Three quarters of people with rheumatoid arthritis are diagnosed when of working age, and one third of people stop working within two years of being diagnosed. People with the disease often lack the right support mechanisms to help them maintain their independence and make an economic contribution to society. In November 2008 the Government accepted the finding of a Review of the health of Britain's working age population that steps were needed to help people with musculoskeletal conditions, but this has yet to filter through to action on the ground.