Lack of NHS resources in Wales could be causing delay to arthritis diagnosis and treatment

The number of patients referred to rheumatology departments in Wales has increased by 66% since 2012, but resources for treatment are not keeping up with the demand, say patients and clinicians.

Consequently, new patients are waiting longer to be seen and treated, and existing patients are struggling to secure follow up appointments and self-management advice.  

About 25,000 people are living with rheumatoid arthritis (RA) in Wales, and 12% of the adult population identify themselves as having some form of arthritis. This is similar to the number of people identified as having a mental illness (13%) and higher than those with diabetes (7%). 

The findings are taken from a new joint report by the British Society for Rheumatology (BSR) and the National Rheumatoid Arthritis Society (NRAS) called Rheumatology in Wales: The State of Play. The report is part of a series that investigates how rheumatology services in the UK are being delivered.

Specifically focusing on services for newly-diagnosed patients, the report identified that: 

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

RA patients already within the system also face problems, including:

• 40% reported that intervals between appointments were too long to keep their condition under control, and 35% 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 members 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 and treatment of inflammatory arthritis 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, said: “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 look better.”

Rheumatology in Wales: The State of Play can be downloaded here.