Chamber and committees

The specific information requested in relation to points (a) and (b) is not held centrally.

However, a Health Care Needs Assessment (HCNA) on Rheumatoid Arthritis (RA) has recently been published. It was conducted by the Scottish Public Health Network at the request of Scottish Government and makes a number of recommendations that aim to assist NHS boards to plan and develop services for people living with RA. It also highlights the role of primary care and the importance of informed self management for people living with RA.

It is for NHS boards to plan and provide services to meet the needs of their resident populations, in accordance with national and local priorities and guidelines. NHS boards will need to consider how they will take the recommendations in the HCNA forward.

The Scottish Government has provided funding to Arthritis Care Scotland to help establish its website “Connect Scotland”. The site is has been written by and is for people living with arthritis. It aims to help them, and health professionals to access information, share experiences and build community networks.

Waiting time information is not available centrally for access to rheumatoid arthritis services, as data is collected at specialty level.

Published waiting times information for the specialty of rheumatology showed that in June 2012, 95.7% of patients were seen and treated within 18 weeks from their initial referral. This performance exceeds the Scottish Government’s delivery target of
90% of patients being seen and treated within 18 weeks.

The information requested is not available centrally. The timing of any second or subsequent outpatient appointment would be a matter for the consultant to determine based on the individual patient’s clinical need.

SCOTTISH PARLIAMENT

WRITTEN ANSWER

7 November 2012

Index Heading: Health and Social Care

Helen Eadie (Cowdenbeath) (Scottish Labour): To ask the Scottish Government whether it will ensure that people diagnosed with rheumatoid arthritis are referred to a specialist at an appropriate time in respect of diagnosis and follow-up appointments and during flare-ups.

(S4W-10466)

Alex Neil: A Health Care Needs Assessment (HCNA) on Rheumatoid Arthritis (RA) has recently been published. This was conducted by the Scottish Public Health Network at the request of Scottish Government and outlines current RA service provision across Scotland. It also makes a number of recommendations that aim to assist NHS boards to plan and develop services for people living with RA.

The HCNA highlights the following aspects which will all help to improve outcomes:

the importance of early recognition of possible RA symptoms

seeking medical advice as soon as possible and

speedy referral to specialist rheumatology services to ensure early diagnosis and enable treatment to commence at the earliest opportunity.

The report also highlights the role of the multidisciplinary team (MDT) in the management of RA in both the early and chronic disease stages. It provides recommendations to NHS Boards that all patients should have access to assessment by a full MDT and that patients and primary care teams have easy access to the rheumatology team for rapid assessment in the event of a flare up.

The role of the Scottish Government is to provide policies, frameworks and resources to NHS Boards in order that they can deliver services that meet the needs of their local population. NHS Boards will therefore need to consider how they will take the recommendations in the HCNA forward.

A key way to support NHS boards to deliver safe, effective and person centred services is by implementing clinical standards. The Scottish Intercollegiate Guideline (SIGN) 123 on the Management of Early Rheumatoid Arthritis, provides clinicians in NHSScotland with evidence based recommendations for the diagnosis and management of early rheumatoid arthritis. NHS boards are expected to implement SIGN guidelines.

This information is not held centrally.

Our Better Heart Disease and Stroke Care Action Plan makes clear the importance of ensuring that cardiac rehabilitation is made available for all those people with heart disease who are found to be eligible. Earlier this year Information Services Division published an audit on cardiac rehabilitation services which found that provision had substantially increased for the priority groups.

The Scottish Government’s Chief Nursing Officer welcomed the publication of the British Association for Cardiovascular Prevention and Rehabilitation’s (BACPR) new standards at their launch in Glasgow on 4 October. We would expect that the revised BACPR Standards will help to inform clinical practice in relation to the delivery of cardiac rehabilitation.

While excellent progress has been made, we recognise that there is still much more to do to help improve the quality of care, particularly for people living with heart failure. Our National Advisory Committee on Heart Disease will continue to work closely with cardiac services and the voluntary sector to take this forward.

We are working closely with the British Heart Foundation and Chest Heart and Stroke Scotland in exploring the different kinds of support which can and should be provided to people with long term conditions, including those with heart failure and angina.

In addition the National Advisory Committee on Heart Disease agreed on 1 October to establish a Heart Failure subgroup, which will be well placed to advise on how we can ensure people with heart failure get appropriate access to rehabilitation and support. We expect this subgroup will be in place in early spring 2013.

The importance of ensuring that people with heart failure or angina have appropriate access to support and care after diagnosis is highlighted within Healthcare Improvement Scotland’s Clinical Standards for Heart Disease.

The standards state that people with chronic stable heart failure, and patients attending chest pain assessment services with new onset or worsening angina, should be identified for assessment by the cardiac rehabilitation service.

Following this they should be assessed by the cardiac rehabilitation team for a menu-based programme as specified in current national guidelines and that assessed patients should be offered a menu-based programme according to their needs.

We expect NHS boards to work towards these clinical standards.

A 2007 audit suggested that 45% of people who had suffered a heart attack, undergone a coronary artery bypass or percutanous coronary intervention had access to cardiac rehabilitation. The interim results of the latest audit published on 13 March 2012 by Information Services Division, show that NHSScotland has substantially increased access to cardiac rehabilitation services for people within the clinical priority group. The report suggests the level of provision has now risen to almost 70%.

We accept however that there is more to do, particularly to ensure that people with heart failure are getting access to the care they need. We are also committed to continuing to monitor the provision of cardiac rehabilitation.

The National Advisory Committee on Heart Disease will review the outcomes from these audits, and agree with NHS boards’ cardiac MCNs, any action that needs to be taken to help ensure people who need access, can access cardiac rehabilitation services.

As indicated in Healthcare Improvement Scotland’s Clinical Standards for Heart Disease, people with chronic stable heart failure, and patients attending chest pain assessment services with new onset or worsening angina, should be identified for assessment for their eligibility for cardiac rehabilitation.

A significant proportion of people with heart failure are over the age of 80 and will have a number of co-mobidities which may mean that they may not necessarily benefit from a traditional secondary care based cardiac rehabilitation programme. We are working with the British Heart Foundation and Chest Heart and Stroke Scotland to explore how we can support these groups more effectively.