Asked by: Luke Murphy (Labour - Basingstoke)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps are his Department taking to ensure NHS staff can recognise rheumatological symptoms and ensure urgent referral to rheumatology services.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The Royal College of General Practitioners has produced e-learning modules on a number of musculoskeletal (MSK) and rheumatic conditions, such as inflammatory arthritis, osteoarthritis, and axial spondyloarthritis, which are designed to help general practitioners and other primary care professionals recognise the symptoms of these conditions.
Additionally, to support health and care professionals in the early diagnosis and management of different rheumatological conditions, the National Institute for Health and Care Excellence has published expert guidance on rheumatoid arthritis, osteoarthritis, and spondyloarthritis, with guidance for all three available, respectively, at the following three links:
https://www.nice.org.uk/guidance/ng100
https://www.nice.org.uk/guidance/ng226
https://www.nice.org.uk/guidance/ng65
The Getting It Right First Time (GIRFT) Programme for Rheumatology has made recommendations on the diagnosis and management of a range of rheumatic and MSK disorders and will support the National Health Service to deliver care more equitably across the country and closer to patients’ homes, and to improve services nationally. The GIRFT National Speciality Report included a number of recommendations designed to help support patients with non-inflammatory MSK conditions to be cared for in primary and community settings, freeing up capacity for those who need it to have urgent referrals to outpatient rheumatology services.
Asked by: Neil Duncan-Jordan (Labour - Poole)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is planning to take to improve the delivery of joined-up care for people affected by (a) axial spondyloarthritis and (b) other musculoskeletal health conditions following the abolition of NHS England.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
As we bring together the Department of Health and Social Care and NHS England to form a new joint centre, we will empower staff to focus on delivering better care for patients, including for people with axial spondyloarthritis and other musculoskeletal (MSK) conditions, driving productivity up, and getting waiting times down. By the end of the process, we estimate that these changes will save hundreds of millions of pounds a year, which will be reinvested in frontline services.
We continue to take forward the Government’s ambitious reform agenda as set out in the health mission, with more details to come when the 10-Year Health Plan is published. The 10-Year Health Plan will deliver the three big shifts the National Health Service needs to be fit for the future: from hospital to community; from analogue to digital; and from sickness to prevention. All of these are relevant to improving MSK care for people in all parts of the country. More tests and scans delivered in the community, better joint working between services, and greater use of apps and wearable technology will all support people to manage their long-term conditions, including MSK conditions, closer to home.
Asked by: Neil Duncan-Jordan (Labour - Poole)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to help support people with axial spondyloarthritis to (a) remain in employment or (b) return to the workforce.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government and NHS England recognise the significant burden of disease associated with axial spondyloarthritis, particularly where diagnosis is delayed. We recognise the work of the National Axial Spondyloarthritis Society in promoting early diagnosis and good access to effective treatment. Time from referral to diagnosis is included in the National Early Inflammatory Arthritis Audit which covers National Health Service rheumatology services in England and Wales, and we have prioritised reducing waiting times for services through the Elective Recovery Programme and the Getting It Right First Time MSK Community Delivery Programme.
We also have a range of specialist initiatives to support individuals to stay in work and get back into work. Measures include support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants, joining up health and employment support around the individual through programmes like WorkWell, as well as the mobilisation of eight place-based trailblazers to reduce economic inactivity.
Asked by: Noah Law (Labour - St Austell and Newquay)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will direct NICE to undertake an assessment of the potential merits of the use of hydrotherapy treatments in the NHS.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
I have no plans to direct the National Institute for Health and Care Excellence (NICE) to assess hydrotherapy treatments, and it would not be appropriate for ministers to circumvent the NICE’s established process for prioritising topics for guidance development.
When developing its guidelines, the NICE considers all the available evidence within the scope of the topic under consideration. Where good quality evidence supports the use of a therapy as clinically and cost effective, the NICE’s independent committee may recommend it for use in the National Health Service.
Hydrotherapy is already recommended as a form of rehabilitation therapy following nerve injury in the NICE’s Rehabilitation after traumatic injury 2022 guideline. It is also recommended in the 2017 guideline Spondyloarthritis in over 16s: diagnosis and management, as an adjunctive therapy to manage pain and maintain or improve function for people with axial spondyloarthritis.
Asked by: Munira Wilson (Liberal Democrat - Twickenham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether she plans to incorporate training on axial spondyloarthritis as a core component of continuous professional development within primary care.
Answered by Andrew Stephenson
The Getting It Right First Time Rheumatology Programme is working to improve the early diagnosis of people with conditions such as axial spondyloarthritis. The programme published a national report on rheumatology in 2021, which makes a series of recommendations to support equitable and consistent access to diagnostic tests.
The programme has also worked with the National Axial Spondyloarthritis Society to develop a pathway for axial spondyloarthritis to support clinicians to provide the best patient care and allow patients and commissioners to see what they can expect from a service.
Additionally, the National Institute for Health and Care Excellence (NICE) has produced a range of guidance to support early diagnosis of conditions such as axial spondyloarthritis. Its Quality Standard on spondyloarthritis [QS170] sets out that adults with suspected axial or peripheral spondyloarthritis should be referred to a rheumatologist. Quality Standards are important in setting out to patients, the public, commissioners, and providers what a high-quality service should look like in a particular area of care. Whilst providers and commissioners must have regard to NICE Quality Standards in planning and delivering services, they do not provide a comprehensive service specification and are not mandatory.
General practitioners are responsible for ensuring their own clinical knowledge remains up-to-date and for identifying learning needs as part of their continuing professional development. This activity should include taking account of new research and developments in guidance, such as that produced by NICE, to ensure that they can continue to provide high quality care to all patients.
Asked by: Munira Wilson (Liberal Democrat - Twickenham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether her Department is taking steps to reduce waiting times for axial spondyloarthritis diagnosis.
Answered by Andrew Stephenson
The Getting It Right First Time Rheumatology Programme is working to improve the early diagnosis of people with conditions such as axial spondyloarthritis. The programme published a national report on rheumatology in 2021, which makes a series of recommendations to support equitable and consistent access to diagnostic tests.
The programme has also worked with the National Axial Spondyloarthritis Society to develop a pathway for axial spondyloarthritis to support clinicians to provide the best patient care and allow patients and commissioners to see what they can expect from a service.
Additionally, the National Institute for Health and Care Excellence (NICE) has produced a range of guidance to support early diagnosis of conditions such as axial spondyloarthritis. Its Quality Standard on spondyloarthritis [QS170] sets out that adults with suspected axial or peripheral spondyloarthritis should be referred to a rheumatologist. Quality Standards are important in setting out to patients, the public, commissioners, and providers what a high-quality service should look like in a particular area of care. Whilst providers and commissioners must have regard to NICE Quality Standards in planning and delivering services, they do not provide a comprehensive service specification and are not mandatory.
General practitioners are responsible for ensuring their own clinical knowledge remains up-to-date and for identifying learning needs as part of their continuing professional development. This activity should include taking account of new research and developments in guidance, such as that produced by NICE, to ensure that they can continue to provide high quality care to all patients.
Asked by: Tom Randall (Conservative - Gedling)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether he is taking steps through the forthcoming Major Conditions Strategy to help improve the diagnosis and management of axial spondyloarthritis.
Answered by Will Quince
On 24 January 2023, we announced our plan to publish the Major Conditions Strategy. This strategy will explore how we can tackle the key drivers of ill-health in England, reduce pressure on the National Health Service and reduce ill-health-related labour market inactivity.
The Strategy will focus on six major groups of conditions, including musculoskeletal (MSK) disorders. MSK conditions affect people across the life course and cover a range of conditions, including inflammatory conditions such as axial spondyloarthritis.
We have now published our initial report ‘Major Conditions Strategy: Case for change and our strategic framework’. It sets out what we have learned so far, and shares what we plan to focus on next to develop the final strategy.
For MSK conditions, it sets out that we will look to: improve secondary prevention and the use of non-pharmaceutical interventions, embedding a biopsychosocial and personalised approach and building upon the progress made through the NHS Long Term Plan; advocate the use of population health management methodologies to target the right kind of support based on individual circumstances and need to those who need it most; and aim to improve services where medical treatment is necessary.
Following publication of the strategic framework, we will continue to develop the strategy, informed by the Call for Evidence and ongoing engagement with stakeholders.
Asked by: Fiona Bruce (Conservative - Congleton)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to reduce the diagnosis time for people with Axial Spondyloarthritis (a) in the Congleton constituency and (b) nationally.
Answered by Helen Whately - Shadow Secretary of State for Work and Pensions
NHS England’s Getting It Right First Time programme has worked with the National Axial Spondyloarthritis Society to create a pathway to support clinicians to improve the diagnosis of Axial Spondyloarthritis, including in Congleton. The pathway is available at the following link:
Asked by: Tom Randall (Conservative - Gedling)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the effectiveness of NICE Quality Standard 170 on spondyloarthritis in reducing delays in diagnosis for people with axial spondyloarthritis.
Answered by Edward Argar
We have made no such assessment. Quality standards issued by the National Institute for Health and Care Excellence are based on a thorough assessment of the available evidence and represent best practice for the health and care system. National Health Service organisations and healthcare professionals should take them fully into account in ensuring that services meet the needs of patients.
Asked by: Caroline Lucas (Green Party - Brighton, Pavilion)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking with stakeholders to ensure the implementation of the June 2018 NICE Quality Standard on Spondyloarthritis; and if he will make a statement.
Answered by Steve Brine
The Department is not involved in the direct promotion of quality standards.
Whilst healthcare and other professionals in the National Health Service are expected to take clinical guidelines which offer education and self-management for patients diagnosed with arthritic conditions fully into account. Clinical guidelines do not override the responsibility of healthcare clinicians to make decisions appropriate to the circumstances of each patient.
On 28 June 2018, the National Institute for Health and Care Excellence published a new Quality Standard (QS) on spondyloarthritis. The QS includes four quality statements identified as the markers of high quality spondyloarthritis care. The first statement sets out that adults with suspected axial or peripheral spondyloarthritis are referred to a rheumatologist. The standard advises that this may be monitored through local data collection, such as audit of patient records.