Health and Social Care Bill A briefing from the Coalition of UK Medical Specialty Societies
briefing has been sent to all members of the House of Lords as they
start to debate the Health and Social Bill. The briefing, which was
coordinated by BSR, has been agreed by all members of the Coalition
of UK Medical Specialty Societies. We hope that our collective voice
will have a greater impact than us all briefing peers as individual
societies and enable peers to understand the concerns we have about the bill and the changes it proposes.
Rheumatoid Arthritis Care Perceptions of Patients and Professionals
Futures report The Rheumatology Futures Forum released its report on
Perceptions of Patients and Professionals on Rheumatoid Arthritis (RA)
Care. It clearly sets out the variability of care and the challenges
that we face to ensure that services for people with rheumatoid
arthritis are improved and that patients get appropriate and timely
treatment. The Rheumatology Futures Group is a consortium of
the main patient, professional and pharmaceutical organisations
including the BSR, BHPR and ARMA, involved in RA care.
NAO report: Services for people with rheumatoid arthritis
welcome this report. It demonstrates the gap between the
recommendations in the NICE rheumatoid arthritis management guidelines,
and what is actually delivered in the NHS. Consequently, it sets a
challenge to both government and clinicians alike.
For government the message is that patients are missing out on vital
treatments & services, and it is time to invest in inflammatory
arthritis services. It demonstrates that if rheumatoid arthritis is not
seen by specialists promptly and treated intensively, it will end up
costing both individual patients and the country much more in the long
Therefore, rheumatoid arthritis services must now have the
highest priority. For clinicians the message is that we must ensure
that we are providing the best quality care for our rheumatoid arthritis
"This is a great opportunity for the government and
the musculoskeletal community to work together for the benefit of
rheumatoid arthritis patients."
Dr Deborah Bax
Quality and outcomes framework (QOF)
quality and outcomes framework (QOF) is a programme of incentives
offered annually to GP surgeries in the UK. Rewards are given for, among
other things, how well they manage some of the most common chronic
diseases, and how well they improve the health of the populations they
A key intention of the QOF is to identify ways of reducing
preventable morbidity and cost. The absence of any musculoskeletal
conditions from the present QOF must be a major concern to government
given the substantial impact these conditions have on disability and
reduced quality of life.
Quality Metrics are a means of measuring the quality and performance of
services to patients using a range of indicators and measures.
Although we believe most rheumatological out patient practice does not
fit into this scheme, from a general perspective, there are some
important points we would like to raise:
- We support standards such as those in the cancer section on Peer Review,
National Audits and their analysis, and the use of specialist nurses.
- We support the promotion of standards for our inpatients in relation to assessment and treatment of serious disease.
- We are disappointed that none of the long term indicators are specifically relevant to rheumatology.
- We agree that there should be patient experience and patient environment
indicators. However, we feel there are far too many, which could have a
negative effect on discharge policies if all patients had to complete
- We support the development of Patient Related Outcome Measures (PROMS).
We support timeliness of care indicators particularly in relation to
Referral to Treatment (RTT).
Prescription charges for those with long term conditions are currently
being reviewed. We believe that patients should be exempt from
prescription charges for Disease Modifying Anti Rheumatic Drugs (DMARDS)
and biologic agents. Serious forms of arthritis typically affect an age group not covered by
existing exemptions. These individuals are dependent on regular and
often multiple medications to control the diseases and their frequent
The National Health Service Constitution
The NHS Constitution will establish the principles and values of the NHS
in England. The draft consultation sets out commitments to patients,
public and staff in the form of rights, pledges and responsibilities.
All NHS bodies, private and third sector providers supplying NHS
services will be required by law to take account of the Constitution in
their decisions and actions. The Constitution will be renewed every ten
NHS Constitution key points:
- The NHS provides a comprehensive service available to all
- Access to NHS services is based on clinical need, not an individual’s ability to pay
- The NHS aspires to high standards of excellence and professionalism
- NHS services must reflect the needs and preferences of patients, their families and their carers
- The NHS works across organizational boundaries and in
partnership with other organizations in the interest of patients, local
communities and the wider population
- The NHS is committed to providing best value for taxpayers’ money and the most effective and fair use of finite resources
- The NHS is accountable to the public, communities and patients that it serves
Visit the Department of Health website for further information on the constitution.
BSR has been working with the NHS Alliance, and colleagues from other
organisations, on integrated care. The NHS Alliance is a collaboration
of clinicians, managers and board members. It is an independent body
that represents NHS primary care.
The document “Integrated Healthcare: from aspiration to
implementation” sets out a vision of integrated care, as well as
responding to the NHS Next Stage Review. It compliments the work that is
also being undertaken by the Royal College of Physicians with their
“Teams without Walls” initative.
Visit the NHS Alliance website for a full copy of Integrated Healthcare.
NHS White Paper Equity and Excellence: Liberating the NHS
View BSR's comments:
Response to the Francis report
The final report of the public inquiry into the events at the Mid
Staffordshire NHS Trust between 2005 and 2009 was published by Robert
Francis QC on 5 February 2013. It detailed a range of serious failings
which caused significant pain and suffering to patients and their
families.The report demonstrates a clear need for individuals and
healthcare organisations to work together to create a different kind of
culture where the quality of patient care is at the heart of everything
that the NHS does. We support this focus and have identified a number of
priorities in response to the report relating to the development of
standards, audit and guidelines, leadership, support for effective
commissioning and sharing of best practice through information systems.
We have also considered our governance arrangements, both in terms of
increasing the patient voice within the organisation and also the
framework by which all future policy, activity, statement or guideline
1. Standards, audit and guidelines
are NICE accredited and their development and revision must follow the
approved protocol. Guidelines on the use of vasculitis management and
tocilizumab use in rheumatoid arthritis have recently been submitted to
Rheumatology for peer-review. Other guidelines are in development and/or
currently under review. Further details will be published on the this
website and updated on a regular basis in order to keep members
We intend to work with NICE to develop measures of outcome in relation
to their work and to assist in the development of measures of standards
compliance. To reinforce this, we believe that minimum levels of staff
numbers and skill mix should be defined. To this end, the society will
offer to support NICE in developing an evidence base and appropriate
benchmarks to take into account the needs of the service. As part of
this, we have established a working group to take forward our work on
BSR has been awarded a contract by HQIP to deliver an audit of rheumatoid and early inflammatory arthritis
As part of this, metrics will be identified which are relevant to the
quality of care and patient safety in rheumatology. The audit will also
provide high quality data comparing different providers and collect
validated patient reported outcomes and experience measures. Where
variations in practice are identified in the course of the audit, we
will provide support to individual units and ensure that the reasons for
variation are understood and acted upon where appropriate.
The NHS Commissioning Board has also been tasked with developing metrics
for use by commissioners and we will offer support to their regional
offices in taking these forward.
The British Society for Rheumatology represents all members of the
rheumatology multidisciplinary team, including doctors in training. Our
courses and policies emphasise the importance of all team members
understanding their responsibilities in promoting patient safety and
being empowered to challenge colleagues, however senior, in the best
interests of patients. We are also keen to promote clinical leadership,
and are currently developing an educational program for members.
3. Support for effective commissioning
The Best Practice Tariff
for early inflammatory rheumatoid arthritis (EIA), the first tariff for
rheumatology, was introduced in April 2013 and supported by BSR,
Arthritis Research UK and the Department of Health. The aim is to drive
improvements in management of EIA, and particularly to support the many
units that have struggled to provide timely and intensive intervention.
BSR is currently working with the seven pilot sites and is in the
process of analysing feedback and benchmarking it against non-pilot
4. Sharing of best practice
We launched the Best Practice Awards to encourage innovation in
rheumatology. The 17 finalists have all made changes to their practice
in order to improve outcomes for patients and we will publish the
winners at the end of September.
BSR is also developing a software program designed to help commissioners
in relation to best practice, costs and epidemiological data. We will
work with the Department of Health, the Information Centre and the Care
Quality Commission to consider how to develop comparative statistics on
the efficacy of treatment in the specialty, for publication and use in
performance oversight, revalidation, and the promotion of patient
knowledge and choice.
We run two registers of patients
receiving biological treatments - BSRBR Rheumatoid Arthritis and BSRBR
Ankylosing Spondylitis. The registers collect data on patient safety for
these relatively new treatments as the long term effects are still
unknown for biologic drugs. We are currently considering how to develop
the registers’ potential and will take into account the recommendations
on common information practices and data records.
There is currently no patient voice within BSR to provide advice,
guidance and monitoring as to whether the work of BSR gives true
priority to the patient. Whilst the recommendations relate to improving
the patient focus of other organisations, such as Monitor and the CQC,
the establishment of adequate patient representation will be
incorporated into our new strategic plan and become a standing item for
Executive Committee meetings.
In addition, we intend to adopt a series of organisational tests which
would be applied to any current or future policy, activity, statement or
guideline. These would be based around the key recommendations of the
Francis report and the identification of any potential conflicts of
interest. In summary the tests to be applied would be:
- Core values: does the policy, activity or statement give
appropriate priority to the patient and is it driven by evidence-based
best practice in rheumatology?
- Leadership and dissemination: is it clear how the content of any
policy, statement or guideline will be disseminated and implemented to
the membership and beyond?
- Information: what measureable outputs are available from the policy
or statement? Is it clear how these will be collected and used?
- Candour: Is any information likely to affect patient interests to be freely available? If not, how can this be justified?
- Conflicts: are potential conflicts of interest identified and balanced in favour of patient care?
We will publish regular updates to our work in these areas.