Scottish Public Health Network A stakeholder health care needs assessment of rheumatoid arthritis A Conacher, M Perry, P

1. Scottish Public Health NetworkA stakeholder health care needs assessment of rheumatoid arthritisA Conacher, M Perry, P Mackie ScotPHN is hosted by

2. Plus… Jane Gibson, Consultant Rheumatologist, NHS Fife Lynne Shand, Consultant Rheumatologist, NHS Grampian Donna Hood, Clinical Nurse Specialist, NHS Greater Glasgow & Clyde Liz McIvor, Clinical Nurse Specialist, NHS Greater Glasgow & Clyde Duncan Porter, Consultant Rheumatologist, NHS Greater Glasgow & Clyde Jemma Pringle, Specialist Registrar, NHS Lanarkshire ScotPHN is hosted by

3. Plus… Janet Harkess, Head Occupational Therapist, Fife Rheumatic Diseases Unit Keith Slater, General Practitioner, NHS Highland Jenny Snell, Government Affairs, National Rheumatoid Arthritis Society Neil McKay, Consultant Rheumatologist, NHS Lothian Mike McMahon, Consultant Rheumatologist, NHS Dumfries & Galloway ScotPHN is hosted by

4. Content • ScotPHN and needs assessment • Background to rheumatoid arthritis needs assessment • Method • Findings • Next steps ScotPHN is hosted by

5. Scottish Public Health Network Specific functions are: • to undertake prioritised national pieces of work where there is a clearly identified need; • to facilitate information exchange between public health practitioners, link with other networks and share learning; • to create effective communication amongst professionals and the public to allow efficient co-ordination of public health activity; and • to support and enhance the capabilities and functionality of the SDsPH Group. National needs assessment key part of work ScotPHN is hosted by

6. ScotPHN Needs Assessment • Epidemiological • Corporate • Comparative • Views of stakeholders (including patients and public) ScotPHN is hosted by

7. Background – Policy and Evidence Context Better Health, Better Care Policy Deliveringfor Health Delivery Framework for Adult Rehabilitation Quality Strategy 2002 2005 2007 2008 2009 2010 2011 Public Health Institute for Scotland - Needs Assessment Report: Rheumatoid arthritis in adults Revised SIGN 48 guideline NHS QIS - Clinical Audit of Care in Rheumatoid Arthritis NICE guidance on management of RA Evidence ScotPHN is hosted by

8. Background • 2009 – Scottish Government asks ScotPHN to consider a project looking at arthritis • Arthritis appeared to be the main chronic long term condition not being progressed in terms of provision of services (with the exception of psoriatic arthritis) ScotPHN is hosted by

9. Stakeholders • Scottish Government • NHS Boards • Primary Care • Primary Care Rheumatology Society • Directors of Pharmacy / Scottish Medicines Consortium • NHS QIS (SIGN) (development of SIGN guideline concurrent) • NHS Education Scotland • Arthritis Care Scotland • Arthritis and Musculoskeletal Alliance (ARMA) • National Rheumatoid Arthritis Society (NRAS) • British Society for Rheumatology • Scottish Society for Rheumatology ScotPHN is hosted by

10. Method – usual ScotPHN project methodology • Project Group and Lead Author • Project Sponsor • Epidemiological assessment • Comparative assessment • Corporate assessment (Stakeholder interviews and questionnaires) • Stakeholder Group Mini groups ScotPHN is hosted by

11. Objectives Project group agreed focus should be on rheumatoid arthritis and should: • Map the policy area and current work being undertaken in this area. • Seek to understand the interfaces with other specialities (musculoskeletal (MSK), osteoarthritis etc). • Understand stakeholder interest. • Annotate and update the PHIS report (December 2002) on rheumatoid arthritis. • Identify the inequalities resulting from current service provision and consider rural and remote issues. • To make recommendations for future work. ScotPHN is hosted by

12. Areas of work 5 Groups were established with a lead to draft ‘mini’ reports: • Initial referral and assessment • Chronic disease management • Rational approach to RA prescribing • Employment and societal impact • Remote and rural provision ScotPHN is hosted by

13. Main Findings ScotPHN is hosted by

14. Incidence and Prevalence • The epidemiology in this area remains relatively under developed. • Generally, rheumatoid arthritis is 2 to 4 times more common in women. • About 1 in 4 patients with RA are work disabled at diagnosis, rising to 1 in 3 at 5 years and approaching 1 in 2 at 15 years. Scotland has significantly higher work disabled RA population than England. ScotPHN is hosted by

15. Projected numbers of males with rheumatoid arthritis for 2010, 2015, & 2020, by selected age groups. Aged 16 years and over. (Mid 2009 based.) ScotPHN is hosted by

16. Projected numbers of females with rheumatoid arthritis for 2010, 2015, & 2020, by selected age groups. Aged 16 years and over. (Mid 2009 based.) ScotPHN is hosted by

17. Key findings • Lack of robust data on management of RA across Scotland • Delay occurs to time of diagnosis and treatment – • shared care not as effective as could be • results in long term disability • Lack of awareness in general public compounds early diagnosis and referral which are key to improved outcome for patient • Pharmaceutical therapy of rheumatoid arthritis has changed considerably since 2002 • Need to understand what is effective use of pharmaceutical therapy ScotPHN is hosted by

18. ScotPHN findings on stakeholder needs assessment It’s hard work… • A lot of people to project manage • Different styles • Reconcile views within report • A lot of recommendations BUT… ScotPHN is hosted by

19. ScotPHN findings on stakeholder needs assessment • Better understanding of all stakeholder view points • Created ownership • Enriched stakeholders’ understanding of own and other parts of service ScotPHN is hosted by

20. Next steps for ScotPHN • Finalisation of write through • Economic analysis • Piloting through National Planning Forum ScotPHN is hosted by

21. Contact Ann Conacher, ScotPHN Co-ordinator (ann.conacher@nhs.net / 0141 354 2979) www.scotphn.net ScotPHN is hosted by