To mark World Arthritis Day, Jamie Hewitt, government affairs manager at the National Rheumatoid Arthritis Society (NRAS), cautions that the Nicholson Challenge is starting to interfere with the coalition government's policy for long-term conditions.
As a charity, NRAS identified a long time ago that improving self-management skills for patients with rheumatoid arthritis (RA) would be an important means to improving clinical outcomes and have wider societal benefits.
When people talk about the need for greater self-management two observations tend to be regularly trotted out. First of all, patients generally have a small amount of scheduled time to spend with their healthcare professionals during the course of a year, so to maximise clinical outcomes it makes complete sense to consider how patients look after themselves for the 90 per cent of the time they are going about their normal daily lives. Secondly, the big bonus for the NHS is that those patients who effectively self-manage use less healthcare, because they end up having noticeably fewer unscheduled, expensive hospital admissions.
There is no doubt successive governments have understood these potential benefits of self-management and indeed we were pleased to see the current coalition government reaffirm its commitment to the cause with a supportive passage in the 'Equity and Excellence: Liberating the NHS' white paper and the development of a specific self-management strand within the Quality, Innovation, Productivity and Prevention (QIPP) transformational programme.
So, it is entirely for these reasons that we decided to invest and develop our own Rheumatoid Arthritis Self-Management Programme in conjunction with the Expert Patients Programme, because we wanted to meet the very specific, tailored needs of people with this chronic autoimmune disease and help them obtain a much better quality of life.
However, many months later and after considerable financial investment, we are now finding that the much broader roll-out and uptake of the programme, previously envisaged, is in jeopardy. How has this occurred? Well, put simply, the Nicholson Challenge, which is causing the NHS to find £20bn of efficiency savings over the next few years, and the accompanying QIPP programme, are not being implemented as originally promised.
Confirmation of this comes from a variety of sources, including the Royal College of Nursing's Frontline First campaign, which has done some commendable work to highlight specific cuts to nursing posts. The previous minister for long-term conditions, Paul Burstow MP, has also recently gone on record to say that some cuts to NHS services occurred during his time in office, despite the coalition government's pledges otherwise.
Sadly, we have come to the view that budgets for patient education have also been surreptitiously added to the list of targets, because they tend to be regarded as a less painless type of cut. On numerous occasions, where we have identified a need, we have spoken to appropriate individuals in the NHS about commissioning our self-management programme only to be told that their budget for this type of specific intervention has been slashed.
This is really short-sighted as the potential of self-management programmes to save the NHS money over the long-term is considerable. Let me quote you just one example to illustrate the point: an Expert Patients Programme report looked at the evidence about the economic effectiveness of self-management and concluded that it leads to cost savings of £1,800 per patient per year. When you consider that there are around 15 million people in England with at least one long-term condition and that the number of long-term conditions is expected to rise as the population ages – the potential savings seem obvious.
Why am I speaking up about this now? Well, we have just published a new report today to coincide with World Arthritis Day, called the Rheumatoid Arthritis (RA) Responsibility Deal.
The document contains a series of practical pledges for different audiences - including patients, healthcare professionals, NHS service managers and policymakers – that if implemented can help to make a real difference to the clinical outcomes of the 690,000 RA patients that live with this chronic autoimmune disease in the UK.
One issue that came up consistently in the nearly 700 consultation responses we received, which informed the report findings, was the desire of patients themselves to take on more self-management and for NHS service managers to encourage greater access to available self-management programmes.
When it comes to patient attitudes towards self-management, our report indicates that the coalition government is pushing at a bit of an open door. We just hope they have enough conviction to walk through it.