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You and Yours - Transcript 成人论坛 Radio 4 |
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TX: 22.01.09 - Arthritis Report from Kings Fund PRESENTER: WINIFRED ROBINSON |
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Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 成人论坛 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Doctors say that they are sometimes having to pretend that their existing rheumatoid arthritis patients are new sufferers when they need to get them seen by a specialist. The doctors are claiming that government targets force them to prioritise new patients by booking a consultant's appointment for them within 18 weeks but that this is coming at the expense of existing patients who keep being pushed to the back of the queue. Even worse these bogus new referrals end up costing health authorities more. The claim's come in a report published today by the health research charity - the Kings Fund. It was commissioned by the Rheumatology Futures Project Group, it's an organisation of patient and medical groups, charities and drug manufacturers. Professor David Scott is a consultant rheumatologist and chief medical advisor to the National Rheumatology and Arthritis Society. How widespread is this business of passing off existing patients as new ones when really they're not? SCOTT I think it's quite widespread but I think we'll have to sort of put it into context. It's important that patients are seen when they first develop arthritis very quickly and I think the target to drive that is very helpful to patients. But if you have established arthritis and are attending a clinic, for example every six months and have a flare in your arthritis it's more difficult to get back sometimes into the system. And therefore, as consultants what we will say if the clinics are full, we might say to a GP it will be easier and quicker to get the patient into the clinic if you refer them as a new patient than as a follow up patient. And that means if you have a chronic illness like chronic rheumatoid arthritis, in particular, which requires specialist intervention and specialist review that those patients are actually disadvantaged as compared to patients with other diseases. ROBINSON So let me get this straight: this is a sort of little collusion then between the specialist and the GP, that between you, you decide to concoct this business of the patient being new? SCOTT That's an unusual way to put it and it's not how I feel. I feel that I work in a system and in my own hospital I think I work in a very good system and I would hate people to think that the problem's just at our hospital because it's not in fact, the environment's extremely good. But I do sometimes say to patients and to GPs that it's quicker and easier to refer the patient back to me, as do many of my colleagues throughout the country, than actually to see the patient as a follow up. To say it's a collusion I think is unfair but it's adapting to a system that was designed to answer a different problem. Eighteen weeks are wonderful for surgical referral but if you have a chronic disease that 18 week target, which drives the clinical needs and the patients attending the clinic, actually has a disadvantage to the patients with chronic disease being followed up. ROBINSON And your belief that this practice is widespread comes from what your colleagues tell you - it's anecdotal? SCOTT Yes it's anecdotal, I don't think people - that's why I don't think it's a collusion. But it's not anecdotal just for one or two, almost every colleague I speak to and every patient I speak to will say the same. ROBINSON Now it costs the health authority more for a new referral - how does that work? SCOTT The way payment by results works, there are tariffs for patients attending and a new patient is charged, I think, it's about £220 and a follow up patient somewhere around £90-95. So that of course means that if a patient should be a follow up patient but is referred as a new patient this is costing you and me, as taxpayers, money and that's one of the problems I have with it, it's obviously inherently wrong. ROBINSON So if this is a question of rationing a scarce resource what's happening - the business of the target and how you're feeling - you're having to get around it in the interests of patients, it's in fact making the problem worse. SCOTT I'm not sure it's making it worse because this is not ... ROBINSON Well the authorities will be running out of money faster won't they? SCOTT I suppose the answer to that is yes, it's not an economical way of doing things. The problem is complex because secondary care trust's income is to an extent based on meeting targets and therefore the trust as a whole, understandably, having to meet a target will arrange to make sure that patients are seen within the 18 week target, which means for the first attendance will be in three or four weeks ... ROBINSON So to put it crudely they win some, they lose some because if you're referring lots of people new, as new patients even if they're not, although it may be costing them more they get a bit back because they've hit a particular target? SCOTT Yeah, but it's illogical and I think we need to get back to the bit that matters and that is that the patient with chronic arthritis, chronic rheumatoid arthritis, will suffer under these circumstances. ROBINSON As you just said the government had a really good reason for introducing this target of 18 weeks from the point that you go to see your GP with suspected rheumatoid arthritis or some symptoms to being referred to a specialist because delaying a diagnosis can make the condition much worse. Now Sarah York is on the line, she's 23 and from Cambridge and she believes that's what happened to her. Sarah. YORK Yes definitely. Well with my situation it was a bit complicated. I was basically in two different areas of the UK. First of all I woke up one morning and I couldn't bend my left thumb. Quite swiftly afterwards I had pains in my feet which resulted in me not being able to walk properly and this was quite upsetting - I had to walk down steps like one step at a time. So I went to my GP in Scarborough and I said about the pains I was suffering from and we spoke about it a bit and basically she just told me to do some yoga exercises, because I was 23 she didn't - well rheumatoid arthritis wasn't even mentioned. When I got back to Cambridge I was advised I really ought to go back to my GP, this time obviously in Cambridge. They were very swift and he said look let's take some blood tests and then they got me referred to my local hospital. Then I was talked to by my specialist and she said that I had - well they thought I had rheumatoid arthritis, even though I didn't have the rheumatoid factor in my blood, I had very high inflammation. ROBINSON And were you damaged by that delay - obviously you were in pain and distress? YORK Well what made it even more damaging is sort of the lack of communication with the actual problems that rheumatoid arthritis causes because if my specialist had said to me - Sarah, you realise the longer that you have the condition - because I'd already been having it for almost a year - without being treated the more damage it's going to do - then I most probably would have cancelled my trip and started my medication. I didn't because I don't believe that I was informed as well as I should have been about it and so when I got back from India that's when I started my medication, so I started my medication roughly a year after the symptoms started. I had some bone degeneration and I believe that the longer you wait then the more harm you're causing to your body really. ROBINSON Professor David Scott, what then would you do about this situation, there's an anxiety to diagnose quickly, there's a target, what would you do? SCOTT Well there are two issues here. One is about awareness of rheumatoid arthritis and the priority that it has, if you like, compared with other illnesses and I think it's very important we highlight this disease because awareness in general practice and awareness in the community is very important because we have very effective treatments for rheumatoid arthritis so access to specialist care is key. But increasing awareness, access to specialist care and then early treatment because - not in all cases but certainly in many cases - damage occurs quite early and is irreversible, so the earlier treatment's started the better. ROBINSON Would you scrape the targets? SCOTT I would adjust the targets for patients with inflammatory arthritis. One has to get a balance. The targets have been very helpful to patients needing surgical treatments, one has to go back a long time and say that very long waiting lists were a huge embarrassment and a disadvantage to patients. But if you have rheumatoid arthritis and you need to access early - early diagnosis you need to have those targets to be seen but you also need to have a system of where we have more access for the patients who have arthritis that may flare getting back into the system. And it's the balance that's missing. ROBINSON Professor David Scott, who's chief medical advisor to the National Rheumatoid Arthritis Society. The Department of Health sent us this statement: "It simply isn't true to say that patients with existing conditions are being forced to wait longer for follow up treatment so that doctors can meet targets for patients with new conditions. We do not apologise for waiting times being at record lows. Nor shall we apologise for achieving a maximum 18 week wait for patients from GP referral to treatment. That will be achieved by the end of December 2008. Prompt access ..." - sorry, so they've already achieved it, by the end of December 2008... "prompt access to treatment" - they go on - "is part of high quality patient care". Back to the You and Yours homepage The 成人论坛 is not responsible for external websites |
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