Agenda item

The University Hospitals Leicester (UHL) to give an update on Rheumatology Services in Leicester.  

The University Hospitals Leicester (UHL) Provided a verbal presentation into Rheumatology Services across Leicester. The following was noted:

·       An apology was provided on behalf of UHL for the late submission of the report, with paper copies circulated at the meeting. It was noted that this was not common practice and that learning had been taken from the issue.

·       The service overview highlighted that Rheumatology covered more complex conditions such as rheumatoid arthritis and lupus, requiring ongoing care rather than discharge.

·       Services were delivered across Leicester Royal Infirmary and Leicester General Hospital, with 12 consultants and specialist nurses supporting adult and paediatric clinics, treatment and follow up care. This included DMARDs, biologics, physiotherapy, pain management, an advice line and joint procedures.

·       Activity levels had increased significantly, with 2,670 referrals in 2025 to 2026, representing a 34% rise. This was linked to chronic conditions and an ageing population.

·       Around 17,000 follow up appointments had been delivered. The DNA rate was 3.2%, which was in line with the national average.

·       Performance against the 18 week referral to treatment standard remained challenged due to increased demand, with 42% of patients treated within 18 weeks.

·       It was noted that longer waits were influenced by the prioritisation of urgent cohorts, particularly within early inflammatory arthritis pathways.

·       The early inflammatory arthritis clinic was highlighted as a key area of strong performance, with earlier treatment leading to improved patient outcomes and remission rates. Performance had improved from around 50% to 56% 3 years ago to 96% of patients now treated within 6 weeks with a DMARD, making the service one of the best performing nationally.

·       The British Society for Rheumatology was undertaking a case study on the service due to its high performance, which exceeded other trusts both regionally and nationally.

·       It was noted that the service had previously been a poor performer but had significantly improved by 2025 to 2026.

·       Work was taking place to support referral to treatment recovery included moving towards a single point of access model to provide early guidance and reduce demand on the service.

·       Increased use of patient initiated follow up had been introduced, enabling patients to re access the service when required.

·       A need to expand the clinical workforce was identified, with a business case being developed to secure additional funding.

In discussion with Members the following was noted:

·       Concern was raised regarding risks to patients alongside a 20% year on year increase in referrals, with continued growth expected. It was queried whether moving towards advice and guidance models could create additional risks by delaying early intervention, and what the current position and capacity was for 2026 to 2027. It was explained that demand had increased significantly, with a historic backlog and capacity pressures, although earlier diagnosis had improved from around 10 years to 2 years for some conditions, particularly inflammatory arthritis.

·       Referral to treatment performance had remained largely static over the past 2 years, with ongoing challenges in managing both new and long term patients. It was explained that many conditions required lifelong management, limiting discharge rates and placing sustained pressure on the service.

·       With 12 consultants and around 53% unmet demand, equating to over 3,500 patients, concern was raised that current workforce plans did not match the scale of need. Additional consultants were required, with at least 2 to 3 posts identified to improve capacity.

·       Increased referrals since COVID 19 reflected a national trend, particularly for rheumatoid arthritis, and that patients were rarely discharged due to the chronic nature of conditions. It was queried whether some patients could be safely managed differently, including earlier stage management outside of acute settings. It was confirmed that a longer term workforce and neighbourhood model approach was being developed to support this.

·       Recruitment remained challenging due to consultant vacancies and retention pressures, although there were opportunities to recruit candidates with local ties. Specialist nurses were also highlighted as a key part of the workforce, supporting clinics and patient care.

·       While improvements in early treatment were welcomed, concern remained about overall capacity given population need and a 27% increase in referrals. Delays in diagnosis were linked to referral quality and pathways, and while no specific figures were available, potential cases of harm had been identified and reviewed through governance processes.

·       It was questioned why additional funding had not been secured. Previous business cases had been submitted, however financial constraints required prioritisation across services. International recruitment was being explored to support workforce expansion.

·       A workforce plan was in development and could be brought back to the Commission, including a 2 year outlook. Same day emergency care and on call rheumatology advice were in place to support urgent cases.

·       Queries were raised about where business cases had been submitted and whether trainee retention was an issue. Recruitment had been impacted by a freeze, although strong training and specialist clinics supported retention.

·       Shared care arrangements were not operating as effectively as intended, increasing pressure on hospital services. Closer joint working between UHL, the ICB and GPs was identified as key, including expanding specialist nurse roles within primary care.

·       The rise in referrals reflected a combination of factors, including improved awareness, more treatment options and limited time within primary care consultations. A triage decline rate of around 15% was noted.

·       Patient safety incidents were monitored through trust governance processes, including weekly reviews of cases involving moderate harm with senior clinical oversight.

·       Concerns were raised about the quality and appropriateness of referrals, with some GPs lacking confidence in diagnosis. Diagnoses required clinical assessment, with detailed management plans provided following specialist review. Work was underway to improve referral quality through guidance, streamlined forms and exploration of AI tools.

·       Some conditions, including fibromyalgia and ME, did not require rheumatology input and should be managed in primary care or pain services, supported by existing guidance.

·       Early inflammatory arthritis clinics operated a 3 week wait, although not all referrals were appropriate, reinforcing the need for improved referral quality and education.

·       The importance of delivering care closer to home was emphasised, including through shared care, neighbourhood working and stronger collaboration with GPs and the ICB. A dedicated forum with primary care partners was suggested.

·       System wide resource constraints continued to impact delivery, particularly access to biologic treatments.

·       Concern was raised about the wider impact of capacity pressures, with a recommendation that the ICB review business cases and funding approaches in light of patient care needs. This was seconded.

AGREED:

1.     That Members note the verbal presentation.

2.     That the item would be added to the work programme for an update in the new municipal year.