“In terms of medical professionals I feel like it can be really hit and miss. I always felt like I was being rushed through the door a little …. like I was a bit of an inconvenience, I didn’t feel as though some of the appointments were constructive for me. It was a case of try this and off you go.” Emma
However, even in secondary care there is no nationally recognised assessment system for disease severity in the UK. Whist various scoring systems are used across the country, such as DLQI, EASI and PASI, in the case of atopic eczema, EASI is not well-known or used across all clinical practice, despite being a widely accepted and validated tool used routinely in relevant research studies. 4 Delays in accessing specialist care In spite of the importance of early diagnosis and referral for patients with inflammatory skin conditions, there are around 434,000 patients currently on the 18-week waiting list, almost double the number waiting pre-pandemic. 9,10 These statistics are supported by patient experience surveys: • One study of eczema patients showed 35% of adult respondents (42% for adults with moderate, severe or very severe eczema) said on the last occasion they were referred to a dermatologist, they had to wait more than three months for an appointment. 37 14% of adults waited more than six months and 5% of adults waited more than a year. 37 • Another survey found that around 30% of respondents with severe eczema had to wait four to seven months before being seen in secondary care after referral. 4 This situation is recognised by NHS England’s referral optimisation guidance, which highlights how patients with long-term skin conditions can find outpatient referral systems and processes inflexible and ineffective, with an inequity of access to care created for people with inflammatory skin conditions despite these diseases having a significant impact on their quality of life. 5 However, it has been suggested that many NHS trusts in England do not monitor or track data on outpatient appointments for adult patients with diagnosed or suspected eczema, and that for those that do, data is not collected in a way that can be broken down by individual skin condition. 4 This makes it difficult to assess the time patients have to wait to access care in different areas of the country, and one study found that only 14% of CCGs know the number of people with eczema in their area. 4 Workforce shortages have exacerbated these pressures. NHSE’s GIRFT report found that workforce shortages across the country were responsible for long waiting times for people with skin diseases, because the limited resources available are prioritised to meet cancer review and treatment targets. 13 This situation has been exacerbated by recent industrial action. A report in September 2023 in the BMJ suggested that as many as one million hospital appointments had been postponed in England due to strike action. 38 While this number spans all services, the disruption to elective care services is likely to be contributing to the rising waiting lists in dermatology noted above. Restrictions in treatment access Once an inflammatory skin condition patient has been seen by a specialist they may still find it difficult to access the optimal treatment for their condition. Many factors influence whether a patient is able to access a certain treatment, such as whether dermatology units have the dedicated personnel or services in place for the prescription and administration of a specialist treatment, or if they have a local documented treatment pathway in place that restricts access. 35
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FROM NATIONAL GUIDANCE TO LOCAL ACTION
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