Information Governance

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1 Information Governance Dept of ehealth NHS Grampian Rosehill House Foresterhill Site Cornhill Road Aberdeen AB25 2ZG Date 12 th May 2011 Your Ref Our Ref FOI/2011/124 Enquiries to Information Governance Team Extension Direct Line Freedom of Information (Scotland) Act 2002 I refer to your dated 11 th April 2011, requesting: What specialist rheumatology services, broken down by clinic and hospital, does you NHS Board offer? Please state which specialist dermatology services, broken down by clinic and hospital, are offered for patients with psoriasis, psoriatic arthritis, and those who require sero-negative and spondylitic services? Please state the sites where there are combined rheumatology and dermatology clinics. Could you list all specialist services which are available within your NHS Board to deal with psoriasis and psoriatic arthritis (including both primary & secondary care)? Which services do you offer to patients with psoriasis/psoriatic arthritis, but that are delivered via another NHS Board (including both primary & secondary care)? Has the service that you provide for patients with psoriasis and/or psoriatic arthritis been altered in any way in the last two years (including both primary & secondary care), and if so please state the nature of that change? Does your NHS Board have any plans to reduce, close or amend the services that you currently offer for psoriasis and psoriatic arthritis within the next two years (including both primary & secondary care)? What is the total cost to your NHS Board of providing specialist psoriasis and psoriatic arthritis What is the total cost to your NHS Board of providing specialist dermatology What is the total cost to your NHS Board of providing specialist rheumatology What actions have you taken to ensure that relevant staff (in both primary & secondary care) are educated about SIGN Guideline 121 diagnosis and management of psoriasis and psoriatic arthritis in adults? What actions have you taken to promote adherence to SIGN Guideline 121, in both primary & secondary care? What actions do you intend to take to promote the use of, and adherence to, SIGN 121 in the future? Are all patients diagnosed with suspected psoriatic arthritis being referred to a rheumatologist?

2 What is the usual waiting time between a patient being diagnosed with suspected psoriatic arthritis and them being seen by a rheumatologist? What services do you provide for the psychosocial care and mental health care of patients with psoriasis and psoriatic arthritis? Has this provision altered, or are there any pans for it be altered, as a result of the publication of SIGN 121? What percentage of patients with psoriasis and/or psoriatic arthritis are currently referred for a mental health/psychosocial assessment? What educational tools are provided to help health professionals in primary and secondary care identify patients who might be developing significant arthritis or spondylitis in association with psoriasis? What percentage of patients with joint damage/dactylitis present are currently referred for a rheumatology assessment? What support is available to GPs to provide an annual review of their patients? Do these annual reviews include: o Documentation of severity using DLQI? o Screening for depression? o Assessment of vascular risk (in patients with severe disease)? o Assessment of articular symptoms? o Optimisation of topical therapy? o Consideration for referral to secondary care? Since the publication of SIGN Guideline 121, what facilities have been developed to provide combined dermatology & rheumatology care to patients with severe joint and skin disease? Are all patients on biologic therapies being offered the opportunity to join the BADBIR long term safety register? What nurse-led clinics for psoriasis are available for delivery of services such as follow-up of specialist caseload, re-access for patients with recurrent disease, and monitoring of systemic therapies? I can now respond as follows: What specialist rheumatology services, broken down by clinic and hospital, does you NHS Board offer? NHS Grampian has a specialist Rheumatology service for out-patients based at Woolmanhill Hospital, and a day case treatment service at Aberdeen Royal Infirmary. General Rheumatology clinics are also held at Dr Gray s Hospital in Elgin and there is an Inflammatory Disease Clinic in Orkney. Please state which specialist dermatology services, broken down by clinic and hospital, are offered for patients with psoriasis, psoriatic arthritis, and those who require sero-negative and spondylitic services? NHS Grampian has Dermatology clinics at Aberdeen Royal Infirmary, Peterhead, Fraserburgh, Banff, Huntly, and Elgin which all offer assessment and treatment for patients with Psoriasis. Please state the sites where there are combined rheumatology and dermatology clinics. NHS Grampian currently has no combined Rheumatology and Dermatology clinics. Could you list all specialist services which are available within your NHS Board to deal with psoriasis and psoriatic arthritis (including both primary & secondary care)?

3 NHS Grampian has Psoriasis clinics and a Biologics service at Aberdeen Royal Infirmary. Which services do you offer to patients with psoriasis/psoriatic arthritis, but that are delivered via another NHS Board (including both primary & secondary care)? NHS Grampian provides an Inflammatory Disease Clinic in Orkney. Has the service that you provide for patients with psoriasis and/or psoriatic arthritis been altered in any way in the last two years (including both primary & secondary care), and if so please state the nature of that change? There have been no significant changes to the service in the last two years. Does your NHS Board have any plans to reduce, close or amend the services that you currently offer for psoriasis and psoriatic arthritis within the next two years (including both primary & secondary care)? There will be a need to move the Rheumatology service to a single site within the next two years although no final decision has been taken. This will enhance care to all patients with rheumatic disease. What is the total cost to your NHS Board of providing specialist psoriasis and psoriatic arthritis What is the total cost to your NHS Board of providing specialist dermatology What is the total cost to your NHS Board of providing specialist rheumatology What actions have you taken to ensure that relevant staff (in both primary & secondary care) are educated about SIGN Guideline 121 diagnosis and management of psoriasis and psoriatic arthritis in adults? Clinicians involved in Rheumatology and Dermatology services are fully informed of the appropriate SIGN Guidelines and disseminate these within their clinical teams. What actions have you taken to promote adherence to SIGN Guideline 121, in both primary & secondary care? NHS Grampian has not taken any specific action to promote adherence to SIGN Guideline 121. What actions do you intend to take to promote the use of, and adherence to, SIGN 121 in the future? NHS Grampian has no specific actions planned to promote the use of, and adherence to SIGN Guideline 121. Are all patients diagnosed with suspected psoriatic arthritis being referred to a rheumatologist? It is likely that the majority of patients diagnosed with suspected psoriatic arthritis are referred to a rheumatologist, however this information is not centrally collated by NHS

4 Grampian and it would be necessary to review the medical notes of all individual patients to confirm this which would cost in excess of the limit set out under s12 of the Act Excessive cost of compliance. What is the usual waiting time between a patient being diagnosed with suspected psoriatic arthritis and them being seen by a rheumatologist? The approximate waiting time for a patient to be seen by a rheumatologist following diagnosis is 6 weeks. What services do you provide for the psychosocial care and mental health care of patients with psoriasis and psoriatic arthritis? NHS Grampian does not provide any specific services for the psychosocial care and mental health care of patients with psoriasis and psoriatic arthritis. Has this provision altered, or are there any plans for it be altered, as a result of the publication of SIGN 121? There have been no alterations as a result of the publication of SIGN 121. What percentage of patients with psoriasis and/or psoriatic arthritis are currently referred for a mental health/psychosocial assessment? This information is not recorded; s17 of the Act refers Information not held. It is likely that the percentage is very small as referral would only take place when major mental health issues are identified. What educational tools are provided to help health professionals in primary and secondary care identify patients who might be developing significant arthritis or spondylitis in association with psoriasis? There are no specific educational initiatives in NHS Grampian to help health professionals in primary and secondary care identify patients who might be developing significant arthritis or spondylitis in association with psoriasis. What percentage of patients with joint damage/dactylitis present are currently referred for a rheumatology assessment? It is likely that the majority of patients are referred to Rheumatology, however this information is not centrally collated by NHS Grampian and it would be necessary to review the medical notes of all individual patients to confirm this which would cost in excess of the limit set out under s12 of the Act Excessive cost of compliance. What support is available to GPs to provide an annual review of their patients? Do these annual reviews include: Documentation of severity using DLQI? Screening for depression? Assessment of vascular risk (in patients with severe disease)? Assessment of articular symptoms? Optimisation of topical therapy? Consideration for referral to secondary care? There is no formal annual review process in secondary care though most patients with significant arthritis will receive continuing out patient care as required. Since the publication of SIGN Guideline 121, what facilities have been developed to provide combined dermatology & rheumatology care to patients with severe joint and skin disease? No facilities have been developed further since the publication of SIGN Guideline 121.

5 Are all patients on biologic therapies being offered the opportunity to join the BADBIR long term safety register? All patients on biologic therapies are being offered the opportunity to join the BADBIR long term safety register. What nurse-led clinics for psoriasis are available for delivery of services such as follow-up of specialist caseload, re-access for patients with recurrent disease, and monitoring of systemic therapies? There are no specific nurse-led clinics, however nurses work alongside medical staff in general clinics and psoriasis clinics. Under section 20 (1) of the Act, if you are dissatisfied with the way NHS Grampian has dealt with your request, you have a right to request a review of our actions and decisions in relation to your request, and you have a right to appeal to the Scottish Information Commissioner. A request for review must be made within 40 working days and should, in the first instance, be in writing to: Directorate of Corporate Communications, Ashgrove House, Foresterhill, Aberdeen, AB25 2ZN or by to grampian@nhs.net Requests for appeal should be made in writing to: S cottish Informa tion Commissioner, Kinburn Castle, Doubledykes Road, St Andrews, Fife, KY16 9DS Telephone: , Fax: enquiries@itspublicknowledge.info Yours sincerely Chris Morrice Information Governance Manager NHS Grampian