Linda Riordan MP: Chronic fatigue must be better assessed

The National Rheumatoid Arthritis Society(NRAS) and leading think tank 2020health have just published a joint report on the impact of chronic fatigue on people with rheumatoid arthritis (RA). The new report raises some interesting questions about the way ‘invisible symptoms’ are assessed during welfare claims and is very timely in light of Work and Pension’s Committee discussions about the efficacy of the Work Capability Assessment.

For those of you who don’t know, RA is a chronic autoimmune disease which chiefly impacts upon the joints but can also affect other organs such as the heart, eyes and lungs. RA is often confused with osteoarthritis, which is an entirely different disease caused by wear and tear of the joints as we get older. Around 690,000 adults have RA in the UK, with approximately 26,000 new cases diagnosed each year in England alone.

Publication of the new report coincides with the launch of this year’s Rheumatoid Arthritis Awareness Week and it calls for the introduction of an additional descriptor into the Employment and Support Allowance’s Work Capability Assessment (WCA) to ensure the impact of chronic fatigue is adequately captured.

The call is based on new evidence presented in the report, which shows that chronic fatigue exerts a large impact on people with RA and their ability to work: nearly 9 out of 10 people with the disease experience it; and around three quarters of working age people with RA, who are unemployed, state chronic fatigue contributed to them not being able to work.

To underline the point, the report cites evidence that 50% of people with RA were placed in the ESA Work-Related Activity Group (WRAG) between 2008-2011 and deemed able to eventually return to work, even though a subsequent survey in 2013 found that 21% of people with RA who had undertaken a WCA believed it took insufficient account of the impact of fatigue.

As the National Rheumatoid Arthritis Society keeps pointing out, the numbers placed in the WRAG seem high compared to the high level of worklessness attributed to RA in several research studies –with a third of people forced to stop work within 1 year of diagnosis and up to a half forced to stop within 6 years.

What also comes over loud and clear from the report is that people with RA want to stay in work and that they only give up work very reluctantly due to the physical effects of the disease. Being told they should prepare to make a return to work, especially in cases where they have already been given retirement on medical grounds, does not make sense and is extremely distressing for claimants.

Three years ago several major national charities produced a report on fluctuating conditions, at the request of Professor Harrington (an independent reviewer appointed by the Department for Work and Pensions), which recommended the introduction of a new descriptor to cover fatigue and pain. Fast forward to 2014 and this specific concern has not been addressed.

With the Work and Pensions Committee having just completed its final oral evidence session for its inquiry into ESA and the WCA, I sincerely hope the Committee will take account of this report’s evidence and its renewed calls for fatigue to be better assessed within the WCA, and reflect this in the Committee’s final report recommendations.

Invisible Disease: Rheumatoid Arthritis and Chronic Fatigue is available to download from the National Rheumatoid Arthritis Society website here.

Linda Riordan is the Labour MP for Halifax.