National Axial Spondyloarthritis Society (NASS): Improving Quality and Aspiring to Excellence

17th August 2023

Male back being checked by nurse to observe for pain


National Axial Spondyloarthritis Society (NASS) is the only charity in the UK dedicated to transforming the diagnosis and care of people with axial Spondyloarthritis (axial SpA) in the UK. NASS aim to build awareness, improve care, and empower the community.

Since October 2019, the NHS TU has supported the delivery of a multi-year programme to reduce time to diagnosis and improve quality of care. Our team work closely with Rheumatology secondary care services across the UK to help form an improvement network for axial SpA services.

The Challenge

1 in 200 of the adult population in the UK have axial SpA. Yet the current average delay to diagnosis from when symptoms start is 8.5 years, by which irreversible damage to the spine may have occurred. 59% of people with axial SpA report experiencing mental health problems compared to 25% of those with musculoskeletal conditions overall. Axial SpA is a lesser-known condition with variation in the standard of services provided for axial SpA across the UK. The challenge is to raise awareness of axial SpA and reduce the average time to diagnosis from first onset of symptoms from 8.5 years to a gold standard of 12 months.

Our Approach

Utilising Institute for Healthcare Improvement (IHI) and our clinical strategy and redesign methodologies, we worked in partnership with NASS to co-design a three-year quality improvement (QI) programme titled Aspiring to Excellence. Our team provide improvement knowledge, and the opportunities for teams to work through problems aided by improvement facilitators and coaching.

This has led to a well-developed programme with links between services in the UK and real change across 16 teams at 19 hospital sites in England and Scotland.

The Outcome

Through the programme, teams have achieved a wide range of improvements for patients and staff, including developing primary care education, implementing new pathways and clinics to ease referral, and reducing the first GP appointment to referral time. One of the hospital sites is now consistently achieving 12-month gold standard time to diagnosis from first onset of symptoms.​

We created a learning environment that facilitated the Aspiring to Excellence teams in delivering a wide variety of QI activities, including engaging primary care clinicians and improving referral pathways, to improving their internal pathways and diagnostics.​

The network of 19 hospitals work closely together, building on lessons learnt by earlier cohorts and developing standardised approaches. They use the networking opportunities we created to share outcomes of root cause analysis and improvement cycles. ​

The improvement coaching, we provided allowed individual sites protected time to drive forward their own projects.​

More information about the programme can be found:

Client Feedback:

“The NHS Transformation Unit has been a truly outstanding partner to our Aspiring to Excellence programme.”

Dr Dale Webb; CEO NASS​

Rheum for improvement podcastLucy Davies, NHS Transformation Unit Delivery Director, in her role as the Programme Lead for NASS’s Aspiring to Excellence programme is the co-host of the ‘Rheum for Improvement’ podcast dedicated to service improvement in axial SpA care.

Episodes 1-6 of Rheum for Improvement can be found here: