Conclusions and recommendations |
1. Implementation of the Framework lacked
leadership at both national and local level, which led to a lack
of impetus, focus and direction.
The Department accepts that leaving implementation solely to local
bodies has not delivered. Unlike other treatment areas, such as
stroke and cancer, neurology does not have a dedicated National
Clinical Director or local networks to coordinate services. The
proposed NHS Commissioning Board should appoint a dedicated National
Clinical Lead for neurology to provide leadership on the commissioning
and design of neurological services. It should also establish
local neurological networks, coordinated by the NHS, with clearly
responsible and accountable local leadership.
2. The Department lacks the data to measure
the effectiveness of services for people with neurological conditions.
The Framework lacked an empirical baseline from which progress
could be measured nationally or locally for health and social
care, and the Department has no way of assessing what resources
and activities result in the best outcomes. The Department
should develop a neurological data set covering resources, services
and outcomes, which should include linking existing health and
social care data using the patient's NHS number. Key indicators
from the data set, including emergency admissions and readmissions
for neurological conditions, should be included in the NHS and
Adult Social Care Outcomes Frameworks with appropriate targets
3. The quality of services for people with
neurological conditions varies around the country, with some areas
having insufficient expertise both in hospitals and in the community.
The compliance of individual Primary Care Trusts with the Framework's
quality requirements has been poor and so the support and treatment
available to people continue to depend on where they live. The
Department should set out in its reply to us how it will ensure
all people with neurological conditions have appropriate access
to services. We would expect this to include how the Department
will drive improvements through the quality section of the NHS
Standard Contract, the Commissioning Outcomes Framework, the Joint
Strategic Needs Assessments and the Health and Wellbeing Boards.
4. Despite people with neurological conditions
requiring a wide range of services, health and social services
are poorly integrated. Poorly integrated
services can result in, for example, increased emergency readmissions
to hospital. Less than 5% of overall NHS and social care budgets
are spent through joint arrangements such as pooled budgets. In
its Commissioning Outcomes Framework, the Department should mandate
joint health and social care commissioning of neurological services,
supported by Health and Wellbeing Boards through the Joint Strategic
5. Individual care is often poorly coordinated,
with only 22% of people with Parkinson's disease, multiple sclerosis
and motor neurone disease having a personal care plan.
Specialist nurses can play an important role in helping people
navigate their way through the range of support they need. While
the Department cited a figure of 80% of people with all long-term
conditions having care plans, this related to a wider range of
conditions and only serves to further underline the disparity
between the support available to people with neurological conditions
and that available to people with other long-term conditions.
The Department should set out in its Commissioning Outcomes Framework
that every person with a neurological condition should be offered
a personal care plan, covering both health and social care. The
evidence suggests that this is best done by a single professional,
for example a specialist nurse or care coordinator.
6. The Quality Standards planned by the National
Institute for Health and Clinical Excellence (NICE) will not cover
all neurological conditions. We welcome
the announcement at our hearing that NICE will be developing Quality
Standards for Parkinson's disease, multiple sclerosis and motor
neurone disease. However, these will not cover other neurological
conditions. In addition to the three Quality Standards announced,
the Department should instruct NICE to develop a generic Quality
Standard covering other neurological conditions.