Services for people with neurological conditions - Public Accounts Committee Contents

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 for reduction.

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 Needs Assessment.

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.

previous page contents next page

© Parliamentary copyright 2012
Prepared 16 March 2012