21.In 2012, the previous Committee recommended that the Department should appoint a national clinical lead for neurology. Although the Department did not accept this recommendation at the time, NHS England subsequently appointed a national clinical director for adult neurology in 2013. The National Clinical Director, Dr David Bateman, is a practising neurologist and works two days a week in his national clinical director role.
22.NHS England told us that, when it was first established, it had appointed a number of new national clinical directors for a period up to March 2016. It said that it was now undertaking a review of how the various national clinical director roles fitted within the broader structure of national clinical leadership, with a view to reducing its running costs. There were currently 24 national clinical directors but NHS England told us that it planned in future to focus on three areas: its corporate priorities; life-cycle areas such as maternity, children and end-of-life care; and the big killers such as cancer. The review had not reached final conclusions at the time of our evidence session, but NHS England said it did not see neurology fitting within these priority areas and indicated that it did not plan to reappoint a national clinical director for adult neurology.
23.NHS England set out that it envisaged leadership for neurological conditions being provided in future in a collaborative way based around strategic clinical networks rather than through a single national clinical director. There are four strategic clinical networks, including one for mental health, dementia and neurological conditions, which work across 12 regions.
24.The National Clinical Director stated that he felt his role was critical. The experience and connections he had developed during his career as a neurologist had been crucial in being able to facilitate and support the development of important initiatives such as the neurology intelligence network. He said that he felt accountable for neurological services within the resources and time available to him. The Neurological Alliance also stressed that clinical leadership at a national level was vital to improving services and outcomes for people with neurological conditions.
25.In 2012, the previous Committee recommended that national datasets should link health and social care data using patients’ existing NHS numbers. The Department accepted this recommendation at the time, but the National Audit Office reported in 2015 that the Department had in fact not implemented the linking of health and social care data.
26.Both the Department and NHS England agreed that the linking of data across different care settings was vital for planning and improving the quality of services, but said that a generic solution had to be found which covered all conditions. NHS England told us that data collection is currently fragmented across NHS England, the Health and Social Care Information Centre and Public Health England. It emphasised the importance of streamlining these arrangements and moving away from the current practice of expensive and time-consuming one-off data collections.
27.The National Clinical Director said that, within a generic approach, neurological expertise would need to be retained in order to understand and interpret the data. At present, the neurology intelligence network provided this expertise. NHS England told us that the key would be to maintain a neurology focus which added value within a more standardised data collection and analysis process.
28.The Department and NHS England said they saw the care.data initiative as the solution to linking data across different care settings. Although it had had a troubled start, their ambition was to have care.data working by 2020. The Department told us that, following the spending review, funding was available to invest in technology and build the digital framework for patient information to be properly exchanged. It also said that the Secretary of State for Health had asked Dame Fiona Caldicott to look independently at the fundamental issue of patients’ ability to opt-out of care.data, and advise on whether linking of data could be done within the existing legislative framework. Dame Fiona was due to report by the end of January 2016 and the Department would then decide how to proceed.
29.Following the reforms to the health system in 2013, clinical commissioning groups commission most hospital, community and mental health services. NHS England commissions specialised health services, which are provided in relatively few hospitals to comparatively small numbers of patients.
30.The commissioning of neurological services is split between clinical commissioning groups and NHS England. However, the Neurological Alliance and Dr Fuller told us that the definition of what constitutes specialised neurological services had not been clear, leading to confusion over who should be commissioning which services. This lack of clarity had resulted in clinical commissioning groups not taking responsibility for commissioning neurological services in the belief that responsibility rested with NHS England.
31.NHS England confirmed that the split between specialised neurological services commissioned by NHS England and general neurological services commissioned by clinical commissioning groups had created fragmentation, particularly for outpatient services. It explained that, in areas where there were specialist centres, a GP referral for a neurology outpatient appointment would be commissioned by NHS England; but in areas without specialist centres, the same referral would be commissioned by the local clinical commissioning group. It accepted that this inconsistency did not make sense.
32.NHS England told us that, from April 2016, all neurology outpatient services arising from a GP referral would be commissioned by clinical commissioning groups. It said that this should allow clinical commissioning groups to have a more holistic view on what neurology outpatient services should look like for local people.
33.We also heard concerns about wide variations in the prices paid for neurological services. NHS England told us that the split between specialised neurological services and those commissioned by clinical commissioning groups might have contributed to variation in the payments received by hospitals for the same services, although this would require further investigation. The National Clinical Director gave the example of the part of the country where he worked where payments for the same service varied by more than 25%. NHS England explained that in this local area there were both specialist centres and non-specialist hospitals, resulting in the same neurological services being commissioned by different organisations at different prices.
Prepared 18 February 2016