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Progress on improving services and outcomes for neurological conditions ‘mixed’

Great deal more work needed to meet PAC recommendations, says public spending watchdog

Caroline White

Monday, 13 July 2015

Progress in implementing recommendations made by an influential panel of MPs designed to improve services and outcomes for people with neurological conditions has been mixed, concludes a report* by the public spending watchdog, the National Audit Office (NAO).

Progress against one of the six recommendation made by Public Accounts Committee (PAC) in 2012 has been good says the NAO report. But progress against three others has been poor, with only moderate progress against the remaining two, it says.

The Department of Health did not initially agree with the MPs that a national clinical lead for neurology should be appointed and local neurological clinical networks created.

But a national clinical director for adult neurology is now in post, and a mental health, dementia and neurological conditions strategic clinical network has been set up, says the report.

But the government has failed to use levers such as the CCG outcomes indicator set to improve access to neurology services across the country and as a result neurology is mentioned in only half of local joint strategic needs assessments.

And it has not improved the supply neurology data, which means that the NHS has no record of the numbers of service users and no effective measure of patient outcomes.

And it has failed to ensure that everyone with a long-term neurological condition has a personal care plan, covering both health and social care.

Some progress has been against PAC’s recommendations that a neurological dataset should be developed and that the National Institute for Health and Care Excellence should develop relevant quality standards, says the NAO.

The Health and Social Care Information Centre published a compendium of neurology data in March 2014, although it did not link health and social care data or include data on emergency readmissions as the PAC had recommended.

The Department of Health has requested five quality standards for neurology, of which only one has been published, with another in development. And the National Institute for Health and Care Excellence estimates that it won’t publish the clinical standard on generic neurological problems until January 2018.

"Some neurological conditions are life-threatening, with many severely affecting quality of life and causing lifelong disability. Overall, however, progress in taking the action needed to improve services for the people with these conditions has been mixed. Considerable further work is therefore needed to make more progress and to achieve better services and outcomes for people with neurological conditions,” commented Amyas Morse, who heads up NAO.  

Arlene Wilkie, Chief Executive of the Neurological Alliance, said: “Three years on, it is unacceptable that so little progress has been made in vital areas that were identified as needing urgent improvement. It only adds to the sense of people living with neurological conditions that they are not seen as a priority within today’s NHS. Urgent action is needed so that the needs of millions of people with complex conditions are no longer overlooked.”

The Alliance says that access to specialist neurology services continues to vary widely, depending on geographical location, while waits for diagnosis and treatment are lengthy.

Admissions to hospital and their associated costs are rising, and care tends to be poorly planned and coordinated, it says.

A recent report published by the Association of British Neurologists found that in the UK there is on average one neurologist per 150,000 of the population, compared with 1 per 25,000 in the rest of Europe.

* Services for people with neurological conditions: a progress review. National Audit Office, July 2015.

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