Unlike the Department of Health's Cancer and Stroke Frameworks, the model adopted to provide services for people with neurological conditions has not worked, a committee of MPs has said.
There have been some improvements for the approximately 2 million people in the UK with neurological conditions since the Framework was launched in 2005 - for example, waiting times have fallen - but services remain well below the quality requirements which it sets out, according to the Commons Public Accounts Committee (PAC).
"Individual care is often poorly coordinated and the quality of services received depends on where you live. Some areas simply don't have enough expertise, both in hospitals and the community," said PAC chair Margaret Hodge, Labour MP for Barking, reporting on the panel's inquiry into services for people with neurological conditions.
The strategies for cancer and stroke are headed by a "tzar" and the Department monitors services with clear data against clear targets. However, for neurological conditions, the Department has left implementation to local health commissioners but given them no leadership at all, say the MPs. It has set no baselines and failed to monitor progress, so it could not hold them to account where things went wrong, they add.
"The present government needs to understand what went wrong here for the future," says the PAC.
The report shows that, over three years, health spending on neurological conditions increased 38% in real terms, from £2.1 billion in 2006-07 to £2.9 billion in 2009-10. Over much the same period, emergency admissions rose 32% and readmissions to hospital within 28 increased from 11.2% to 14%, and this is of particular concern, say the MPs. These “rates are well above those for the NHS as a whole, and present poor outcomes for people with neurological conditions and poor value for money for the NHS,” they notes.
Among the Committee's recommendations are for the proposed NHS Commissioning Board to appoint a dedicated National Clinical Lead ("tzar") for neurology, to provide leadership on the commissioning and design of services. The Board should also establish local neurological networks, coordinated by the NHS, with clearly responsible and accountable local leadership.
The Framework covers neurological conditions such as Parkinson's disease, motor neurone disease and multiple sclerosis (MS) - not migraine - but only 22% of people with these conditions have a personal care plan, the MPs report. They call on the Department to set out, in its Commissioning Outcomes Framework, that every person with a neurological condition should be offered such a plan, covering both health and social care.
While the Committee welcomes the announcement that the National Institute for Health and Clinical Excellence (NICE) will be developing Quality Standards for Parkinson's disease, MS and motor neurone disease, it points out that other neurological conditions will not be covered. Therefore, in addition to the three Quality Standards announced, the Department should instruct NICE to develop a generic Quality Standard covering other such conditions, it says.
The report concludes that there are key lessons to be learnt as the Department develops its proposed new health and social care landscape, in which it intends to decentralise and localise decision-making with central monitoring, and it will be vital that it sets clear objectives for the outcomes and services for people with neurological conditions.
“The delivery model needs to work better and put patient needs at its heart if services and outcomes are to improve. There needs to be stronger central and local leadership, and commissioners need to be held to account for outcomes. The Department's central monitoring of services must enable it to intervene where services are failing," the MPs emphasise.
- Their findings follow a damning report last December by the National Audit Office (NAO), which found that progress in implementing the strategy for people with long-term neurological conditions had been poor and that local organisations lacked incentives to improve the quality of services.
"It is not clear how lessons will be learnt, and there are risks to services which the Department must address to ensure that care improves," NAO head Amyas Morse said at the time.
The MPs have called on the NAO to follow up, in 2014, progress made against the recommendations made in their report.