Services in the UK for people with long-term neurological conditions are not as good as they should be, despite a large increase in spending, says the National Audit Office (NAO).
Since 2005, when the Department of Health introduced its National Service Framework for Long-Term Conditions, people with neurological conditions have had better access to health services, but key indicators of quality - such as the rate of emergency hospital readmissions - have worsened, according to a new analysis from the NAO.
Moreover, "the Department does not know what the Framework and additional spending of nearly 40% over four years has achieved," it says.
The Framework was designed to improve care for people with neurological conditions, but progress in implementing it has been poor, the report finds. Access to health services for people with long-term neurological conditions such as Parkinson's disease, multiple sclerosis and motor neurone disease has improved, and waiting times for inpatient and outpatient neurology have decreased since 2007. The number of elective neurological operations has also increased.
However, the NAO also finds that the rate of emergency admissions to hospital has increased significantly, and there is large variation in emergency admission rates between Primary Care Trusts (PCTs).
Access to services for patients also varies significantly depending on where they live, it adds. For example, the analysis finds there is variation across the country in the number of specialist nurses per person with multiple sclerosis.
There are also still significant problems with current services. Following their diagnosis, many patients are not given information on their condition, about local services or on available support. Ongoing care is fragmented and poorly coordinated, and there is a pattern of patients being referred to hospital for treatment, then discharged and then referred to hospital again, says the NAO, which adds that it has also found that there is poor coordination between health and social services.
An estimated 2 million people in the UK have a neurological condition, excluding migraine. Between 2006-07 and 2009-10, health spending on neurological services increased by 38% in real terms, from £2.1 billion to £2.9 billion. Social services spending on adults with a physical disability, of which a significant proportion will have a neurological condition, has remained flat in real terms since 2005-06, and the number of adults with a physical disability receiving social services has fallen since that time, because fewer people are now eligible for these services, the report notes.
Commenting on the study's findings, NAO head Amyas Morse said that progress in implementing the Department's strategy has been poor, and local organisations lack 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," he warned.