Neurological services: costs up, quality down

It is widely acknowledged that people with neurological conditions require a range of services, across a number of organisations including health, social services, employment, benefits, transport, housing and education. The services a person needs can change, particularly where the condition rapidly deteriorates, or fluctuates. Fluctuation can affect access to services, in particular, when people’s entitlement is assessed during periods where their condition may have temporarily improved. The National Service Framework for Long-term Conditions (the Framework) introduced by the Department of Health (DH) in March 2005, focused on people with neurological conditions. The Framework identified a range of problems faced by people with neurological conditions including lengthy diagnosis; poor information for patients on their condition and services; variable access to, and little integration of, health and social services; and poor quality of care in hospital. The Framework was developed at a time when accountability and delivery were being devolved to the front line, rather than centrally driven, and reflecting this approach it allowed local commissioners to determine the speed of implementation according to local priorities.

Quality requirements

At the core of the Framework are 11 quality requirements designed to put the individual at the heart of care and to provide a service that is efficient, supportive and appropriate from diagnosis to end of life. The quality requirements were to be fully implemented by 2015. However, while the Framework remains part of the DH’s approach there is uncertainty about its status among the stakeholders spoken to by the National Audit Office (NAO) while compiling a report – Services for people with neurological conditions. This uncertainty was attributed to a variety of reasons, including the election of a new Government; the cancellation of a planned mid-point review agreed by the previous Government; and the decommissioning of the Long-Term Conditions Delivery Support Team in March 2011 due to the cessation of NHS bundle funding. The report looks at services for people with a neurological condition resulting from disease, rather than sudden brain or spinal cord injury. It focuses on three progressive conditions – Parkinson’s disease, multiple sclerosis (MS) and motor neurone disease, and it is estimated that around two million people in the UK have one of these neurological conditions. Since the Framework was introduced (between 2006 and 2007 and 2009 and 2010) health spending on neurological services increased by 38% in real-terms, going from £2.1 bn to £2.9 bn, but it is difficult to see what this additional spending has achieved, as key indicators of quality – such as the rate of emergency hospital readmissions – have worsened. The number of people admitted to hospital as an emergency has increased significantly. The report found that the variation of emergency admissions across PCTs was greater than expected, after taking into account the variation due to chance. In addition, emergency readmissions following an overnight stay have increased for patients with Parkinson’s disease, multiple sclerosis and motor neurone disease within seven days (4.5% to 5.7% of discharges) and 28 days (11.2% to 14% of discharges) days between 2004-05 and 2009-10.