Off last night to the official launch of the Neurological Commissioning Support’s exciting new online tool for commissioners “NeuroNavigator”. Keen readers of the MAC blog will know that the partnership worked with the Motor Neurone Disease Association (MNDA) a couple of years ago to develop its highly praised “Year of Care” commissioning pathway document. Over pudding, in a guest appearance as the seventh out of eight “during-and-after dinner” speakers, Baroness Finlay – palliative care consultant based in Cardiff – reminded everyone how “bowled over” she had been by the usefulness of this very large piece of paper which sets out in detail not only all the services and equipment that a person with MND is likely to need in a year, but also what they are likely to cost. Baroness Finlay still has a copy on her office wall for teaching students.
Of course, big bits of paper are all very well, but not everyone has that much wall-space so it seemed entirely logical to turn it into an interactive web-based tool. This time the tool includes not only a Year of Care for MND but also for Multiple Sclerosis and Parkinson’s Disease and has been produced with the support of the three big charities (MNDA, Parkinson’s UK and the MS Society).
Commissioning Ready Reckoner
Using demographic data and recognised reference costs, and supported by a raft of evidence and good practice guidance, it takes the form of a ready reckoner enabling commissioners to calculate the costs of providing the best possible care for people living with these particular neurological conditions. At the moment it is aimed at PCT and GP consortia based commissioners but in future NCS hopes it will be possible to use it to develop costed personalised pathways for individuals.
We were very pleased to be involved in choosing contractors and setting the goals for the development of this tool and it is great to see that our chosen developer Ben Eveling of Beetlebrow has succeeded in turning our big “ordnance survey map” into an easy-to-use “app” which, let’s hope, will be the first of many more to help commissioners get to grips with commissioning for individuals with complex needs across health and social care. It is a good sign, we hope, that Mr Lansley has said he likes this approach.
Commissioners All At Sea?
Commissioning is in flux in England as our NHS is “liberated” whether it wants to be or not. We would be the first to acknowledge that no matter how smart the kit is, it will not be much use unless the new commissioners understand what they are doing and what a year of care pathway tool is for in terms of value for money, improved patient and carer experience and improved quality outcomes. As our favourite management consultant Florence Nightingale was fond of saying “no report is self executive”. She meant it had to be sold in, to use the parlance of marketing. That is also true of tools for new commissioners. This is a leadership challenge for the neurological organisations leading NCS. We highlighted some signs during the summer when the NHS Operating Framework was changed that could spell difficulties in keeping the commissioners’ eyes on the neurological targets. And that was long before the present distractions of an austerity financial regime which will not spare the NHS.
Setting a Clear Course
To address all of this, we need leadership from neurological leaders based on setting a clear course for commissioning at consortium level and and the role of the National Commissioning Board in terms of the division of long term neurological conditions between them. Some will be “specialised” and some won’t be – and should not be. Some will have “specialised” elements in their intervention possibilities and then there is always the question of new drugs appearing on the market to consider. Cancer drugs are getting all the running about this, but there are plenty of other conditions to consider in terms of NICE approvals and their cost benefits.
Safe Haven Needed for Neurological Commissioning
We think all of this this is going to be troublesome because there is no consensus about what goes where for neurological commissioning. GPs historically do not have a strong affinity with neurological conditions and there will be temptations to let this drop off the commissioning table. What proactive line is the neuro 3rd sector community going to take to overcome this? And what are they doing to own “Nothing about me without me” for people with LTNC and switch on the power of the patient and carer voice?
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations.
We assist with the development of e-applications and websites to engage users and support commissioners.