Half Way to … Nowhere

Are we there yet? You wouldn’t expect the answer to be “yes” mid way through a projected 10 year journey, but you could reasonably expect to be about half way to your destination.   Alarmingly, the 10 year journey of the Long Term Neurological Conditions National Service Framework (LTNC NSF) launched in 2005 seems to be a journey to nowhere.  The evaluation of progress recently undertaken by our friends at Neurological Commissioning Support is welcome but makes depressing reading.  Wherever users of neurological services are, they are certainly not “at the heart of neurology commissioning” as they ought to be.

‘5 years after this NSF was published, not a single audited site could meet a single Quality Requirement’

That is the damning conclusion of the LTNC NSF half way review. This is simply scandalous and yet, as far as we can see, there has been no outcry about this national failure – as there certainly would have been were the subject cancer or heart disease or diabetes as opposed to neurological conditions.

Halfway there? Far from it according to the NCS written evidence to Health Committee enquiry on commissioning

Neurological Commissioning Support has discovered that there are insufficient numbers of health and social care staff with specialist training and understanding in neurology who are competent to manage the needs of the 8 million people living with a neurological condition in England (and 10 million in the UK). The lack of understanding of the needs of these people has led to excessive and costly length of stays in hospital or inappropriate emergency admission where preventative treatment would have been more cost effective as well as enhancing the individual’s quality of life.

The orphan NSF

Parkinson’s UK says Coalition Government has abandoned the LTNC NSF.  It recently told the Health Select Committee

…. the foundations for neurological commissioning are too weak to see health and social care services through the transitional period. The Coalition Government have abandoned the National Service Framework for long term neurological conditions without putting in place anything to replace it. Even with the National Service Framework in place, neurological services were often not meeting the quality requirements. Without it, we worry that the services that are in place will not continue to be commissioned by GP consortia. In two or three years time, neurological services could have fallen away with little impetus to replace them.

An Opportunity Lost, maybe Forever

MAC’s view from working in the field is that “Long Term Conditions” as a concept is not understood by most clinicians or commissioners to include neurological conditions. This NSF was mis-named from the start.  That makes the LTNC NSF very much a  “lost NSF” and the carers for people with LTNC are often “lost carers” whose needs are not even looked for, much less met.

There was never any alignment between the LTNC NSF, the commissioning guidance for LTNC of April 2007, the NSF neurological care metrics that the Healthcare Commission was developing (but never used) and the “10 Quick Wins” for local implementation. The potential synergy between these was so obvious, but was squandered and lost.  Why did this happen?  Because no one was in charge.

QIPP to the rescue –  maybe

Will QIPP be any better for LTNC?  It has potential.  The Rightcare initiative could be applied to neurology and delivering this NSF, but someone will have to show the way to do it.   Integrated pathway commissioning across health and social care has to happen for this diverse group. But only the neuro organisations banging the drum with the new GP commissioners and HWBBs can make a difference. We wish them well but the omens are not good.  GPs with special interests in neurology are thin on the ground.  And specialist neurological nurses – whose value is demonstrated every time you talk to a person with a long term neurological condition who uses their services – are at risk in the transition to the new commissioning system.

Custodians of what?

In 2008, the third sector neuro organisations were told bluntly by Government, “you are now the custodians of the NSF”.   Despite the sterling work of those who created this NSF, Ministers didn’t own it, there was never enough sustained national level leadership and – crucially – no resources were put to achieving the “quality requirements” and metrics in it, unlike the CHD NSF.

Nothing has changed.  And so at the five year midpoint we have to ask: if the NHS couldn’t or wouldn’t do these things in the boom times, what chance is there in an age of austerity?  We hope we are proved wrong and quickly.

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