Move to local control has led to poorer care for neurological patients

BMJ 2012; 344 doi: (Published 16 March 2012) Cite this as: BMJ 2012;344:e2112
  1. Adrian O’Dowd
  1. 1London

Local control of neurological care has allowed standards to fall in contrast to successful national targets on cancer and stroke, according to MPs.

The parliamentary public accounts committee has criticised poor coordination of care for the estimated two million people in the UK who have a neurological condition and the variation in quality of care around the country.

The committee’s report on services for people with neurological conditions says efforts to improve services in recent years have made some difference, but have not worked as well as similar efforts to improve cancer and stroke care.

In 2005, the government published its National Service Framework for long term conditions, containing 11 quality indicators, designed to improve services for people with such conditions.

Similar strategies also emerged for cancer, published in 2000, and stroke, initially as targets within the National Service Framework for older people in 2001 and a specific stoke strategy in 2007.

Unlike the cancer and stroke strategies, the model used to implement the long term conditions framework had not worked, said MPs, because implementation was left to local commissioners without national leadership to ensure improvements.

No baseline for services or outcomes was established when the framework was introduced and there was no ongoing monitoring of progress.

There has been some improvement, says the report, which acknowledges that health spending on neurological conditions increased by 38% in real terms, from £2.1bn (€2.5bn; $3.2bn) in 2006-7 to £2.9bn in 2009-10.

Despite the fact that people with neurological conditions need a range of services that cross boundaries between health and social care, spending on social services for such people was an estimated £2.4bn in 2009-10, and has remained flat since 2005-6.

MPs said that other improvements, such as reduced waiting times, have been offset by the fact that services remain below the quality requirements set out in the framework.

Of particular concern is a 32% increase in emergency admissions and the increased rate of readmissions to hospital within 28 days from 11.2% to 14%, since the introduction of the framework.

The MPs’ report concludes that despite the complex needs of people with neurological conditions, their care is often poorly coordinated, with only 22% of people with Parkinson’s disease, multiple sclerosis, and motor neurone disease having a personal care plan.

The department intended to decentralise and localise decision making, with central monitoring, so the MPs said it was essential that it set clear objectives for the outcomes and services for people with neurological conditions.

They recommended the proposed NHS Commissioning Board appoint a dedicated national clinical lead for neurology as well as local neurological networks.

Margaret Hodge, committee chair and Labour MP for Barking, said: “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.”

Speaking of the framework on long term conditions, Hodge said: “Unlike the strategies for cancer and stroke, the model used to implement the framework hasn’t worked. The cancer and stroke strategies were headed by a tsar and the department monitored services with clear data against clear targets.

“For this clinical area, the department left the implementation to local health commissioners but gave them no leadership at all. It set no baselines and failed to monitor progress. The present government needs to understand what went wrong here for the future.”


Cite this as: BMJ 2012;344:e2112

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