MS and neurological services in the UK
Open Door - February 2007 page 2
Nicola Russell, Director of Services, MS Trust
It is all too easy at the present time with the NHS seeming to be in 'meltdown' to forget the progress that has been made. In 1995 there were three MS specialist nurses; now there are in excess of 200. This number is still short of the target of 300 but much improved and for those people with MS who have regular access to an MS specialist nurse we know they recognise the benefits. Why then are these posts coming under threat? The answer of course is money; an MS specialist nurse is more expensive than a generalist nurse, and certainly more expensive than no nurse. For many Chief Executives struggling to achieve financial balance, to cut a number of specialist posts across a variety of disciplines can seem an effective way of trimming their balance sheet. Our role in 2006 has therefore been to work with the nurses and produce business plans showing the financial gains that they bring to the NHS, and it is pleasing to report that in most cases we have been successful. Further work is however still needed, and the target of 300 nurses must not be lost.
Is everyone with MS seeing an MS specialist neurologist? If not why not?
There are still only 400 consultant neurologists across the UK to see people with a range of neurological conditions. There are only approximately 60 who specialise in MS and thus in some areas specialisation is currently an unrealistic luxury. Is this acceptable? No.
Are people with MS getting access to the drug therapies they need at the appropriate time to ensure minimal neurological damage?
No. Postcode restrictions still exist and if a person never gets to a specialist neurologist they may never get the right advice.
Are people with MS getting access to the multi-disciplinary team? Can they get physiotherapy when required?
No. The development of the Therapists in MS group, supported by the MS Trust, is helping raise the awareness of specialist therapy interventions but more work is needed.
Is there a fundamental cause that underpins the issues listed above?
In the summer of 2006 the Kings Fund published research (see below) showing that within Primary Care Trusts in England only 3% of their budget was spent on neurology. Whilst these are English data there is no reason to suggest that the outcome would have been different in other parts of the UK. Yet data show clearly that 10 million people in the UK have a neurological condition. If neurology continues to have an inadequate share of the total NHS budget then there will always be problems, and in times of financial crisis, such as now, neurology services will be under intolerable pressures. The MS Trust will be working hard, both alone and with the Neurological Alliance, to gain recognition of this fundamental issue.
Finally we will be working to ensure that the NICE Guideline launched in 2003 and the National Service Framework for Long-term Neurological Conditions launched in 2005, both excellent documents, are implemented. This work has already started with an appointment with the Health and Social Care Commission in January.
So plenty of work still to be done – I feel weak already!
To read what the MS Trust is doing to support access to MS services and treatments visit the Campaigns pages
King's Fund research
The King's Fund is an independent health policy charity. In August 2006 it published a research report, which documented starkly the differences in health spending across primary care trusts (PCTs).
The report show that there are differences in spending per head of population that are only partially explained by the different needs of their local population.
What this research also shows is the woefully low spend on neurology. In the financial year 2004/2005, the year in which the research is based, the total spend for the NHS in England was £58bn. The top three areas for spend were mental health, circulation and cancers, all three being government priority areas. These three consumed approximately 29% of all money spent. Neurology captured only £1.8bn or 3.1% of the money spent.
There are 10 million people with neurological conditions in the UK. 16.5% of the population has a neurological condition but only 3.1% of the NHS spend in England goes on neurology. No wonder there are inequities and poor services.
The full report is available from the Kings Fund website
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