National clinical guidelines
The MS Trust's campaign
NICE (the National Institute for Health and Clinical Excellence) published the National Clinical Guidelines for the Management of Multiple Sclerosis in Primary and Secondary Care in the National Health Service in November 2003. The guidelines are designed to provide a reasonable level of care for everyone with MS across England.
Whilst publication of the guidelines was a positive step, implementation was always going to be the critical phase. To assess the implementation the MS Trust and the Royal College of Physicians conduct an audit of MS services every two years.
2008 audit
The most recent audit was published in July 2008. This audit found that:
- Access to neurological rehabilitation services remains wholly inadequate - only 36% of people with MS had access to such services
- Although access to specialist neurological services has improved, there are still long delays from GP referral to diagnosis, with 50% of all patients waiting over 20 weeks
- 6% of people surveyed had developed a skin pressure ulcer during the previous 12 months despite the occurrence of pressure sores being identified as a 'quality marker' for MS services.
2006 audit
The first audit was published in July 2006. It concluded that: "Current service provision is of low quality and inadequate quantity. Most of the seven recommendations made in the NICE Guidelines are not complied with at present, there are few plans to change this."
What the NICE guidelines say
Key recommendations
The guidelines make six key recommendations for general service improvement. These reflected the stated concerns of many people with MS, whether they were undergoing diagnosis or had had MS for many years.
- Access to specialised services
- Rapid diagnosis
- Seamless services
- A responsive service
- Sensitive but thorough problem assessment
- Self-referral after discharge
Scotland, Wales and Northern Ireland
NICE Clinical Guidelines strictly only apply to England. However, the MS Trust has used the Guidelines as a lever to improve services in Scotland, Wales and Northern Ireland, and as stated above our latest audit has been carried out in Wales as well as England. Scotland's policy of Managed Clinical Networks to provide care for people with MS is beginning to deliver improved services, and we continue to work with health professionals everywhere.
Healthcare Commission health check
In October 2008, the Healthcare Commission published a report, known as a health check, on the quality of services provides by health trusts across England.
Whilst the health check shows that on the whole standards are improving, it does illustrate that some areas are providing better services that others. The survey underlines the need for all trusts to achieve a basic standard so that people receive good NHS care regardless of where they live.
Such standards do exist for MS services in the form of NICE's Guidelines for the Management of Multiple Sclerosis in Primary and Secondary Care and the National Service Framework (NSF) for Long-term conditions. However, the audits carried out by the Royal College of Physicians and the MS Trust demonstrate that improvement in this area are happening more slowly.
Since the publication of the 2008 audit, the MS Trust has been in contact with the Healthcare Commission about monitoring services for people with MS and has been encouraged by their wish to work to use MS data in the future.
