National Service Framework (NSF) for long-term conditions
The Department of Health launched the NSF for long-term conditions in March 2005. This NSF focuses specifically on the needs of people with neurological disease, brain or spinal injury.
This document follows a different format from previous NSFs. It does not have targets but rather focuses on 11 quality requirements, with patient centred care underpinning all the quality requirements. Full implementation of the quality requirements would result in significantly improved care for everyone with MS.
The launch of the NSF, aligned to the NICE MS Clinical Guidelines, offered hope for people with neurological conditions that after far too long services would be restructured and people with MS could expect a fairer deal. Implementation has however been very disappointing with much of the impetus being lost due to reorganisations of the NHS, budget restrictions and a lack of understanding by NHS commissioners.
The MS Trust is very unhappy about the lack of implementation of the NSF and NICE MS Clinical Guidelines and is working both alone and with the Neurological Alliance to register our concerns. To analyse the implementation to date the MS Trust is working with the Royal College of Physicians (RCP) to research implementation across England and Wales.
The Therapists In MS group has produced a publication around the NSF entitled Therapists in MS - delivering the long-term solutions. This publication launched in the House of Commons in 2006 outlines how therapists can make the quality requirements reality for people with MS.
Neurological competencies for health professionals
Aligned to the NSF the Department of Health in conjunction with Skills for Health has devised a framework for the health professionals who work with people with long-term neurological conditions. This framework is designed to set standards for the knowledge and skills base of all health professionals working in this area.
The MS Trust has now completed the Competencies for MS specialist services. These are aligned to the new NHS structures and the Knowledge and Skills Framework and we will be campaigning for their adoption.
Neurological Health Services Clinical Standards - Scotland
In October 2009 NHS Scotland published Neurological Health Services Clinical Standards, and the document will be officially launched in January 2010. The launch of this document marks the end of a lengthy process, assessing the current provision and the needs of the target population. NHS Scotland is to be congratulated for engaging all the stakeholders in the process especially the health professionals and the final document contains excellent aspirations. The proof of the pudding will of course be in the implementation.
The publication recognises that Scotland has an especially high incidence of the most common physically disabling condition affecting young people namely multiple sclerosis (MS). It also recognises the fact that one in five of the emergency admissions, one in eight general practice consultations and a high proportion of disability is due to neurological conditions. Particularly encouraging is the fact that the document recognises that the UK has lagged behind other European countries in its development of neurological services.
Some findings of the analytical phase were:
- NHS Boards were unable to describe their neurological services accurately
- NHS Boards appeared to consider neurological health services a low priority
- Specialist nurses were considered a valuable resource, but their provision varied greatly across NHS Boards
- The recent pilot of telemedicine neurological services in the north of Scotland was regarded as successful by patients, consultants and nurses.
Looking to the future the standards publication sets six key dimensions of quality:
- Safe
- Effective
- Patient-centred
- Timely
- Efficient
- Equitable
The specific standards for MS are:
- An effective and comprehensive specialist MS service is available across all NHS boards
- The NHS board provides a co-ordinated MS diagnosis service with access to a multidisciplinary team experienced in the diagnosis of MS
- Patients with MS have ongoing access to specialist services appropriate to their needs
We would encourage people with MS to start to demand services in line with these new clinical standards.