Policy and campaigning update - September 2008
Way Ahead 2008;12(4):1-2
- The Darzi vision: quality, engagement and professionalism
- MS Trust audits MS services
- Wales
- Mental Capacity Act
The Darzi vision: quality, engagement and professionalism
How often has the NHS published words to herald change and will the Darzi review be any different?
Health-care costs are rising, the population is aging, treatments and technologies are improving and we are all better informed and more demanding patients. A challenging set of parameters for the NHS which has to operate within a fixed budget even if the size of the budget has grown significantly over the last decade. The Darzi review is England centric but the Darzi principles are relevant across the UK, and they do offer some hope for redressing the balance between management and clinicians.
It has been a worrying truth that for several years important decisions for patients have been taken at levels completely divorced from clinical reality. If the new principles being espoused by Darzi and others can shift the focus from counting numbers, to quality and safety there will be real gains for people with MS.
It is always easy for health professionals to hide behind their clinical caseload, and clearly for many these remain too high, but time taken to enter into discussions about quality services should bring real rewards both for the professionals and patients. Elsewhere in this issue, you can read about an MS commissioning pathway which may facilitate such discussions. In addition, on the front page of this issue we report on the research undertaken by the MS Trust in conjunction with the Royal College of Physicians looking at implementation of the NICE MS management guidelines1. If your area has been involved in the audit this can be a helpful catalyst for change, or if not the recommendations may stimulate areas of consideration.
The Darzi visions for each Strategic Health Authority can be found on our website where you can also read the MS Trust's response to each of these. This data may be used to help you develop services in your locality.
1. National Institute of Clinical Excellence. Multiple Sclerosis: management of multiple sclerosis in primary and secondary care. NICE Clinical Guideline 8. London: NICE; 2003
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MS Trust audits MS services
An audit of services for people with MS by the MS Trust and the Royal College of Physicians (RCP) shows that the NHS is still failing to implement the 2003 NICE guidelines for MS. The audit, carried out in the first two months of 2008, asked people with MS, Hospital Trusts, Primary Care Trusts and Strategic Health Authorities a series of questions based on NICE's six key recommendations and one quality marker of the NICE guidelines.
The survey shows that access to neurological rehabilitation services remains wholly inadequate - only 36% of people with MS had access to such services. As we know, it is the inadequacy of symptom management which causes distress, and may worsen disability. If neurological rehabilitation were readily available, the severity of disability would be reduced.
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.
The survey also reports that 6% of people surveyed had developed a skin pressure ulcer during the previous 12 months. Occurrence of pressure sores was NICE's identified "quality marker" for MS services - and for very valid reasons. A grade 4 pressure ulcer costs the NHS an estimated £10,551, with total costs in the UK at £1.4-£2.1 billion - about 4% of the total NHS expenditure. Service quality remains low.
'World class commissioning' is cited as a priority objective within the NHS. This audit clearly demonstrates that there are few people at any level taking responsibility for commissioning neurological services. Local needs assessments, patient involvement in planning and development and robust quality measures are all noticeable by their absence. Clearly, for people with MS to have access to the services they need is still a matter of geographical accident. Where there are clinical champions for MS, services are good, but those services are not underpinned by commissioning and are therefore vulnerable in a time of cutbacks. The postcode lottery is now about basic services - continence, prevention of pressure sores, wheelchair assessments, pain relief.
Pam Macfarlane, Chief Executive of the MS Trust, said: "The results of this audit demonstrate how far wide of the mark standards of care for people with MS really are. We hope that this audit will enable the teams of committed health professionals who work with people with MS on a daily basis to challenge the organisational structures that are failing to deliver the required standards of MS care."
The MS Trust encourages all health professionals to study the report and the data from their respective localities and identify those areas which would really improve the quality of care delivered through their MS service.
This audit is the second carried out by the MS Trust and RCP and there are plans to repeat it early in 2010.
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Wales
A plan for complete reorganization of the NHS Wales was recently announced by Health Minister Edwina Hart. Under the proposals, all of the 22 local health boards (LHBs) would be replaced by seven health organisations. If the proposals are taken forward, it would mark the end of the NHS internal market and a return to a per capita method of funding the NHS in the principality. The MS Trust will formulate a response to this proposal once further developments unfold.
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Mental Capacity Act
The 'Mental Capacity Act 2005' for England and Wales was implemented in October 2007 to cover all decisions made, or actions taken, on behalf of people lacking capacity to make those decisions themselves.
A report recently published by the Office of the Public Guardian (OPG) revealed that since enforcement of the Act, more people are taking steps to ensure their rights and those of their loved ones, are respected by registering plans setting out what should happen to their financial and health matters should they lose mental capacity.
Mental capacity is a complex area and in order to navigate the Act and ensure best practice in treating people with complex neurological difficulties the Institute of Neuropalliative Rehabilitation, commissioned by the Department of Health, has produced guidance for clinicians. 'The management of people with complex neurological disabilities' is a comprehensive document that considers specific sets of circumstances and provides insight into all the relevant provisions of the Mental Capacity Act with practical measures to take forward best practice.
- The guidelines cost of £7.50. For more information visit the Institute of Neuropalliative Rehabilitation website
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Way Ahead articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.
