Our health, our care, our say

A new direction for community services

Health and social care working in partnership

January 2006

The MS Trust, whilst welcoming certain aspects of the White Paper 'Our health, our care, our say: a new direction for community services', is disappointed that there is no specific mention of services for people with neurological conditions.

The emphasis of the White Paper is on prevention, earlier intervention, giving individuals a louder voice, and integrating health and social services. It states that the government wishes to tackle inequalities and improve access to community services. People with long-term conditions are mentioned specifically regarding the provision of an 'information prescription' and the development of personal health and social care plans.

However, the White Paper makes only a passing reference to specialist nurses, who we know have made such an impact on the support of people with MS over the last decade.

Whilst the White Paper espouses certain principles that will help people with MS, the MS Trust hopes that it will not deter commissioners from implementing the NICE MS Management Guidelines and the National Service Framework with its eleven quality requirements. Both of these initiatives, if implemented, would revolutionise services for people with MS.

The MS Trust will therefore continue to campaign for the implementation of the NICE Guidelines and the NSF, as well as the provision of specialist services for people with MS.

Key points for people with MS include:

Emphasis on self care, including increasing investment in the Expert Patient Programme threefold.
A commitment to developing an 'information prescription' for anyone with a long-term condition, which will help them manage their condition and point them towards further sources of information and advice. Basis of this to be reviewed during 2006.
By 2008, every area in England to have a joint health and social care managed network and/or team to support people who have very complex long-term needs, with a single expert case manager and a 24/7 service contact.
Joint health and social care plans for people with long-term conditions - by 2008 for those who use both health and social care, and by 2010 for anyone with a long term condition.
Improving partnership between health and social services, including joint appointments at Director level and joined up local planning.
Pilot and evaluate a scheme that gives patients in one area direct contact with physiotherapy services. If successful, this may be rolled out to other therapy services. No timescale is given for this pilot.
National criteria for the means testing of social care services.
Extending the Direct Payments scheme for social care services (personal care).
Rolling out the Individual Budgets scheme that covers all aspects of social care, including social services, community equipment, Access to Work, independent living funds, disabled facilities grants and Supporting People programmes. The aim is to give people more control over what and how these funds are spent.
Investment in technology and equipment to help people continue to live at home.
A new National Framework for NHS-funded continuing care and nursing care, due in 2006. This will clarify what the NHS will provide for those with the most complex long-term care needs.
New deal for carers (no timescale is given for this):
- a national carers' helpline for information and advice of all types
- creation of an Expert Carers' Programme for issues around caring
- each council area to ensure short-term, home-based respite care is available for crisis and emergency situations
End-of-life care: developing co-operative end-of-life care networks, bringing together local health services, social services, hospices, palliative care services and hospitals, and will provide rapid response service, by investing in community-based, specialist palliative care services. All staff to be trained to work with the dying. No timescale is given for these developments.

Significant points for MS specialist health professionals

Recognition of input from specialist nurses into the integrated case management team.
Direct access (self-referral) to physiotherapy and other therapy services.
Potential for development in integrated case management teams.
5% shift of resources from secondary to primary care over the next 10 years, to enable the transfer of services from hospital to local settings. This is particularly true in the services that are likely to be transferred, ie dermatology, ENT, general surgery, orthopaedics, urology and gynaecology.
Director of Public Health and Director of Adult Social Services to be a joint or partnership appointment where possible. Potential for the Director of Adult Social Services to focus on co-ordinating agencies such as health, housing and transport to promote social inclusion, as well as responsibility for quality of social care services (guidance due 2006).

Other important elements of the White Paper are:

Developing General Practice to move more care out of hospital, particularly in specific areas eg dermatology, ENT, trauma and orthopaedics.
Providing incentives to improve out of hours care, advance booking and extended surgery hours for General Practice, using other service providers such as advanced nurses.
An improved role for community hospitals as points of access for services.
A new service, the NHS Life Check, to provide a check-up at certain ages to assess lifestyle risks and target health advice accordingly.
Better services for mild mental health problems, including emphasis on talking.
therapies such as cognitive behaviour therapy.
More choice for women in maternity care.
A new screening programme for bowel cancer, available from April 2006.
Better services and follow-up for ex offenders.
Better services for adults with learning disabilities.
Improved access to Child and Adolescent Mental Health Services nationally.
IT to support a new shared health and social care record.