The National Institute for Health and Care Excellence (NICE) published the revised clinical guideline Management of multiple sclerosis in primary and secondary care in October 2014, eleven years after the original guideline.
According to NICE "clinical guidelines are systematically-developed recommendations on how healthcare and other professionals should care for people with specific conditions. The recommendations are based on the best available evidence. Clinical guidelines are also important for health service managers and those who commission NHS services." Clinical guidelines make recommendations about:
- the care and services that are suitable for most people with a specific condition or need
- ways to promote and protect good health, and prevent ill health where possible
- the configuration and provision of health and social care services
- how public sector organisations and partnerships can improve the quality of care and services
NICE Clinical Guidelines are available for everyone to use, however, it's normally anticipated that they will be of most value to GPs and other healthcare professionals such as MS specialist nurses. The Guideline only applies to the NHS in England; the other nations may choose whether to implement it.
The 2014 MS Guideline identifies the following key priorities for implementation:
- rapid referral for diagnosis, which should not be based on MRI alone
- information and support, especially around the time of diagnosis
- co-ordination of care, involving the multidisciplinary team, identified as including: neurologist, MS specialist nurse, physiotherapist and occupational therapist, speech and language therapist, psychologists, dietitians, continence specialists and social care
- supervised exercise programmes for people with MS who have mobility problems and/or fatigue
- treat relapses with oral steroids
Not key priorities, but also positive steps forward for MS, are recommendations around:
- an annual review by a healthcare professional with expertise in MS
- cognitive symptoms of MS
The 2014 Guideline goes on to make recommendations about addressing gaps in the research evidence for MS. It does this by posing five key research recommendations:
- what is the clinical and cost effectiveness of cognitive rehabilitation for people with MS?
- is IV methylprednisolone more clinically and cost effective than oral methylprednisolone in people with relapsing remitting MS and people with secondary progressive MS with continued relapses?
- what is the optimal frequency, intensity and form of rehabilitation for mobility problems in people with MS?
- what non-pharmacological interventions are effective in reducing spasticity in people with MS?
- can vitamin D slow down the progression of disability in MS?
Overall, though, the 2014 MS Guideline is disappointing, with the single biggest problem being that there is no overarching vision of what a good MS service will look like to people with MS. It also fails to identify that MS specialist nurses are ideally placed to deliver many of these elements, as the availability of MS specialist nurses and their central role in the delivery of holistic care is a key indicator of overall service quality.
Additionally, there are gaps and omissions, such as not enough emphasis on rehabilitation, and the complete omission of some disabling MS symptoms such as tremor.
NICE's recommendations do not apply in Scotland. NHS Quality Improvement Scotland published national standards of care for neurological conditions in October 2009.
Wales normally follows NICE Guidance.
The Department for Health, Social Services and Personal Safety Northern Ireland considers NICE Guidance. The local Departmental review of the majority of Clinical Guidelines is expected to be complete within 8 weeks of publication by NICE. As soon as the local review is complete, endorsement decisions will be published on the Department's website.
Last updated: 8 October 2014
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