The publication of the Public Accounts Committee’s report on services for people with neurological conditions throws down the gauntlet to the Department of Health and NHS England. Its message to the NHS chiefs is clear and stark: progress on neurology services has been nowhere near good enough for far too long, and people with neurological conditions are suffering as a result. But how can patient organisations like the MS Trust help the NHS rise to the challenge?
What does the report say?
The report states unequivocally that neurological conditions are not a priority for the Department of Health and NHS England and that services for neurological conditions are consistently not good enough, with wide variation across the country in access, outcomes and how people experience services.
That’s not news, is it?
The reiteration that neurology services within the NHS require urgent attention is very welcome and extremely timely given NHS England’s proposal to cut the role of National Clinical Director for Neurology (a post that the report strongly recommends keeping). But how do we make sure that this vital analysis does not become just another tome on the groaning bookcase of similar reports finding that neurology services are all too often the poor relation?
The previous Public Accounts Committee reported on neurological services in March 2012, making six recommendations aimed at improving services and achieving better outcomes. But in July 2015, the National Audit Office found that the Department of Health and NHS England had made ‘good’ progress against only one of those recommendations, with progress against a further three assessed as ‘poor’, and the remaining two as ‘moderate’. A 2015 report by the Neurological Alliance found that neurology has largely been ignored by local commissioners, with only 20% of Clinical Commissioning Groups (CCGs) able to even identify the number of people using neurological services in their local area, let alone develop a thorough understanding of their needs. As a result, neurology services continue to lag behind other conditions in service quality, availability and access as seen in recent news that over half of people with MS in the Southern Trust area of Northern Ireland are waiting more than 18 weeks for a first appointment with a neurologist.
So will this new report make any difference?
The kind of rigorous scrutiny brought to bear on neurological services by a body as influential and well respected as the Public Accounts Committee can only be a good thing. However history would suggest that this report, on its own, is not enough to bring about changes in leadership, accountability, planning, funding and delivery of services that are necessary to see real improvements. That is why the MS Trust launched an ambitious programme earlier this year bringing together everyone with a stake in the future of MS services to find ways to look at how MS services currently work, find ways to make best use of resources and skills to make sure specialist services work for everyone, and explore how we might measure what equitable care looks like in practice. Our ambition is that this work will help NHS England deal with the challenges highlighted by the Public Accounts Committee.
What is the MS Trust doing about it?
We launched MS Forward View because we believe that patient organisations like the MS Trust don’t just have a valuable role to play; we also have a duty to use our skills and resources to work with the NHS to help improve services for people living with MS.
The Public Accounts Committee expects NHS England to report back to them by April 2017 on what it has done to make best use of the available neurologists and reduce variations in access, including through re-designing services and making more use of other clinical staff, particularly specialist nurses. By mapping the MS workforce, looking at the skills needed to deliver what people with MS need, and identifying how commissioning systems can support service improvement, MS Forward View will directly tackle this challenge and provide a valuable resource for NHS England if they are prepared to engage with us. We will be writing to NHS England to offer an open dialogue about how MS Forward View can help them to address the challenges ahead. We hope that by the time NHS England reports again to parliament that we will have helped them to support real improvements in both local services and national health policy for people living with MS.
The Public Accounts Committee is a cross-party committee of MPs appointed by Parliament to scrutinise the value for money of public spending. It holds the government to account for the delivery of public services.