The Committee finds there is still "wide variation across the country in access, outcomes and patient experience" and in particular that "diagnosing neurological conditions takes too long, services in hospitals are variable and local health and social care services are often poorly coordinated".
It highlights findings that over 40% of people with a neurological condition do not think local services work well together, and only 12% of people have a written care plan to help coordinate their care.
While the Report acknowledges some progress on implementing recommendations set out by the previous PAC in 2012, "these changes have not yet led to demonstrable improvements in services and outcomes for patients".
"Clear that neurological conditions are not a priority"
The Committee concludes: "It is clear that neurological conditions are not a priority for the Department of Health and NHS England, and we are concerned that the progress that has been made may not be sustained."
Neurological conditions, such as Parkinson’s disease, motor neurone disease and epilepsy, result from damage to the brain, spinal column or peripheral nerves and can be life-threatening. Many severely affect people’s quality of life and cause lifelong disability.
The most recent estimate indicates there are 4.7 million neurological cases in England.
Meg Hillier MP, Chair of the PAC, said:
"This Report serves as a wake-up call to the Department of Health and NHS England. The message from the frontline is clear and central government must listen and learn.
Our Committee heard of unsettling disparities in outcomes for people living with what can be devastating or even fatal conditions. We also heard of the huge knock-on costs the NHS can incur as a result of poor care.
Barely more than one in ten patients has a written care plan and four in every ten feel local services do not work well together.
These are stark findings and doubly alarming when you consider that NHS England could abolish the role of national clinical director for adult neurology—a role our inquiry found to have had a positive impact in this important field.
Strong, consistent leadership and accountability are crucial if patients are to see sustained improvements to services and more effective use of the resources available.
This must start with improvements in planning, coordination and the use of data and we will be holding the Department and NHS England to account for this in the months and indeed years ahead."
£3.3 billion on neurological services
The NHS spent £3.3 billion on neurological services in 2012–13, representing 3.5% of total spending, up from 3.1% in 2010–11. Hospital activity involving patients with neurological conditions has increased in recent years, although the rate of growth has slowed.
There are no specific data on spending on social care for people with neurological conditions or on the number of people with neurological conditions receiving social care services. However, on the basis of the more general data that are available, both spending and activity can be assumed to have fallen significantly since 2009–10.
Six recommendations for the Department
The previous PAC reported on services for people with neurological conditions in March 2012, making six recommendations aimed at improving services and achieving better outcomes.
In its report in July 2015, the National Audit Office found that the Department of Health and NHS England had made ‘good’ progress against just one of the six recommendations, with progress against a further three assessed as ‘poor’, and the remaining two as ‘moderate’.
Over 4 million people in England have a neurological condition. Services for people with these conditions are not consistently good enough, and there remains wide variation across the country in access, outcomes and patient experience.
As well as affecting patients, poor care has implications for the NHS; for example, it costs £70 million to deal with emergency admissions of epilepsy patients and many of these admissions are likely to result from shortcomings in care.
Neurological services remain poorly integrated with a lack of joint commissioning of health and social care. Over 40% of people with a neurological condition do not think that local services work well together, and only 12% of people have a written care plan to help coordinate their care.
Some implementation progress
There has been some progress in implementing the recommendations that the previous Committee made in 2012, including the appointment of a national clinical director for adult neurology and some improvements in data. However, these changes have not yet led to demonstrable improvements in services and outcomes for patients.
It is clear that neurological conditions are not a priority for the Department of Health (the Department) and NHS England, and we are concerned that the progress that has been made may not be sustained. We therefore intend to review the position again later in this Parliament.