COMMONS

Public Accounts Committee reports on services for people with neurological conditions

16 March 2012

The Commons Public Accounts Committee publishes its 72nd Report of the Session, on the basis of evidence from the Department of Health and Neurological Health Professionals

The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:

"Approximately two million people in the United Kingdom have a neurological condition, including Parkinson's disease, motor neurone disease or multiple sclerosis. But individual care is often poorly coordinated and the quality of services received depends on where you live. Some areas simply don't have enough expertise, both in hospitals and the community.

In 2005, the Department for Health launched a new Framework to provide services for people with a neurological condition. There have been some improvements, such as a reduction in waiting times. But unlike the strategies for Cancer and Stroke, the model used to implement the Framework hasn’t worked. The Cancer and Stroke strategies were headed by a Tsar and the Department monitored services with clear data against clear targets.

For this clinical area, the Department left the implementation to local health commissioners but gave them no leadership at all. It set no baselines and failed to monitor progress and so could not hold them to account where things went wrong. The present Government needs to understand what went wrong here for the future.

Health spending on neurological conditions increased by nearly 40 per cent in three years. Over much the same period, emergency admissions have risen by 32 per cent and readmissions to hospital within 28 days have increased from 11.2 per cent to 14 per cent.

The Department needs to explain to the Committee how it is going to ensure that all people with neurological conditions have appropriate access to services and how the Department will ensure value for money.

Health and social services are failing to provide an integrated range of services for people with neurological conditions. The Department is moving towards a decentralised health and social care landscape. In doing so, it must set clear objectives for joint health and social care outcomes and services for people with neurological conditions."

Margaret Hodge was speaking as the Committee published its 72nd Report of this Session which, based on evidence from the Department for Health (the Department), examined its implementation of the National Service Framework for Long-term Conditions. The Committee also examined the Department’s proposals for improving services for people with neurological conditions.

Two million people in the UK have a neurological condition, including for example those with Parkinson's disease, motor neurone disease and multiple sclerosis. The figure excludes people with migraine. In 2005, the Department published the National Service Framework for Long-term Conditions (the Framework) to improve services for people with neurological conditions.

Health spending on neurological conditions increased by 38% in real terms, from £2.1 billion in 2006-07 to £2.9 billion in 2009-10. Spending on social services for people with neurological conditions was an estimated £2.4 billion in 2009-10, and has remained flat since 2005-06. While there have been some improvements, such as reduced waiting times, services remain well below the quality requirements set out in the Framework.

People with neurological conditions need a wide range of services that can cross boundaries between health and social care, employment and benefit services, transport, housing and education. Despite these complex needs, coordination of care for individuals is poor, and there is a lack of integration between health and social services. There is still a lack of neurological expertise, both in hospitals and in the community, and access to services varies widely. Implementation of the Framework lags behind those for cancer and stroke care, even though many neurological conditions severely affect quality of life and cause lifelong disability. Of particular concern is the 32% increase in emergency admissions, and the increased rate of readmissions to hospital within 28 days from 11.2% to 14%, since the introduction of the Framework. Rates are well above those for the NHS as a whole, and represent poor outcomes for people with neurological conditions and poor value for money for the NHS.

Unlike the Cancer and Stroke strategies the model used to implement the Framework has not worked. Implementation was left to local commissioners without the national leadership necessary to drive improvements. No baseline for services or outcomes was established when the Framework was introduced. There was no monitoring of progress, and local commissioners were not held to account for implementation.

There are key lessons to be learnt as the Department develops its proposed new health and social care landscape. The Department intends to decentralise and localise decision making, with central monitoring, and it will be vital that it sets clear objectives for the outcomes and services for people with neurological conditions. The delivery model needs to work better and put patient needs at its heart if services and outcomes are to improve. There needs to be stronger central and local leadership, and commissioners need to be held to account for outcomes. The Department’s central monitoring of services must enable it to intervene where services are failing. We would like the National Audit Office to follow up on progress against our recommendations in 2014.

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