Outcomes for people with long-term neurological conditions have stalled or deteriorated, six years on from a key policy to improve support for the group and despite significantly increased funding for care.
That was the message from the National Audit Office today in a report which said the 2005 National Service Framework for Long-term Conditions had been poorly implemented, on the grounds that it “lacked clear leadership, co-ordination, appropriate accountability structures and monitoring information”.
The framework established 11 quality requirements to improve outcomes for people with conditions such as multiple sclerosis or Parkinson’s disease over the subsequent 10 years, including improved access to rehabilitation, personal care and equipment and better support for carers.
However, the NAO concluded that many of the problems identified by the framework – including poor information and advice for patients and carers, poor co-ordination between health and social care and a postcode lottery in care – remained, despite a 38% real terms increase in NHS spending on neurological conditions from 2006-7 to 2009-10.
While there had been some improvements, for instance reduced waiting times for inpatient and outpatient neurology services, other indicators had deteriorated. For instance, emergency neurological admissions to hospital rose by 31% from 2004-5 to 2009-10, compared with a 20% rise in emergency admissions overall.
“Services for people with long-term neurological conditions are not as good as they ought to be, despite a large increase in spending,” said Amyas Morse, head of the National Audit Office. “Progress in implementing the department’s strategy has been poor and local organisations lack incentives to improve the quality of services.”
The NAO said the Department of Health put in place no arrangements for monitoring the implementation of the framework and was thus unable to hold primary care trusts and councils accountable for delivering on it.
In the framework the DH had said that local agencies should establish a baseline for services against which to measure progress but the department did not have information on how far this had happened.
The NAO also pointed out that the coalition had cancelled a mid-point review of the framework agreed by its Labour predecessor, meaning that it was not clear how lessons would be learned from the framework to inform future work on long-term conditions.
Among its recommendations, the NAO said:-
- The Department of Health should clearly define accountabilities between itself, the NHS Commissioning Board and local commissioners for improving support for this client group, and establish clear baselines against which performance will be measured.
- The DH must examine how far additional spending on neurological conditions in recent years has been effective, and why performance has deteriorated in some areas.
- NHS commissioners should require hospital trusts to give patients adequate information about their condition and contact details for community support organisations on discharge from hospital.
- Local commissioners should ensure that all patients with long-term neurological conditions have a personal care plan for health and social care with a single professional in charge of co-ordinating it.
- Caseloads for specialist nurses should be no greater than those recommended by the National Institute for Health and Clinical Excellence.