National Service Framework for Long-term Conditions not made a priority, say campaigners

In his foreword to last year’s National Service Framework for Long-term Conditions, the then health secretary, John Reid, said it marked a “real change” in the way health and social care would deliver services.

But 16 months on, campaigners claim the framework has not been made a priority and that it has not made any difference to the lives of people with long-term conditions (news, page 9, 29 June).

One of their main worries is that the white paper on health and social care – Our health, our care, our say – published in January this year, has overshadowed the NSF because it, too, has a focus on long-term conditions.

But David Pink, chief executive of the Long Term Medical Conditions Alliance, claims the two documents are “different beasts”. He says: “The white paper is political and aspirational. The NSF is a detailed guidance document.”

The multiplicity of policies on long-term conditions – as well as the NSF and white paper there has been a service model and strategy for self-care – could also “confuse” managers, he adds.

At the heart of the NSF are 11 quality requirements, complete with evidence-based markers of good practice, for the treatment of people with long-term conditions such as epilepsy and multiple sclerosis. These relate to:

– person-centred services;
– early recognition, prompt diagnosis and treatment;
– emergency and acute management;
– early and specialist rehabilitation;
– community rehabilitation and support;
– vocational rehabilitation;
– providing equipment and accommodation;
– providing personal care and support;
– palliative care;
– supporting family and carers;
– and caring for people with neurological conditions in hospital or other health and social care settings

In common with some other national service frameworks, this one does not prescribe how agencies should work but broadly outlines the types of activities that will enable them to implement its standards over a 10-year period.

But its misfortune is that, not long after its publication, the NHS started to spiral into a financial crisis from which it is yet to fully recover, while reconfiguration of primary care trusts will not have helped either.

Pink says the NSF does not feature among NHS managers’ priorities, which include hitting waiting time targets and cutting health inequalities.

Changes in the Department of Health’s ministerial team have not helped either, he says, nor has a “rebranding” of the NSF as a neurological framework rather than one for long-term conditions with an emphasis on neurological conditions.

Pink says: “From a social care perspective this creates difficulties because people in social care don’t usually work by a medical model. The rebranding portrays it as a medical model.”

A survey of strategic health authorities by the Neurological Alliance earlier this year found that implementation of the NSF was “patchy and inconsistent” across primary care trusts.

One accusation is that the government has not promoted this NSF to the same extent as others.

Jeff Jerome, co-chair of the Association of Directors of Social Services disabilities committee, says roadshows in March led by Kathryn Hudson, the national director for social care, and older people’s tsar Ian Philp were “not given the publicity they should have had”.

He also says problems in implementing the NSF do not lie solely within the NHS, and that social services must also “give more thought to it and pick it up”.

The DH has moved to counter concerns by pledging to do more in the next year to promote the NSF.

A spokesperson says it will work to link the NSF to other departmental programmes, such as the health and social care white paper, and commission work from bodies such as the Care Services Improvement Partnership to support local implementation. This could include workshops, online support and guidance, and managed neuroscience networks.

National Service Framework for Long-term Conditions

Our health, our care, our say