Since 2005, when the Department of Health introduced its National Service Framework for Long-term Conditions, people with neurological conditions have had better access to health services; but key indicators of quality – such as the rate of emergency hospital readmissions – have worsened. The Department does not know what the Framework and additional spending of nearly 40 per cent over four years have achieved.
The Framework was designed to improve care for people with neurological conditions but progress in implementing it has been poor. Access to health services for people with long-term neurological conditions, such as Parkinson’s disease, multiple sclerosis and motor neurone disease, has improved and waiting times for inpatient and outpatient neurology have decreased since 2007. The number of elective neurological operations performed has also increased. However, the rate of emergency admissions to hospital has increased significantly and there is large variation in emergency admission rates between Primary Care Trusts.
Access to services for patients also varies significantly depending on where they live. For example, the NAO’s analysis shows variation across the country in the number of specialist nurses per person with multiple sclerosis.
There are still significant problems with current services. Many patients, following their diagnosis, are not given information on their condition, about local services or on available support. Ongoing care is fragmented and poorly coordinated and there is a pattern of patients being referred to hospital for treatment, then discharged and then referred to hospital again. The NAO also found that there is poor coordination between health and social services. The number of adults with a physical disability receiving social services has fallen since 2005-06, because fewer people are now eligible for these services.
"Services for people with long-term neurological conditions are not as good as they ought to be, despite a large increase in spending. Progress in implementing the Department's strategy has been poor and local organisations lack incentives to improve the quality of services."
"It is not clear how lessons will be learnt and there are risks to services which the Department must address to ensure that care improves."
Amyas Morse, head of the National Audit Office
Notes for Editors
The NAO focused for its fieldwork on services for people with three progressive conditions: Parkinson's disease, multiple sclerosis and motor neurone disease.
It is estimated that 2 million people in the United Kingdom have a neurological condition (excluding migraine). Between 2006-07 and 2009-10, health spending on neurological services increased by 38 per cent in real terms, from £2.1 billion to £2.9 billion. Social services spending on adults with a physical disability, of which a significant proportion will have a neurological condition, has remained flat in real terms since 2005-06.
There has been an increase in neurological inpatient admissions of 31 per cent between 2004-05 and 2009-10, compared to a 20 per cent increase for the NHS as a whole. There has been an increase in emergency neurological admissions of 32 per cent over the same period, compared to a 17 per cent increase for the NHS.
Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained from The Stationery Office on 0845 702 3474.
The Comptroller and Auditor General, Amyas Morse, is the head of the National Audit Office which employs some 880 staff. He and the NAO are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.