Progress has been mixed in implementing recommendations made by the Public Accounts Committee in 2012 aimed at improving services and achieving better outcomes for people with neurological conditions, according to the National Audit Office.
While progress against one of the recommendations has been good, progress against three of the recommendations has been poor, with moderate progress against the remaining two recommendations.
Although the Department of Health did not initially agree with the Committee’s recommendation that a national clinical lead for neurology should be appointed and local neurological clinical networks created, progress against both elements of this recommendation has been good, with the appointment of a national clinical director for adult neurology and the establishment of the mental health, dementia and neurological conditions strategic clinical network.
The three recommendations against which the NAO judged progress to be poor were:
using the clinical commissioning group outcomes indicators set, joint strategic needs assessments and health and wellbeing boards to ensure that all people with neurological conditions have appropriate access to services;
mandating joint health and social care commissioning of neurological services; and
ensuring that everyone with a long-term neurological condition is offered a personal care plan, covering both health and social care.
According to the NAO, moderate progress has been made against the Committee’s recommendations that a neurological dataset should be developed and that the National Institute for Health and Care Excellence should develop relevant quality standards. The Health and Social Care Information Centre published a compendium of neurology data in March 2014, although it did not link health and social care data or include data on emergency readmissions as the Committee recommended. Public Health England and NHS England also jointly sponsor a new neurology intelligence network. The Department of Health has requested five quality standards relating to neurology, of which one has been published, one is in development and two are awaiting the publication of updated clinical guidelines. For the remaining standard on generic neurological problems, NICE estimates that it will publish the clinical guideline in January 2018.
"Some neurological conditions are life-threatening with many severely affecting quality of life and causing lifelong disability. Overall, however, progress in taking the action needed to improve services for the people with these conditions has been mixed.Considerable further work is therefore needed to make more progress and to achieve better services and outcomes for people with neurological conditions.”
Amyas Morse, head of the National Audit Office
Notes for Editors
Estimated number of neurological cases in England (excluding migraine, headache, dementia and stroke)
Estimated NHS spending on neurological services in 2012-13 (excluding chronic pain)
Percentage of total NHS spending accounted for by neurological services in 2012-13
Spending by local authorities on social care services for adults with a physical disability in 2013-14 (an estimated quarter of whom have a neurological condition)
Proportion of people with a long-term neurological problem who said they definitely, or to some extent, had enough support from local services, reported in January 2015
Growth in neurological inpatient admissions between 2010-11 and 2013-14
Growth in neurological outpatient appointments between 2010-11 and 2013-14
Proportion of people with a long-term neurological problem who had a written care plan, reported in January 2015
New National Institute for Health and Care Excellence (NICE) quality standard relating to neurological conditions
1. The Public Accounts Committee reported on services for people with neurological conditions in March 2012, following a National Audit Office report in December 2011.
2. 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 by using the relevant links on our website.
3. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 810 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.15 billion in 2014.