Health: Neurological Services

Baroness Gale Excerpts

Tuesday 20th November 2012 Lords Chamber

[Baroness Gale]

My Lords, I congratulate my noble friend Lady Ford on securing this important debate tonight. I declare an interest as I chair the All-Party Parliamentary Group on Parkinson’s. Approximately 127,000 people in the UK live with Parkinson’s and rely on the support provided by the neurological services to help them manage with the debilitating effects of that condition. Neurological services in the UK are not working as best they could to serve the people who have neurological conditions. This is despite the introduction of the National Service Framework for long-term conditions in 2005.

When the National Audit Office published its report on services for people with neurological conditions in 2011, it found that although waiting times for inpatient and outpatient neurology had improved, the NSF for long-term conditions had not delivered for people with neurological conditions. The report found that there had been a decline in quality services, despite an increase in health spending on neurological conditions of 38% in real terms, from £2.1 billion in 2006-07 to £2.9 billion in 2009-10. The NAO report identified a number of problems including delays in receiving a diagnosis, a lack of access to information and care that is fragmented and poorly co-ordinated.

The report also found that the Department of Health had not put in place specific arrangements for monitoring how the NSF for long-term conditions was implemented. As a result, it was unable to hold local commissioners to account for implementation because no national monitoring of its impact had taken place.

Following the NAO’s report, the Public Accounts Committee conducted its own inquiry into neurological services and published its report in March 2012. It made a number of recommendations, including one that a national clinical director of neurology should be appointed to provide clear national leadership. Other noble Lords have called for this tonight, so I hope that the Minister will take that seriously. It is disappointing that the Government rejected a number of the recommendations, including the call for a national clinical director for neurology. The Government agreed to adopt some of the recommendations, including developing a data set for neurology and ensuring that NICE develops a quality standard for neurological conditions.

In the new structure, the NHS Commissioning Board has appointed directors to the specific domain outcomes. This means that neurological conditions are considered under both domain one, reducing avoidable death, and domain two, long-term conditions. These are extremely large areas for the appointed directors to consider, and there is concern that neurological conditions will not receive the appropriate focus that they require.

There is a similar lack of prioritisation within the new structure of the NHS when it comes to appropriate outcomes and indicators for neurology. There are 44 indicators that have been published for the Commissioning Outcomes Framework, which will be used by the NHS Commissioning Board to hold clinical commissioning groups to account. While there are indicators specifically for dementia and stroke and one for epilepsy in under-19s, the only indicators relevant to neurology apply to all long-term conditions. This is further compounded by the fact that the NHS Outcomes Framework, which will be used to hold the NHS Commissioning Board to account, does not have any indicators specific to neurology.

The NHS Commissioning Board has acknowledged the need to improve services for specific conditions at a national level and has therefore introduced strategic clinical networks, one of which is for mental health, dementia and neurological conditions, to support and advise clinical commissioning groups. There is great urgency for a quality standard to be developed for both Parkinson’s and for neurological services, as identified in both the National Audit Office and the Public Accounts Committee reports.

A crucial part of ensuring that services are appropriately developed and improved is the use of accurate and up-to-date data to make decisions. It is encouraging that an appropriate database for neurology will be developed. However, there is real concern about how the data will be collected. Sir David Nicholson feels that data should be collected from voluntary sector organisations that represent patients with neurological conditions. While organisations like Parkinson’s UK can contribute to these data sets, the Government cannot rely solely on voluntary organisations to provide a robust and accurate data set.

The lack of specific leadership means that neurology will not receive the prioritisation that it needs to make the clearly and repeatedly identified and much needed improvements. The lack of specific outcomes and indicators suggests that neurology may be neglected for areas that do have specific targets. The lack of a comprehensive data set means that it will be impossible to get even a baseline understanding of what is needed to bring about these improvements.

I will put some questions to the Minister. Will she give assurances that people with neurological conditions will see the much needed improvement in neurology services? Can she give assurances that neurological conditions such as Parkinson’s will be appropriately prioritised within the new structure? How and when will the data set for neurology be developed, and what steps will be taken to ensure that it will be suitable, accurate and comprehensive so that it takes account of everyone living with a neurological condition? Will she provide clarity about when the quality standards for Parkinson’s and for neurological conditions will begin to be developed and when they are likely to be implemented? I look forward to the Minister’s response.