Covid-19: People with Neurological Conditions Debate

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Baroness Penn

Main Page: Baroness Penn (Conservative - Life peer)

Covid-19: People with Neurological Conditions

Baroness Penn Excerpts
Thursday 27th May 2021

(2 years, 10 months ago)

Grand Committee
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My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Gale, for securing this important debate, recognising her tireless commitment to championing neurological conditions, including through her many years of service as co-chair of the All-Party Parliamentary Group on Parkinson’s.

As this debate has illustrated, the pandemic has resulted in unprecedented pressure across the health and social care system. All noble Lords recognise the outstanding work done by staff and volunteers across the NHS, social care and the voluntary sector at this difficult time. Early in the pandemic, NHS England and NHS Improvement advised that in-person consultations

“should only take place when absolutely necessary”.

This decision ensured that care was provided to those in greatest need during extremely challenging times. Neurology services saw new models of care emerge, with triage processes to ensure that patients receive appropriate care and are seen in outpatient settings closer to home. Providers rolled out remote consultations, using video, telephone, email and text message services, including for patients with neurological conditions. To support these new models of service provision during the pandemic, from March 2020, the Association of British Neurologists, the Royal College of Physicians and the Chief Medical Officer’s team produced guidance for clinicians, including recommendations on where services could be temporarily paused or moved from face-to-face, and where normal practice should continue. This was updated to ensure that it continued to meet the scale of the challenge and maximise the quality of care offered.

However, we all recognise that these were necessary but undesirable decisions that were taken to deal with the pandemic, and the Government completely recognise that this has resulted in delays to elective care, including non-urgent surgery, which has been impacted throughout the pandemic. Neurosurgery activity levels fell by 29.8% between 2019-20 and 2020-21, representing a reduction of about 30,500 completed patient pathways, and as noble Lords have noted, the waiting list has grown from 34,600 to 43,200 in the same period. However, it should be noted that urgent care was maintained throughout the pandemic to ensure that those requiring emergency care still received it. I will come on to our plans to address the backlog shortly, but a small sign of improvement is that median neurosurgery waiting times have dropped from a peak of 19.5 weeks in July 2020 to 14.3 weeks in March 2021.

Moving into the recovery phase of the pandemic, the Association of British Neurologists has published specific guidance on recommencing neurology services, including assessments on which services and patients require urgent prioritisation, considering the severity and onset of symptoms. As the NHS transitions from pandemic incident management to recovery of services, our priority is addressing the pressures caused by the pandemic. On 18 March, we announced an additional £7 billion to support pandemic recovery and £1 billion for elective recovery in 2021-22. While this funding is not allocated towards specific specialities, it will go towards services that benefit people with neurological conditions. NHS England and NHS Improvement are currently developing recovery plans across all services, including for patients with neurological conditions. Specialised services are setting a clear approach for recovery of services which ensures that patients are treated at the correct time in the appropriate setting, while balancing the ongoing Covid-19 pressures and front-line staff well-being.

I cannot say what the plan is for specific treatments, such as DBS for Parkinson’s, but I would be happy to follow up to the noble Baroness, Lady Gale, on that point in writing. I can say that, based on current information, neurology inpatient services should be fully restored to pre-pandemic appointment levels by the end of September this year, if there are no further significant Covid-19 outbreaks.

A number of noble Lords have expressed how challenging the past year has been in its impact on individuals’ mental health and well-being, including those with neurological conditions. The Government will continue to do our utmost to ensure that our mental health services are there for those who need them. Although talking therapies are available remotely, the NHS is working to ensure that the option of face-to-face support is provided to people with serious mental health illnesses where it is clinically safe to do so. For those with severe needs or in crisis, all NHS mental health providers have established a 24/7 urgent mental health helpline.

In March 2021, we launched our mental health recovery action plan, backed by an additional £500 million for this financial year, to ensure that we have the right support in place. We are committed to our ambition in the long-term plan to expand and transform mental health services, including by investing an additional £2.3 billion a year in mental health by 2023-24.

As the noble Baroness, Lady Gale, rightly highlighted, it is also imperative that we have a skilled and resilient neurology workforce. In August 2022, improvements to the neurology curriculum will be implemented. During their five-year training programme, trainees will accredit dually in neurology and internal medicine and obtain sub-specialty training in stroke medicine. Based on current numbers undergoing neurology training, this will mean that each year from 2028 onwards at least 40 neurology trainees each year will complete their training in neurology and stroke and be eligible to lead stroke services—a major boost to the workforce.

Furthermore, over recent years we have increased the number of funded medical school places in England by 1,500, a 25% increase. In the process, we have delivered five brand-new medical schools across the country. This expansion completed in September 2020 and will significantly increase the pipeline for doctors, including neurologists and other doctors treating neurological conditions, in future years.  

As noted by a number of noble Lords, including the noble Baroness, Lady Thornton, we are also keen to understand any neurological impacts of Covid-19 and are aware of studies that suggest the potential for longer-term neurological symptoms developing in people who have had Covid-19. It is for this reason that we are providing more than £50 million of research funding and are working with world-leading scientists better to understand the virus and its long-term effects and how to treat them effectively. One such study is the Covid-19 clinical neuroscience study, which was awarded £2.3 million by UK Research and Innovation and the Department of Health and Social Care. It will look at 800 patients in the UK who were admitted to hospital with Covid-19 and had neurological or neuropsychiatric complications to understand how these problems occur and to develop strategies to prevent and treat them.

The noble Baronesses, Lady Greengross and Lady Thornton, also raised broader research funding, and I reassure them that the Government are committed to providing funding towards innovative research in neurological conditions. DHSC funds research into these conditions through the National Institute for Health Research, and funding was at £56 million in 2018-19. However, this is not the only route of research funding that we provide. We also provide funding through the Medical Research Council and UKRI, through the Biotechnology and Biological Sciences Research Council, which supports a diverse portfolio of neuroscience research and innovation totalling around £30 million per annum.

Longer term, a variety of improvements are under way for neurological conditions. The noble Baroness, Lady Gale, raised the important neuroscience transformation programme, which was intended to be a five-year programme and launched in 2018. At present, the programme is working with key stakeholders and patient groups to develop a collaborative model of care to improve local neurology services, improve care closer to home and reduce variations in access and treatment within and across systems. In light of the pandemic, the programme is currently reviewing its approach and priorities to align with the overall service restoration and recovery work.

The NHSE/I specialised neurology service review is looking at the optimal model for neurology services with the aim of ensuring patients are seen quickly in the most appropriate setting and carrying forward lessons learned during the pandemic. This review is now complete and NHSE/I is considering its recommendations. NHSE/I also supports the National Neurosciences Advisory Group, which is a collaborative leadership group for neurosciences in England. The overall purpose of the group is to improve outcomes for patients living with neurological conditions.

In April this year, NNAG published a report into the effects of the pandemic on neurological services and care pathways. The report highlighted the benefits of remote care methods but also recommended a fuller evaluation of remote care which, as a number of noble Lords have highlighted, is not appropriate for all people with neurological conditions. The report’s long-term recommendations are for NHSE/I to lead a national neurology plan in collaboration with NNAG and its members to develop and invest in a national rehabilitation plan, which the noble Baroness, Lady Gale, also raised, and to develop a clinically-led, pragmatic system of clinical classification of outpatient episodes. NHSE/I will be considering these recommendations as part of its ongoing recovery and restoration work and the future transformation of neurological services.

To respond to the point raised by several noble Lords about patients having the right to choose how they interact with health professionals in the right setting, the Government are committed to ensuring that patients have personalised care that considers their needs and preferences. That is why it is embedded in the NHS constitution and set out in the long-term plan.

I fear that I am running out of time. A number of noble Lords raised specific conditions. My noble friend Lord Vaizey mentioned epilepsy and my noble friend Lady Blackwood mentioned autonomic dysfunction. Many other conditions were also raised. I say to noble Lords that we are committed to improving services for people with these conditions. We acknowledge that, particularly where people have specialised conditions, further work is needed to acknowledge those conditions, raise awareness of them and improve their treatment. On specific points on any of those conditions, I will write to noble Lords.

I close by thanking the noble Baroness, Lady Gale, once again for securing this debate and thank all noble Lords who have taken part in it.