Neurology forms part of a larger network of Mental Health, Dementia and Neurological Conditions (MHDN) and is one of the four strategic clinical networks (SCN) which came into being as from 1st April 2013. The overall aim of the SCN is to facilitate improved patient outcomes through evidence based, transformational change and to influence commissioning priorities; in order to do this a number of work programmes are being developed across the network.
Neurological Conditions is a new area of improvement for clinical networks. There had previously been the National Service Framework (NSF) and a number of quality indicators that featured in the Outcomes Framework, however there is little within the Clinical Commissioning Group (CCGs) strategic and operational plans regarding neurology services.
The MHDN Development Day in July 2013 had excellent representation from the field of Neurology; this event enabled national strategic messages to be delivered by the national clinical director, local priorities to be identified and a local Clinical Director for Neurological Conditions to be appointed.
Based on the outputs from the development day, Thames Valley Strategic Clinical Network (SCN) commissioned a report on the status of neurological services within Thames Valley, to identify a baseline position of services available, quality and variation.
through a report which will give an in-depth understanding of the neurological service provision across Thames Valley, incorporating both Health and Social care and the third sector (i.e. voluntary sector such as the Neurological Alliance).
The aim of the National Commissioning Support (NCS) Report is to provide an analysis of services both in cost and activity, a gap analysis and actionable recommendations.
The company comm9ssioned to deliver this report was the Neurological Commissioning Support a n0n-profit organisation with previous links to the department of health. The methodology used was a mixture of interviews with stakeholders and data analysis.
On 20 June 2014, a stakeholder workshop was held by the SCN and NCS to discuss the report and their findings and to get feedback on the way forward with a further opportunity to comment on the report before final publication.
The makeup of neurological services across the Thames Valley SCN is complex. Historically having little local leadership for long-term neurological conditions (LTNC) across all health economies, has led to a lack of designated leads, formalised integrated pathways and informed neurology commissioning. Services have evolved over time, driven by clinicians with individual interests in specific conditions.
There is no Joint Strategic Needs Assessment (JSNA) overall for neurology so no definite numbers around local disease prevalence or incidence and prediction for numbers of patients in the future.
Community service provision is patchy, again due to unclear referral pathways. Anecdotal information regarding waiting times suggests that for some services waits can be lengthy which could lead to detrimental outcomes for patients. There is a lack of data for community services hence findings are anecdotal. Where data is available, such as Community Neuro-Rehabilitation Services and the Community Head Injury Service within Buckinghamshire Healthcare Trust, this is held at local Trust level.
Across the Thames Valley SCN region, there is a lack of understanding around how services are commissioned and by whom. There is some confusion surrounding the reach and extent of specialised commissioning for neurological services but evidence of on-going work to ensure further clarity going forward.
Data is not being routinely used by commissioners to inform service planning and provision across the pathway of care. Admissions and costs for neurological conditions across the acute sector are in the main rising year on year. Weighted data across the CCGs indicates varied and unexplained differences in performance which should be explored.
Further work is now being undertaken to redesign neurological services.