NHS neurological care 'not value for money', report finds

Care for neurological conditions such as Parkinson's disease and MS has largely failed to improve and in some cases worsened, despite the DH pumping billions of pounds into national projects, a report has warned.

A highly critical report from the National Audit Office (NAO) said the poor design of the schemes meant the DH was unable to measure their impact on patient health.

This is despite spending by £10bn over four years, with funding rising by 38% in this time.

The NAO said care remained 'fragmented and poorly co-ordinated'.

The report investigated the effect of national service framework for long-term conditions, launched by the DH in 2005, on care for patients with neurological conditions such as Parkinson’s disease, MS and motor neurone disease.

Access to health services has improved for these patients and hospital bed days reduced since 2005, though this was at an increasing cost to the NHS.

Between 2006/7 and 2009/10, health spending on neurological services increased by 38% in real terms, from £2.1bn to £2.9bn.

But neurological inpatient hospital admissions rose 31% between 2004/5 and 2009/10. This compared to a background increase of 20% for the NHS as a whole.

There was also an increase in emergency neurological admissions of 32% over the same period, compared to a 17% increase for the NHS. Large variation still exists between PCTs.

Measuring outcomes
The NAO said the DH had failed to put in place plans to monitor how the framework was implemented: 'There was no national baseline assessment of the cost, access to, and quality of, neurological services when the framework was introduced and no national monitoring of its impact.'

It said the department therefore had 'no way to measure the effect of the additional spending on services or patient outcomes'.

It added that, with the DH cancelling its mid-point review of the framework that was agreed by the previous government, 'it is not clear how lessons will be learnt and integrated into the design of the department's new long-term conditions strategy'.

Just two thirds of patients referred by their GP see a specialist within six weeks, patient information is poor and access to services is a postcode lottery, the report said.

Improvements needed
The NAO concluded that 'current spending on neurological health and social services is not value for money as the department cannot demonstrate any significant quantifiable improvements against the framework’s quality requirements'.

Amyas Morse, head of the NAO, said: '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.'

The Royal College of Physicians said the report agreed with the conclusions of its own report published earlier in the year, and showed there was a shortage of local neurologists to see emergency neurology admissions.

The NAO said it was the DH's view that there was insufficient evidence that current spending on neurological health and social services is not value for money.

An estimated two million people in the UK have a neurological condition, excluding migraine.

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