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Neurology services get worse despite extra cash

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Standards of care for patients with conditions such as Parkinson’s disease, multiple sclerosis and motor neurone disease have fallen in recent years, despite receiving 38% more funding, a report has warned.

The National Audit Office, which produced the report, said the availability of specialist nurses for neurological conditions was widely variable across the country, but found that where they were accessible they improved quality of care.

Its investigation, published this morning, said key quality measures had worsened since the beginning of a government drive to improve services for people with long term neurological conditions.

Despite the Department of Health’s National Service Framework for Long Term Conditions, which launched in 2005, emergency hospital admissions and readmissions went up by 31% between 2004-05 and 2009-10 – faster than for other conditions.

Between 2006-07 and 2009-10, spending on neurological services rose from £2.1bn to £2.9bn.

Although the drive had no specific performance targets, there were 11 quality requirements, covering areas such as support for carers, centring services on the patient and supporting people in their homes. The DH could not demonstrate any significant improvement against these.

The NAO said: “The DH does not know what the framework and additional spending of nearly 40% over four years have achieved.”

“Current spending on neurological health and social services is not value for money,” the study concluded.

However, the contribution of nurses was praised. “Specialist nurses can help to improve patient care and the coordination of health and social services resulting in reduced hospital admissions,” the report said.

Such initiatives can enable people to be cared for in the community, and “need to be championed”.

The NAO also called on commissioners to ensure that the positive impact of specialist nurses was not undermined by excessive caseloads.

The study found large regional variation in nurse staffing levels. While in the North West region there was one multiple sclerosis nurse for every 650 patients, there was a nurse for every 220 patients in the East of England.

There was also wide variation across the country in hospital admission rates.

However, overall access to neurological services has improved, the NAO found, with the number of patients waiting 18 weeks or more for treatment has fallen since 2007.

Ongoing care was fragmented and “poorly coordinated” between health and social care. The authors also found perverse incentives in the system, with measures tracking the number of follow-up appointments encouraging hospitals to discharge patients early, leading to a cycle of discharges and referral.

Charities said ministers should create a more targeted and “properly resourced” national strategy for people with neurological conditions.

Parkinson’s UK chief executive Steve Ford said the report “exposes a wasteful failure to provide vital care for people with neurological conditions”.

“Being admitted into hospital unnecessarily can cause problems for people with Parkinson’s because they often do not get their medication on time. Late or missed medication can make their symptoms unmanageable so they have to stay in hospital longer and in sometimes they may never recover.”

He added: “The report also confirms that people are being discharged from hospital before they are ready.”

Simon Gillespie, chief executive of the Multiple Sclerosis Society, said: “MS specialist nurses play a critical role in providing this support and coordinating care. But with one MS nurse to every 454 people, these posts are sadly rare and many are at threat due to short-sighted budget cuts.”

Responding to the report, care services minister Paul Burstow admitted that “too many people are not getting presonalised support to suit their needs”.

He said that is why ministers were developing a new “outcomes strategy”, piloting personal health budgets, and increasing the use of telehealth technologies.

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