14th August 2015

Blog: it's time for a full review of neurology

In July 2015 the National Audit Office (NAO) published a review of services for people with neurological conditions, which assessed progress against recommendations made by the Public Accounts Committee (PAC) in 2012.

The PAC’s 2012 report found that neurological services deliver ‘‘poor outcomes for people with neurological conditions and poor value for money for the NHS.” Three years later, the NAO has found that the key recommendations for improving neurology services remain unachieved, and “considerable further work” is needed to achieve them.

As a result, services for people with neurological conditions continue to be affected by significant quality and access issues that would be unacceptable in higher-profile condition areas. This is outlined in the recent Neurological Alliance report, Invisible Patients: Revealing the state of neurology services, which shows that 58% of neurology patients have experienced difficulty and delay in accessing services, while almost 40% wait over a year for a diagnosis.

The NAO’s report shows that the key areas for improvement identified by the PAC have not been addressed, for example:

Neurology data
Three years after the call on the government to rectify the shortage of neurology data, the NAO notes that “NHS England does not know how many people have a neurological condition because data is not centrally collated”. The Government has also failed to deliver a resource for linked health and social care data or for data on emergency re-admissions relating to neurological conditions, as recommended by the PAC. As a result, neurology services operate in an information vacuum, without proper scrutiny of costs, outcomes and value for money.

Improving neurology commissioning
The PAC also called on the government to use levers such as the clinical commissioning group outcomes indicator set (CCGOIS) and local Joint Strategic Needs Assessments to improve access to neurology services across the country. However, the NAO’s review finds almost no progress in this area, with minimal representation for neurology in the CCGOIS.

As the NAO suggests, the lack of indicators specific to neurological conditions may be limiting clinical commissioning groups’ engagement with local neurology services. A Freedom of Information request sent to every CCG by the Neurological Alliance in 2014 found that as few as 20% have made an assessment of the prevalence of neurological conditions locally, while only 15% are aware of the costs associated with provision of neurological services in their area. As a result, the needs of people with neurological conditions are frequently marginalised by local commissioners.

Full review of neurology services
The lack of progress on these recommendations has real consequences for neurological services and those who use them. Our recent survey of just under 7,000 people with neurological conditions found that 58% have experienced difficulties accessing the services and support that they require, while almost 40% wait over a year for a diagnosis.

For far too long, neurology has been treated as a low priority condition area by the health service. Inefficient and poor-quality commissioning, an absence of data, and significant under-representation in incentive and accountability architecture mean that millions of people with neurological conditions have poor and inequitable access to diagnosis and care.

The Neurological Alliance has now written to the PAC calling for a full inquiry into neurology services in order to ensure that these issues are effectively addressed.

Alex Massey, Senior Policy & Campaigns Adviser

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