Where neurology fits in the NHS long term plan

On 7 January, the NHS launched their long term plan for the future of healthcare in our country. In his speech presenting the NHS Long Term Plan (2019), Simon Stevens, CEO of NHS England, noted that

‘this past year we have celebrated 70 years of the NHS… [this plan] is about our 80^th.’

Outlining the many elements of the NHS that remain successful, he highlighted the areas we need to focus on to ensure that the next decade of healthcare continues to grow, develop, and meet the changing needs of our population.As is often the case when looking at health as a whole, neurology was quietly absent from the role-call of prominent, debilitating diseases and conditions, and whilst stroke and dementia gained individual mention, many of the neurology community are concerned that the complex needs of those living with a neurological condition could be ‘lost under the ‘long term condition’ umbrella’The Neurological Alliance have produced a full and comprehensive report in response to the Plan, outlining key areas of relevance, concern and opportunity for the neurology community.Some of the key areas for attention highlighted by them are:

• A drive towards integrated care and population-based health
• Detailed proposals on clinical priorities
• Expansions in digital services including digital primary care

For more info: www.neural.org.uk/blog

Integrated – and localised – care planning

The rollout of integrated care systems (ICSs) is anticipated as a key means of delivering the Plan, and since April 2018, waves of sustainability and transformation partnerships (STPs) have been transitioning to ICSs. The Plan highlights that all organisations should be on this journey and ICSs covering the country by 2021. ICSs will produce ‘system operating plans’ to include both specialist and clinically commissioned services and will be supported by a new accountability and performance framework. This will give one single and consistent framework for all to work to; a positive step towards creating equality of services and equity of access.Ultimately, ICSs are expected to bring together local organisations to redesign care and improve population health, integrating primary and specialist care, physical and mental health services, and health with social care (although the plan does not address social care, something the Care and Support Alliance have issued a statement on.)

Local priorities

This means that neurology service design and delivery will be carried out at a local level, according to local priorities. Whilst this could potentially have an adverse affect on service equality nationally, all ICSs will be provided with national data through the Get it Right First Time (GIRFT) programme alongside RightCare and voluntary sector data to help understand the national picture and to benchmark against locally.The Neurology Academy recently hosted an event to begin unpicking variance in multiple sclerosis services, and Dr Geraint Fuller, neurology lead for GIRFT, gave a compelling presentation into the programme’s role in reducing unwanted variation in neurology services. Where localised planning and nationally relevant data come together, there is a real opportunity for informed, population-based planning, and as Geraint shared in his talk, ‘once Trusts and clinicians alike were presented with their own data they began to make vast improvements.’ Through shared decision-making across agencies via the ICS, combined with useful data intelligence, the Plan hopes to see ‘genuine, place-based decision making’.

Digital revolution

Already introduced through Health and Social Care Secretary Matt Hancock’s speech last year on his priorities for the health and social care system, there is an unsurprising emphasis on the role of digital technologies in the coming decade as a means of improving and developing healthcare.In apps and individual technologies, there has already been reasonable headway as the Neurology Academy summarised last year, looking at key neurological technologies. The voluntary sector have been making headway in this area too, with Parkinson’s UK employing a Director of Digital Transformation and the MS Society conducting research with the Nuffield Trust into technology to support people with MS, and creating an action plan to implement change nationally.However, technology in healthcare is more than apps and monitoring, and must be considered to overhaul whole systems where real benefit can be gained. The role of technology in healthcare going forward was eloquently outlined at our recent event on multiple sclerosis (MS) service variance by Professor Ben Bridgewater. Highlighting that the emphasis should be on transformation, not technology per se, he advocated looking outside of healthcare for examples, and being clear of our outcomes, then seeking to meet them through technology, rather than using technology to augment existing services. This is a key lesson to take forward for this goal to be truly beneficial.One of the Plan’s targets along these lines is for digital primary care services to be offered to improve patient access to their GP, with every patient being offered e an online or video consultation by 2022-23. Virtual outpatient appointments is another goal, and whilst there are some concerns over the impact on individual patient care within the neurology community, there are examples where virtual clinics are already reducing face to face appointments where they are unnecessary, thereby freeing up more appointments for those that are. One such example of this is the virtual disease-modifying treatment clinics at St George’s in London.

Challenges

A number of challenges, and concerns, have been raised by the Neurological Alliance, such as the focus on frailty in the elderly which is not extended to those of a younger age who may be experiencing frailty through their condition, and the challenges in a under-supported neurology workforce which is not explicitly addressed in the workforce element of the Plan. There are also concerns from the neurology community as to whether the specific needs of those with neurological conditions – often nuanced – will be understood in the wider categories set out in the Plan; areas like mental health and secondary care prevention are both highly relevant to neurology, but without knowledge of the nature of neurological conditions, may not be the measures outlined are not obviously applicable to neurology. Inclusion of neurological population needs in these will be reliant on the shared expertise of local clinicians and professionals in key decision-making bodies. As with all elements of this Plan, integrated working, talking, planning and understanding will be key.As with all ambitious plans, the aim for an integrated, technologically supported healthcare system immediately raises as many challenges as it seeks to address. However, it puts much focus on shared decisions, joint planning, and making the best possible choices for the most possible people, all aims that must be met with enthusiasm. As for the challenges: we can meet them as part of those shared decisions and joint plans, ensuring the best outcomes possible for people with neurological conditions.

A final note… Dementia

One of the arms of the Neurology Academy is our Dementia Academy. The Long Term Plan explicitly addresses improvements in care for this patient group, covering additional research funding, awareness raising and community support. Find out more.