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Recommendations for commissioning

Adults :: Long term neurological conditions :: Recommendations for commissioning

The following recommendations are those that are likely to be locally practicable and have the biggest impact, in terms of numbers involved, severity of the condition(s), risk and costs associated. The recommendations have tried to build upon or further inform existing opportunities and initiatives.

1. Develop a strategy for neurology that is jointly owned and developed by health services, social care and relevant third sector organisations

• Improved integration for patient-focused services
• Ownership within healthcare to include different medical specialties
• Inform service planning through better use of data and existing estimates

2. Improve community neuro-rehab to meet the on-going needs of people with LTNCs

• Appoint a community neurology specialist nurse to work closely within or alongside Medway Community Health's emerging community neuro-rehab pathway, case management approach, condition-specific specialist nurses and palliative care team.
• Develop a structured programme of training for community physios with the aim of having at least two physios with confidence in dealing with specific LTNCs. Additional neuro-physio capacity is likely to be required in the short term to achieve this.

3. Improve management of epilepsy through provision of ESN(s)

• Pursue the plan to appoint an epilepsy specialist nurse at MFT as soon as possible
• Closely monitor this nurse's caseload/performance and plan for the appointment of at least one additional ESN, based either at MFT or in the community.
• Determine optimal configuration of ESNs via discussion with the current ESN at DVH/Lordswood and investigation of the model used in Canterbury

4. Provide appropriate emotional and psychological support to people with LTNCs

• Build a more complete picture of the need: a) run a complete audit of GP records combining all main LTNCs with a range of relevant mental co-morbidities; b) consider this alongside priorities expressed by SNs, charities and patients.
• Explore opportunities for vocational rehab for people with LTNC such as MS to ensure they reap the mental health benefits of being in employment

5. Establish arrangements for secure on-going provision of palliative and pre-palliative care

• Consider and negotiate proposed arrangements for a neuro-rehab palliative care team and ensure that sustainable funding is available for the existing MDT for MND
• Facilitate more proactive and regular assessment of people in the complex phase of MS that might require transition to palliative services
• Pilot a MDT for advanced PD cases, coordinated by the PD specialist nurse. One major focus would be to ensure care is arranged for people with multiple morbidities that might not, taken individually, warrant referral to a specialist.