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Evidence of what works

Adults :: Long term neurological conditions :: Evidence of what works

The National Service Framework (NSF) for LTNCs[1] is a comprehensive resource that, while out of date, outlines the key issues in this area. Its 11 quality requirements (QR) remain a useful gold standard for service provision for LTNCs across the health and social care sectors. A 2011 review of the NSF by the National Audit Office[2] was partly based on a systematic review of 146 documents. Included within these are fairly recent published audits of compliance with clinical guidance for a range of LTNCs.

The QRs in the NSF have the common theme of 'integration' running across them, but very limited advice is given about how to implement this in practice nor how to evaluate whether the outcome of continuity of care has been achieved.[3] Continuity of care should comprise good continuity in healthcare and social care, but also improved social and economic inclusion. Three types of service are highlighted that have the various factors identified as being necessary to promote continuity of care: 1. community interdisciplinary neurological rehabilitation teams (CINRT) 2. specialist nurses (SN) 3. proactive, holistic day opportunities services[4]

Common blockages to accessing these services include eligibility criteria, poorly-defined pathways and a lack of local availability or capacity. Third sector organisations also play an important role by improving access and promoting continuity of care.[3]

It is clear is that specialist nurses play a crucial role within a multi-disciplinary team (MDT), which is felt to be the best way of ensuring patient–centred services are delivered. SNs can act as a catalysts for change, lead service development and be a constant figure for the patient.[5]

An implementation framework now exists for end of life care in LTNCs. It notes that well delivered palliative care services, particularly if they are delivered holistically with pain and symptom management, can improve patients' quality of life as conditions progress.[6]

NICE has published comprehensive clinical guidance (CG) on the diagnosis and management of MS (CG8, 2003), PD (CG35, 2006) and epilepsy (CG137, 2012). NICE quality standards (QS) have also been published for epilepsy in adults (QS26) and children and young people (QS27). Quality standards are also being developed for MS, MND, cerebral palsy, PD, and for 'relatively uncommon neurological problems e.g. muscular dystrophy'.

The Association of British Neurologists has guidelines on the management of MND, viral encephalitis in adults and the treatment of MS.

Map of Medicine has maps for a range of conditions: Bell's palsy in adults, epilepsy in adults, headache in adults, HD, MS, PD.

Neurological Commissioning Support has also published care pathways for Progressive Supranuclear Palsy (PSP) and PD.


References

[1]   Department of Health. National Service Framework for Long Term Conditions 2005; Department of Health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198114/National_Service_Framework_for_Long_Term_Conditions.pdf .
[2]   National Audit Office. Department of Health, Services for People with Neurological Conditions. Report by the Comptroller and Auditor General. 2011; National Audit Office. http://www.nao.org.uk/wp-content/uploads/2011/12/10121586.pdf .
[3]   Bernard S, Aspinal F, Gridley K, et al. Integrated services for people with long-term neurological conditions: evaluation of the impact of the national service framework. Final Report. 2010; University of York. http://php.york.ac.uk/inst/spru/research/summs/ltnc.php .
[4]   Department of Health Policy Research Programme. Improving outcomes for people with LTNCs. Building services for the future. 2012; Department of Health. http://www.ltnc.org.uk/ALMO/building_services_for_future.html#outcomes .
[5]   Skills for Health Workforce Projects Team. Long term neurological conditions: a good practice guide to the development of the mutlidisciplinary team and the value of the specialist nurse 2008; MS Society. http://www.mssociety.org.uk/sites/default/files/Documents/Professionals/Long%20Term%20Neurological%20Conditions_good%20practice%20guide_professionals%20resource.pdf .
[6]   National End of Life Care Programme. End of life care in long term neurological conditions a framework for implementation 2010; National End of Life Care Programme. http://www.endoflifecare.nhs.uk/assets/downloads/improving_eolc_neurology.pdf .