Local commissioning

The Neurological Alliance’s work on local commissioning has had an impact in providing additional levers for those engaged in lobbying locally for improved services. It has also contributed to national policy activities in building the case for coordinated, concerted action to improve neurology services.

Sustainability and Transformation Partnership-level patient experience data

Our 2018/19 National Neurology Patient Experience Survey data has been broken down to into Sustainability and Transformation Partnership (STP) areas.  An online interactive mapping tool, enables STPs to review their data and compare it to other areas.

Clinical Commissioning Groups audits

Clinical Commissioning Groups (CCGs) are clinically-led statutory NHS bodies responsible for the commissioning of health care services for their local area. Given that they are responsible for commissioning that accounts for approximately two thirds of the total NHS England budget, it is important to understand how they commission services for the local population and how neurology is prioritised and supported at CCG level.

In 2018 The Neurological Alliance gathered evidence through a Freedom of Information Request about the extent to which CCGs were prioritising neurology in their improvement plans.  This found that for 2018/19, 37 out of 195 CCGs had submitted delivery plans that include neurological conditions as part of their RightCare improvement programmes.

Previously, in 2014, then again in 2016 The Neurological Alliance carried out quality of commissioning audits, issuing Freedom of Information requests to all CCGs in England. The 2016 results show that:

• 17% (n=36) of CCGs have made an assessment of the total costs of neurological
  services in their area
• 20.5% (n=43) of CCGs have made an assessment of the prevalence of
  neurological conditions in their area
• 21% (n=44) have made an assessment of the number of people using
  neurological services in their area

Read more about our quality of commissioning audits in our 2015 Invisible Patients report and our 2017  Going the Distance 2 report.

Sustainability and Transformation Plans audit

Sustainability and transformation partnerships (STPs) constitute another place-based approach to planning services. Their role is to bring together relevant partners to run services in a coordinated way. They also agree system-wide priorities, and plan together how to improve residents’ day-to-day health. They have a larger geographical footprint than CCGs, and bring together the CCGs and local councils in the area they cover. There are 44 STPs in England.

There are no specific requirements relating to neurology for STPs. However, the introduction of longer-term strategic planning at a local level could result in a step forward for neurology services. To test whether this was the case, The Neurological Alliance worked with Sue Ryder in 2017 to undertake an audit of STPs’ plans, to see to what extent they were prioritising neurology improvement. The audit found that:

• STPs most commonly engaged with neurology by engaging with stroke/dementia
• The quality of STPs plans for neurology was poor overall, although plans for stroke and dementia were stronger.
• STPs that had more substantive plans for neurology were more likely to have stronger plans for stroke, and for dementia.
• Some STPs plans only mention neurology in relation to specialised commissioning, which is undertaken nationally rather than locally. This suggests a lack of understanding of their responsibilities in planning neurology services locally.

We believe that STPs should engage more with neurology and replicate existing good practice. We are working with the specialised commissioning clinical reference group to clarify commissioning responsibilities through the neurology service specification, and NHS Rightcare to support STPs in making improvements.

Read more about Sue Ryder’s STP audit in our 2017 Going the Distance 2 report.

Transforming community neurology in the Thames Valley

The Neurological Alliance worked with the Thames Valley Strategic Clinical Network in 2016 to develop a new commissioning brief for local commissioners. The aim of the brief was to help them to improve the services provided in community settings to people diagnosed with a long-term neurological condition.

The report is in three parts:

• Part A: Transformation guide
• Part B: Reference reports
• Part C: Examples

This report is aimed primarily at local clinical commissioning groups and contains information on:

• Identifying the needs and priorities of people living with a long-term neurological condition and their carers
• Neurology datasets and benchmarking
• Delivering integrated care pathways
• Integrating good mental health into care pathways
• Technologies to enable community care models for long-term neurological conditions

The report was produced as part of a collaborative project between the Thames Valley Strategic Clinical Network (SCN), Sue Ryder, Southampton and Royal Holloway London Universities, Windsor Ascot and Maidenhead Clinical Commissioning Group, Neural Pathways (UK), and The Neurological Alliance. The project supported the aims set out in NHS England’s Five Year Forward View to explore the potential of new models of care to deliver locally-provided, integrated care, organised around the patient.

About the community neurology project

The NHS Five Year Forward View set out the vision for the future, describing a healthcare system that is facing major challenges and which needs to change and evolve to meet these challenges. It describes a future NHS that focuses on locally-provided, integrated care, organised around the patient. Part of that is a vision for forms of new models of care that will, ultimately, contribute to preventing some neurological conditions and improving the quality of life for people who acquire or develop such conditions. The Five Year Forward View has a clear focus on empowering patients and communities, and both primary and secondary prevention.

The aim of the programme is to:

• Stimulate the delivery of person centred co-ordinated care for people with neurological conditions by encouraging the adoption of community based care model(s)
• Develop an evidence base to demonstrate and help commissioners understand the value and benefits of good community neurology.

This will be achieved by building capacity and capability within the community and better utilising existing community resources to support:

• Care planning.
• Self-management and promote independence.
• The provision of proactive care for people with long term conditions, especially those with complex care needs.
• Demonstrating different ways of organising and delivering care, particularly when harnessed to investment in technology innovations. This will support the wider new care models work and ensure appropriate and timely access to services when patients require them.
• Exemplifying how investment in well-co-ordinated community services can reduce pressures on the acute system through admission avoidance and reduced length of stay, to deliver better outcomes and value for money.