Following a review of specialised adult neuroscience services in England conducted by the NHS England Specialised Commissioning team in collaboration with other programmes such as Getting It Right First Time and NHS RightCare, The Nuffield Trust has issued two briefings detailing the service improvements necessary in adult neurosurgery and specialised neurology services for adults to resolve issues of flow and access.
The reports were developed before the COVID-19 pandemic, but many of their findings remain relevant. However, in addition to the areas for improvement identified in the reports, growing waiting lists resulting from the suspension of many specialised services, redeployment of staff, and shielding of patients have resulted in further delays to treatment. In concert, heightened infection prevention and control measures have reduced outpatient and diagnostic capacity. Furthermore, demand for specialised neurology services can be expected to increase in future given the association between COVID-19 infection and neurological symptoms.
Working through the pandemic has demonstrated the feasibility of providing outpatient and other care via phone and video communication. This approach not only allows continuity of care, but is also more convenient for patients. However, for both adult neurosurgery and specialised neurology services for adults, imbalances between capacity and demand must be addressed to deal with problems with flow, and work is needed to improve the interface between inpatient services and rehabilitation.
The key messages of the reports are as follows:
- costs, activity, and demand are growing
- efficiency may be increased through improved use of theatres, supplementation of critical care with enhanced care, and addressing flow
- a more networked model of provision, with standardised pathways, is needed
- investment in e-referral, information and image exchange, and advice and support systems is required
- Integrated Care Systems (ICSs)/CCGs must work with neuroscience centres (NSCs) and NHS England to achieve more integrated commissioning of rehabilitation
- formal arrangements for repatriation should be negotiated within each NSC footprint as ICSs develop, mechanisms should be put in place to involve them in commissioning, so that they grow this capability over time.