Neurological care and support: consultation report

Aim D and Commitments 14-15

124. The National Action Plan explained that there are many challenges in providing care and support for disabled people, many of whom will have a neurological condition, and in enabling them to remain in their own home.

125. A total of 15 respondents provided general comments in relation to this aim and the related commitments. One third sector organisation felt there is a need for these commitments to be more wide ranging as the two commitments are more narrow in scope than the aim and will not on their own deliver the aim. Another third sector organisation commented that Commitment 14 does not meet the aim as it is based on a medical model which Aim D is not and suggested an additional commitment on how equitable access to social care and support will be improved. Two individuals also felt the Commitments look good on paper but noted the need for services to be in place before they can be improved upon and queried how these will be achieved given the current shortage of experienced staff in the workforce.

126. A small number of respondents suggested that workforce planning needs to be undertaken to ensure that specialist staff are available; MS (multiple sclerosis) and ME were both cited as examples of neurological conditions where the required staff are not accessible at present.

Views on Aim D

Improve equitable and timely access to care and support across Scotland.

127. Respondents were asked to say if they agreed with this aim and the following table demonstrates there was almost universal agreement with this Aim.

Table 23: Q25 Do you agree or disagree with Aim D

	Number
	Yes	No	Not answered
Health & Social Care Partnerships (2)	2	-	-
NHS / Health (11)	9	-	2
Pharmaceutical / manufacturing (2)	1	-	1
Representative organisation (7)	6	-	1
Third sector (24)	21	-	3
Other (3)	3	-	-
Total organisations (49)	42	-	7
Individuals (96)	90	1	5
Total respondents (145)	132	1	12

128. A small number of respondents made comments specifically in relation to Aim D, most of whom welcomed this Aim although there were some comments of the need for funding to be able to achieve this.

Commitment 14

129. The National Action Plan then went on to note that the Scottish Access Collaborative is working to sustainably improve waiting times for patients waiting for non-emergency procedures and will shape the way services are provided in the future. The Scottish Government has convened a Neurology Group within the Scottish Access Collaborative and this work, in conjunction with the Modern Outpatient document, should lead to better referral guidelines and care and support pathways for people with neurological symptoms across Scotland.

We will seek to improve access to Health and Social Care and Support by working with the Scottish Access Collaborative for Neurology to develop nationally agreed, regionally and locally applied guidelines for services and referral pathways for neurological conditions; and work with stakeholders on the development of a national or regional approach for access to services based on DCAQ (Demand, Capacity, Activity and Queue) for hospital neurology and neurophysiology services. In particular we will encourage NHS Boards and Integration Authorities to consider introducing/strengthening current provision for commonly accessed services including:

• open access clinics for suspected new epilepsy / first seizure patients, that accept referrals from patients, emergency departments and GPs
• rapid access neurology clinics
• pilots of community based teams for dealing with common neurological symptoms

130. Respondents were asked to indicate their agreement or otherwise
with Commitment 14. As table 24 shows, there was very little disagreement with this Commitment.

Table 24: Q26 Do you agree or disagree with Commitment 14?

	Number
	Yes	No	Not answered
Health & Social Care Partnerships (2)	2	-	-
NHS / Health (11)	6	-	5
Pharmaceutical / manufacturing (2)	-	-	2
Representative organisation (7)	6	-	1
Third sector (24)	19	1	4
Other (3)	2	-	1
Total organisations (49)	35	1	13
Individuals (96)	85	2	9
Total respondents (145)	120	3	22

131. A total of 47 respondents provided commentary in relation to Commitment 14. As with the previous commitments, the key theme was support for this or for elements of this although again there were some qualifying comments. These comments included the need for funding and resources, the need to consider workforce requirements and ascertain what staff groups are required, and the need to see how different networks can link into each other.

132. Allied to the issue of funding and where services are needed, some respondents commented that DCAQ work should provide insight into demand in each area as well as considering all specialities.

133. A few respondents wanted to see rapid access neurology clinics extended to other conditions and there were a small number of queries as to why there is reference to epilepsy but not to other conditions, with one third sector organisation suggesting that open access clinics need to be extended and include other conditions such as MS. There were also a small number of comments on the need for treatment specific protocols rather than generic protocols. Once again, there were also references to ME specifically, with respondents noting the need for setting up a specialist centre of excellence for the diagnosis and management of ME and for the provision of equitable service for those with this neurological condition.

134. Other comments made by very small numbers of respondents included the need:

• For rapid access to rehabilitation services, including vocational rehabilitation.
• To include respite services within the scope of the new guidelines.
• For the NAP to have consistency between national, regional and local guidelines to ensure equity in provision.
• To ensure the NAP is informed by the experience of individuals with neurological conditions.
• To recognise that emergency access to a neurological team may be outwith normal hours.
• For priorities to be set under these Commitments.
• For a proactive approach on the part of agencies, authorities and health practitioners in identifying and engaging with individuals with a neurological condition.
• For a transition pathway between adult and older adult services.
• For support to help develop generic staff to give appropriate advice and support.

Commitment 15

135. The National Action Plan then explained that there is considerable variation in access to services, and that the services received can be varied. The Scottish Atlas of Variation aims to highlight geographical variation in Scotland's population health, the provision of health services and associated health outcomes.

We will work with the Scottish Atlas of Variation Group to explore developing an Atlas on neurological conditions.

136. Respondents were asked to indicate their agreement or otherwise with Commitment 15. As the following table shows, only four individuals disagreed with this Commitment.

Table 25: Q27 Do you agree or disagree with Commitment 15?

	Number
	Yes	No	Not answered
Health & Social Care Partnerships (2)	2	-	-
NHS / Health (11)	9	-	2
Pharmaceutical / manufacturing (2)	1	-	1
Representative organisation (7)	6	-	1
Third sector (24)	21	-	3
Other (3)	3	-	-
Total organisations (49)	42	-	7
Individuals (96)	79	4	13
Total respondents (145)	121	4	20

137. Only 9 respondents commented specifically on Commitment 15, with most of these noting their support of this commitment. Other comments noted the need for a realistic timeframe to be stated under this commitment and that this Atlas should not just be limited to NHS services.

In summary:

There was almost universal support for this Aim and its related Commitments.

Commitment 14: Again, there were references to the need for funding and resources, the need to consider workforce requirements and to see how different networks can work together. There were some requests for rapid access neurology clinics to be extended to conditions other than epilepsy; and some reference to the need for treatment-specific protocols rather than generic protocols.

Commitment 15: There were requests for a realistic timeframe to be stated as well as comments that the Atlas should not just be limited to NHS services.