Neurological care and support: consultation report

Aim E and Commitments 16-17

138. The National Action Plan explained the need to consider the workforce and those who support the independence, health and wellbeing of people with neurological conditions.

139. A total of 10 respondents provided general comments in relation to this aim and the related commitments, with the key comment being of a need for better integration of services and for workforce planning to deliver joined up services that focus on anticipatory and preventative care which respond to peoples' needs. Once again, the need for appropriate funding and resources was referred to. A small number of organisations referred to work which had been undertaken and one third sector organisation outlined its view of how an ideal person centred model would work. An organisation in the NHS / health sector noted the need for partnership between NHS boards and local authority social care workforce plans.

Aim E

Build a sustainable neurological workforce fit for the future.

140. The following table shows that all who answered this question definitively supported Aim E.

Table 26: Q29 Do you agree or disagree with Commitment 16?

	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	-	6
Total respondents (145)	132	-	13

141. A small number of respondents made comments specifically in relation to Aim E, most of whom welcomed this Aim, although there were some comments of the need for funding and resources to be able to achieve this; as well as support for people to access the relevant services at the point of need.

Commitment 16

142. The National Action Plan then went on to note that there are currently gaps in the provision of adequately trained staff to deliver care and treatment.

We will discuss a national or regional approach to workforce planning with stakeholders, to test the extension of existing workforce planning tools and their application to the wider neurological workforce in Integration Authorities and NHS Boards; supporting review of job plans for Consultant Neurologists and Neurophysiologists to make posts more attractive, while recognising the national approach to consultant contracts. We will support a programme of innovation and the development of a phased approach to implementation where emerging evidence supports changing models of workforce, such as testing new roles of Advanced Practice for nurses, allied health professionals, general neurology keyworkers and healthcare Scientists working in neurological care and support services.

143. Respondents were then asked to indicate their agreement or otherwise with Commitment 16. As table 26 shows, almost all those answering were supportive of this commitment.

Table 26: Q30 Do you agree or disagree with Commitment 16?

	Number
	Yes	No	Not answered
Health & Social Care Partnerships (2)	2	-	-
NHS / Health (11)	6	1	4
Pharmaceutical / manufacturing (2)	-	-	2
Representative organisation (7)	6	-	1
Third sector (24)	19	1	4
Other (3)	3	-	-
Total organisations (49)	36	2	11
Individuals (96)	85	3	8
Total respondents (145)	121	5	19

144. A total of 48 respondents, across all sub-groups, provided commentary in relation to Commitment 16. As with the previous commitments, the key theme was support for this either in part or wholly, although there were some qualifying comments such as the need to include mental health services in workforce planning.

145. A few respondents commented on the current lack of support available in terms of overall access to services as well as timely access to services. Allied to this, a number of respondents commented on the need to have a wider range of professionals referred to, including the full range of neurological specialists such as neurology nurses, neuro immunologists and neuropsychologists, and GPs, pharmacists and any others who would form part of the integrated care team. One Health and Social Care Partnership noted the need for this to cover all staff groups and to identify the roles needed to deliver pathways, as well as to identify the knowledge, skills and experience needed for each role. There was reference to the need for the Scottish Government to be realistic about how it aims to meet the potential additional need that will be bought about by the implementation of this Plan.

146. There was also some reference to the need for a full list of all neurological conditions, with ME being cited specifically by a few respondents.

147. A few respondents referred to specific roles that should be created. These included:

• Consultant neurologists with responsibility for each condition to ensure leadership.
• Key worker co-ordinator.
• Advanced neurological AHP / nurses who can assess and order tests and prescribe medicine.
• General neurology key workers.
• Posts within acute neurology services that link patients with appropriate services across sectors including health and social care, and benefit services.

148. A few comments were made, each by only very small numbers of respondents. These included:

• Commitment 16 on its own is not sufficient in that there is also a need to create conditions to attract staff to the sector.
• This commitment needs to be more explicit to provide clarity of certainty for Aim E to be met effectively.
• There needs to be an overarching national development strategy.
• There needs to be a national workforce in order to have a level playing field.
• There is a need to consider how plans for improving neurology can provide flexible models of care; for example, community-based models of care would be suitable for some individuals and would in turn alleviate some of the pressure on other services.
• Workforce planning should include rehabilitation services.
• The NAP needs to connect with the AHP Specialist and Advanced Practice short life working group at HIS.

Commitment 17

149. The National Action Plan then explained that the Scottish Government has been giving consideration to consultancy vacancy rates and the age profile of the current consultant workforce and to recruitment, particularly within acute neurology and neurophysiology services. It also noted that there is no national framework for the development of non-medical staff working with people with neurological conditions, whether knowledge or competence based; and that there needs to be consideration as to the sustainability of this workforce, while still recognising the independence of the sector.

We will work with stakeholders, in the context of the work taking place under the National Health and Social Care Workforce Plan, to explore how best to further support the development of appropriate expertise in the health and social care and support workforce for those working with people with neurological conditions.

150. Respondents were then asked to indicate their agreement or otherwise with Commitment 17. As the following table shows, almost all respondents agreed with this commitment; and only two respondents disagreed.

Table 27: Q31 Do you agree or disagree with Commitment 17?

	Number
	Yes	No	Not answered
Health & Social Care Partnerships (2)	2	-	-
NHS / Health (11)	8	-	3
Pharmaceutical / manufacturing (2)	-	-	2
Representative organisation (7)	6	-	1
Third sector (24)	20	1	3
Other (3)	3	-	-
Total organisations (49)	39	1	9
Individuals (96)	89	1	6
Total respondents (145)	128	2	15

151. A total of 23 respondents commented specifically on Commitment 17, with most of them noting their support of this commitment. Other comments noted the need to ensure the provision of information and appropriate training for all staff, with a small number of references to specific neurological conditions such as ME or MS.

152. There were a small number of references to the need to consider barriers to recruitment and retention within the sector. One third sector respondent felt this commitment lacked the necessary detail to underpin how the sustainability of the workforce would be considered; another that this needs to address the shortage of care staff and not just their shortage of expertise.

In summary:

Again, there was almost universal support for this Aim and Commitments.

Commitment 16: There were references of a need to ensure overall access to services, as well as timely access to services. There were also requests for reference to the need for a wider range of professionals in order to deliver the necessary services to individuals with neurological conditions.

Commitment 17: There were references to the need to ensure the provision of information and appropriate training for all staff, and the need to consider barriers to recruitment and retention in the sector.