Neurology

Maintaining quality

Measuring value/quality

Measuring the value of an intervention or the quality of care is difficult in a specialty that manages a wide range of conditions, including many progressive long-term neurodegenerative illnesses. An evidence base will need to be developed for a range of quality measures that will lead to improved care in all areas of neurological disease rather than just in easily measurable settings. Care will be needed to avoid simply developing measures of process, unless these processes are clearly linked to quality. 

A number of easily identified quality measures should be introduced over the first 2 years of commissioning to drive rapid access to quality care for urgent neurological disorders. Examples might include TIA or stroke services, first seizure or multiple sclerosis relapse services, or provision of neurological assessment in acute DGH settings. A biannual review of quality measures should be undertaken to drive improved services. Necessary developments are likely to vary depending on local needs and priorities.

What should a high-quality neurology service include?

NICE has published approved standards for certain neurological conditions. The ABN and Neurological Alliance and its stakeholders have produced quality standards (opens PDF,138KB) on some of the other conditions not covered by NICE. Commissioning toolkits, such as this epilepsy toolkit , are being developed to enable commissioners to develop and improve the services that already provided.

Current costs, efficiencies and cost reduction

Neurology Commissioning Networks were launched in June 2015 to support commissioning of high-quality, outcomes-focused, value-for-money neurology services.

Thames Valley Strategic Clinical Network (SCN) launched a commissioning brief in June 2016 for local commissioners, to help them improve the services provided in community settings to people diagnosed with a long-term neurological condition.

The ABN’s Neurology Commissioning Toolkit includes this ten-point plan for better commissioning to improve the quality of neurology care:

• Know your population to reduce unplanned admissions.
• Get smart with data.
• Promote the self-care agenda.
• Ensure neurology is in your local JSNA.
• Promote better medicines management.
• Introduce integrated, multidisciplinary teams.
• Focus on end-of-life care for neurology.
• Link into or develop local neurology networks.
• Work with the voluntary sector to improve patient outcomes.
• Educate your workforce in neurology.

Guidance to support good practice

Data for quality improvement                                                   

Neuro Numbers, published by the Neurological Alliance, provides useful information on the prevalence of neurological disorders and their impact.

The Neurology Intelligence Network provides access to national data on various conditions including epilepsy. The Health and Social Care Information Centre publishes a compendium of neurology data in England allowing direct comparisons of patient activity to be made by clinical commissioning groups.

The following publications provide information on national audits and guidelines for various conditions:

• The RCP’s Stroke Programme
• Concise guidance to good practice: Long-term neurological conditions
• National audit of services for people with multiple sclerosis
• Acute neurology survey 2017 (ABN)
• National audit of seizure management in hospitals
• Public Accounts Committee review into services to people with neurological conditions.

Association of British Neurologists guidance

• Neurology Commissioning Toolkit
• Unscheduled care: neurological emergencies and acute neurology (opens PDF, 138KB)
• Non-urgent neurological conditions (opens PDF, 137.74KB)
• Multiple sclerosis guidelines 2015