Long-term neurological conditions are very common and a typical CCG may be responsible for commissioning services for 59,000 patients. Neurology has the highest spend and poorest outcome of all long-term conditions in over half of all CCGs. Services for those with long-term neurological conditions have traditionally been organised around secondary and tertiary sectors, yet care organised this way leads to delayed access to expert advice, particularly at time of crisis. 70% of NHS spending is for long-term conditions, including over £750 million on urgent and emergency admissions to hospital, but much of this is avoidable.
To meet the challenging health care needs of the population the Five Year Forward View called for the development of more integrated approaches, to improve the quality and efficiency of services and improve patient outcomes by moving care closer to home from acute settings to community services wherever possible and through better co-ordinated care, delivered where and when it is required.
NHS England has developed a Vanguard programme to pilot new models of care. One such example is the Neurology Network at the Walton Centre in Liverpool. Its aim is to reduce variation in care and provide more services to patients nearer to home by increasing collaboration between hospitals, GPs and community services in the region, ensuring patients get the right care wherever they are and when they need it.
Opportunities in the Thames Valley & local STP footprints
Thames Valley SCN undertook an analysis using the focus packs issued by NHS RightCare in January and April 2016 has found that each local STP footprint and the majority of CCGs in the region (based against their statistical neighbours) have opportunities for potential savings on elective, non-elective or prescription spend for neurology care, totalling over £3 million per year in this region.
Locally developed Transformation Guide
To achieve the national requirements set out in the 5YFV, and address local issues identified by RightCare, commissioners are encouraged to read its recent Transformation Guide for community neurology (developed in collaboration nationally and taking a wide stakeholder view), which recommends the adoption of community-based person-centred new care model for those with neurological conditions.
Features of the care model
Embracing the well developed House of Care model and a stratified approach to care from self-care through needs-led interventions to complex care, the challenge and a potential solution has been well defined for commissioners.