Wednesday 8 August 2012

Strategic Clinical Network report launched by the NHS Commissioning Board: where next for neuromuscular services?

Managed Clinical Networks are a vital part of the health care structure and I am delighted that Strategic Clinical Networks have been endorsed by the NHS Commissioning Board. However I am concerned that the future funding of neuromuscular networks is not guaranteed by the new document. There is mention of a Strategic Clinical Network for neurological patients but not what conditions are covered by this umbrella label. It is imperative that neuromuscular networks are safeguarded by the board.

Nic Bungay, Director of Campaigns, Care and Information

On the 26^th July the NHS Commissioning Board released The Way Forward: Strategic clinical networks - a document which set out the need to continue and build upon the success of the current NHS clinical networks.

Co-ordinating care, delivering results

NHS clinical networks are the structures which co-ordinate primary, secondary and tertiary care around specific conditions or patient groups. They link up the care available to patients in a particular area or across a range of services. Some networks have full-time, paid, co-ordinators whose job it is to link up services.

Existing neuromuscular networks demonstrate the value of networks to improve quality of care for patients with a neuromuscular condition. Service provision for people with neuromuscular conditions has been patchy and disjointed. The network approach in the South West, see box, has fostered a more organised approach to providing for patients across the region, which has enabled the delivery of a more equitable service. The network approach has also raised awareness of the specific needs of these patients, enabling delivery of a better service.

Networks will be particularly important under the new NHS structures as they will be essential to ensuring that there is no fragmentation of the pathway between services commissioned by the National Commissioning Board and those services commissioned at clinical commissioning group level. Networks allow for joint planning with other agencies and encourage third sector involvement.

Success in the South West

One NHS neuromuscular network which has delivered real benefits to patients is the South West Neuromuscular Network. It has two full time members of staff and it supports the South West region’s four Neuromuscular Care Advisors. It is overseen by a Steering Group which comprises commissioners, neuromuscular clinicians, clinicians from co-specialities (respiratory and cardiac), allied health professionals, provider trust managers and patient representatives. The group meets regularly to monitor and record progress towards meeting the needs of people with a neuromuscular condition in the South West. It ensures that improvements to services are driven forward and that resources are pooled between the different parts of the NHS. More networks like these would deliver benefits to patients nationally and ensure the best value for money across the complex care and support systems needed by people with muscular dystrophy and related neuromuscular conditions.

Currently several types of health network operate within the NHS. The funding for these networks does not come from a dedicated central "network" budget; a network can be funded and organised by various different parts of the health service. The new report says that the National Commissioning Board (which will be the body responsible for commissioning specialised services after the NHS reorganisation) will set up a new type of network, a "strategic clinical network". These will take on some of the functions of existing networks and be tasked to "advise commissioners, support change projects and improve outcomes".

The report states: "Strategic clinical networks, hosted and funded by the NHS Commissioning Board (NHS CB), will cover conditions or patient groups where improvements can be made through an integrated, whole system approach. These networks will help local commissioners of NHS care to reduce unwarranted variation in services and encourage innovation. The conditions or patient groups chosen for the first strategic clinical networks are: Cancer; Cardiovascular disease (including cardiac, stroke, diabetes and renal disease); Maternity and children's services; Mental health, dementia and neurological conditions"

The new paper ensures the funding of the named strategic clinical networks for up to five years and says that they will be managed by 12 locally based support teams.

What about neuromuscular networks?

The Muscular Dystrophy Campaign wants the NHS Commissioning Board to clarify what the future is for neuromuscular networks and whether they fall under the category of "neurological conditions" in the strategic clinical network groups named in the report. We are concerned that with such a broad category of conditions (mental health, dementia and neurological conditions) being organised into the same system that neuromuscular conditions could be sidelined.

On the 21^st February 2012, the Rt Hon Andrew Lansley MP, Secretary of State for Health, responded to a question by Mary Glindon MP about the need for neuromuscular networks by saying "As we have set out clearly, we want to promote clinical networks more widely, not just in relation to cancer and stroke, as has been the case in the past".

We call on the NHS Commissioning Board to clarify that this means that neuromuscular networks will be safeguarded to ensure their future under the new commissioning structures. People with neuromuscular conditions need to access vital non-specialised services such as physiotherapy, hydrotherapy and psychological support and it is therefore vital that care is co-ordinated through fully funded and secure regional networks.