Audit of MS Services
a partnership between the RCP and MS Trust
Chris Jones, Chief Executive, MS Trust
Open Door - August 2008 page 9
The word 'audit' in the title, we appreciate, is not the guaranteed 'must read' of the literature that comes your way today!
However, it is a sad fact that it is only by conducting such surveys and, if necessary, demonstrating poor results, that we can improve service quality, particularly when the audit in question is conducted with partners, the Royal College of Physicians.
This audit was conducted earlier this year, following on from a similar survey two years ago. We plan, with the RCP, to make this a two yearly event. We'd also like to say a big thank you to everyone who completed the survey - 1,300 people across England and Wales who had used the NHS in 2007 in relation to their MS.
'Five years on, NHS still failing MS patients' was the headline on the press release which was sent out to all media on 9 July. The results demonstrate that the NHS is still failing to implement the 2003 NICE guidelines on the management of MS. The guidelines carried six key recommendations and one quality marker which formed the basis of the questions we put to people with MS, hospital trusts, primary care trusts and the strategic health authorities.
The survey showed that access to neurological rehabilitation services remains wholly inadequate - only 36% of people with MS had access to such services. As we know, for people with MS it is the disabilities and symptoms that cause distress, and disability is often a direct consequence of poor symptom management. If neurological rehabilitation were readily available, the severity of disability would be reduced.
We feel it is unacceptable that access to the services people with MS need is still a matter of geographical accident. The postcode lottery is about basic services - continence, prevention of pressure sores, being assessed for the right wheelchair if you need it, pain relief. Quality services should not depend on the accident of finding a doctor or a nurse who really understands and responds to your needs. It should be built into the commissioning structure of the NHS - and it is not.
The audit also showed that although access to specialist neurological services had improved, there were still long delays between initial referral and diagnosis, with 50% of all patients waiting over 20 weeks.
6% of people surveyed had had a pressure sore during the previous 12 months. The occurrence of pressure ulcers was NICE's identified 'quality marker' for MS services - and for good reason. Firstly, pressure sores are always avoidable and secondly, a grade 4 pressure ulcer costs the NHS an estimated £10,551, with total costs in the UK at £1.4-£2.1 billion - about 4% of total NHS expenditure. Such figures of course do not include the pain and distress they cause.
As well as the media, we are alerting those with influence in delivering better services to the findings of the audit: commissioners, providers and performance managers, the Healthcare Commission, NICE, politicians and civil servants. Let us hope that when we repeat the audit in 2010, we will see significant improvement.
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