MS information for health and social care professionals
These pages have been compiled by the Multiple Sclerosis Trust with the help of specialist health and social care professionals, and of people affected personally by multiple sclerosis (MS). The aim of these pages - and of the MS Trust - is to improve the level of understanding of MS amongst those who work with, and care for, people who have the condition.
The intention is to:
- offer an overview of MS
- provide a resource for professionals who work with people with MS
- answer some of the questions about the management of MS and its symptoms
- offer directions for further information through references and bibliographies.
National guidelines
National Service Framework (NSF) for long-term conditions
The National Service Framework (NSF) for long-term conditions was published in 2005. The aim of the NSF is to improve standards of neurological care across the country. Implementation will be over a 10-year time frame.
The NSF has identified 11 quality requirements to transform the way health and social care services support people with long term neurological conditions to live as independently as possible and these will be used to benchmark service delivery:
- A person centred service
- Early recognition, prompt diagnosis and treatment
- Emergency and acute management
- Early and specialist rehabilitation
- Community rehabilitation and support
- Vocational rehabilitation
- Provision of equipment and accommodation
- Provision of personal care and support
- Palliative care to enable people to make choices about end of life care
- Support for families and carers
- Caring for people with neurological conditions in hospital or other health and social care settings
NICE clinical guideline
The NICE clinical guideline, Management of multiple sclerosis in primary and secondary care, was introduced in 2003 and is incorporated into this edition. It aims to ensure that all health professionals are working to high quality, evidence-based national standards to achieve best practice in all areas of management of MS. The guideline covers the whole range of health care that should be available on the NHS including pharmacological, physical therapy, rehabilitation and psychosocial aspects. Six key recommendations have been made concerning:
- Specialised services
- Rapid diagnosis
- Seamless service
- Responsive service
- Sensitive but thorough problem assessment
- Self-referral after discharge
These clearly highlight that specialist neurological and neuro rehabilitation services should be available to people with MS, whilst also stressing the important role of the primary care team. It is also important to note that this Guideline recognises pressure sores as a sentinel event.
The MS Trust, in partnership with the Royal College of Physicians, carried out a national audit of NHS MS services in England in 2006 to assess the implementation of the MS NICE Guideline two years after it was published. The findings make for disappointing reading, with little impact being seen in services following the introduction of the Guideline. Much work remains to be done and we hope this publication will support this.
Risk-sharing Scheme
The efficacy of disease modifying drugs (DMDs) has been well established for some time. The Department of Health Risk sharing Scheme allows all people eligible for DMDs to be treated on the NHS with prescribing being undertaken in specialist centres. The long-term data on cost efficacy is being collected and will be analysed. The knock on effects have been the setting up of centres of excellence headed by a neurologist with a specialist interest in MS throughout the country (see the map of specialist centres). Tysabri is now also available to people with highly active relapsing/remitting MS.
It remains vital that people with MS and their families also receive expert care from the primary care team and that a joined up service is available to address both health and social issues.
Bibliography
- National Institute for Clinical Excellence. Multiple sclerosis - Management of multiple sclerosis in primary and secondary care. NICE Clinical Guideline 8. London:NICE;2003.
- National Institute for Clinical Excellence. Multiple Sclerosis - Beta interferon and glatiramer acetate for treatment of multiple sclerosis. NICE Technology Appraisal Guidance No. 32. London:NICE;2002.
- Department of Health. Cost effective provision of disease modifying therapies for people with multiple sclerosis. Health Service Circular (2002/04) London: Stationery Office;2002.
- Department of Health. The National Service Framework for long- term conditions. London: Department of Health; 2005.
- Royal College of Physicians, MS Trust. NHS services for people with multiple sclerosis: a national survey. London:RCP; 2006.