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Improving MS services: more still to be done

Way Ahead 2006;10(4):1

The MS Trust, in partnership with the Royal College of Physicians, has conducted the first national audit of NHS MS services in England. The survey was carried out to determine the effect of the NICE Guideline two years after it was published. The audit used a triangulation approach comparing, in six selected, diverse geographic regions defined by their Strategic Health Authorities (SHAs), the perspectives of SHAs (as performance managers), Primary Care Trusts (PCTs, as service commissioners), hospital Trusts (as secondary care providers), and patients (as service users).

The results have now been published and, with few exceptions, they make for depressing reading, with little impact being seen on services following the introduction of the Guideline. The main findings were as follows:

  • SHAs reported very little monitoring of the commissioning of services by PCTs. Some noted that this was not their responsibility, others accepted responsibility even if not undertaking any performance management.
  • PCTs did commission using the recommendations, but few monitored the delivery of services against the NICE recommendations.
  • Some hospital Trusts did provide services according to some of the recommendations, but few monitored their performance against the recommendations.
  • Although people with MS expressed general satisfaction with NHS services when asked to quantify their satisfaction globally, more detailed quantitative data and the qualitative comments they made revealed to a significant extent both poor quality services and dissatisfaction with services received.

The report concludes, "This national audit shows that the NICE recommendations are not being implemented within the NHS, and that the NHS organisations are not currently positioned to do so. It provides baseline data against which future service change can be compared. It also shows that simple questions on satisfaction with services do not reflect patient experience. Current service provision is of low quality and inadequate quantity. Improvement requires organisational change and action within the NHS, and cannot be achieved by clinical staff alone."

The MS Trust and the Royal College of Physicians will be using this data to highlight the importance of improving services. There is little point in NICE commissioning guidelines if they simply sit on a shelf. We must get them off the shelf and use them to refocus the NHS on good service provision for people with MS, as we know so many of you are working hard to do.

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