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On 9 June 2022, the House of Lords is due to debate the following question for short debate:
Lord Dubs (Labour) to ask Her Majesty’s Government what steps it is taking (1) to ensure that people with neurological conditions receive timely access to health and care services, and (2) to ensure that the sector’s workforce is properly staffed to deal with demand.
1. Types of neurological conditions
A ‘neurological condition’ refers to a condition that affects the brain, spine and/or nerves. There are over 600 known neurological conditions according to the Neurological Alliance. These can be separated into four main categories:
- ‘sudden onset conditions’ such as strokes, traumatic brain injury, spinal injury and meningitis
- ‘intermittent conditions’ such as epilepsy and migraines
- ‘progressive conditions’ such as Parkinson’s disease, dementia and motor neurone disease
- ‘stable with changing needs’ such as Tourette’s syndrome, narcolepsy and cerebral palsy
Neurological conditions have several causes, including genetics, bacterial or viral infections and traumatic injuries.
2. Neurology workforce and waiting lists
The Association of British Neurologists (ABN) conducted a neurology workforce survey between November 2018 and March 2019. The ABN’s key findings included:
- For neurology consultants involved in patient care (direct clinical care and supporting programmed activity), the number of full time equivalents was one consultant per 91,175 population (1.1 per 100,000). This was less than expected when compared to similar high-income European countries such as France and Germany which both had one consultant per less than 25,000 population. The ABN said this impacted the quality of care provided to patients with neurological conditions in the UK, specifically with regard to ensuring patients receive timely access to consultant neurologists.
- A significant geographical variation existed in the number of neurology consultants throughout the UK. Despite the greatest number of consultants being based in London and the south-east, the ABN said the proportion of consultants was still low when compared to other high-income countries.
These findings were based on 615 ABN survey respondents, in addition to data from the Royal College of Physicians (RCP) 2018–19 census of the physician workforce in the UK. The RCP conducts a consultant census each year and aims to provide data on the state of the UK physician workforce.
Commenting on the ABN’s findings in March 2020, neuroscience education provider the Neurology Academy described the situation as an “emerging neurology workforce crisis”.
The latest NHS hospitals and community health service workforce statistics showed that there were 1,638 people (full time equivalent) in the neurology workforce in England on 31 January 2022. This compared to 1,562 and 1,468 for the same day in 2021 and 2020 respectively.
2.2 Waiting lists
Elective care waiting lists in England have continued to grow. ‘Elective care’ refers to care that is planned in advance, for example those who require assessment or treatment by a hospital doctor following a GP referral.
In February 2020 there were 4.3 million people on a waiting list for care across all specialisms, according to NHS backlog data analysis from the British Medical Association. Since then, the disruption to NHS service delivery caused by the pandemic has exacerbated the problem. In February 2022, figures suggested that over 6.1 million people were on a waiting list.
For neurological conditions specifically, a Neurological Alliance briefing paper from February 2022 included recent NHS data on waiting times. It said in December 2021 there were:
- 51,195 people waiting for neurosurgery. 7% (3,584) of these people had been waiting for surgery for over 12 months.
- 174,243 people waiting for a neurology appointment (to diagnose, treat and manage their conditions). Of these, 3,485 (2%) had waited more than 12 months for an appointment.
These figures were taken from NHS England’s ‘consultant-led referral to treatment waiting times’ data.
3. Actions to improve neurological care
Several plans have been created by the NHS and neuroscience organisations to improve health care services for people with neurological conditions.
In February 2022, the NHS published its NHS ‘Delivery plan for tackling the Covid-19 backlog of elective care’ (the plan). This set out how the NHS plans to recover elective care in England across all specialisms over the next three years. Ambitions include meeting the following targets for elective care waiting times:
- Eliminate waits of over two years by July 2022.
- Eliminate waits of over 18 months by April 2023.
- Eliminate waits of over one year, except for specific specialities, by March 2025.
Additionally, the NHS also plans to make effective use of independent sector capacity. It said any extra capacity created within the NHS would then be used to take on more complex work such as neurosurgery.
The Neurological Alliance briefing paper from February 2022 welcomed the NHS plan. However, it said the plan had failed to include a comprehensive strategy for the neuroscience workforce. The Neurological Alliance said it would continue to advocate for improvements in care for those with neurological conditions, and specifically those who face long waiting lists. It also committed to analyse data from the Neurological Alliance national patient experience survey, ‘My Neuro Survey’, to better understand which groups of people (such as those with, or those suspected of, a neurological condition) are experiencing the longest waits. The Neurological Alliance said it expects to publish the survey results in June 2022.
During a House of Lords debate in May 2021 on Covid-19 and people with neurological conditions, government whip Baroness Penn said that a variety of improvements were under way. This included the neuroscience transformation programme and the elective care transformation programme previously launched by NHS England and NHS Improvement.
The National Neurosciences Advisory Group (NNAG) is developing a range of optimum clinical pathways for neurology and neurosurgery. The purpose of the pathways is to set out what good treatment, care and support looks like for people with neurological conditions. The NNAG said it hopes these pathways would help to improve services and set aspirations for good care.
On 19 May 2022, a government response from health minister Gillian Keegan to a written question on neurology said that the neuroscience services transformation programme would use the NNAG pathways to inform its work. The minister also said that NHS England and NHS Improvement planned to recruit a national clinical director for neurology. The purpose of this role would be to provide clinical leadership and advice across the specialism.
The Department for Health and Social Care announced the development of a cross-government strategy on acquired brain injury. To inform the strategy, the department launched a 12-week acquired brain injury call for evidence in March 2022. This seeks views on what the priorities, content and actions of the strategy should be. The call for evidence is scheduled to close to responses on 6 June 2022.
4. Neurological conditions and Covid-19
Health and care services for those with neurological conditions have been significantly impacted by the pandemic. A ‘Lessons learnt from the Covid-19 pandemic’ report in April 2021 by the NNAG said that since the pandemic onset, people with neurological conditions had been directly impacted across all areas of life, including their access to health and social care services. The reallocation of “already over-stretched” resources away from neurology to respond to the pandemic had increased existing gaps and variations in care for people with neurological conditions. Additionally, the NNAG also found that there was an increasing number of long-Covid patients requiring neurological care.
The University of Liverpool and King’s College London are carrying out a study to assess the potential link between Covid-19 and brain injury. The organisations said that Covid-19 patients had been found to frequently suffer brain problems during the infection, and some have been left with symptoms of brain injury. The study will analyse how these problems occur and what strategies could be developed to prevent and treat them.
The House of Lords Library briefing ‘Neurological conditions and Covid-19’ provides more information about the impact of Covid-19 on people with neurological conditions and their access to health care services.
5. Read more
- Adrian Burton, ‘How do we fix the shortage of neurologists?’, 18 April 2018, The Lancet, vol 17, issue 6, pp 502–3
Cover image by Anna Shvets on Pexels.