Executive summary

Introduction

1. This National Service Framework (NSF) for Long-term Conditions is a key tool for delivering the government’s strategy to support people with long-term conditions outlined in the NHS Improvement Plan: Putting People at the Heart of Public Services.

2. The NSF aims to build on proposed changes in NHS management and commissioning to bring about a structured and systematic approach to delivering treatment and care for people with long-term conditions. It should be read alongside National Standards, Local Action: The Health and Social Care Standards and Planning Framework 2005/6 – 2007/8, which promises consistently high standards of NHS care across the country, and Supporting People with Long-Term Conditions – An NHS and Social Care Model to support local innovation and integration. The forthcoming Green Paper on the future of social care for adults in England will consult on how more joined-up, responsive social care services may be achieved to enable people to live independently in the community. The NSF applies to health and social care services working with local agencies involved in supporting people to live independently, such as providers of transport, housing, employment, education, benefits and pensions.

3. At the heart of this NSF are the 11 quality requirements (QRs) set out in detail in Chapter 2. These are drawn from and mapped against the core and developmental standards in National Standards, Local Action, and are to be fully implemented by 2015.

4. Chapters 3, 4 and 5 explain how these QRs could be delivered. They cover models for clinical neuroscience networks for commissioning and service delivery, initiatives to support local delivery and guidance on taking the next steps. Further advice is available in the accompanying NSF Good Practice Guide:

Good Practice Guide (opens in new window)

Long term conditions

5. The NSF does not address individual neurological conditions separately as there are so many elements of service provision common to different conditions. However, where appropriate, the QRs have a separate section addressing the needs of people with rapidly progressing neurological conditions, such as motor neurone disease, because of the need for services to respond quickly.

6. Although this NSF focuses on people with neurological conditions, much of the guidance it offers can apply to anyone living with a long-term condition. Commissioners are therefore encouraged to use this NSF in planning service developments for people with other long-term conditions.

7. Implementing this NSF will contribute to the following Public Service Agreement targets:

• to improve health outcomes for people with long-term conditions by offering a personalised care plan for vulnerable people most at risk;
• to reduce emergency bed days by 5% by 2008 through improved care in primary care and community settings for people with long-term conditions;
• to improve access to services, ensuring that by 2008 no one waits more than 18 weeks from GP referral to hospital treatment, including all diagnostic procedures and tests.

8. The NSF fully supports the concept of choice set out in Building on the Best: Choice, responsiveness and equity in the NHS. This aims to ensure that all people have a choice of when, where and how they are treated from onset of illness until the end of life.

The quality requirements (QRs)

9. The QRs are based on currently available evidence (i), including what people with longterm neurological conditions told us about their experiences and needs.

Quality requirement 1: A person-centred service

People with long-term neurological conditions are offered integrated assessment and planning of their health and social care needs. They are to have the information they need to make informed decisions about their care and treatment and, where appropriate, to support them to manage their condition themselves.

Quality requirement 2: Early recognition, prompt diagnosis and treatment

People suspected of having a neurological condition are to have prompt access to specialist neurological expertise for an accurate diagnosis and treatment as close to home as possible.

Quality requirement 3: Emergency and acute management

People needing hospital admission for a neurosurgical or neurological emergency are to be assessed and treated in a timely manner by teams with the appropriate neurological and resuscitation skills and facilities.

Quality requirement 4: Early and specialist rehabilitation

People with long-term neurological conditions who would benefit from rehabilitation are to receive timely, ongoing, high quality rehabilitation services in hospital or other specialist settings to meet their continuing and changing needs. When ready, they are to receive the help they need to return home (ii) for ongoing community rehabilitation and support.

Quality requirement 5: Community rehabilitation and support

People with long-term neurological conditions living at home (ii) are to have ongoing access to a comprehensive range of rehabilitation, advice and support to meet their continuing and changing needs, increase their independence and autonomy and help them to live as they wish.

Quality requirement 6: Vocational rehabilitation

People with long-term neurological conditions are to have access to appropriate vocational assessment, rehabilitation and ongoing support, to enable them to find, regain or remain in work and access other occupational and educational opportunities.

Quality requirement 7: Providing equipment and accommodation

People with long-term neurological conditions are to receive timely, appropriate assistive technology/equipment and adaptations to accommodation to support them to live independently, help them with their care, maintain their health and improve their quality of life.

Quality requirement 8: Providing personal care and support

Health and social care services work together to provide care and support to enable people with long-term neurological conditions to achieve maximum choice about living independently at home (iii).

Quality requirement 9: Palliative care

People in the later stages of long-term neurological conditions are to receive a comprehensive range of palliative care services when they need them to control symptoms, offer pain relief, and meet their needs for personal, social, psychological and spiritual support, in line with the principles of palliative care.

Quality requirement 10: Supporting family and carers

Carers of people with long-term neurological conditions are to have access to appropriate support and services that recognise their needs both in their role as carer and in their own right.

Quality requirement 11: Caring for people with neurological conditions in hospital or other health and social care settings

People with long-term neurological conditions are to have their specific neurological needs met while receiving treatment or care for other reasons in any health or social care setting.

Delivering change

10. These QRs are designed to put the individual at the heart of care and to provide a service that is efficient, supportive and appropriate at every stage from diagnosis to end of life. The emphasis throughout this NSF is on supporting people to live with long-term neurological conditions, improving their quality of life and providing services to support independent living. The Department of Health (DH) is committed to ensuring policies are properly funded. As the NSF places no new requirements on local authorities and they, with their partners, are able to set their own pace of change within the 10 year implementation period according to local priorities, DH expects individual local authorities to take the NSF forward within their existing spending plans.

11. Implementing this NSF by 2015 will improve services significantly, not just for those with neurological conditions but also for many other people living with long-term conditions.

12. This NSF is supported by a webbased NSF Good Practice Guide, a NSF Information Strategy, a leaflet for the public and glossary of terms:

Good Practice Guide (opens in new window)

Information Strategy (opens in new window)

Leaflet for the public (opens in new window)

Glossary of terms (opens in new window)

Long term conditions

(i) The evidence base for the NSF as a whole is described in Annex 2.
(ii) ‘Home’ in this context means the place where the individual chooses to live, which may be their own accommodation or may be a residential or care home.
(iii) ‘Home’ in this context means the place where the individual chooses to live, which may be their own accommodation or a residential or care home.