How this NSF fits into the changing NHS

5. The NSF is a key element within a wider package of initiatives to improve services for people living with long-term conditions. In particular, the NSF should be viewed in the context of:

• The NHS Improvement Plan: Putting People at the Heart of Public Services;
• National Standards, Local Action – The Health and Social Care Standards and Planning Framework 2005/6 – 2007/8;
• Supporting People with Long Term Conditions – An NHS and Social Care Model to support local innovation and integration;
• The Prime Minister’s Strategy Unit’s project: Improving the Life Chances of Disabled People;
• The Public Health White Paper: Choosing Health;
• The forthcoming Green Paper on the future of social care for adults in England.

6. Chapter 3 of The NHS Improvement Plan: Putting People at the Heart of Public Services and Supporting People with Long Term Conditions – An NHS and Social Care Model to support local innovation and integration demonstrate the high priority that the government gives to improving care and support and quality of life for people with long-term conditions. This NSF is the next step in delivering real change in services.

7. The NSF builds on the management strategy described in Supporting People with Long Term Conditions – An NHS and Social Care Model to support local innovation and integration in exploring how person-centred care planning, information and support, self care, disease management and case management can be put into practice to transform services for people living with long-term neurological conditions. Although there is substantial common ground between the NSF and this strategy, it is important to preserve the neurological focus in implementing the NSF and make sure that it retains its own discrete identity under the umbrella of the broader long-term conditions programme.

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 everyone has a choice of when, where and how they are treated and the right to choose where they wish to die. The NSF will also help to deliver Choosing Health, the government’s White Paper on improving public health in England. Choosing Health aims to provide information, advice and support to give people the opportunity to make healthy choices and change their lifestyles to improve their physical, sexual and mental health and their well-being.

9. This NSF concentrates on adult services but also takes account of other relevant NSFs, particularly those for children and older people. As a result, it highlights the fact that transition issues (eg when someone needing ongoing care moves from children’s to adult services) need to be properly addressed to ensure continuity of care, support through life changes and that access to services is based on need, not age.

Standards, targets and assessment

10. The NSF supports the NHS in working with social services and their partners at local level to plan and deliver services for people with long-term neurological conditions in line with the national standards set out in National Standards, Local Action – The Health and Social Care Standards and Planning Framework 2005/6 – 2007/8.

11. These standards include a requirement (Standard D2 on clinical and cost effectiveness) for people to receive effective treatment and care that conforms to nationally agreed best practice, particularly as defined in NSFs. Other standards particularly relevant to this NSF include those cited under ‘Patient Focus’ (access to information, care planning and self care) and ‘Accessible and Responsive Care’. The QRs in this NSF are drawn from and mapped against these national core and developmental standards and this is indicated in a footnote on the first page of each QR.

12. National Standards, Local Action emphasises that all health and social care organisations, including NHS Foundation Trusts, should regard NSFs as part of their developmental standards. Their performance will be assessed not just against how they do on national targets but increasingly on whether they are delivering high quality standards across a range of areas, including NSFs. This NSF is for implementation over 10 years and local bodies can set their own pace of change within this period, according to local priorities. However, the Planning Framework makes clear that the NHS and local authorities will need to demonstrate that they are making progress in planning and developing the levels of service quality described in the NSF over the course of the three year planning period (2005/8). In due course, the Healthcare Commission and the Commission for Social Care Inspection (CSCI) may undertake thematic reviews of progress, jointly where appropriate.

13. Implementing this NSF will contribute to the following Public Service Agreement (PSA) targets:

• to improve health outcomes for people with long-term conditions by offering a personalised care plan for vulnerable people;
• 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 (with all diagnostic procedures and tests completed during this period).

14. The NSF is supported by a web-based 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) 

15. This NSF is based on the current body of evidence. Randomised controlled trials and other quantitative methodologies are not necessarily best suited to research questions about quality of life. Therefore, a new typology has been developed (and agreed with the Department of Health’s Research and Development Division) for this NSF to review the evidence available. It separates judgements of research quality from descriptions of research design. This research typology is set out in detail in Annex 2 and a full list of references that support the QRs is in Annex 3. Evaluating services over time will be crucial to delivery, including considering the need for a primary research programme where appropriate. This evaluation will be most effective if it is based on sharing expertise within and between agencies and on building user and carer experience into service review and development.