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Q. What is a National Service Framework (NSF)?

NSFs are blueprints for care, aimed at driving up quality and reducing variations in health and social care services.

Q. What is the focus of this NSF?

The NSF will set standards to suggest how we improve neurological services across the board so that we can deliver a first class service for everyone with a neurological condition over the next 10 years. It will also allow us to look at some of the generic issues that are relevant to people with a long term condition or illness in using health and social care services.

Q. What conditions does the NSF cover?

The NSF focuses on improving the standard of neurological services. Examples of the types of condition that are covered include epilepsy, multiple sclerosis, Parkinson's disease, motor neurone disease, brain and spinal injury and other similar conditions.  The NSF also covers some of the generic issues relevant to a wide range of people with other long-term conditions and disabilities.

Q. What generic issues does the NSF cover?

The NSF draws out some of the common issues in the experience of patients with long-term conditions in using health and social care services such as patient and carer involvement, information, rehabilitation, and care and support in the home.

Q. How will you ensure that people with other long-term conditions are not excluded from the improvements in services?

This NSF draws out some generic issues that are likely to benefit people with a wide range of long term conditions.  However, NSFs are not the only mechanism for improving services for a particular group.  Other strategies include the NICE work programme, 'Action on' programmes, and modernisation and service re-design programmes where the NHS Modernisation Agency has an important role to play.

Q. How will standards deliver effective improvements for specific conditions?

Then very nature of Long term Conditions means that there are distinct ways in which health and social care services should interact with people who have such conditions.  They need clear communication and information.  They need to have their expertise in their own condition recognised.  They need to be able to access services over an extended period.  Improvements in areas such as these will benefit many different conditions.

Q. How will the NSF address problems that fall within the remit of other Government Departments?

Links have been made with other government departments to ensure that the needs of people with long-term neurological conditions across related areas of housing, transport, benefits and leisure are considered although the NSF cannot make prescriptive recommendations in these areas.

Q. What is the role of the ERG?

The role of the ERG has been to suggest ways of achieving high quality services for people with neurological conditions in hospital, community and social care settings as well as improvements in a range of general disability services over a 10-year period.  The ERG was also tasked with providing advice on an implementation guide based on good practice to help local health and social care communities achieve these standards, linked wherever possible to NICE guidelines and appraisals.  The ERG completed its work in May 2004.  More information on the ERG, their terms of reference and notes of their meetings are available on the department's website.

Q. Who was appointed to the ERG?

An External Reference Group (ERG) was appointed and began work in late 2002.  It is chaired by Diana Whitworth, formerly of Carers' UK, with Lynne Turner-Stokes, Professor of Rehabilitation Medicine at King's College Hospital in London as her Deputy.  The rest of the membership was drawn from health and social care professionals, service users and carers and representatives from the voluntary sector.  The ERG also established various working groups to help develop possible standards for inclusion in the NSF.

Q. How was membership of the ERG selected?

Membership of the ERG was drawn from the nominations we received following an open invitation in September 2002 and includes health and social care professionals, service users and carers, voluntary organisations and other advocates to ensure we are able to engage the full range of views.

Q. What is voluntary organisation representation like on the ERG?

There are a number of voluntary organisations represented on the ERG and its working groups representing both users and carers.  In particular we have worked closely with the Neurological Alliance (NA) and the Long-term Medical Conditions Alliance (LMCA) on the development of this NSF.

Q. How widely did you consult in developing this NSF?

We have involved voluntary and professional organisations, patients, carers and experts throughout the development of this NSF. A wide range of organisations were represented at the workshops in November 2001 and March 2004 and we also received a large number of submissions from a wide range of stakeholders about what they wanted to see included in the NSF and suggesting examples of good practice from existing service provision. Voluntary organisations, service users and carers have also played a key role in the work of the ERG and its sub-groups.  In addition we  arranged a secondment to the Long Term Medical Conditions Alliance to secure service user and carer involvement in developing the NSF, and provided funding for the Neurological Alliance to run a series of focus groups.

Q. Is there a comprehensive research and development strategy to support the NSF?

The Research and Evidence Group have commissioned work already to look at user and carer experiences to inform the development of the standards.  We have also been looking at epidemiology and service mapping.  In addition we have £2m set aside from 2004-05 to fund research to support the implementation of the NSF.  The Modernisation Agency has also set aside £1.2 million for an 'Action On' programme on neurology.  This will run for about 18 months starting from the end of 2003.

Q. When will the NSF for LTCs be published, and implemented?

We expect to publish this NSF early in 2005 for implementation over a 10-year period from April 2005.

Q. Why do we have to wait until 2005 for improvements to start?

Improvements in services will continue even without the NSF, which is about setting standards and direction over a 10 year period.  Other policies and work programmes will provide a lot of the support for the NSF. The NICE work programme, Integrating Community Equipment Services initiative, the wheelchair collaborative and work to improve epilepsy services have all already begun to deliver improvements in services.

Q. Will we have to wait until 2015 to see improvements?

There is a 10 year implementation period for this NSF, because we want to set challenging standards which will it will take time to achieve.  Of course some services will be closer to the ideal already.  Others will have to work hard to bring themselves up to the standard the NSF will set.  However, we recognise that people want to see improvements in services as quickly as possible, so we will be looking to set a range of shorter and longer-term goals for services to work towards.

Q. Will there be any targets or milestones against which to measure progress on implementing the NSF?

The NSF will need to be effective within the context of an increasingly devolved NHS.  The NSF will provide a blueprint for the Commission for Health Audit and Inspection and the Commission for Social Care Inspection to use as a benchmark for measuring progress but it will be for local health and social care organisations to decide what needs to be done locally to improve services, according to local priorities.  Service users will also have a role in assessing progress through Patient and Public Involvement Forums.

Q. How do you expect the NHS to implement so many NSFs at the same time?

We are looking at ways to ensure that publication and implementation of NSFs is phased so that health and social services can actually deliver the changes on the ground. For example, there is a team with overall responsibility for co-ordinating and planning all NSFs. Another group is looking at managing the impact of NSFs on primary care.

Additionally a long term conditions care group workforce team will develop the workforce strategy to underpin the NSFs for Long Term Conditions, diabetes and renal services. It will cover all aspects of workforce planning and development including medical and nursing, allied health professions and social care professions.

Q. Will extra funding be made available to support the NSF implementation?

The government has announced extra funding for the NHS - an annual average increase above inflation of 7.5% over the five years 2003/04 to 2007/08 - and Social Services - an average of 6% increase in each of the three years 2003/04 to 2005/06. This funding will help ensure that the NSF is implemented. We need to make sure that resources are used effectively.

Q. Will there be increases in the NHS and Social Care Workforce to help deliver this NSF?

A Long Term Conditions Care Group Workforce Team (CGWT) has been established to consider what skills and competencies will be needed to deliver patient centred services that meet the standards set by the NSF and how these can best be developed within the NHS Workforce.

The CGWTs work closely with the health and social care policy leads within the Department of Health and Workforce Development Confederations to encourage innovations in various human resources fields such as recruitment and retention, pay, education and training, new roles or skill-mix.