Website of the Department of Health

We want this NSF to provide a blueprint for raising the standard of neurological services across the country to improve the quality of life of people with neurological and other long-term conditions. And we want to achieve this in a way that fully involves users, carers, voluntary and independent organisations, and health and social care professionals.

However, the NSF will also need to be effective within the context of an increasingly devolved NHS. So first I would like to outline some recent developments in the way health and social services are managed.

Changes in Health and Social Care Services

The Government is creating a new health and social care system:

To realise these ambitions the Department has embarked on the most extensive programme of reform in the history of the NHS. These changes will:

With all of these new organisations what will the Department of Health's role be? Over the next year it will become smaller. We will aim to set the overall direction rather than managing and monitoring services from the centre.

Additional Funding & Investment

We will also have to provide the resources to support such an extensive programme of change. The Government has pledged that NHS funding will increase by £12.7 billion over the next three years. An increase of 9.5% a year. Social services funding will increase by 6% a year on average in real terms.

The unprecedented financial commitment the Government has made to the NHS means that more money is available to extend effective services: services that people want. It will also enable us to meet NHS Plan commitments around workforce development.

We are already making good progress. We have already met the 2004 targets to recruit 20,000 additional nurses, 1,000 specialist registrars and 550 GP registrars. We are on course to meet of target of 6,500 additional Allied Health Professionals. And this year we have seen recruitment of consultants at almost double the rate of the previous ten years.

In addition we are investing £1.5m a year in the National Social Work Recruitment Campaign, to inform the public about social work and social care roles, and to encourage recruitment and retention. By 2004 our aim is to raise the number of people applying for social work training by 5,000. So far more than 40,000 people have responded to the campaign. And last year applications to study social work increased by 6.5% - the first time they have increased in more than 5 years.

All this is helping to ensure that we have the services and the workforce capable of delivering the challenging standards the NSF will set. It also means the NSF itself needs to be developed in a way that is line with this changing world.

NSF for Long Term Conditions

The NSF will consist of a set of around 12 user-focused standards representing a set of aims or outcomes that services should aspire to meet. In other words what users should be able to expect from their services. These will be underpinned by evidence to demonstrate why these standards are necessary. It will also include examples of possible service models to demonstrate how change can be achieved.

We want the NSF itself to be a short, focused and accessible document that sets out a clear direction for achieving improvements in key services. This will be backed up by an implementation guide giving advice and suggestions on how the aims of the NSF can be achieved locally.

So what will the content of the NSF be? The ERG is some way off providing me with detailed advice on the content of the NSF - though I expect to be able to say more about this at the Neurological Alliance's AGM on 4 November. However, it is clear that the NSF will need to have two equally important aspects.

In part it is about improving the quality and co-ordination of a range of health services that are essential to improving outcomes for people with neurological conditions. New treatments and approaches to the management of these conditions are being pioneered within the NHS. But nationwide the quality of provision remains uneven. This NSF will therefore help to raise awareness of best practice in the treatment of neurological and other long-term conditions. It will set benchmarks for services across the country to work towards.

Neurological conditions account for around 17% of GP consultations, and 10% of A&E attendances are neuro-related. We need to ensure that these frontline services have the necessary skills and experience to recognise these conditions and provide a gateway through which patients can access more specialist services for diagnosis, treatment and ongoing care and support. Improvements in these interactions will not only have a huge impact on the experience of people with neurological conditions but will benefit patients with other long-term conditions and disabilities. It will also reduce the burden on frontline services.

So the NSF is in part about medical outcomes. But it is quite clear that one-off medical interventions and outcomes are only part of the picture for many people. Many have a continuing involvement with health and social care services over a long period - sometimes for decades. They are entitled to services that enable them to enjoy the maximum possible quality of life and level of social inclusion. The second aspect of this NSF will therefore be to tackle some of the more general issues affecting people with long-term conditions and disabilities. Examples of the kind of thing I mean include access to rehabilitation services, and better information and support for users and carers.

We must also remember that long-term conditions can have an impact on the lives of family members and others who take on a caring role. To support the implementation of the Carers' Strategy we are increasing the funding available to support carers from £20 million in 1999 to £185 million in 2005. We are grateful to Lord Pendry, who introduced the Private Members Bill that became The Carers and Disabled Children Act (2000). The Act strengthened the rights of carers to an assessment of their own needs, and gives local councils mandatory duties to support carers by providing services directly, and providing greater flexibility in provision of short breaks through the short break voucher scheme. The Government has also ensured that carers not in paid employment are able to build up credits towards their pension. As in so many other areas, I look forward to seeing what the ERG recommends for carers.

Stakeholder Involvement in the NSF

One of the most vital aspects in the development of this NSF is effective stakeholder involvement. We know how important it is to actively encourage, listen to and represent the views of all stakeholders. So, we have consulted widely and welcomed the contribution of service users, carers and voluntary organisations. We will continue to take this approach in our work on the NSF and in other policy areas. And will continue to work with the LMCA to ensure that effective consultation and communication remains a key feature of this NSF.

I know that the External Reference Group is as keen as I am to draw upon the wealth of knowledge that exists across the voluntary sector. Indeed just this week we will be distributing a set of questions around areas the ERG has identified as key to driving service improvements. We want your views on the key practical steps needed to make these improvements happen. Copies will be available through the LMCA or from the Department's website.

What is more, through this NSF we will recommend that the involvement of services users should be a key feature in the design and delivery of services locally. I have already touched upon the long-term relationships many people with health and social care services. This, along with the expertise many build up about their own condition makes them a valuable source of expertise on the most effective way to deliver those services. Improving their interactions with health and social care can therefore bring long term benefits, not just to their own care and support, but to the way those services approach the care and support of others in the community.

I can see that the development of the NSF is benefiting from having an effective strategy around stakeholder involvement. This in turn will ultimately benefit people with long-term conditions by ensuring the NSF takes account of their needs and wishes.

The NSF will also be supported by a range of other underpinning strategies, covering communications, information, research, finance and workforce issues. But it is important not to view the NSF in isolation. It is neither possible nor desirable to tackle every issue that affects people with long-term conditions in one document. As I set out at the beginning, there are now clear divisions of responsibility within the Department and its agencies. The NSF will set guidelines that will help tackle the key structural issues affecting people with long-term conditions. It will sit alongside more detailed guidelines produced by NICE and SCIE. It will be used to inform inspections of health and social care services.

The NSF is therefore being developed with close links to other related initiatives and programmes of work to ensure that it is not seen as prescriptive, repetitive or burdensome, but rather as a workable tool designed to compliment and correlate with other initiatives. I would like to briefly point to one such initiative that I believe is particularly relevant to the theme of today's conference.

Choice, Responsiveness and Equity

One of the key issues that has emerged in work so far on the NSF has been the need to improve choice, responsiveness and equity in access to services for people with long term conditions.

A new initiative - Fair To All, Personal To You - has been launched by the Secretary of State. It aims to build on NHS Plan principles to foster a greater level of choice and inclusion. The Department has already demonstrated its commitment to developing Patient and Public Involvement with the expansion of the Expert Patient Initiative, the creation of PALS and the establishment of PPI forums. This new initiative will seek to extend the achievements of these programmes.

On 1 August Sir Nigel Crisp, Chief Executive of the NHS, launched a consultation that will help shape future policy and plans in this area. We are asking you to contribute ideas for the development of a customer focused health and social care system. To share experiences of good practice where services are already responding to the needs and wishes of users. And to begin a process of debate and discussion that focuses health and social care on the needs of all users.

A number of Working Groups have also been established to help generate innovative ideas for driving this agenda forward. These groups cover areas such as primary care and long-term conditions. Each of the groups has a majority of users or user representatives. I am pleased that David Pink has agreed to join the group that will be focusing on primary care, and that Melinda Letts and Robert Johnston will be joining the group looking at elective care. Those of you whose organisations have local groups may wish to encourage them to contribute to local consultation exercises being run across the country.

Trying Out New Ideas

Of course, we recognise that before people with long-term conditions can enjoy the benefits of greater choice, in some areas basic levels of service must improve.

So as well as drawing links to broader streams of work the NSF will also take account of existing initiatives that promote new and innovative approaches to providing better services. This is something we as a department are always looking to encourage, through support and investment.

One thing we know people with long term conditions want is access to someone with specialist knowledge about their condition. We are committed to spending nearly a million pounds a year over the next three years to develop the network of MS specialist nurses. This is in support of a national scheme to deliver modern MS drugs to people in which the Department of Health are working in partnership with commercial and voluntary organisations to modernise services.

I am pleased to announce that this year we have received successful bids to fund an additional 21 MS specialist nurses. A similar number are being funded by independent organisations.

But right across the country there are examples of health and social care professionals working with service users to try out new ideas. Ideas that make best use of available resources and help provide all sorts of services in the most effective way possible.

For example, as part of the Integrating Community Equipment Services initiative the community equipment service in Gateshead has used the Government's recent investment to provide more equipment that helps keep people independent. To provide it to more people. And to make information about it available via demonstration facilities and a website.

The Wheelchair Services Collaborative is another nationally led project that aims to deliver local improvements. The Department and the Modernisation Agency are working in partnership with those employed in the wheelchair service, manufacturers and suppliers as well as users and carers to improve wheelchair services. There are currently 44 participating sites around the country, all looking at how they can play a part in establishing and spreading good practice. Reducing delays in their service. Maximising efficiency. And introducing sustainable improvements which will ensure that every user gets the right service at the right time.

In addition we are investing £9m over the next three years in the Direct Payments Development Fund. Building on the success of the Direct Payment Scheme, this investment will enable national, regional and local voluntary organisations, working in partnership with local councils, to play a significant role in the development and promotion of direct payments.

And we have recently launched a new initiative to encourage similar innovation in neurology services.

We have allocated £1.2m to the Modernisation Agency for an 'Action On' programme to support the implementation of the NSF. It will follow a similar path to other 'Action On' programmes such as the one covering dermatology. Pilot sites in NHS trusts will be commissioned and supported to explore innovative ways of providing services, and testing and developing good practice, with an emphasis on improving access. While the focus of this 'Action On' programme will be neurological services the programme will look at the inter-relationship between health and social care needs which will have a wider application for other long-term conditions.

I am pleased to announce that applications are now being invited for pilot sites, with a closing date of 9 October.

These are national initiatives delivering front-line improvements. But the recent Social Services Inspection of Adult Disability Services has highlighted examples of innovation at local level.

Dorset County Council, in partnership with local NHS and voluntary organisations and a local housing association have acquired and adapted a property to provide supported housing for clients with acquired brain injuries. They provide individually tailored care packages including support from Community Service Volunteers, personal assistants and social services staff.

Also In Dorset, the Community Employment Service has staff based in hospitals and day centres to support disabled people in accessing work placements and employment opportunities.

Liverpool City Council have established the Acorn Centre: a well equipped and physically accessible education and training centre. It offers vocational, educational and independent living skills courses, including computer training for disabled people as well as support in taking up employment opportunities.

It will be the accumulation of these local decisions that will deliver the health and social services we all want.

Conclusion

All of this activity points to an exciting period of improvement in services for people with long-term conditions.

We want to make deep changes and this will take time: the NSF will have a ten-year implementation period. But we also want to identify early actions so that people will see some improvements at an early stage.

The Department is only one player in the implementation of the NSF.

Those of you from organisations that deliver services in collaboration with health or social care providers will have role to play in improving what is delivered to people with long-term conditions. Those of you that don't deliver such services will also have a major role. One of my main themes today has been how the development of the NSF has benefited from drawing on the expertise of the voluntary sector. We need to continue to draw upon that expertise, not only in the development of the NSF but in its locally tailored implementation.

I'm happy to take questions in the time remaining.