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The publication of NHS operational planning guidance is a significant moment in the health service calendar as it sets out the NHS priorities for the coming year and dictates what the strategic focus should be for health services. The devolved nations also publish similar policy documents, which outline the key priorities for NHS spending and focus. These policy documents are important for all neurology services as they set out the key areas of activity for healthcare and what services will be measured against. For those working in neuroscience services, the guidance can provide direction on which areas the NHS sees as important to change or improve, which can then be addressed at a local level where nurses can get involved. Sue Thomas provides an overview of directional policy in the UK for the coming year. [ABSTRACT FROM AUTHOR]

The publication of our NHS Long Term Workforce Plan (NHS England, 2023) is perhaps one of the most seminal moments in the 75-year history of the NHS. This is the first time the government has asked the NHS to come up with a comprehensive workforce plan; a once-in-a-generation opportunity to put staffing on a sustainable footing and improve patient care. The future outlook for the nursing workforce holds both promise and challenges as the healthcare landscape continues to evolve. With ongoing shifts in demographics, technology, and healthcare delivery models, nurses play a crucial role in providing quality patient care. But does the NHS know how many nurses are currently working in neurology? Are there enough to manage the care that is required? Sue Thomas highlights the current challenges facing the neurology and nursing workforce, trends in nursing employment, the impact of technology and highlights the lack of information about our current neurology nursing numbers and suggests that strategies are needed to address neurology nursing shortages. [ABSTRACT FROM AUTHOR]

Neurology service transformation is one of the key policy drivers for 2024. Sue Thomas outlines key issues from a recent transformation meeting that nurses working in neuroscience service delivery need to be familiar with. One of the key elements of successful service delivery is the ability of nurses and nursing to adapt to the new NHS landscape by embracing service integration and working with all service partners. This new policy will evolve throughout the coming months. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic prompted one of the authors to develop a simple yet innovative solution to detecting urinary tract infections in people with multiple sclerosis, in order to improve their wellbeing and reduce hospital admissions. The initiative has been longer lasting, wider reaching and has had better outcomes than expected. The authors discuss the initiative, how and why it was developed, patient outcomes and limitations. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) can result in uro-neurological dysfunction, leading to a range of different urological problems that are distressing to the patient and costly for the NHS. Sue Thomas outlines why bladder management in MS needs greater focus to alleviate both negative patient experience and the financial burden of urinary dysfunction on the NHS. [ABSTRACT FROM AUTHOR]

At the end of November 2023, the Medicines and Healthcare products Regulatory Agency published a UK-wide National Patient Safety Alert relating to the use of sodium valproate in men and women with epilepsy. Sue Thomas outlines the rationale for this and the implications for nurses who are caring for patients who might be taking this medication. [ABSTRACT FROM AUTHOR]

Data, information and research are key to understanding health services and identifying areas for improvement. Without reliable, up-to-date data on activity, outcomes and spending, health and care services cannot be effectively monitored and held to account. Sue Thomas and George Lawton outline how data is currently used, giving examples of how one type of data, Hospital Episode Statistics, can be used. The current transformation of NHS services will require everyone to be data aware. In neurology, the launch of a new online national adult neurology data dashboard will support integrated care boards (ICBs) to monitor key neurological conditions. This is one of the ICB tools being developed for the NHS neurology transformation agenda, which will raise greater awareness of the need for ICBs to ensure neurology has a much greater profile in the future. [ABSTRACT FROM AUTHOR]

NHS England has established a Neurology Service Transformation Programme, following publication of the neurology GIRFT programme, to ensure recommendations from the GIRFT neurology review are implemented. This is now a dedicated transforming workspace available to neurology healthcare professionals, where updates on progress, guidance and tools to support whole-system transformation can be accessed. Sue Thomas outlines the initial areas that Transform Neurology is working on. [ABSTRACT FROM AUTHOR]

Sue Thomas outlines the UK rare conditions framework and the subsequent action plan that was published in February 2023. Estimates indicate nearly half of all rare diseases are neurological, and as many as 90% of all paediatric rare diseases have a major neurological (central nervous system) component to them, which makes the rare disease policy very relevant to those working in neuroscience settings. [ABSTRACT FROM AUTHOR]

Sue Thomas highlights the challenges and opportunities that face neurology in the coming year by outlining the NHS Operational Plan 2023 and the Hewitt Review. She details how neurology is finally raising its profile in policy across the UK and speculates how this could be turned into action. [ABSTRACT FROM AUTHOR]

This article outlines how the bladder can be affected in neurological conditions such as multiple sclerosis (MS) and the impact this has on patient quality of life and NHS resources. A group of MS and bladder and bowel nurse specialists has developed consensus bladder pathways in the hope that all nurses in contact with patients who are likely to have neurogenic bladder symptoms become 'bladder aware'. [ABSTRACT FROM AUTHOR]

The multiple sclerosis (MS) bladder is associated with an increased risk of neurogenic problems that are distressing for people with MS (PwMS), as well as being a leading cause of hospital admissions. Almost all PwMS will have bladder symptoms after 10 years of living with the disease, which impacts their quality of life and has a huge economic burden on the NHS for problems including urinary tract infections (UTIs). Following the publication of updated MS bladder management guidelines and the development of MS bladder pathways, Sue Thomas outlines the implementation progress that has been made within the past year. [ABSTRACT FROM AUTHOR]

Sue Thomas highlights how population health management and the wider determinants of health need to be considered in the new NHS landscape for future planning and delivery of health and social care services. [ABSTRACT FROM AUTHOR]

Following on from the publication of the multiple sclerosis 'Bladder consensus guidelines' in 2022, an expert group of healthcare professionals have since developed 'Consensus multiple sclerosis bladder management pathways', a priority of the guidelines. This article describes the methodology and process for this work and highlights that a team approach to management is required. They encourage all nurses to be 'bladder aware' in multiple sclerosis. [ABSTRACT FROM AUTHOR]

For many years, the concept of managed clinical networks has been well established throughout the NHS. However, recent reforms are set to give these networks more prominence and structure. Sue Thomas discusses the importance of these clinical networks, especially for neurology, and how they are vital to instill transformational change. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is a chronic neurological disease of the central nervous system with an autoimmune inflammatory basis that presents with clinical variability and progressive disability. The most common type of multiple sclerosis presents with a relapsing and remitting pattern. A range of disease-modifying treatments are available to treat multiple sclerosis, with more to come in the drug pipeline. This article briefly summarises multiple sclerosis alongside the range of disease-modifying treatments that are currently available. Two patient scenarios are outlined to illustrate how disease-modifying treatments may be prescribed. The article highlights that efficacy of treatment is not the only consideration for prescribing. The needs of the person with multiple sclerosis and their family must also be considered, alongside social issues, such as participation and employment, the impact the treatment has on the NHS workforce, and the capacity and financial impacts. Therefore, this article highlights the complex nature of the treatment decisions. [ABSTRACT FROM AUTHOR]

A newly updated non-oral treatment pathway for people with Parkinson's who have complex needs provides clear, instructive guidance on identifying, assessing, treating and managing individuals on these therapies. While specialists provide much of the care within these pathways, district and community nurses are essential to ensure that patients progressing to more complex phases of the condition are identified and referred for specialist assessment, as well as being instrumental in the monitoring and ongoing management required once a new therapy is in place. [ABSTRACT FROM AUTHOR]

Background: Extending specialist palliative care to people with Parkinson's disease (PD) has been a priority over the past two decades. Despite improvements in advance care planning and early integration of palliative services, little is known about the dying phase of PD. Aims: To systematically review and synthesise the literature describing the occurrence and management of symptoms in the terminal phase of PD. Methods: Searches of MEDLINE, Embase, CINAHL, PsycInfo and Web of Science from 1990 to 2020 were conducted. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were integrated to produce the final analysis. Findings: 285 articles were reviewed and 18 met the inclusion criteria. Professionals found recognition of the terminal phase challenging, and palliative care services are underused. Difficulties include titration of dopaminergic medication, leading to premature termination, or incorrect dosing, of medication. Conclusion: More research is needed to capture the terminal phase of PD, in both the hospital and community setting, in order to increase the evidence base for symptom management. [ABSTRACT FROM AUTHOR]

As 2022 draws to a close, the NHS has never been in a more fragile condition. As a result of the COVID-19 pandemic and, more recently, inflation and the cost-of-living crisis, the NHS is under some of the most significant pressures in its history. But how do these pressures impact on neurology services? Sue Thomas explores the main issues causing the NHS crisis and delves into how neurology services need to respond. [ABSTRACT FROM AUTHOR]

In 2021, the UK Reset and Reform report highlighted areas of improvement within the NHS. Sue Thomas and Gavin Giovannoni evaluate the impact of the report over the last year. [ABSTRACT FROM AUTHOR]

Originally launched in 2015, the Getting It Right First Time (GIRFT) programme has become a leading authority for quality improvement in the NHS. In September 2021, the programme published an impressive series of reviews in no fewer than 18 subject areas, neurology being one of these. While earlier GIRFT reports tended to focus on acute care, the new reports have a much wider scope and scan a whole pathway approach for unwarranted variations in practice and what needs to happen to improve patient outcomes. In Part 1, Sue Thomas explores what GIRFT says about the organisation of neurological services and recommendations for service delivery, while Part 2 will explore parallel services, commissioning and future directions. [ABSTRACT FROM AUTHOR]

Bladder and bowel problems can affect people of all ages, and can lead to feelings of anxiety, embarrassment and despair. Their management is a fundamental issue, particularly for those who have a neurogenic bladder. Discussing elimination can be a difficult subject to broach. Sue Thomas highlights the significant cost of constipation in terms of health outcomes, quality of life and the NHS. [ABSTRACT FROM AUTHOR]

The NHS is undergoing significant organisational change, moving to a structure in which neurological patients will be managed within integrated care partnerships. Those working in neurology will need to play a major part in new service design at place level. Sue Thomas highlights these new frameworks and attempts to demystify how they will operate. [ABSTRACT FROM AUTHOR]

The 2021 MS Trust conference offered many valuable insights, including into the way in which nurses and allied health professionals are currently undertaking bladder management. Using one of the symposiums as a foundation, Sue Thomas outlines how health professionals can use data to provide quality improvements in relation to bladder management in multiple sclerosis. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy is a rare neuromuscular condition that affects infants from birth, but which can also present later in life. The recent development of the drugs nusinersen, risdiplam and onasemnogene, has changed the treatment landscape and brought new hope. As a result of changes in treatment, an expert group is developing an overview pathway for care. Sue Thomas provides a brief overview of existing standards of care, the new treatments available and the policies that enable their administration. [ABSTRACT FROM AUTHOR]

Multiple sclerosis can result in uro-neurological dysfunction, leading to a range of different urological problems that are distressing to the patient and costly for the NHS. Sue Thomas outlines the more common problems and assessment and management solutions that may alleviate both negative patient experience and the financial burden of urinary dysfunction. [ABSTRACT FROM AUTHOR]

The formation of public policy relies on decisions made by the political leadership within a government. However, these decisions are usually shaped by a multitude of other factors and different stakeholders, including civil servants, professionals and citizens. Nonetheless, how is policy made and how is this translated into action? Sue Thomas highlights how a parliamentary debate in Wales is set to influence policy making in the Wales principality for the management of incontinence. [ABSTRACT FROM AUTHOR]

Launched in 2015, the Getting it Right First Time (GIRFT) programme is a change agent for quality improvement in the NHS. In September 2021 the GIRFT neurology report was published, which outlines a whole pathway approach for the management of unwarranted variation in neurology practice and the actions needed to improve patient outcomes. In part 1, published in BJNN volume 17 issue 6, Sue Thomas explored what GIRFT says about the organisation of neurology services and its recommendations for service delivery. Part 2 explores parallel services, commissioning and future directions. [ABSTRACT FROM AUTHOR]

The article discusses a range of policy surrounding headache including "Headaches in over 12s: diagnosis and management" by the National Institute for Health and Care Excellence (NICE), a NICE quality standard "Headaches in over 12s," and the British Association for the Study of Headache (BASH) guideline "National Headache management system for adults."

The author discusses the combination of factors within health and care policy practice arena that give multiple sclerosis (MS) a higher profile nationally, according to Professor Gavin Giovonnoni at the MS Trust Annual Conference, with topics mentioned such as Public Health England, The Health Improvement Network, and primary progressive MS.

The article discusses policy developments in neurology in Great Britain as of February 2021, particularly the National Institute for Health and Care Excellence Quality Standards for Suspected Neurological Conditions, and the Getting It Right First Time (GIRFT) neurology method.

Significant changes in the way neurology services operate were triggered in 2020. Sue Thomas outlines the key issues of the past 12 months and looks towards the main possible challenges for 2021. [ABSTRACT FROM AUTHOR]

The NHS is currently drawing up a 'roadmap' to recovery; likewise, neuroscience nurses need to look to the future to see how services will relaunch. Sue Thomas outlines the next stages, highlighting the NHS Reset initiative, and the issues surrounding the recovery strategy from the perspective of neurology services. [ABSTRACT FROM AUTHOR]

Patient benefit, unfortunately, often comes after financial considerations when new treatments are being assessed by wider health services. Recent developments see those diagnosed with multiple sclerosis and its subtypes pushed to the back of the queue. Sue Thomas explains [ABSTRACT FROM AUTHOR]

With the COVID-19 pandemic limiting face-to-face interaction, the drive for innovation and the need to develop alternative solutions to patient engagement, treatment and diagnosis has been suddenly accelerated. Sue Thomas and national and international colleagues outline a novel technological initiative launched in Italy to cope with the pressures of the pandemic, providing inspiration for similar future projects in the UK [ABSTRACT FROM AUTHOR]

The article discusses a policy developed by National Health Service England in relation to the life science industry and an initiative called the accelerated access collaboration to create a more flexible strategy to the prioritisation and adoption of innovative products.

The article offers news and information about a programme known as Getting It Right First Time, which aims to identify areas of unwarranted variation in clinical practice and/or divergence from the best evidence, with topics mentioned include consultant neurologist Geraint Fuller, National Neurological Census, and Association of British Neurologists Acute Neurology Survey.

The article reports on the series of regional neurology meetings undertaken by the Getting It Right First Time programme to report on its assessment of neurological services in England, with topics mentioned such as neurological care, clinical commissioning group, and the progressive neurological conditions toolkit.

The article reports on the commitment of the National Health Service (NHS) England and NHS Improvement to publishing an implementation framework after the publication of the NHS Long Term Plan, with topics mentioned such as place-based care, clinical commissioning groups, and primary care network.

The article discusses a report published by the Neurological Alliance titled "Neuro Numbers 2019," which provides data on the impact that people with neurological conditions have on the National Health Service (NHS), with topics mentioned such as Neurological Alliance Chief Executive Officer Sarah Vibert, the NHS Long Term Plan, and The King's Fund.

The article analyzes the implications of the National Health Service (NHS) Long Term Plan for neurology, that include integrated care systems, population-based healthcare, clinical measures relating to neurological conditions, and expansion of digital services including digital primary care.

The article looks at a report by the Royal College of Physicians that outlined thinking on how outpatient care should be managed in the future. Outpatient appointment (OPA) in Great Britain account for nearly 85 percent of hospital activity. OPAs in England have reached more than 118 million appointments each year. The National Audit Office detailed a 44-percent increase in OPA from 1 million in 2005-2006 to under 1.4 million in 2009-2010.

The article discusses developments in the field of neurology, with the rejection of the Public Accounts Committee (PAC) recommendation for National Health Service (NHS) England to retain the role of national clinical director (NCD) for adult neurology in England in 2016. Topics discussed include Clinical Commissioning Groups (CCGs) responsible for neurology services, proposed overall neurosciences national structure, and Public Health England (PHE)/NHS England Commissioning for Value packs.

The article reports on a 10-year plan that aims to support the full integration of health and social care services for the National Health Service in England.

The article discusses how neuroscience nurses can best leverage data such as hospital episode statistics (HES), Parkinson's UK Excellence Network and Neurology Intelligence Network data to improve their practice.

The article focuses on an increase in demand for emergency medical care for long-term neurological conditions in Great Britain from January 2017 to January 2018.

The article looks at some issues on transformation and transition in the National Health Service in Great Britain during 2017 including vanguard expansion, medicines management, and the launch of capped expenditure process.

The article discusses a revised National Institute for Health and Care Excellence Guideline "Parkinson's disease in Adults," which was published in July 2017 to replace the former 2006 Parkinson's guideline.

The article looks at a study published in the "British Journal of Neuroscience Nursing" that examines acquired brain injury and the key policies relating to multiple sclerosis.

There is increasing recognition that integrated services provide improved quality and cost-effective care (Ham, 2011; Ham and Curry, 2011; Goodwin et al, 2012). This article outlines the steps taken to create an integrated care pathway for people living with Parkinson's, a process that could be transferred to benefit those living with other neurological conditions. The impetus for this work followed increasing national interest in how services delivered by multiple service providers and professionals could be improved, and financial efficiency gained, while also optimising quality of care for those living with Parkinson's. The project sought both to create an effective integrated care pathway benefiting those living with a given condition within a specific area and then to understand how this process could be replicated for other areas and conditions. [ABSTRACT FROM AUTHOR]