Author: Rachael Hansford

A neurology news update

New data intelligence report analyses how people with neurological conditions in Wessex use hospital services and why

A new Neurology Intelligence Report provides insight into how people with various neurological conditions can be better supported to stay well. The report is the work of NHiS in partnership with Wessex Strategic Clinical Network and CLAHRC, and The National Institute for Health Research. It was launched at an event in Southampton on the 19 April 2016 and can be accessed at www.nhis.com/wessex-neurology-report?utm_
source=announcement&utm_medium=email-and-share&utm_campaign=
Wessex-Report-Launch

News from NICE

Suspecting Neurological Conditions – Recognition and Referral

The final scope and equality impact assessment for this NICE guideline have now been published, along with all the stakeholder comments that were received during consultation and NICE’s responses to these comments. See www.nice.org.uk/guidance/indevelopment/gid-cgwave0800/documents http://bit.ly/1WmcIGU

Stroke in Adults Quality Standard update released

The Stroke in adults quality standard has just been updated and is available from
 www.nice.org.uk/guidance/qs2/chapter/Update-information

Clinical News

Neurological care in England criticised by MPs report

The BBC recently reported that the Department of Health and the NHS are to be held to account in the months and years ahead with regard to provision of neurological care, following the publication of a Public Account Committee report. According to the BBC, the report recommends that NHS England find a way of tackling the problem of variation in services and explain how it will offer everyone with a long-term condition a personalised care plan. It also urges NHS England to make better use of the 650 neurologists in England, as well as other specialist nurses, to improve access to care for patients. Read the report at www.publications.parliament.uk/pa/cm201516/cmselect/cmpubacc/502/50202.htm

Parkinson’s Disease and sleep

According a new global study, sleep is the number one factor influencing well-being in people with Parkinson’s. Other factors highlighted were exercise, pain, stress and mood. You can read more about this study at http://parkinsonslife.eu/global-parkinsons-study-reveals-sleep-as-biggest-influence-on-wellbeing/

If you are interested in how you can help patients with sleep disorders, you may wish to read about the workshop with OT and sleep specialist, Andrew Green, taking place on the 4th of May. Details are available at www.communitytherapy.org.uk

Improving outcomes for people with neurological 
conditions

The Neurological Alliance is working with the NHS England Long Term Conditions Support Unit and the Strategic Clinical Network Neurology Collaborative to deliver a coordinated programme of work to improve care and outcomes for people living with neurological conditions. www.neural.org.uk/nhs-england-community-
project-for-neurology

Improving neurological function in MS

Recent research with the disease modifying MS drug, alemtuzumab, has shown it improves pre-existing disability in people with relapsing-remitting multiple sclerosis. This is according to the commonly used scale in MS, known as the Expanded Disability Status Scale (EDSS). The results lead the authors to conclude that ‘the findings may influence treatment decisions in patients with early, active relapsing-remitting MS displaying neurological deficits’. 
See www.jns-journal.com/article/S0022-510X(16)30090-9/abstract?rss=yes

Brighton and Sussex University Hospitals reduces general anaesthetic administration by a third

Royal Sussex County Hospital has helped to reduce the administration of general anaesthetic by a third in patients aged 4-17 by expanding its MR capability with the help of new technology from Siemens Healthcare. The MAGNETOM® Aera 1.5T is part of a threefold operation to provide enhanced MR access to paediatric patients, relocate the neurology department and ensure a better experience for inpatients, due to its wide bore and comfort-enhancing features.

“The new MAGNETOM Aera is adjacent to The Royal Alexandra Children’s Hospital which provides a safer and more comfortable transition for our paediatric patients,” states John Wilkinson, Imaging Services Manager at Royal Sussex County Hospital. “Since the installation, Royal Sussex has reduced the administration of general anaesthetic to paediatric patients by a third due to increased compliance and comfort. This is due to a combination of factors including the wide bore system, which makes the process less claustrophobic and an in-bore television, kindly donated by Rockinghorse Children’s Charity so paediatric patients can have a more enjoyable and relaxing experience.”

The system will also be used to ensure better throughput for neurology patients following Royal Sussex’s appointment as a regional centre for neurology.

Ground-breaking treatment for TBI sufferers

Traumatic brain injury is the leading cause of death and disability around the world. Many years of productive life are lost and people suffer years of disability after brain injury. In addition it engenders great economic costs for individuals, families and society. Without effective treatment, many TBI victims lead lives of quiet desperation, isolation, and depression. The Lefaivre Rainbow Effect is ground-breaking treatment for TBI sufferers. Christine Lefaivre’s book and courses explore this transformative treatment, which focuses on the cognitive retraining of the brain based on pre-injury lifestyle as well as the organic damage.

“I have worked with Chris using this model, and have seen clients who initially had Glasgow Coma scores of 4-6 recover, over a period of years, to the point where they could live independently, hold employment, and have normal relationships.” Bill de Bosch Kemper, Neuropsychologist, Canada.

Traumatic Brain Injury Case Management online courses launched this April, and an examination series in conjunction with the University of British Columbia Continuing Studies will follow: http://rainboweffect.ca/

Christine’s textbook is available now in print and ebook formats: Traumatic Brain Injury Rehabilitation: The Lefaivre Rainbow Effect
Christine Lefaivre

www.crcpress.com ISBN 9781482228243, priced at £25.99.

Lumie lights to be used in Cambridge University research into Huntington’s Disease

Cambridge-based light therapy specialist Lumie is to supply some of its lamps for use in a research study into Huntington’s Disease that is to be conducted by the School of Clinical Medicine’s Neurology Unit at Cambridge University.

24 of Lumie’s most powerful light boxes, Lumie Brazil, are being donated to the research project that will examine the efficacy and tolerability of two non-pharmaceutical interventions to improve the life and sleep quality of people who have Huntington’s disease. One of these interventions is bright light therapy, the other being sleep restriction therapy.

Huntington’s disease is caused by an inherited faulty gene that damages certain nerve cells in the brain. This brain damage gets progressively worse over time and can affect movement, cognition (perception, awareness, thinking, judgement) and behaviour. Early features can include personality changes, mood swings, fidgety movements, irritability and altered behaviour.

Cambridge-based Lumie is a light therapy specialist whose products promote a healthy sleep/wake cycle by regulating the body clock as well as helping patients to feel more energetic and productive throughout the day. Lumie Brazil offers a much higher light intensity than standard lighting, emitting 10,000 lux at 35cms. To put that in context, on a bright day but not in direct sunlight the level of brightness ranges from 10,000 to 25,000 lux while in direct sunlight that goes up from 32,000 to 100,000 lux. Bright light has been shown to have an immediate impact, increasing levels of alertness, boosting mood and improving performance.

New MR applications to provide greater efficiency in neurology departments

Siemens Healthcare has launched a range of MR applications to help hospitals reduce the time needed for MR imaging within neurology. It is estimated that 20 to 25% of all MR examinations are neurological, with the number expected to grow in 2016. The applications have therefore been designed to help organisations increase patient throughput in order to maintain an efficient workflow.

One of the applications, Simultaneous Multi-Slice (SMS) EPI, employs an innovative technique to acquire imaging slices simultaneously rather than sequentially, reducing 2D acquisition times with acceleration factors up to eight. Simultaneous Multi-Slice (SMS) EPI can bring DTI and BOLD into clinical routine. This can particularly benefit surgical neurology cases through surgical mapping, potentially helping to reduce post-surgical deficits, and ultimately leading to improved efficiency in the utilisation of operating room resources.

A further application, GOBrain, enables clinically validated brain examinations in just five minutes. This can improve patient throughput, and costs per scan can potentially be reduced. Shorter scan times can also be better tolerated by patients, and can help reduce the need of sedations and rescans.

In addition to speed and quality, standardisation across systems is also an important element for hospitals. Siemens Healthcare has introduced the syngo® MR E11 software platform, a uniform application platform for the MAGNETOM® family and the Biograph mMR MR-Pet system. The focus, in addition to expanding the application offering, is achieving consistency across the entire fleet of systems and managing these effectively.

www.siemens.co.uk/healthcare

Xadago – a new treatment for PD

The first new treatment for PD in 10 years will launch in the UK in May. Xadago has had marketing authorisation in Europe since February 2015, having been approved as an add-on to L-dopa alone or in combination with other PD medications in mid-late stage PD patients with motor fluctuations.

The active substance in Xadago, safinamide, is a monoamine oxidase-B (MAO-B) inhibitor. It blocks the enzyme monoamine oxidase type B (which breaks down dopamine), thereby helping to restore dopamine levels in the brain and improving the patient’s symptoms.

Xadago, as an add-on treatment to levodopa with or without other medicines for Parkinson’s disease, has been compared with placebo in two main studies involving 1,218 patients with late stage Parkinson’s Disease who experienced fluctuations. In both studies, 6 months treatment with Xadago increased the time during the day during which patients were ‘on’ and able to move by 30-60 minutes when compared with placebo. Another study showed maintenance of this effect for 24 months. Xadago is available as tablets (50 and 100 mg).

Find out more at a series of meetings organised by Profile Pharma. See advertisement on page 16 or call 01444 412772 for more details.

Danish design offers a lift for rehabilitation patients

Patients in the UK are learning to walk again and being given new hope from a Danish invention. A new bodyweight-supported rehabilitation invention from Danish mobility company Ergolet offers earlier rehabilitation including gait-training, which improves motor function and strength after serious health problems such as an acquired brain injury.

The Ergo Trainer linear body relief system gives patients an equal body-weight support during training, removes the risk and fear of falls or strain, and props up user confidence along with their weight to let rehabilitation start earlier.

Developed in collaboration with Copenhagen University, its inventors say it offers increased mobility for people recovering from acquired brain injury caused by strokes, accidents and tumours, or learning to use prosthetic limbs.

“We can intensify physical training and show significantly faster, better recovery through an ergonomically designed device which makes the user feel safe and secure, and makes exercise fun and motivating”, said UK sales director David Lomas.

“Typically, products come with a built-in treadmill which is very limiting. Ergo Trainer is used with a variety of equipment or for various floor exercise. Clients can even kick a football around”.

It was developed in co-operation with the Centre for Rehabilitation of Brain Injury (CRBI), Copenhagen, and used in patient studies there with dramatic results. CRBI’s neurorehabilitation specialist Jørgen Jørgensen said stroke patients facing paralysis improved their walking speed by an average of 65% after a 12 week period.

Ergolet will run workshops at Neurological Rehabilitation Expo, on June 15-16 2016 with CRBI study results presented by Jørgen Jørgensen. Book free tickets at www.neurorehabexpo.co.uk

ACNR 2015;16(1): 34-35. Published online 14/6/16

Medical charity Cobalt held its inaugural annual Dementia Conference in conjunction with Siemens Healthcare, attracting over 100 healthcare professionals including radiologists, neurologists, psychiatrists, and nursing staff. “Dementia is now being recognised for what it is – a sizeable concern that places a signifi­cant drain on resources, stated Professor Iain Lyburn, Medical Director and research lead at Cobalt Health. “While there continues to be no cure, heightening awareness is essential to early diagnosis.”

The annual Dementia Conference follows Cobalt’s recent unveiling of a new Biograph mCT Flow EdgeTM PET/CT system from Siemens Healthcare, installed at Cobalt Imaging Centre in Cheltenham. Anna Cartwright, UK Molecular Imaging Product Specialist at Siemens Healthcare said, “With the evolution of our PET/CT technology paving the way for enhanced dementia diagnosis through the elimination of stop-and-go imaging, Siemens is proud to have been able to support this inaugural event.”

For more information E. laura.bennett@siemens.com, www.siemens.co.uk

ACNR 2015;15(2):29.   Online 23/06/15

Conference details: 27 November 2014, London, UK.

Over 250 delegates attended the United Kingdom Acquired Brain Injury Forum (UKABIF) 6th Annual Conference, which took place late November last year, at the London headquarters of the Royal College of General Practitioners. The morning presentations focused on commissioning rehabilitation services and were followed in the afternoon by discussions about the issues facing people with a brain injury from both service users and family perspectives.

The diverse audience included members of the interdisciplinary rehabilitation team, case managers, personal injury lawyers, social care workers, voluntary organisations, care providers and people who have had a brain injury.

Dr John Etherington, National Clinical Director for Rehabilitation and Recovery in the Community, NHS England opened the conference by saying that the National Health Service does not focus on rehabilitation, or even consider it to be an important part of healthcare services. However, rehabilitation is everyone’s business and all health professionals need to understand that it is important – but that remains a challenge. The vision is that in 10 years, rehabilitation will be a key part of every episode of care from acute all the way through to community services. However, the current commissioning structure is an obstacle to care – for example three months is not long enough for a rehabilitation programme, so why use that disease model to commission services? Dr Etherington emphasised that the right clinical and technical training is required to deliver rehabilitation services and that intensity and a significant duration of rehabilitation treatment is essential to produce outcomes for patients.

Dr Michael Dixon addressed delegates wearing several ‘hats’, including Chair of the NHS Alliance and the first President and Senior Adviser to the new organisation ‘NHS Clinical Commissioners’, which was created to represent Clinical Commissioning Groups (CCGs) bringing together the commissioning arms of the NHS Alliance, NHS Confederation and the National Association of Primary Care. He acknowledged that the rehabilitation of people with brain injuries has been haphazard. Dr Dixon acknowledged that rehabilitation commissioning needs to be sorted and in a timely fashion. However, Dr Dixon discussed some of the problems facing CCGs such as the increased cost of health services versus real income and a shrinking budget for patients. The reality, said Dr Dixon, is that ‘not everyone’s ambitions can be fulfilled’.

An excellent model for commissioning Acquired Brain Injury services was discussed by Neil Brownlee, Head of Service/Long-term Conditions Lead, Northumberland Head Injuries Service at the Northumberland, Tyne and Wear NHS Foundation Trust. This ‘one-stop shop’ is an integrated health and social care community service for people living in Northumberland who have had a traumatic brain injury. The service provides a holistic, interdisciplinary approach and clients are seen by specialist health and social care professionals. It is a timely and efficient model and has been demonstrating excellent outcomes since it was established 22 years ago. The persons’ needs are assessed and goals agreed to maximise the person’s independence and involvement in the community.   At any one time the service has between 100 and 150 service users with mild, moderate and severe traumatic brain injury.

Emma Gaudern, EMG Solicitors gave an interesting presentation on the issues and implications of the Mental Capacity Act. Emma currently acts as deputy for around 50 people and represents clients with a range of disabilities and many have significant communication problems. The Revd Dr Joanna Collicutt, Karl Jaspers Lecturer in Psychology and Spirituality, Ripon College, Oxford was thought provoking in her presentation on some of the ethical dilemmas posed by Acquired Brain Injury. Multiple impairments may be involved and they may relate to identity. What makes us who we are? How do we work out who we are? The person’s place in society may change after an Acquired Brain Injury or it can impact on memory which can be deconstructed or wiped out for large periods of time. The possibility for conflict is enormous and occurs with the past, present and future self as well as with the family, clinical team and carers.

James Piercy, science communicator and Maureen Le Marinel, past President of UNISON and current National Executive Council Member, both talked about the impact of brain injury on family members. James’s life changed dramatically in January 2011 when a serious road accident left him with a severe head injury. He was in hospital for nearly two months and whilst making a remarkable recovery, he still lives with the effects of his injury. James vividly described his recovery process in the context of him having to return to work and provide for his family. Maureen gave a moving talk about her niece, Katie who, at 12 years of age, was involved in a ‘hit and run’ accident which left her with a brain injury. Maureen outlined the need to involve the family in the rehabilitation programme and also highlighted the need for information. UNISON is currently distributing leaflets to promote the ‘Head and Brain Injury Information Signpost’, a UNISON and UKABIF joint collaboration. This web-based resource is for people with an Acquired Brain Injury, their families and all professionals involved in their care and support.

For further information, please contact: Chloë Hayward, UKABIF
T: 0845 6080788 • M: 07903 887655
E: info@ukabif.org.uk • www.ukabif.org.uk

ACNR 2014;15(1):36. Online 15/04/15

Turin, Italy 9-12 October 2014

Nearly 1000 healthcare and allied professionals (including many “big names” from both sides of the Atlantic and beyond) attended the biennial EANO meeting which was held in the Lingotto Conference Centre in Turin, Italy, part of the converted former Fiat factory. This was constructed in the early 1900s, the design being unusual in that it had five floors, with raw materials going in at the ground floor, and cars built on a line that went up through the building. Finished cars emerged at rooftop level to go onto the test track (which featured in the film “The Italian Job” and is still there). However, the other thing for which this city is particularly famous, the Turin Shroud, was not available for viewing.

The conference opened with an Educational Day consisting of parallel clinical and laboratory science sessions, both having an emphasis on CNS metastasis. We mustn’t forget that whilst GBM (glioblastoma multiforme) is still a major challenge, approximately 40% of brain neoplasms are actually secondaries from other cancers eg lung, melanoma, breast etc, and these are an increasing problem as patients live longer due to treatments for the primaries becoming more effective. Although there are no exact data, one speaker cited brain “mets” as affecting 6% of the population. There were then another 21Ž2 days with up to four sessions running concurrently, including nursing and quality of life topics, evening satellite symposia sponsored by various companies, and poster viewings.

Read more…

Published online 23/01/15

Interview by GEMMA CUMMINS | Portrait by Paul Cash

A career highlight Realising, about 15 years after being appointed a Consultant Neurologist at Addenbrooke’s and five years after being appointed Clinical Dean in the University of Cambridge, that there was no place I would rather be in my career. I was a clinician working in a world class research centre, surrounded by the stimulation of young research students and clinical students and yet still spending much of my time in direct contact with patients.

Biggest regret That I probably never will write that novel, otherwise I refer readers to Edith Piaf.

Inspiring mentor Michael Harrison (at the Middlesex hospital), probably the best Neurologist of his generation and certainly the nicest, he inspired me in many ways personally and neurologically.

Most memorable patient There have been many, memorable for different reasons. One lasting impression was left by a patient with metastatic cancer I met as a clinical student. He said “I hope you’re not going to tell me I only have months to live, because some idiot of a doctor told me that 4 years ago!” This taught me never to specify any person’s lifespan…doctors are usually wrong when they try to guess how long someone has to live.

If I hadn’t been a neurologist When I was 10 years old, admiring my father, I wanted to be a fighter pilot. At school I was mainly interested in literature and art but good at biology, so medicine seemed to be a good practical choice. At various stages as an undergraduate I wanted to be a Psychiatrist, a Paediatrician and General Physician (internist) in that order (I never saw myself as a Surgeon). I only decided to commit to being a neurologist after nearly five years working post qualification in various medical specialties including two years as a general medical registrar. Already having an intellectual interest in the brain I realised that in neurology I would be able to practice the clinical method in its ultimately satisfying form, now aided by increasingly sophisticated neuroscience and imaging. Remember I started as a medical undergraduate the year levodopa was introduced as a treatment for Parkinson’s disease and qualified in the year CT imaging of the brain was introduced into clinical practice.

I now see that if I hadn’t become a neurologist I would have been very disappointed with my life (unless I had written that novel).

Hidden talent Having so few I prefer not to hide any talent I think I have!

Advice to budding Charcots (ie trainee neurologists) Never let someone else direct your career, believe in yourself but check your ambitions against reality. Try to end up doing something you are good at rather than something you wish you were good at. Disappointment in careers arises from a mismatch in a person’s ambition and his/her ability to achieve it. Take advice from multiple sources and then see what these different sources have in common. Always consider whether someone is advising you for their own benefit or yours. There is a lot of luck involved in the evolution of someone’s career but luck favours the prepared.

3 most important qualities in a neurologist He or she must be an empathetic physician. You must combine your knowledge of the science of disease and your clinical skills at identifying it with compassion for the individual, treating the patient and not the disease. Apply the scientific method to understand the disease and with this use human compassion to manage the patient’s illness. Try to be the neurologist you would like to consult.

Next frontier in neuroscience is… If I predict this I will be wrong. However I suspect it will be in the territory furthest from our understanding now, which is the frontier between the brain and the mind (and whether this is a discoverable border after all).

Guilty pleasure Eating too well. I don’t feel guilty about drinking too well and I’ve given up smoking long ago….as to other pleasures I feel no guilt.

Favourite tipple in favourite place A glass of American IPA anywhere with one or more of my grown up children, one a Neurologist, one a Clinical Psychologist and one on his way to becoming a Psychiatrist and all three, with their partners, my closest friends and the parents of my (soon to be) five grandchildren.

Favourite quote Voltaire is reported to have said “The effective physician is one who successfully entertains the patient whilst nature effects a cure”. When I told this to a neurosurgical colleague he said “I suppose you will be saying that the effective surgeon is one who successfully entertains himself whilst nature effects the cure”.

Most embarrassing moment When, on my first ward round as a clinical student at Guy’s Hospital, I realised that the zip on my trouser fly had totally failed.

Most cherished possession (apart from family) My Bamboo handled “Queen Square” style tendon hammer, a chimeric object derived from multiple sources over thirty years. It does more than obtain reflexes, it is my totem. Generations of registrars have been trained to retrieve it from lost regions of the hospital.

Fireside read Novels by the new generation of Indian and British Indian authors such as Amulya Malladi, Vikram Chandra and Amitav Ghosh.

Painting I would like on my wall A good one that I had painted, another unrealistic ambition, failing that “Sainte-Victoire Dagï” by Cezanne or David Hockney’s “Woldgate Woods”.

Desert island playlist I would take a collection which reminded me of various stages in my growing up:

1. Harry Belafonte “The banana boat song (Day O).” My father would play this frequently whilst I was a child growing up in India, where he worked as a Tea Planter. My father was the greatest man I have ever known, my icon still.
2. Cliff Richard “Livin’ lovin’ doll.” This came out when I was nearly 11 and my older brother played it endlessly in the school holidays.
3. Charlie Parker “My old flame.” Charlie Parker was my musical obsession at 16 when I was wrestling with the choice of whether to do science A levels or English and History.
4. Beatles “Love me do.” This peaked in the British charts at the same time as my last holiday visit to my parents in India; it marked the beginning of the crazy 1960’s as far as I was concerned.
5. Rolling Stones “Get off of my cloud.” A reminder of my somewhat disorganised life as an undergraduate.
6. Credence Clearwater Revival “Down on the Corner” Would remind me of more time in the “wasted” part of my youth.
7. Cat Stevens “Morning has broken.” My long suffering wife was a Cat Stevens fan when we met and this was played at our wedding in 1973.
8. Mozart Bassoon Concerto in B flat major, K. 191/186. I played Mozart cassettes nearly continuously in the car when travelling around East Anglia in anticipation of applying for my consultant post involving clinics in Cambridge, Peterborough and Kings Lynn.

ACNR 2015;14(6);16-17.  Online 23/01/15

Glasgow Caledonian University (GCU) researchers, in partnership with the University of Newcastle and Newcastle-based SME Peacocks Medical Group, have been awarded significant funding for the design and manufacture of innovative foot orthotics using 3D-printing technologies.

The project has been granted a £77,000 Small Business Research Initiative (SBRI) Healthcare development contract. SBRI Healthcare is an NHS England initiative, championed by the newly formed Academic Health Science Networks to develop innovative products and services that address unmet health needs.

The funding was awarded following a call to address challenges in improving diagnosis, self-management and prevention of musculoskeletal disorders.

Disabling foot and ankle conditions affect approximately 200 million European citizens. Over 300 million per annum is spent treating many of these people with orthoses and splints, often relying on hand-crafted manufacturing techniques which are slow, costly and difficult to reproduce.

With an increasingly ageing population and a growing health burden in long-term conditions, the global market for custom foot orthoses continues to grow.

The GCU team, led by Dr Gordon Hendry and Professor Jim Woodburn, will work with Peacocks Medical Group and researchers from Newcastle University on the ‘FootFEMan’ project, which will utilise a computational engineering tool called finite element analysis to improve the functional design of orthotic devices for individual patients.

The improved personalised design will then be printed layer by layer using 3D-printing techniques developed previously in the team’s award-winning EU-funded project, A-FOOTPRINT.

Dr Hendry said “We are confident that we can successfully 3D print new orthotic insole devices. This project will now enable us to improve each orthotic tailored to the individual patient according to whatever foot problem they have.

“We will test the new products in controlled clinical studies here at GCU to see if we can improve foot function during walking and further lessen disabling foot symptoms.”

Professor Woodburn added: “GCU’s collaborative partnership with Peacocks will enable them to maintain and grow their market position as the leading SME developing innovative and knowledge-based orthotic products.”

For more information, E. Fiona.ramsay@gcu.ac.uk

ACNR 2015;14(6);17.  Online 23/01/15

If you, or a member of your family, had an acute and potentially serious neurological problem would you expect to have the benefit of a specialist neurological opinion on the day of your admission to hospital? The Association of British Neurologists (ABN) surveyed all UK Neurologists, who were asked to provide details of their local services, which generated data for 195 acute hospitals across the country. The result is the Acute Neurology Report, the first national survey of acute neurological services, which has just been published by the ABN and reveals that on average across the UK a neurological opinion within 24 hours is only available in just over half of acute hospitals. At worst, in District General Hospitals without a dedicated neurology service, a same-day neurological opinion is only available 30% of the time, on days when a ‘visiting Neurologist’ is present. The thirty-one Neuroscience Centres in the UK mostly meet the highest quality standards by providing daily neurology specialist review and CT and MRI available 24 hours a day. But there remain a disturbingly large number of hospitals with no neurology service at all, with the Northern region, Northern Ireland, the North West, Wales and the West of Scotland having the most sites with significant gaps in neurology services.

This mixed model of neurology service provision, a reflection of the way the NHS has developed around small local hospitals, District General Hospitals and specialist tertiary referral Neuroscience Centres, inevitably leaves gaps and means the experience of a patient with a neurological illness is determined by geographical location rather than clinical need. It is well established that neurological input leads to improved diagnosis and shorter hospital stays, and it is reasonable to conclude that patients with neurological disorders admitted to hospitals without resident neurologists will have significantly worse access to appropriate investigations and services, which is likely to impinge on the quality of their care.

The ABN has proposed a set of Quality Standards, which define appropriate acute neurology care, and can be summarised as follows:

• There should be access to daily consultation by neurology specialists within 24 hours of admission (if necessary by telemedicine) with care in an appropriate inpatient setting depending on clinical need (including the option of transfer to a neuroscience centre, neurosurgery or intensive care).
• Advice on the management of acute neurological emergencies should be available from a neurology specialist at all times
• Urgent inpatient imaging (CT and MRI), where indicated, should be available
• Lumbar Puncture should be available at all times.
• Rapid access pathways should exist for referral from Emergency Departments and Acute Medical Units to neurology outpatient services

The readers of ACNR will no doubt find these standards simple and obvious and may be baffled that they are not part of every hospital’s acute care policy. But the lack of a specific commissioning strategy for neurology has led to inequities in care. Although neurological services have expanded greatly, it is a matter of concern that the provision of inpatient neurological care has been neglected compared to other specialties such as cardiology and gastroenterology, with increased access to outpatient neurological services over recent decades being driven mostly by waiting list targets. Many of the commissioning services and NICE quality standards are disease specific and as a result patients with undiagnosed neurological conditions can be neglected by this process.

A significant step in the right direction would be the adoption by commissioners of the ABN’s Quality Standards, so that neurological services can develop to meet the increasing burden of an ageing population.

ACNR 2015;14(6);19.  Online 23/01/15