Written - Independent Adult Neurosciences Expert Review

In December 2007, I established the Welsh Adult Neurosciences Expert Review, led by James Steers, a consultant neurosurgeon from Edinburgh, to advise me on high quality, safe and sustainable neuroscience service for the population of Wales, as close to home as possible.

The group met six times from January 2008 onwards. It made considerable efforts to take evidence from all interested parties and to visit all relevant establishments, either as a group or as individuals.

It’s work is now complete and the group has produced three sets of recommendations. I convey my thanks to this group for its time and the energy with which it has completed a very complex task within a limited time. I am pleased to attach a copy of the All Wales recommendations and source document.

I have previously given my response to both the North and South & Mid Wales sets of recommendations, which were published on 16 July and 18 September respectively. The All Wales recommendations, being published today, bring together both sets of previous recommendations. They highlight that Wales needs to improve access to all neuroscience services, in particular, to neurology and neurological rehabilitation.

In summary, this report makes the following recommendations:

1. The workforce delivering all aspects of care to people with acute and long term neurological conditions including neuromuscular disorders needs to be increased. 
2. Service delivery needs to be improved and made equitable across Wales, provided on a 24/7 basis and support the care of acute non surgical traumatic brain injury and patients suffering stroke.
3. Rehabilitation services for acquired brain injury, long term neurological conditions and for spinal injury need to be improved. An added benefit of ongoing rehabilitation should be reduced re-admissions and reduced demands on respite care.
4. Thrombolysis services, for stroke, should be established alongside the neurology centres and networks then formed to include other main hospital sites. Rapid access neurovascular clinics should be established in stroke centres.
5. The care pathway for head injured patients needs to minimise the time taken for initial assessment and transfer to a neurosurgical unit when necessary. Image transfer in the context of acute head injury needs to be addressed, as a priority. 
6. Neurocritical care services need to be developed in Wales and services for acute spinal emergencies and non-complex spinal surgical services need to be improved.
7. Neurological services should be provided on a networked basis and include the development of care pathways from initial diagnosis to end of life care with access to clinical neurophysiology service with waiting times for elective referrals of no more than six weeks. Networks need to work with paediatric services to ensure transition care from child to adulthood is addressed appropriately.

Of key importance, today’s All Wales report recommends that services should be developed on a network basis to ensure they are planned and provided on an equitable basis across Wales working to agreed evidence-based care pathways.

I have been impressed not only by Mr Steers and his review group’s dedication and enthusiasm, but also by the co-operation and support they have received from the NHS in Wales. I am pleased to confirm that Mr Steers has agreed to retain his Expert Group to provide advice to both myself and the implementation planning groups, which are being formed to take forward the recommendations for North Wales and for Mid and South Wales. The Expert Group will also lead on the development of evidence based care pathways.

The All Wales recommendations explicitly highlight the need to improve services for people with neuromuscular conditions. The provision of services for this group of patients has been raised with me on numerous occasions since I became Minister for Health and Social Services. Many of the issues facing this group of patients are set out clearly in a report entitled Building on the Foundations: The Need for a Specialist Neuromuscular Service across Wales, published in February 2008 by the Muscular Dystrophy Campaign. I have, therefore, decided to establish a working group under the Neuroscience Expert Group, which will have local clinical input, to develop care pathways for Long Term Neurological Conditions.

The recommendations published for North Wales in July, for Mid and South Wales earlier this month and for Wales as a whole today, are an excellent basis on which to start planning the delivery of an improved neuroscience service for the population of Wales. This latest set of recommendations will now be fed into both the North Wales and the Mid & South Wales Implementation Planning Groups. The Welsh Assembly Government will monitor progress with implementation.