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House of Lords Hansard
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National Clinical Director of Adult Neurology
09 June 2016
Volume 773

Question

Asked by

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To ask Her Majesty’s Government why the National Clinical Director of Adult Neurology post was ended, and what assessment they have made of the consequences of that decision.

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My Lords, the reduction in national clinical directors resulted from NHS England’s review of its clinical advisory resource. This review sought to refocus capacity on areas where major programmes were being taken forward and in areas identified as priorities for improvement. NHS England will still be able to access neurological clinical advice in future. From 1 July 2016, clinical expertise will be provided by NHS clinical leads, the neurology clinical reference group, royal colleges and wider engagement.

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While I thank the Minister for his response, I am very disappointed. I am sure he is aware that there has been no transparency whatever, and no consultation on making this post redundant. He will be aware that the Neurological Alliance and the Public Accounts Committee have urged that this post should remain where it is. There was great rejoicing when the post was created three years ago and great disappointment that it has now been ended. Will the Minister agree to meet the Neurological Alliance so that we can have a full discussion and a full understanding of why this post was made redundant? Nobody seems to understand it, as it has all been done very quietly. I hope that this is not just a cost-cutting exercise.

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My Lords, I am of course very happy to meet the Neurological Alliance with the noble Baroness. I just say this: if the medical director and board of NHS England cannot make decisions about where they should get their clinical advice, one is bound to ask what on earth the point of them is. There are certain decisions that must be made by NHS England and Bruce Keogh, its medical director, came to this decision. I think it is a decision that he should make, not politicians.

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If three years has been long enough for NHS England to decide that the national clinical director and the regional clinical networks are not working well enough for neurology, how long is it planning to give the new system to prove that it is better for patients?

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I do not think that anyone is saying that the system was not working well enough. The argument that NHS England put was that it had to focus its resources on a smaller number of key national priorities—for example, mental health, cancer and learning disabilities—and that is what it is doing. It is poking the resource into a smaller number of well-focused and well-defined areas, but it can still get all the advice that it needs on neurology from the clinical reference groups and other sources.

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Do the Government recognise that the UK has only one-sixth of the number of neurologists that the rest of Europe has, which accounts for delays in diagnosis, poor outcomes for patients and wide variation in services? That needs to be addressed urgently for patients to have earlier diagnosis and better outcomes, and for their families to be better supported. Co-ordination of clinical and research efforts needs to be across the UK. I declare an interest at Cardiff University, where the amazing CUBRIC has just been opened by Her Majesty the Queen. It has the potential to transform neurological diagnosis in the UK, but there needs to be UK-wide effort.

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Health is of course a devolved matter in the UK, but there is absolutely nothing to stop the devolved parts of the UK—Scotland, Wales, Northern Ireland and England—from working closely together on these issues. I do not think that the lack of a national clinical director prevents us in any way from doing that.

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I want to register a sort of interest: 28 years ago, almost to the day, I was given six months to live. I had a brain tumour and was saved by a team of neurologists at the Royal Free Hospital. I hope that, in listening to this, the Minister and the department will always remember that individuals and families are at the forefront of this. If there is a belief that somebody central is needed to ensure that the best treatment is given, maybe we could look at it again.

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I do not want in any way to diminish the huge clinical importance of this and the suffering of many people with long-term neurological conditions. They are among some of the worst illnesses that anyone can have and I am delighted that my noble friend recovered from his. From everything that I have been told by NHS England and Bruce Keogh, I do not believe that the lack of a national clinical director will in any way detract from the resources that we are making available to neurology.

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My Lords, I have enormous respect for Sir Bruce Keogh but, as my noble friend Lady Gale said, NHS England has essentially set out to decimate the influence of clinical advisers at the level of senior decision-making teams. When we set up national clinical directors, they were based in the Department of Health, had direct access to Ministers and were hugely influential. The current situation in NHS England is that they are often part-time appointments with virtually no support and limited influence. Is it not time that Ministers started to reassert control over services for which they are accountable to Parliament?

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I do not think I agree with the last part of the question. We have set up NHS England as an arm’s-length body, and a key part of the reforms—the bit that probably everyone supported in the 2012 Act—was to get politicians more out of the day-to-day running of the NHS and to give more power to clinicians. It is better that clinicians rather than politicians should make these decisions. On what the noble Lord said about decimating the influence of clinical advice in NHS England, I just do not think that that is the case. In so far as he has raised it with me, I will have a meeting with Bruce Keogh and put that point to him and get his response.

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My Lords, is the Minister aware that there are many very complex neurological conditions? Surely there should be a co-ordinator and an adviser. It is really very difficult. Surely it should be upgraded, not downgraded.

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My Lords, it would be a great mistake to think this was a downgrading exercise. This is NHS England deciding to get its clinical inputs from a clinical reference group rather than having a national clinical director. It has reduced the number of clinical directors by six. We are not talking about just neurology; five others have gone in different specialties—for example, pathology. It would be a great mistake if the House went away with the impression that NHS England was in any way decimating or downgrading the importance of neurology.