UK neurological care: time to confront the crisis

The Lancet

The Lancet Neurology, Volume 10, Issue 8, Page 671, August 2011
doi:10.1016/S1474-4422(11)70159-4
There are serious shortfalls in the local provision of adult neurological services in the UK, according to the results of a June 2011 report by the Royal College of Physicians and The Association of British Neurologists. In a country where neurological disorders account for at least 10% of acute admissions and 1 in 50 people is disabled by a neurological condition, this is an unacceptable situation.
Neurological care in the UK is focused on regional neuroscience centres, which provide excellent tertiary services with strong clinical and research collaborations. However, at the local level, and particularly in district general hospitals (DGHs), resources are inadequate to provide appropriate care. By contrast with the USA and the rest of Europe, several major areas of neurology, including dementia, are usually not covered by neurologists, and, of particular concern, neurologists are rarely involved in the acute care of patients with common neurological disorders such as stroke and head injury. In some regions, as few as 8% of patients presenting with acute neurological conditions are seen by a neurologist. For some specialties, such as epilepsy, this might lead to diagnostic errors by non-neurologists. Furthermore, the neurological services that are provided outside regional centres are often focused on diagnosis, with little provision for the long-term support of patients with chronic conditions.
At the heart of this problem is a dearth of neurologists. The UK has among the lowest number of neurologists for its population size in Europe, with just one neurologist per 115 000 population in 2006—less than a third of the European average. In a 1996 report, the Royal College of Physicians recommended that neurologists should be appointed to every DGH. Although there have been some improvements, this goal is still far from being realised. Moreover, there are striking discrepancies in numbers of neurologists across the UK: for example, in Wales there are only a third as many neurologists for the population size as in London, and only 86 of the 285 consultant appointments in the past decade were made directly to DGHs.

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