Spinal cord injury services are national assets and need to remain so

By R.F. Hunt with the Spinal Injuries Association

When I sustained my spinal cord injury (SCI) when I was just 18, I was taken to the nearest hospital. I was lucky because at this hospital I had a surgeon who was a specialist in spinal surgery.

But when I was able to be discharged from their care, follow-up care was under the Spinal Cord Injury Centre (SCIC) where I have been seen at least once a year since then.

That’s because with such complex injuries, it was better to be followed-up by a unit that had specialists that could treat me holistically, not just looking at my spinal injury but how I was doing in other areas of my life post-injury.

These centres are such assets, providing a key role in the care and monitoring of all those with a SCI, as most of the of the key specialists required to care for such complex injuries are all under one roof.

Importantly, they are national assets.

• National commissioning has been effective in reducing geographicalvariation and postcode lotteries.
• National service specifications have improved consistency of standards, care, treatment.
• National leadership has provided a clear line of oversight and accountability.

But under plans from the Government in the Health Bill rather than these services being under national coordination, they instead will be placed under local Integrated Care Boards (ICBs)

The Spinal injuries Association (SIA) say: “We…believe it is imperative that services should remain nationally commissioned where their clinical complexity, patient population, workforce, infrastructure, or need for national coordination makes this necessary.

“Where specialised services are commissioned by ICBs), patients should have equally strong protections: nationally mandated standards and service specifications, effective national oversight of their implementation, transparent assessment of the impact of commissioning changes, and clear accountability for performance.”

It shouldn’t be the case that I was lucky because I lived near a SCIC.

Everyone, no matter where they live should have access to the care I received. Such specialised services, and the units that house them, need to remain.

If there was to be major organisational change, then the danger is it could create fragmented services, weaken clinical expertise and make it harder to identify those services who are providing care that falls below the established national standards.

Worrying the SIA have said: “Experience to date has demonstrated significant limitations in securing clear and effective accountability from ICBs, particularly where responsibility is dispersed across local and regional structures.”

What has been clear is that as these ICBs take on greater responsibility for specialised services, clear national oversight and routes of accountability should be there from the outset.

The SIA are asking the Government to use the Health Bill to establish a durable national framework for specialised services, with protective measures such as enforceable national standards, including service specifications for services commissioned by ICBs.

They also want transparent reporting on the performance of such specialised services, and how they are doing in terms of access and outcomes.

SIA argue that: “These protections would not prevent appropriate local integration or innovation.

“They would strengthen those by providing the national framework within which it can happen safely, while ensuring that where a patient resides does not determine the standard of specialised care they receive.”

Already it can be very difficult for those who reside in rural areas to get access to the type of care I got, and the ease with which I received it.

Removing national oversight for such specialised care can only make that situation worse and risk the fragmentation of care more widely.