Shared learning database

Type and Title of Submission


One Stop Shop for Multiple Sclerosis relapse management


The submission presents documentation detailing results of a multiple sclerosis audit utilising the MS Society Measuring Success Audit tool to identify gaps in relapse management. It includes draft relapse care pathways and an action plan for service development to embed an integrated care pathway for relapse management between services. Also a power point presentation delivered at stakeholders day highlighting the requirement for a 'One Stop Shop'



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG8 - Multiple sclerosis

Category(s) that most closely reflects the nature of the submission:

Audit tool
Collaborative working to change service delivery to implement clinical guidance

Is the submission industry-sponsored in any way?


Description of submission


The aim of our implementation initiative was to enable the person with Multiple Sclerosis to be central in service delivery. Timely assessment and treatment would reduce inequalities experienced in current service delivery. Utilising NICE guidance implementation ensuring a rapid access, interdisciplinary rehabilitation approach to care locally would provide evidence based care and improve PWMS quality of life.


1. To improve the care of a client experiencing a neurological disturbance by provision of a rapid relapse assessment undertaken by staff experienced in care of PWMS. 2. To ensure that staff received education about relapse assessment, treatment and therapeutic interventions which were evidence based and compliant with NICE guidance. 3. To establish an integrated care pathway for relapse management between primary, secondary and voluntary services.


Historically, inequality of service provision existed for people with Multiple Sclerosis (PWMS) living in the Walsall borough compared to rehabilitation service provision for PWMS in other boroughs of Birmingham and Black Country. The Consultant Neurologist and Clinical Nurse Specialist - Multiple Sclerosis provided support for PWMS and GP's with relapse assessment. Steroid treatment if indicated was arranged at Medical Day Case Unit. Whilst therapeutic input to assist with post relapse treatment care was not provided in an interdisciplinary or timely manner. Exciting changes occurred to improve neurological service development due to proactive collaboration between users and service providers. Joint working evolved between Commissioning, Local Implementation Team, Long Term Neurological Conditions Operational Group, Disability Forum and User Groups including MS Society. It resulted in an increase of service delivery by establishment of a Community Neurological Rehabilitation Team. Integral members consisted of Consultant Physician in Rehabilitation Medicine, physiotherapists, occupational therapists, speech and language therapists, generic staff and neuro-psychologist. The NICE guidelines (2003) and NSF (2005) for Long Term Conditions, form the foundation for evidence based, high quality, cost effective care for PWMS. Whilst the visionary targets for health services in West Midlands is for collaborative work between clients, carers and service providers/purchasers to provide high quality patient centred care delivered close to home. The project encapsulated components of all targets, to become transferred to and embedded in service delivery.


Objective 1. Specific MS Clinics have been established by Consultant Neurologist and CNS-MS at Out-Patient Department in the acute hospital, and in the community by Consultant Physician in Rehabilitation Medicine and CNS-MS. These clinics have enabled clients requiring rapid relapse assessment to attend for an urgent walk in appointment within 1 - 2 weeks of reporting neurological disturbance. If true MS relapse assessed and steroid treatment indicated, intravenous Methyl-Prednisolone is prescribed as per NICE guidelines, and administered at Medical Day Case Unit. Following collaborative working with Clinical Intervention Team of Intermediate Care team, it is being organised for treatment to also be offered at home. To assist with functional recovery, timely therapeutic intervention is now provided by Community Neurological Rehabilitation Team. Post relapse assessment is then undertaken 6 - 12 weeks later in clinic to evaluate outcome. When appropriate, relevant clients are assessed for eligibility criteria for disease modifying therapy (DMT) by Consultant Neurologist. The assessment, prescribing of, monitoring of clients on DMT has been transferred to local service delivery by Consultant Neurologist and CNS - MS from Regional Centre. Objective 2. A study day on relapse management was undertaken for staff in Walsall borough organised by CNS-MS, for which 70 staff attended. Staff on CNRT, are educated about the appropriate interventions and strategies for dealing with relapse management. Objective 3. A stakeholder event has recently been held involving staff involved with relapse management and user representation to agree on draft relapse care pathways. Following this an MS relapse steering group has been established to collaboratively work on ratification process of pathway and protocols.

Results and evaluation

Utilising the MS Society Measuring Success Audit Tool (March 2009), which measures both NICE (2003) and NSF (2005) quality requirements, gaps in service provision for relapse management were identified by CNS-MS. This involved staff from acute and community services. Whilst the MS Society, in partnership with Walsall Community Health, held focus groups with PWMS, the results of which will soon be available. The action plan and objectives will be reviewed ongoing by MS relapse steering group, during the planned bimonthly meetings to assess achievement. Once the integrated care pathway for relapse management is embedded within service provision, the audit tool will be reapplied in 12 - 18 months time. It is envisaged feedback from service users and staff will be obtained by focus groups/questionnaire during the duration of the project.

Key learning points

Things that are successful - The NHS plan was established to change things so that NHS care is shaped around the convenience and concerns of patients. Proactive collaboration between users, statutory and voluntary services can influence changes of service delivery. - Any change in service delivery can appear challenging and threatening to staff in an unstable healthcare economy. It is paramount that the project is facilitated appropriately so that staff will have 'ownership' of project. Constant inclusion and feedback at all levels is required throughout the project. - User involvement is essential to enable the PWMS to be central in service delivery. It enables service providers to learn and understand from a PWMS journey through service delivery. - Improved autonomy for PWMS, knowing who to contact, service provided and options for treatment if neurological disturbance occurs. Things to avoid - Underestimating how long it takes to implement changes - at least treble initial estimation. - Working in isolation - users and service providers for several medical conditions collaborated to ensure all neurological conditions were represented in establishing service development. - Being inflexible - an overall goal in service development will often occur in phases.

View the supporting material

Contact Details

Name:Julie Bent
Job Title:Clinical Nurse Specialist - Multiple Sclerosis
Organisation:NHS Walsall Community Health
Address:Dartmouth House, Ryecroft Place
Town:Ryecroft, Walsall
County:West Midlands
Postcode:WS3 1SW


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This page was last updated: 28 September 2009

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.