Service improvement and innovation
Information for MS professionals improving access to services.
Exercise and activity
This toolkit was developed as part of the Access to Exercise Pathway project. It's ideal for a broad range of people. It's particularly relevant for commissioners of health, wellbeing and leisure services and anyone delivering these services.
It explains how the Neuro Therapy Centre developed this project in West Cheshire with many different partners. The toolkit outlines how other services can adopt this approach - including training for exercise professionals, managing referrals and working with leisure services.
You can find local personal trainers with neuro expertise through the Wright Foundation. They also offer training for healthcare professionals.
Browse the Wright Foundation's website
You can also find certified activity and health practitioners with the Chartered Institute for the Management of Sport and Physical Activity (CIMSPA).
People living with MS can also find information on exercise and MS on our website.
This is a presentation by Nadia Abdo, MS Specialist Practitioner at Brighton General Hospital.
Nadia looks at exercise through the prism of medication. Nadia treats exercise like a DMT – she looks at how it works, potential barriers to uptake and side effects. The talk uses the most recent evidence and gives easy and accessible information to help you support your patients to get active.
The Access to Exercise Pathway project demonstrated the benefits of exercise for people living with neurological conditions. The project was led by the Neuro Therapy Centre in Saltney, West Cheshire. And this was in partnership with Brio Leisure, the Walton Centre, and Sheffield Hallam University.
Sheffield Hallam University carried out the evaluation of the project. You can read the full evaluation report and watch the Evaluation Conference on the Neuropathy website.
Benefits of the project included significant increases in:
- exercise self-efficacy
- perceived importance of exercise
- life satisfaction at the 12 month re-interview stage
- activity levels each time the participants were assessed.
The Level 4 Exercise for Long Term Neurological Conditions course is part of the project. This was developed to help reassure healthcare staff that leisure services have suitably trained staff. And that the services meet the NICE guidelines, and their patients would be safe.
Explore the Exercise for Long Term Neurological Conditions course on the Wright Foundation’s website
Clinical pathways
This pathway was developed by the National Neurological Advisory Group (NNAG) and a working group of MS healthcare professionals. It sets out care and support for patients with MS. It aims to support them from their first appointment with their GP through every step of their journey. And also includes support for positive end of life care.
The pathway recommends the help of a knowledgeable MS administrative coordinator to support patients with:
- relapses
- disease progression
- symptom management
- palliative care
- end of life care
The coordinator should work together with an MS nurse who can help to manage each patient’s care plan.
Keeping care as local as possible is one of the main aims of this pathway. Patients should have access to a specialist MS team and clinic with different HCPs working together throughout their journey. DMTs can be delivered by a network of virtually-linked specialists. These will operate through local services with access to an infusion centre. And IT systems to support safety monitoring.
Neurological conditions can leave people with physical, sensory and cognitive impairments. And they’re a leading cause of complex disability. Rehabilitation aims to minimise the loss of function and help to maintain and restore it. Successful rehabilitation means people can continue to live independently for longer.
Rehabilitation has been identified as a priority in the NHS Long Term Plan. There are long delays for patients waiting for transfer to specialist rehabilitation centres. This prevents the efficient use of neurology, neurosurgery and trauma beds.
The majority of community rehabilitation services are uncoordinated and inconsistent. There’s not enough data to help improve services. And there aren’t enough staff to meet patients’ needs.
This pathway sets out what good treatment, care and support looks like. It sets out goals for good care and supports the improvement of services. And enables commissioning of quality services, locally and nationally.
This includes treatment and support for people who may be experiencing the first symptoms of a neurological condition. And it includes people at all stages of living with a neurological condition, including those who have lived with it for a long time.
This mental health pathway was developed by the National Neurological Advisory Group (NNAG) and people living with a neurological condition. It is part of a suite of optimal neuroscience clinical pathways that have been developed by the neurological community.
The pathways set out what good treatment, care and support looks like. This includes treatment and support for people who may be experiencing the first symptoms of a neurological condition, right through to people who have lived with a
condition for a long time.
We know neurological bladder and bowel dysfunction has a wide-ranging negative impact on the quality of life for people living with MS. Bladder dysfunction affects 1 in 10 at the point of diagnosis and up to 90% within 10 years of being diagnosed. 68% of MS patients will report bowel dysfunction including constipation and faecal incontinence. There are now well established pathways for the optimum care and treatment of bladder and bowel dysfunction for people with MS.
In January 2022, the British Journal of Neuroscience Nursing published an updated consensus document on the management of bladder dysfunction in people with MS. The consensus document was produced by a multidisciplinary panel of clinicians and patients. Alongside this the panel produced a Bladder Pathway that can be followed to deliver the best possible care for people living with MS.
Read the Expert Opinion Consensus Document (PDF, 992 KB)
Use the interactive Bladder Pathway guide (PDF, 1.19 MB)
We recently organised a webinar to bring together a range of expert speakers to share the work that they have been involved with in developing and implementing the MS Continence Care Pathway.
Watch the Bladder and Bowel Pathway webinar on YouTube
Continence Care Pathway Update 2024
In November 2024 we revisited the topic to follow up on progress towards adoption of the pathway and other developments in continence care for people with long-term neurological conditions.
Sue Thomas presents an overview of the continence pathways work across the UK as well as adoption of the pathways. She highlights how using the pathway can support improved patient outcomes and quality of life as well as contributing to NHS operational planning priorities.
This report identifies some current approaches to coordinating care for people with progressive MS and not on a DMT, and compares these with the optimum clinical pathway for MS. Commissioned by the MS Society and undertaken by ICF, the case studies highlight elements of best practice, including MDTs and support for self-management, but also some gaps around formal care coordination and use of care plans.
The report looks at ways to improve care coordination for those not on a DMT - who are more likely to be disengaged from services, have a reduced frequency of follow up appointments, and need more joined up care provision between acute and community services.
The Rapid Access to Neurology Assessment (RANA) service, developed by clinicians at The Walton Centre, provides patients with direct access to expert neurologists when they visit Emergency Departments with neurological signs and symptoms.
The new assessment pathway was created by Dr Anita Krishnan, the Trust’s Clinical Director for Neurology. She said:
“Under RANA, patients who fit the criteria will now be referred immediately to The Walton Centre and receive the most appropriate care, from the most appropriate person, at the most appropriate time, without getting stuck in the wider healthcare system unnecessarily.”
We recently ran a webinar that will give you an insight into how the RANA service was developed, how it operates in practice and the patient outcomes from the service.
We know that people with progressive MS are more likely to experience unplanned hospital admission and longer hospital stays. And risk deteriorating significantly during these stays. Caring for the person with progressive MS in hospital can be challenging due to the complex physical and sometimes cognitive disabilities they may present with.
Two experienced clinical nurse specialists in MS, Emma Matthews and Miranda Olding, have developed a pathway that prompts staff on general wards in the best care, using simple, achievable actions. To help prevent deterioration, reduce length of stay and promote speedier and safer discharge home.
Emma and Miranda shared their work on the pathway in an Experts in MS webinar. They also answered a number of questions from the professionals in attendance. You can watch the webinar and find out more by clicking the link below.
The pathway will now be piloted across two NHS Hospital Trusts. A more comprehensive implementation package, designed to support Health Care Professionals in introducing the Pathway, will be produced following the pilot in 2024. You can view and download the care pathway by clicking the link below.
Continence resources
Professor Jalesh Panicker shares his experience of continence management in MS patients and the ongoing unmet urological needs of people living with MS.
Rebecca Parry is the MS Bladder and Bowel Clinical Specialist Nurse at Cardiff and Vale University Health Board. She shares an overview of the delivery of the specialist bladder and bowel service for people living with MS including how the service operates and the patient outcomes for the service.
Ann Yates, Director of Continence Services at CVUHB, gives an overview of the development of an exciting new e-learning package for bowel care.
Our range of expert speakers respond to questions from the attendees of the continence care webinar.
NeuroResponse is a service that allows people with MS in North and Central London to get quick and easy 24/7 access to clinicians at NHS 111 to aid early detection of urinary tract infections. This helps reduce the need for GP appointments and unnecessary hospital attendances.
Many people living with MS experience urinary tract infections, but getting appropriate advice and treatment can be a challenge. In this webinar we share how an MS community came together to co-design NeuroResponse, which provides timely assessment and treatment.
We discuss the principles of co-design, the barriers and enablers of innovation in the NHS, and explore experiences to see how 'people power' can transform care delivery. And you’ll find out how to access this innovative service.
Mental health and cognition
The Neurological Alliance 2025 survey based on responses from over 10000 people found that:
- 62% couldn’t access neuropsychology services
- 48% were unable to access counselling services
This webinar presents the current commissioning guidance and the business case for developing this area of work. It goes on to present some good practice examples that can meet the need that the above survey results identify.
Current commissioning guidance, business case and commission routes
Mark Griffiths (Lead Clinical Health Psychologist at Liverpool Heart and Chest) will introduce some professional guidance around the commissioning and clinical governance of neuropsychological rehabilitation services. Mark also shares a number of case studies that implement some of this guidance and deliver improved services and cost savings.
Talking therapies and neuro psychology services
Amanda Mobley (Consultant Clinical Neuropsychologist and Head of Neuropsychology in Leicester). This presentation will give an overview of a quality improvement initiative developing joint working between specialist services in neuropsychology and primary care talking therapies.
Watch the talking therapies presentation
Functional neurological disorders and group work
Perry Moore (Lead Clinical Psychologist – Walton centre). Information will be given on the rationale for setting up the service and some of the results from the group work provision.
Watch the functional neurological disorders service recording
Neuro Therapy Centre (NTC)
Glesni Roberts Counselling Service lead in the Voluntary Sector will talk about the range of support the Centre offers to both people living with neurological conditions, and their carers/loved ones.
Find out about the Neuro Therapy Centre support
Question and answer session
The webinar concluded with some time for questions for the panel of speakers and an opportunity to think about how participants can take this information back to the workplace.
Watch mental health and neuro psychology services Q and A session
Approximately 40 to 60% of people with MS have cognitive difficulties which can have a negative impact on their personal, professional and social lives. Despite the prevalence of cognitive problems, we know that MS clinics do not routinely screen for these. And where such problems are identified, cognitive rehabilitation is not systemically offered to all those who are likely to benefit from such interventions.
We recently delivered a webinar focused on the application of psychological and neuropsychological science to better understand and treat psychological issues related to neurological conditions. It provides an overview of:
- what kind of cognitive screening can be done within your clinic
- the evidence of the effectiveness of cognitive rehabilitation
- how you and your team can offer some support towards cognitive rehabilitation.
It also explored how cognitive screening and rehabilitation can be delivered remotely by mobile phones or online platforms (such as Microsoft Teams).
We are grateful to Professor Roshan das Nair of University of Nottingham (UK) and SINTEF (Norway), and Lauren Taylor, PhD Student Clinical Psychology for leading the webinar and sharing their research findings.
Watch the cognitive screening and rehabilitation webinar on YouTube
Neurorehabilitation
On Thursday 25th September we held a Neurorehabilitation Forum in Chester. We had 35 delegates in attendance across a range of teams and professions including managers, consultants, nurses, physiotherapists, occupational therapists and 3rd sector organisations.
The forum was an opportunity to share good practice from across the region, network with colleagues, discuss opportunities and the priorities to improve services for people living with a long term neurological condition.
We held our Glasgow Neurorehabilitation Forum on World MS Day, Friday 30 May 2025. We had 42 delegates in attendance across a range of teams and professions including managers, consultants, nurses, physiotherapists, occupational therapists and 3rd sector organisations.
Part of the day included roundtable discussions focused on the priorities to improve services for people living with a long term neurological condition.
During 2025 we held a series of regional, in-person and virtual engagement events on neurorehabilitation for health decision makers, service managers and policy makers. Following the series we have collated the key themes from these events into a joint summary.
On Monday 3rd March 2025, we hosted a webinar as part of our series on neurorehabilitation about some recent research exploring access to community neurorehabilitation.
Shona Pride and Owen Williams presented the results of their award winning research, focusing on the challenges people with progressive neurological conditions in Northern Ireland face when accessing community neuro-rehabilitation. They also described what good access looks like from the perspective of people living with a progressive neurological condition and discussed priorities for local service improvements.
On Wednesday 13 November we hosted a webinar about the Somerset Neurorehabilitation review.
Julie Jones is Programme Manager for Stroke and Neurorehabilitation for Somerset NHS Foundation Trust. She gave an overview of how the review of neuro-rehabilitation services across Somerset has been conducted. She told us how the review team involved staff, patients and third sector partners in the review.
Julie talked through how the case for change document that persuaded the Integrated Care Service (ICS) of the need for further work was developed and told us about the next steps.
Information about the review can be found on the Somerset ICS website
We collaborated with the Greater Manchester Neurorehabilitation and Stroke Integrated Delivery Network on long term conditions and treating culturally diverse patients. On Wednesday 13 December 2023, we held a webinar that included presentations from Dr Carol Sampson, (Neuropsychologist), Suki Wong, (Neuro Physiotherapist) and Joanna Rutkowska-Wheeldon (Neuro Occupational Therapist).
They shared their practice and patient case studies of applying cultural awareness to improve outcomes. These case studies highlighted the importance and value of cultural and value-based goal setting. It also explored how understanding these values can help shape neurorehabilitation services and improve patient care.
Watch the cultural awareness within neurorehabilitation webinar on YouTube
