Communication about delivery to stakeholders and the wider public needs to be improved. Establishing a national communication platform is critically important, cascading information to the people who are actually on the ground. Key management data in terms of readmission rates, waiting times, length of stay in hospital and so on is collected and analysed at local health board level, but all-Wales data of this kind was not provided as evidence to this inquiry. Lack of management data related to the outcome indicators of the plan and the delivery of diagnosis, treatment, services and support for people with neurological conditions is a significant problem. It's impossible to track improvements over time without a properly resourced mechanism to gather and publish this kind of data.

The removal of the requirement for individual health boards to publish annual neurological delivery plans and annual reports has resulted in it being more difficult to consistently consider progress generally or at an individual health board level. Local health board integrated medium-term plans have not been effective at driving change on NCDP priorities. They often lack neurological-specific sections and any neurological service references can be dispersed under different IMTP sections. Patients and carers have not been genuinely given the opportunity to take part in service improvement. Financial restraints have had a negative impact on neurological services, access to treatment, services and support. This has increased travel time and costs for individuals with neurological conditions, which has a very negative physical, emotional and financial impact on people, and can result in them not accessing that treatment and care that they all need.

The cross-party group on neurological conditions urges Welsh Government to accept the recommendations and commit to taking the necessary actions identified in the report. These include ending the chronic underfunding of neurological services within investment in health and social care services to meet the needs of people in Wales, and creating a new neurological condition strategy and action plan, with clearer outcomes and a stronger accountability structure.

Due to the low starting baseline, the NCIG has yet to deliver anything like the scale of change required to ensure that people with neurological conditions across the whole of Wales have safe, timely and equitable access to treatment, services and support.

While the current approach has begun to yield positive results, it will not be possible to create the step change that is needed without wider strategic commitment from across NHS Wales, from Welsh Government and from local authorities at a senior level. Improving services and support for people with neurological conditions must be sustained if we're to make real change to people's lives. It's also evident that people with neurological conditions and carers must be partners in this process. While the focus on increasing support for rehabilitation in the community is welcomed, the poor experiences that are reported show that sustained focus and continued investment is necessary. This is urgently required given the damaging impact of shielding or self-isolating due to the coronavirus pandemic on many people living with a neurological condition.

The Wales Neurological Alliance survey on the impact of the coronavirus pandemic revealed that it has significantly impacted on people living with neurological conditions, and has had major ramifications on the provision of health and social care services for them. Although people with neurological conditions have needed to continue to access specialist services during the outbreak and beyond to maintain their well-being, isolation and shielding has increased anxiety and impacted on the mental health of people living with neurological conditions, triggering or exacerbating their symptoms or condition. Rehabilitation and mental health services have not adapted to meet the meet the needs of people living with neurological conditions. Services and treatment have been delayed or stopped during the pandemic. The NHS in Wales must apply strong leadership and set out its priorities for restarting services for people living with neurological conditions as soon as it is clinically safe to do so.

Our report is based entirely upon the extensive written and oral evidence we received from a wide range of stakeholders, including individuals living with neurological conditions and carers, charities representing people affected by neurological conditions, specialist clinicians, the royal colleges, the Wales Neurological Alliance and the neurological conditions implementation group. We commend our report to the Welsh Government and we look forward to their response. Thank you. Diolch.