The role of the neurological conditions implementation group, or NCIG, is clearly defined within the NCDP. However, when the NCDP was first introduced, there was little or no co-ordination across neurological services at an all-Wales level. Networks for conditions such as cancer, cardiac and renal services were well established by that stage, but this was not the case for neurological services. As a result, the task that NCIG faced was complex and difficult.

The majority of evidence that was submitted to the cross-party group's report with regard to progress in raising awareness under the NCDP related to activity rather than outcomes or impacts. Co-production activity between NCIG, third sector organisations and individuals with neurological conditions was welcomed. In particular, contributors cited the joint working between NCIG and the Wales Neurological Alliance to create a patient-reported experience measure, or PREM, as a positive step. Discrete educational activity was cited by NCIG as a positive. However, as the report states:

'Contributors questioned the extent to which the plan had enabled genuine coproduction and participation with people with neurological conditions and carers. They expressed disappointment with the lack of discernible progress in setting up a Neurological Conditions Service User Forum in every LHB. One third sector organisation told this inquiry "Neurological Service User Forums have not been established acros Wales as intended by the plan. It is not evident whether Health Boards or NCIG have drawn on feedback from service user forums".'

Although the report states that partnership working with

'Third sector involvement in NCIG was perceived as positive', it also states that 

'concerns were shared that third sector involvement generally is patchy, inconsistent and not equitable across Wales or by condition.'

The greatest success of the NCDP is that it's created a focus on the needs of people with neurological conditions in Wales. It has thrown a spotlight on the factors that have been missing in terms of strategic delivery of services for neurological conditions, for example, networks such as those that exist for cancer, cardiac and other conditions. Furthermore, it has provided an opportunity and structure for individuals and third sector organisations to share their concerns and poor experiences. As a result, it has allowed those involved in implementation to begin to take action to address unmet need and to find solutions to challenges.

The appointment of a clinical lead role for neurological conditions is welcomed. The clinical lead has begun defining the areas of required intervention and identifying clinical pathways underpinning clinical services and principles. However, the appointment was made relatively late in the implementation process and it only has one day per week of ring-fenced funding.

NCIG has worked hard to establish a baseline and is beginning to promote good practice and to marshal pragmatic improvement activity. However, it's vital that this group should continue to exist and be embedded more permanently in order to deliver a better network approach to promoting ongoing improvement and efficiency across Wales. There are so many challenges that need to be resolved. It is clear that this focus should be sustained.

Remaining challenges pertaining to the implementation of NCDP include maintaining the work of NCIG, for it would be extremely detrimental to lose the focus on service improvements and networked approach that they've introduced; funded posts for a clinical lead and a co-ordinator, emphasising the seriousness of intent for the delivery plan to effect real change; accountability for delivery—NCIG monitors the progress of the NCDP, but does not have a mandate to hold local health boards to account for critical elements of implementation like workforce development strategy; if this is indeed not the role of NCIG, it could be suggested that this accountability should be provided by another means in order to effectively incentivise service change.