Written evidence from the Division of Neuropsychology, part of the British Psychological Society






About the Division of Neuropsychology


  1. Neuropsychologists are experts in psychology as applied to neurological conditions providing expertise on how physical changes in the brain can impact on a person’s cognition, behaviour and emotions. The Division of Neuropsychology represents both clinical neuropsychologists and those working in research settings. In clinical settings neuropsychologists work with those affected by neurological or brain related conditions to support their psychological needs which can span effective diagnosis, treatment and rehabilitation.  In research settings neuropsychologists are the link between the fields of neuroscience and psychology. [Clinical Neuropsychology Services: Delivering value for the NHS – A briefing for NHS commissioners and policy makers, British Psychological Society, March 2015]


Why we are submitting evidence to this review


  1. We are submitting evidence to the committee, as we are concerned that NHS services for those affected by neurological conditions do not always provide adequate support for emotional, cognitive and mental health needs.  As these needs are often related to physical changes in the brain, they cannot be met by general mental health services.  The costs of these co-morbidities going untreated can be high. [The Kings Fund & The Centre for Mental Health:  Long-term conditions and mental health: The cost of co-morbidities. February 2012]


  1. The Committee recommended all people with neurological conditions have access to the right services. Whilst psychological and mental health needs of this patient group have not been specifically considered in the PAC and NAO reviews to date, as the NHS moves to implement parity of esteem between physical and mental health we believe that this area of services requires the committee’s attention.



High Quality and Cost Effective Services for neurological conditions


  1. Providing for the emotional, cognitive and mental health needs of those affected by neurological conditions and brain injuries is an integral part of effective inpatient neurological rehabilitation. Neuropsychology and neuropsychiatry services provided on an inpatient basis can support better patient outcomes, improve the effectiveness of the multi-disciplinary team and reduce the length of hospital stays. In Nottingham an integrated approach to rehabilitation has been successfully trialed which has reduced hospital stays for children with acquired brain injury by an average of 22 days. A London trust found that a neuropsychology post within the multi disciplinary rehabilitation team providing for the emotional and cognitive needs of adult stroke patients freed up 36 bed days per month.  [Evidence submitted to the Division of Neuropsychology by clinical neuropsychologists.]


  1. In the community, those affected by brain related conditions may continue to need access to specialist services as they may have distinct needs which cannot be met by general mental health provision.  Lack of effective referral pathways can lead to repeat visits to GPs, patients presenting across a range of services and higher social care costs. Ensuring the emotional, cognitive and mental health needs of patients are met is a prime example of where there needs to be joint health and social care commissioning of neurological services as the cost benefits of effective psychological support can support better self-management of neurological conditions and deliver savings in the care required.


  1. When commissioned as part of an integrated multidisciplinary team or service, neuropsychological services benefit patients and offer economic value for the NHS. Without neuropsychological assessment and intervention, important information that can support the ongoing management of a condition may be missed and care planning affected. This raises the costs of treatment, reduces its effectiveness and may also cause significant stress to those affected.


Recommendations to the Committee


We recommend that the definition neurological services includes provision for emotional, cognitive and mental health needs of this patient group. We further recommend that in assessing progress against the PACs recommendations, that this is taken into account.  Committee members may wish to ask those giving evidence what steps are being taken to ensure that neurological services deliver on the NHS’s parity of esteem agenda.


12 October 2015