Published: 05/05/2005, Volume II5, No. 5954 Page 3

'There is no show without Punch' and for some clinicians and managers that is the problem with the new style national service frameworks. They believe lack of targets and milestones have severely reduced the status of these NSFs in a target-centric NHS. To put it bluntly, there is no 'P45 factor' - no-one will lose their job if a new NSF is not correctly implemented.

No surprise then that the recent launch of the NSF for long-term neurological conditions caused few ripples. Managers, still grappling with the latest policy initiative on long-term conditions in the hope of meeting their emergency admission targets, may feel it is one NSF that is safe to ignore.

But they would be foolish to do so. Not just because the 10 million people it is designed to aid make up such a large proportion of their patient population.

Not just because it might just help them meet a couple of their admission and waiting time targets. Rather, because this is the first NSF to place the proper emphasis on a patient-centred rather than a target-centred approach (see pages 20-22). Quite simply it reaches the parts that other NSFs do not.

True, other NSFs have had patientcentred elements. But in the neurological conditions NSF the voices of patients, their families and carers can be heard on virtually every page. It holds lessons for the whole of health and social care, not just those trying to improve the care of the people living with long-term conditions.

In terms of seeking genuine improvement in partnership with those it is designed to serve, it shows just how far NSFs have come.