I feel the guidelines do set out a fairly comprehensive recommendation for how disciplines should work together to achieve the optimum outcome for the patient. I particularly like the emphasis on timely intervention. There is perhaps not as much about third sector involvement as there should be. For instance, we are finding the MNDa to be a very valuable  resource for advice for staff and patients, training, networking, and financial, practical, and emotional support for patients.

The barriers to optimal implementation we are finding are: Firstly, a lack of understanding from commissioners about what the patients for whom they are commissioning services actually need. Secondly, lack of a clear local or regional pathway for patient journeys through multiple Trusts. Thirdly: difficulty recruiting appropriate staff (the origins of which may be governmental?) which can then result in relatively long delays for assessment and treatment despite the best efforts of staff. It also means referral out to yet another service.

The facilitators are a band of experienced, enthusiastic staff, keen to learn and provide the best service they can.