The full document gives specific advice to clinical staff on a huge range of issues such as the management of bladder problems, the treatment of spasticity, therapy for reduced walking ability and the identification and management of difficulties in swallowing. One strong message is that clinical staff need to be systematic in their approach to each person with MS so that all remediable problems are identified and managed effectively. This depends upon a well-trained body of staff working in a team with appropriate support from information systems.

Finally, the document emphasises the importance of prevention of ill health, which is a vital function of the NHS. Prevention is especially important in people with long-term conditions because they are often at risk of many specific secondary conditions. For example people with MS may experience infections, contractures, and falls. However, the occurrence of a pressure ulcer is perhaps the most serious and the best marker of service quality. We have suggested that the occurrence of a pressure ulcer in someone with MS should be considered an adverse event worthy of formal investigation.

If the NHS can deliver a good service to people with MS then it will also be delivering a good service not simply to other people with neurological disability but to all people with long-term conditions. This guideline should help set the NHS on course for this.

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