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Summary
LondonDifference
from LondonDetails
Admissions
Neurology admissions per 100,000 population 1,794 1,904 -110 p.1
Emergency admissions per 100,000 population 1,384 1,258 126 p.1
Proportion of emergency admissions 68% 64% 4% p.2
Condition with highest emerg. admission rate per 100,000 pop.
Epilepsy 48 50 -3 p.3
Bed days
Emergency bed days per 100,000 population 1572 1572 0 p.4
Condition with highest number of emergency bed days
Epilepsy 192 164 28 p.4
Cost
Spend per neurology inpatient (£) 1,069 1,033 36 p.6
Spend per emergency inpatient (£) 858 1,067 -210 p.6
Condition with highest spend per inpatient (£)
CNS infections 3,170 3,696 -526 p.6
Outpatients
Outpatient appointments attended 59% 72% -13% p.7
Spend per 1,000 outpatients (£) 9,392 6,741 2,651 p.5
NHS Tower Hamlets
CCG
A high proportion of neurology admissions are on an emergency basis,
and a particularly high proportion of admissions for patients with
epilepsy, migraine headache and Parkinson’s disease are on an
emergency basis. There has been little improvement in decreasing the
proportion of emergency admissions over the past 4 years. This may
indicate that better management of neurology admissions is needed.
Comments
While mean length of stay for neurology patients has previously been
low, it has recently risen in the past 2 years to exceed the London
average. There are more emergency bed days than expected for
patients with migraine headache.
Tower Hamlets CCG’s neurology budget is similar to the London
average. A higher proportion of the budget (78%) is spent on secondary
care than the London average and therefore spend per neurology
patient is higher than average. However, spend on epilepsy and
migraine headache patients is higher than average. Less money is spent
on neurology patients compared to other budget categories such as
circulation, respiratory problems or musculoskeletal problems.
Only 59% of neurology outpatients attended appointments in 2012-13,
which is the lowest rate in London. The non-attendance rate of 11% is
higher than the London average and is also higher than for other
specialisms. While the 90% referral to treatment target of 18 weeks is
being met in neurology, the percentage of neurology outpatients seen
within 18 weeks is one of the lowest in London at 93%. Neurosurgery
specialisms did not meet the target, at 87%.
How many patients with neurological conditions are being admitted to hospital?
Primary diagnosis Primary diagnosis
Number of admissions 1,794 Number of emergency admissions 847
Number of admissions per 100,000 people 629 Number of emergency admissions per 100,000 people 297
London value 721 London value 316
Mention* Mention*
Number of admissions 4,695 Number of emergency admissions 2,872
Number of admissions per 100,000 people 1,645 Number of emergency admissions per 100,000 people 1,006
London value 2,025 London value 1,230
Payment by Results Programme Budget Category** Payment by Results Programme Budget Category**
Number of admissions 5,120 Number of admissions 3,463
Number of admissions per 100,000 people 1,794 Number of admissions per 100,000 people 1,384
London value 1,904 London value 1,258
*A mention is defined in this instance as patients admitted to hospital had a neurological condition, though this was not necessarily their primary diagnosis or reason for being admitted to hospital. For an overview of common comorbidities in London see Appendix 1.
1
All neurology admissions Emergency neurology admissions
** PbR category admissions are based on treatment or intervention as well as primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group (HRG) coding system. Therefore, admission numbers differ compared to admission numbers based on Hospital Episode Statistics (HES) data, which is based on
diagnosis.
0
200
400
600
800
1,000
1,200
100
200
300
400
500
0
500
1,000
1,500
2,000
2,500
3,000
0
500
1,000
1,500
2,000
0
500
1,000
1,500
2,000
2,500
3,000
0
500
1,000
1,500
2,000
How have neurology admission trends been changing?
Per 100,000 population
2012-13
All admissions 1,794
Emergency admissions 1,384
Elective admissions 557
Emergency proportion
CCG 68%
London 64%
Elective proportion
CCG 31%
London 35%
How have admission trends for specific neurological conditions been changing?
NHS Tower Hamlets CCG London
08/09 09/10 10/11 11/12 12/13
Epilepsy 94 94 101 105 90
CNS infections 13 10 13 13 18
Migraine headache 13 28 29 28 39
Parkinson's disease 7 9 9 8 8
Multiple sclerosis 9 46 42 62 80
Neuropathies 53 89 72 68 82
2
1,778
1,223
537
2011-12
1,743
2009-10
2,099
2010-11
1,410
29%
665
67%
65%
32%
33%
Number of admissions per 100,000 population in NHS Tower Hamlets
CCG
35%32%
Note that admissions for multiple sclerosis have increased throughout London due to an increase in
disease-modifying therapy.
69%
66%
30%
1,223
510
70%
64%
0
20
40
60
80
100
120
08/09 09/10 10/11 11/12 12/13
0
500
1,000
1,500
2,000
2,500
2009-10 2010-11 2011-12 2012-13
All admissions Emergency admissions Elective admissions
0%
10%
20%
30%
40%
50%
60%
70%
80%
2009-10 2010-11 2011-12 2012-13
CCG Emergency CCG Elective
London emergency London elective
Note that the admissions data on Page 1 is based on Hospital Episode Statistics (HES), while the data on the left is based on the Payment by Results (PbR) neurology budget category. The PbR category admissions are based on treatment or intervention as well as primar y diagnosis, and therefore the numbers differ compared to HES data.
Proportion of elective and emergency neurology
0
20
40
60
80
100
120
08/09 09/10 10/11 11/12 12/13
Epilepsy
CNS infections
Migraine headache
Parkinson's disease
Multiple sclerosis
Neuropathies
Number of neurology admissions per 100,000
Are there any neurological conditions with higher emergency admission rates?
The following neurological conditions have been focused on as they have the highest admission rates in London (2012-13)
London
emergency
admissions
rate
London lowest
value
London
highest value
Epilepsy 50 24 76
CNS infections 8 4 14
Migraine headache 23 11 33
Nervous system tumours 13 7 23
Parkinson's disease 5 2 10
Multiple sclerosis 5 0 8
Neuropathies 5 0 9
Are your neurology patients being managed in the right way?
Number of
admissions
London
proportion
London lowest
value
London
highest value
Epilepsy 147 15% 7% 30%
CNS infections 28 17% 6% 36%
Migraine headache 100 23% 6% 48%
Nervous system tumours 40 5% 0% 16%
Parkinson's disease 24 26% 10% 45%
Multiple sclerosis 236 17% 10% 35%
Neuropathies 231 6% 2% 12%
3
18%
8%
Admissions
per 100,000
people
57
11
39
14
9
84
88
Proportion of patients admitted with a primary neurology diagnosis that are managed by a consultant neurologist (2012-13)This is the specialty under which the consultant responsible for the care of the patient is registered. The data below is for all admitted patients, both elective and non-elective.
Proportion of
admissions managed
by a neurology
consultant
20%
29%
21%
5%
5
5
5%
5%
17%
Range for proportion of consultant managed admissions
Number of patients
managed by a
neurology consultant
29
8
21
2
4
43
18
Range for emergency admission rate per 100,000 peopleEmergency admissions
per 100,000 people
48
8
27
9
7
Proportion of
admissions that are
emergencies
83%
69%
70%
61%
76%
Use of bed days following emergency admissions (2012-13)
London
value
London lowest
value
London
highest value
Neurology 1572 601 3732
Epilepsy 164 80 241
CNS infections 87 32 212
Migraine headache 27 11 58
Parkinson's disease 73 10 158
Multiple sclerosis 51 6 130
Neuropathies 46 5 86
How well are patients with epilepsy being managed?
ValueLondon
value
London lowest
value
London
highest value
Prevalence of epilepsy1 457 563 457 713
Percentage of patients drug treatment and seizure free 52% 61% 52% 71%
Proportion of patients with a seizure frequency record 96% 95% 94% 97%
Under 75 mortality from epilepsy (2009-11)1 0.81 1.20 0.18 2.53
Admission rate for primary diagnosis of epilepsy1 57 60 31 89
Emergency admission rate for primary diagnosis of epilepsy1 48 50 24 76
Emergency admission rate for children with epilepsy (2011/12)2 27.20 49.98 15.29 80.19
1 per 100,000 population2 per 100,000 population aged 0-17
Mean length of stay (days) for patients with long term neurological conditions Emergency 28 day readmissions for neurological conditions (2012-13)
35
2009-
10
2010-
11
2011-
12
2012-
135%
CCG value 8 8.4 8.7 11.1 12%
London value 11.2 10.2 10 10.2 11%
4
Number of
emergency
bed days
4488
547
255
166
161
36
111
Proportion of bed
days that are
emergencies
60%
83%
86%
97%
* As a percentage of all emergency admissions
Note: the above data for readmissions for neurological conditions is based on Secondary Uses Service (SUS) data which is not published and therefore there
may be data quality issues.
Readmissions for all conditions in England
Range for emergency bed days per 100,000 people
Number of emergency readmissions in NHS Tower Hamlets CCG
Readmissions for neurological conditions in NHS Tower Hamlets CCG*
Readmissions for all conditions in London
Range
98%
88%
81%
Emergency bed days
per 100,000 people
1572
192
89
58
56
13
39
6
7
8
9
10
11
12
2009-10 2010-11 2011-12 2012-13
NHS Tower Hamlets CCG
London
How is money being spent on neurology admissions in your area?
Payment by Results (PbR) Neurology Programme Budget (2012-13)
Proportion of
total
London spend
per 1,000
people (£)
London lowest
value (£)
London
highest value
(£)
Prevention 0% 8 0 118
Primary care 0% 10 0 185
Primary prescribing 12% 10,575 7,404 14,968
Inpatient (Elective and Day Case) 18% 10,937 6,715 16,046
Inpatient (Non-elective) 43% 24,589 8,323 51,446
Outpatient 13% 6,741 564 12,864
Other secondary care 4% 5,746 778 15,364
Ambulance 3% 1,935 1,492 3,033
A&E 2% 878 511 2,372
Community care 1% 10,395 0 59,415
Other setting 0% 870 0 10,716
Non health/social care 4% 3,267 523 8,896
Total secondary care 78% 48,013 33,556 70,111
Total - 75,951 54,487 124,936
CCG spend on the Neurology Programme Budget Category per 1,000 people Proportion of neurology budget spent in different care settings
0%
0%
14%
14%
32%
9%
8%
3%
1%
14%
1%
4%
63%
5
2,498,000
3,594,000
8,860,000
2,557,000
858,000
341,654
186,000
Spend per
1,000 people
(£)
0
0
9,175
13,201
0
0
585,000
683
121
3,225
58,288
74,896
32,543
33,000
878,000
15,869,000
20,390,654
1,255
Care setting Range for spend per 1,000 people
9,392
3,151
2,149
Total spend (£)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Primaryprescribing
Inpatient(Elective and
Day Case)
Inpatient (Non-elective)
Outpatient Othersecondary care
Ambulance A&E Communitycare
Other setting Nonhealth/social
care
NHS Tower Hamlets CCG London average
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000NHS Tower Hamlets CCG
London average
How much is being spent on neurology patients?
Trend in spend per patient
Admission typeLondon lowest
value
London
highest value
All admissions 925 1,189 2009-10
Emergency admissions 388 3,375 NHS Tower Hamlets CCG1086
Elective admissions 721 1,063 London neurology average1098
Epilepsy 1,138 1,750 London all conditions1409
CNS infections 2,101 6,612 2010-11 2011-12 2012-13
Migraine headache 625 891 1133 1160 1069
Parkinson's disease 1,562 3,298 1092 1058 1033
Multiple sclerosis 625 2,039 1456 1435 1419
Neuropathies 867 1,261
How much money is spent on neurological conditions compared to other budget categories? (2012-13)
Programme Budget Category
Neurology 74,896 2,432
Circulation 135,928 6,475
Cancers 121,570 5,030
Musculoskeletal problems 80,359 4,804
Genito-urinary problems 147,011 3,147
Gastro-intestinal problems 102,709 2,839
Respiratory problems 101,961 3,350
Trauma and injuries 103,025 5,851
6
830
London
value
1,033
1,067
2,730
669
Range for spend per patientSpend per
patient
1,069
3,668,958
164,830
1,047985
62,790
153,267
1,391
3,696
713
Total spend
5,471,258
93,142
1,485,984
389,433
858
935
1,515
2,721
3,599
6,155
4,473
2,071
12,454,000
17,619,000
12,247,000
2,14021,877,911
40,024,269
27,962,866
10,280,000
11,326,000
17,475,000
14,983,000
12,117,000
2,435
5,12020,390,654
37,007,003
33,098,000
Total spend on
inpatient care
Number of
inpatient
admissions
2,668
230,469
910
3,170
839
Total spend
(all care
settings)
Spend per 1,000 people Spend per inpatient
27,759,276
28,048,914
800
900
1,000
1,100
1,200
1,300
1,400
1,500
2009-10 2010-11 2011-12 2012-13
NHS Tower Hamlets CCG London neurology
London all conditions
How well are neurology outpatients being managed?
What percentage of neurology outpatient appointments are attended? (2012-13) Percentage of outpatient appointments not attended
London
highest valueCCG London England
Attended 84% 11% 10% 7%
Not attended 15% 9% 7%
Cancelled by patient 13%
Cancelled by hospital 20% Neurology
All specialisms
What proportion of neurology outpatients are treated within 18 weeks? (2013/14)
Percentage of neurology outpatients treated within 18 wks Percentage of neurosurgery outpatients treated within 18 wks
Total number of outpatients
London average
CCG average for all specialties
What is the median waiting time for neurology outpatients? (2013/14)
Median waiting time (weeks) for neurology outpatients Median waiting time (weeks) for neurosurgery outpatients
Median waiting time for outpatients (weeks)
CCG average for all specialties
7
RangeLondon lowest
value
59%
6%
*No data available for NHS Tower Hamlets CCG as number of outpatients is less than 50
London average
84%
29
93%
98%
Neurosurgery
123
87%
82%
Neurology
20% 3%
1%
2.8 9.0
8.2
Outpatients not treated within 18 wks 2 16
% of outpatients treated within 18 wks
Neurology
0.0
Neurosurgery
8.2
Value
59%
11%
10%
London
value
72%
10%
8%
10%
*CCG level data for outpatients not attended for all specialisms is not available
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
NHS Tower Hamlets CCG
London average
Target
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
NHS Tower Hamlets CCG
London average
Target
0
1
2
3
4
5
6
7
NHS Tower Hamlets CCG London average0
2
4
6
8
10
12
14
16
18
NHS Tower Hamlets CCG London average
0% 2% 4% 6% 8% 10% 12%
Neurology
All specialisms
NHS Tower Hamlets CCG London England
Appendix 1: What are the main comorbidities for neurological conditions?
Comorbidities are very common in patients with neurological conditions. The following is an overview of the main comorbidities where neurological conditions were the secondary diagnosis (data represents
number of patients with the comorbidity condition). Due to small numbers, it would not be reliable to present this data at CCG level and so it is presented for the entire London region.
The data gives an indication of conditions which people with neurological conditions are commonly admitted to hospital with and therefore where care pathways could be improved. For instance, following an
audit at UCLH by Neurological Commissioning Support which identified that patients with multiple sclerosis were commonly admitted to hospital with UTIs, a working group led by Bernadette Porter (UCL) is
investigating the UTI pathway so that unnecessary admittances to hospital can be decreased through better management of patients with multiple sclerosis.
Appendix 2: London Neurology Profiles Metadata
Indicator Definition Value type Unit Data source Indicator Source Definition of numerator Source of numeratorDefinition of
denominatorSource of denominator Methodology Caveats
Primary diagnosis of a
neurological condition:
proportion of admissions that
are emergencies
The proportion of
admissions to hospital with
a primary neurology
diagnosis that were on an
emergency basis
Proportion %
Health & Social
Care Information
Centre (HSCIC).
Inpatient Hospital
Episode Statistics
(HES)
Count of emergency
admissions for neurological
conditions; primary
diagnosis; CCG responsible
population
Hospital Episode Statistics
taken from Compendium of
Neurology data published
20th March 2014
http://www.hscic.gov.uk/cat
alogue/PUB13776
Count of admissions
for neurological
conditions; primary
diagnosis; 18+ years;
CCG responsible
population
Hospital Episode
Statistics taken from
Compendium of
Neurology data
published 20th March
2014
http://www.hscic.gov.uk
/catalogue/PUB13776
Emergency admission
data divided by admission
data
HES inpatient data and ONS population statistics are generally considered to be complete and
robust. However, there may be a question regarding the quality of external cause coding. Some of
these cases may represent admissions for observation due to observed symptoms following an
external cause event. There may be differences in admission thresholds. There may be variation
between Trusts in the way hospital admissions are coded. There may be variation in data recording
completeness.
Secondary diagnosis of a
neurological condition:
proportion of admissions that
are emergencies
The proportion of
admissions to hospital with
a secondary neurology
diagnosis (i.e. patient was
admitted to hospital with a
different primary diagnosis)
that were on an emergency
basis
Proportion %
Health & Social
Care Information
Centre (HSCIC).
Inpatient Hospital
Episode Statistics
(HES)
Count of emergency
admissions for neurological
conditions; secondary
diagnosis; CCG responsible
population
Hospital Episode Statistics
taken from Compendium of
Neurology data published
20th March 2014
http://www.hscic.gov.uk/cat
alogue/PUB13776
Count of admissions
for neurological
conditions; secondary
diagnosis; 18+ years;
CCG responsible
population
Hospital Episode
Statistics taken from
Compendium of
Neurology data
published 20th March
2014
http://www.hscic.gov.uk
/catalogue/PUB13776
Emergency admission
data divided by admission
data
HES inpatient data and ONS population statistics are generally considered to be complete and
robust. However, there may be a question regarding the quality of external cause coding. Some of
these cases may represent admissions for observation due to observed symptoms following an
external cause event. There may be differences in admission thresholds. There may be variation
between Trusts in the way hospital admissions are coded. There may be variation in data recording
completeness.
Neurological condition
emergency admission rates
(epilepsy, CNS infections,
migraine headache, nervous
system tumours, Parkinson's
disease, multiple sclerosis,
neuropathies)
The number of emergency
admissions to hospital with
a primary diagnosis of a
specific neurological
condition, expressed as a
crude rate per 100,000 (CCG
responsible population)
Crude rate per 100,000
Health & Social
Care Information
Centre (HSCIC).
Inpatient Hospital
Episode Statistics
(HES)
Count of emergency
admissions for specific
neurological conditions;
primary diagnosis; CCG
responsible population
Hospital Episode Statistics
taken from Compendium of
Neurology data published
20th March 2014
http://www.hscic.gov.uk/cat
alogue/PUB13776
All age CCG registered
population
Quality Outcomes
Framework HSCIC,
http://www.hscic.gov.uk
/catalogue/PUB12262
Emergency admission
data divided by CCG
registered population,
result multiplied by
100,000 for rate
HES inpatient data and ONS population statistics are generally considered to be complete and
robust. However, there may be a question regarding the quality of external cause coding. Some of
these cases may represent admissions for observation due to observed symptoms following an
external cause event. There may be differences in admission thresholds. There may be variation
between Trusts in the way hospital admissions are coded. There may be variation in data recording
completeness.
Trend in admissions for
neurological conditions
(epilepsy, CNS infections,
migraine headache, Parkinson's
disease, multiple sclerosis,
neuropathies), 2008/09 -
2012/13
The number of admissions
to hospital due to specific
neurological conditions,
expressed as a crude rate
per 100,000 (CCG
responsible population)
Crude rate per 100,000 NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Count of admissions for
specific neurological
conditions covered under
the Neurology Programme
Budget Category; PCT
responsible population;
2008/09 - 2012/13
Secondary Uses Service
Payment by Results (SUS PbR)
taken from NHS Comparators
All age PCT registered
population based on
GP practice registered
population
NHS Comparators
Admission data divided
by PCT registered
population, result
multiplied by 100,000 for
rate
Secondary Uses Service Payment by Results (SUS PbR) data is based on the Neurology programme
budget category. PbR category admissions are based on treatment or intervention as well as
primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group
(HRG) coding system. Therefore, admission numbers differ compared to HES data.
Data is presented for PCTs rather than CCGs, as most CCGs have retained similar boundaries to PCT
predecessors. However, Sutton and Merton PCT divided into Sutton CCG and Merton CCG, and
therefore data for these two CCGs is based on GP practice lists published in April 2011.
Trend in proportion of
neurology admissions that are
emergencies, 2009/10 -
2012/13
The number of admissions
and emergency admissions
to hospital due to a
neurological condition,
expressed as a crude rate
per 100,000 (CCG
responsible population)
Crude rate per 100,000 NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Count of admissions and
emergency for neurological
conditions covered under
the Neurology Programme
Budget Category; CCG
responsible population;
2008/09 - 2012/13
Secondary Uses Service
Payment by Results (SUS PbR)
taken from NHS Comparators
All age PCT registered
population based on
GP practice registered
population
NHS Comparators
Admission data divided
by PCT registered
population, result
multiplied by 100,000 for
rate
Secondary Uses Service Payment by Results (SUS PbR) data is based on the Neurology programme
budget category. PbR category admissions are based on treatment or intervention as well as
primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group
(HRG) coding system. Therefore, admission numbers differ compared to HES data.
Data is presented for PCTs rather than CCGs, as most CCGs have retained similar boundaries to PCT
predecessors. However, Sutton and Merton PCT divided into Sutton CCG and Merton CCG, and
therefore data for these two CCGs is based on GP practice lists published in April 2011.
Proportion of patients admitted
with a primary neurology
diagnosis that are managed by
a consultant neurologist
In patient admissions where
the specialist code was
recorded as consultant
neurologist. The main
specialty code for
Neurology is 400.
Percentage rates were
calculated with respect to
the total episode counts
pertaining to neurological
conditions.
Proportion %
Health & Social
Care Information
Centre (HSCIC).
Inpatient Hospital
Episode Statistics
(HES)
Percentage of Finished
Admission Episodes with
primary diagnosis for
specified neurological
conditions managed by
consultant neurologist by
CCG of residence and
diagnosis for 2012-13.
Specialist code was
recorded as consultant
neurologist (400).
Hospital Episode Statistics
taken from Compendium of
Neurology data published
20th March 2014
http://www.hscic.gov.uk/cat
alogue/PUB13776
Number of finished
admitted episodes for
a primary diagnosis of
specified neurological
condition by CCG of
residence and
diagnosis for 2012-13.
Hospital Episode
Statistics taken from
Compendium of
Neurology data
published 20th March
2014
http://www.hscic.gov.uk
/catalogue/PUB13776
Indicator derived from
HSCIC supplementary
information files
'Neurology data for
Intelligence Network'
HES inpatient data and ONS population statistics are generally considered to be complete and
robust. However, there may be a question regarding the quality of external cause coding. Some of
these cases may represent admissions for observation due to observed symptoms following an
external cause event. There may be differences in admission thresholds. There may be variation
between Trusts in the way hospital admissions are coded. There may be variation in data recording
completeness.
Emergency readmittances
within 28 days
Percentage of primary
diagnosis neurology
emergency readmissions
within 28 days of all primary
diagnosis neurology
emergency admissions
Proportion %Secondary Uses
Service (SUS)
Secondary Uses
Service (SUS)
Count of primary diagnosis
neurology emergency
admissions that occurred
within 28 days of the
patient having a previous
primary neurology
admission; CCG responsible
population.
Secondary Uses Service (SUS)
Count of primary
diagnosis neurology
emergency admissions;
CCG responsible
population.
Secondary Uses Service
(SUS)
Emergency readmissions
divided by all emergency
admissions
The Secondary Uses Service (SUS) data used is unpublished data and has not been aggregated or
cleaned as Hospital Episodes Statistics (HES) data is. Data may not therefore be entirely accurate or
complete.
Use of emergency bed days
following admissions for a
neurological condition (all
neurological conditions,
epilepsy, CNS infection,
migraine headache, Parkinson's
disease, multiple sclerosis,
neuropathies)
The sum of individual
hospital lengths of stay
following an emergency
admission where the
primary diagnosis was for
neurological conditions per
100,000 population
Crude rate per 100,000 NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Sum of individual hospital
length of stay following an
emergency admission
where the primary
diagnosis was for a
neurological condition
covered under the
Neurology Programme
Budget Category; PCT
responsible population.
Secondary Uses Service
Payment by Results (SUS PbR)
All age CCG registered
population
Quality Outcomes
Framework HSCIC,
http://www.hscic.gov.uk
/catalogue/PUB12262
Emergency bed days
divided by CCG registered
population, result
multiplied by 100,000 for
rate
Secondary Uses Service Payment by Results (SUS PbR) data is based on the Neurology programme
budget category. PbR category admissions are based on treatment or intervention as well as
primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group
(HRG) coding system. Therefore, admission numbers differ compared to HES data.
Data is presented for PCTs rather than CCGs, as most CCGs have retained similar boundaries to PCT
predecessors. However, Sutton and Merton PCT divided into Sutton CCG and Merton CCG, and
therefore data for these two CCGs is based on GP practice lists published in April 2011.
Mean length of stay for
patients with long term
neurological conditions,
2009/10 - 2012/13.
The length of all completed
hospital spells for
neurological averaged over
the number of spells for
neurological conditions,
indirectly standardised by
age and sex
Indirectly
standardised rateDays NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Sum of PbR length of stay
for spells with a primary
diagnosis for a long term
neurological condition
(note: where length of stay
is in excess of 90 days then
this is trimmed to 90 days);
PCT responsible population;
2009/10 - 2012/13.
Secondary Uses Service
Payment by Results (SUS PbR)
Count of completed
inpatient spells with a
primary diagnosis of a
long term neurological
condition; PCT
responsible
population; 2009/10 -
2012/13.
Secondary Uses Service
Payment by Results (SUS
PbR)
Length of completed
spells divided by the
number of spells. Result
indirectly standardised by
calculating the ratio of
observed mean length of
stay and the expected
length of stay based on
national average, given
the mix of age and sex of
patients in the PCT.
Secondary Uses Service Payment by Results (SUS PbR) data is based on the Neurology programme
budget category. PbR category admissions are based on treatment or intervention as well as
primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group
(HRG) coding system. Therefore, admission numbers differ compared to HES data.
Data is presented for PCTs rather than CCGs, as most CCGs have retained similar boundaries to PCT
predecessors. However, Sutton and Merton PCT divided into Sutton CCG and Merton CCG, and
therefore data for these two CCGs is based on GP practice lists published in April 2011.
Prevalence of epilepsy
The number of people aged
18 years and over receiving
drug treatment for epilepsy
recorded on practice
register as a proportion of
all people (18+) registered
in the CCG.
Crude rate per 100,000
Health & Social
Care Information
Centre (HSCIC).
NHS Quality and
Outcomes
Framework (QOF)
The number of people aged
18 years and over receiving
drug treatment for epilepsy
recorded on practice
register.
Prevalence table for number
of patients with epilepsy at
CCG level, Quality and
Outcomes Framework, HSCIC
18+ years CCG
registered population
Prevalence table for
number of patients with
epilepsy at CCG level,
Quality and Outcomes
Framework, HSCIC
Number on register for
2012-13 divided by 18+
population registered in
CCG
QOF statistics are generally considered to be complete and robust. However, there may be a
question regarding the quality of external cause coding.
Percentage of patients with
epilepsy on drug treatment and
seizure free
Proportion of individuals
aged 18 years and over
receiving drug treatment for
epilepsy recorded on
practice register who have
been seizure free in the last
12-months
Crude rate %
Health & Social
Care Information
Centre (HSCIC).
NHS Quality and
Outcomes
Framework (QOF)
The number of people aged
18 years and over receiving
drug treatment for epilepsy
recorded on practice
register seizure free in the
last 12-months
Quality Outcomes Framework
HSCIC,
http://www.hscic.gov.uk/cat
alogue/PUB12262
The number of people
aged 18 years and over
receiving drug
treatment for epilepsy
recorded on practice
register including
exceptions.
Quality Outcomes
Framework HSCIC,
http://www.hscic.gov.uk
/catalogue/PUB12262
Divide the number
seizure free by the total
number on the CCG
register.
QOF statistics are generally considered to be complete and robust. However, there may be a
question regarding the quality of external cause coding.
Proportion of patients with a
seizure frequency record
Proportion of individuals
aged 18 years and over
receiving drug treatment for
epilepsy who have a record
of seizure frequency in the
previous 15 months
Proportion %
Health & Social
Care Information
Centre (HSCIC).
NHS Quality and
Outcomes
Framework (QOF)
The number of people aged
18 years and over receiving
drug treatment for epilepsy
recorded on practice
register who have a seizure
frequency record
Quality Outcomes Framework
HSCIC,
http://www.hscic.gov.uk/cat
alogue/PUB12262
The number of people
aged 18 years and over
receiving drug
treatment for epilepsy
recorded on practice
register including
exceptions.
Quality Outcomes
Framework HSCIC,
http://www.hscic.gov.uk
/catalogue/PUB12262
Divide the number with a
seizure frequency record
by the total number on
the CCG register
QOF statistics are generally considered to be complete and robust. However, there may be a
question regarding the quality of external cause coding.
Under 75 mortality from
epilepsy
Mortality from epilepsy for
people aged under 75, per
100,000 population
Directly age-
standardised rate
(DSR)
per 100,000
Spend and
Outcome Tool
(SPOT)
Commissioning for
Value data
Deaths from epilepsy 2009-
11 per CCG
Spend and Outcome Tool
(SPOT)
ONS population for
2009-11
ONS mid-year population
estimates
The age-specific rates of
the subject population
are applied to the age
structure of the standard
population. This gives the
overall rate that would
have occurred in the
subject population if it
had the standard age
profile
Emergency admission rate for
children with epilepsy
Emergency admission rate
for children with epilepsy
per population aged 0-17
years
Indirectly
standardised rateper 1,000
Hospital Episode
Statistics (HES)
Commissioning for
Value data
First finished episodes for
2009/10 - 2011/12 for all
persons aged 0-17 years
with primary diagnosis ICD
codes G40 and G41 and
with an emergency
admission method
Hospital Episode Statistics
(HES)
Mid year GP relevant
population estimates
by PCT, aged 0-17
years.
ONS mid-year population
estimates
Emergency admissions for
persons aged 0-17
divided by population for
each year 2009/10,
2010/11 and 2011/12.
Data was individually
indirectly standardised
for each year and the
counts and expected
counts then pooled over
the three year period.
Epilepsy pathway indicators
Payment by Results tariffs do not include non-mandatory prices and some activity is excluded from
PbR and remains subject to local prices. In 2012-13 there were non-mandatory tariffs for neurology
and neurosurgery outpatient attendances, and also for high cost drugs and diagnostic imaging.
Data presented for PCTs. Sutton and Merton PCT data presented for both Sutton CCG and Merton
CCG without split.
Below is a breakdown of the 12 care settings:
Prevention & health promotion: Includes primary & secondary prevention, health promotion,
family planning, school health services, national screening programmes, public health programmes
for communicable and non-communicable disease, epidemiological surveillance and public health
administration.
Primary care: Primary care costs relating services provided by GPs, primary dental services and
primary ophthalmic services, excluding those which relate to prevention/health promotion.
Primary prescribing: Primary care activity relating to prescribing or pharmaceutical services,
excluding those which relate to prevention/health promotion. Inpatient elective & day case: Admitted patient care activity which takes place in a hospital setting
where the admission was elective or as a day-case.Inpatient non-elective: Admitted patient care activity which takes place in a hospital setting where
the admission was as an emergency/non-elective.Outpatient: Outpatient attendances or procedures.Other secondary care: Activity included with this setting will include direct access services,
unbundled services (excluding critical care) and secondary care services which cannot be allocated
to more specific settings. Mental Health secondary care services should also be included within this
care setting.
Ambulance: Urgent and emergency transport, i.e. Ambulance activity and 111 expenditure.
A&E: Activity which takes place within A&E departments and minor injury units.
Community care: Care delivered outside of a hospital and within local communities. Activity carried
out within community hospitals should be classified as secondary care activity.
Care provided in other setting: All other health and social care services which are not included
within the other health settings. Includes prison healthcare, nursing homes, hospice care.
Continuing care, intermediate care, respite care, free nursing care should be included within this
setting. Social care and learning disability services should be included within this setting unless
otherwise specified by the mappings.
Non health / social care: Expenditure which is not related to the commissioning or provision of
health / social care services (e.g.. costs relating to facilities & estates).
Spend per neurology patient
(elective, non-elective,
epilepsy, CNS infections,
migraine headache, Parkinson's
disease, multiple sclerosis,
neuropathies)
Spend of the neurology
programme budget per
inpatient
Crude rate £ NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Sum of PbR tariff for
neurology programme
budget category conditions;
PCT responsible population
Secondary Uses Service
Payment by Results (SUS PbR)
Admissions for
neurology programme
budget category
conditions; PCT
responsible population
Secondary Uses Service
Payment by Results (SUS
PbR)
PbR tariff divided by
number of admissions
Spend of neurology programme
budget per 1,000 population
Spend of the neurology
programme budget per
1,000 population
Crude rate per 1,000 NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Sum of PbR tariff for
neurology programme
budget category conditions;
PCT responsible population
Secondary Uses Service
Payment by Results (SUS PbR)
All age PCT registered
population based on
GP practice registered
population
NHS ComparatorsPbR tariff divided by
population
Trend in spend of neurology
programme budget per
inpatient, 2009/10 - 2012/13
Spend of the neurology
programme budget per
inpatient, 2009/10 -
2012/13
Crude rate £ NHS Comparators
Secondary Uses
Service Payment by
Results (SUS PbR)
Sum of PbR tariff for
neurology programme
budget category conditions;
PCT responsible population;
2009/10 - 2012/13
Secondary Uses Service
Payment by Results (SUS PbR)
Admissions for
neurology programme
budget category
conditions; PCT
responsible population
Secondary Uses Service
Payment by Results (SUS
PbR)
PbR tariff divided by
number of admissions
Spend of programme budget
categories per 1,000 population
Spend of programme
budget categories
(Neurology, Circulation,
Cancers, Musculoskeletal
problems, Genito-urinary
problems, Gastro-intestinal
problems, Respiratory
problems, and Trauma and
injuries) per 1,000
population
Crude rate per 1,000
2012/13
Programme
Budgeting
Benchmarking Tool
Payment by Results
2012/13
Programme Budget
PCT total programme
category budgets
expenditure
2012/13 Programme
Budgeting Benchmarking Tool
2012/13 weighted
population using
weighted capitation
formula (calculated by
the Department of
Health)
2012/13 Programme
Budgeting Benchmarking
Tool
PCT expenditure divided
by the weighted
population, result
multiplied by 100,000
Payment by Results tariffs do not include non-mandatory prices and some activity is excluded from
PbR and remains subject to local prices.
Data is presented for PCTs. Sutton and Merton PCT data is presented for both Sutton CCG and
Merton CCG without split.
Spend of programme budget
categories per inpatient
Spend of programme
budget categories
(Neurology, Circulation,
Cancers, Musculoskeletal
problems, Genito-urinary
problems, Gastro-intestinal
problems, Respiratory
problems, and Trauma and
injuries) per inpatient
Crude rate £
2012/13
Programme
Budgeting
Benchmarking Tool
Payment by Results
2012/13
Programme Budget
PCT programme category
budgets expenditure on
inpatient settings (elective,
day case, non-elective)
2012/13 Programme
Budgeting Benchmarking Tool
Count of admissions
(elective, day case, non-
elective) for the
respective programme
budget category
NHS Comparators;
Secondary Uses Service
Payment by Results (SUS
PbR)
PCT expenditure on
inpatient care divided by
inpatient admissions
Payment by Results tariffs do not include non-mandatory prices and some activity is excluded from
PbR and remains subject to local prices.
Secondary Uses Service Payment by Results (SUS PbR) data is based on the Neurology programme
budget category. PbR category admissions are based on treatment or intervention as well as
primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group
(HRG) coding system. Therefore, admission numbers differ compared to HES data.
Data is presented for PCTs rather than CCGs, as most CCGs have retained similar boundaries to PCT
predecessors. However, Sutton and Merton PCT divided into Sutton CCG and Merton CCG, and
therefore data for these two CCGs is based on GP practice lists published in April 2011.
PCT expenditure of
neurology programme
category budget across 12
care settings
2012/13 Programme
Budgeting Benchmarking Tool
2012/13 weighted
population using
weighted capitation
formula (calculated by
the Department of
Health)
Secondary Uses Service Payment by Results (SUS PbR) data is based on the Neurology programme
budget category. PbR category admissions are based on treatment or intervention as well as
primary diagnosis, assigned to programme budget categories through a Healthcare Resource Group
(HRG) coding system. Therefore, admission numbers differ compared to HES data.
Data is presented for PCTs rather than CCGs, as most CCGs have retained similar boundaries to PCT
predecessors. However, Sutton and Merton PCT divided into Sutton CCG and Merton CCG, and
therefore data for these two CCGs is based on GP practice lists published in April 2011.
Budget indicators
PCT expenditure divided
by the weighted
population, result
multiplied by 100,000
2012/13 Programme
Budgeting Benchmarking
Tool
Payment by Results Neurology
Programme Budget (2012-13)
Spend of the neurology
programme budget for each
care setting per 100,000
weighted population
Crude rate per 100,000
2012/13
Programme
Budgeting
Benchmarking Tool
Payment by Results
2012/13
Programme Budget
Outpatients indicators
Percentage of neurology
outpatient appointments
attended
Percentage of neurology
outpatient appointments
attended, not attended,
cancelled by patient, and
cancelled by hospital
Proportion %
Health & Social
Care Information
Centre (HSCIC).
Outpatient Hospital
Episode Statistics
(HES)
Number of outpatient
appointments for Neurology
(400) attended, not
attended, cancelled by
patient, and cancelled by
hospital; CCG responsible
population
Hospital Episode Statistics
taken from Compendium of
Neurology data published
20th March 2014
http://www.hscic.gov.uk/cat
alogue/PUB13776
Total number of
outpatient
appointments for
Neurology (400)
Hospital Episode
Statistics taken from
Compendium of
Neurology data
published 20th March
2014
http://www.hscic.gov.uk
/catalogue/PUB13776
Number of outpatient
appointments attended,
not attended or cancelled
divided by total number
of outpatient
appointments
Proportion of outpatients
treated within 18 weeks
Percentage of neurology /
neurosurgery outpatients
treated within 18 weeks of
referral
Proportion %NHS England
Statistics
Unify2 data
collection
Count of neurology (400)
outpatient referral to
treatment waiting times
that are less than 18 weeks
(on an adjusted basis where
clock pauses are discounted
from the total wait)
Unify2 data collection
Count of neurology
(400) outpatient
referral to treatment
waiting times
Unify2 data collection
Number of neurology
outpatient RTT within the
18 week period divided
by total RTT time
Median waiting time for
outpatients
Median referral to
treatment waiting time
duration for neurology /
neurosurgery outpatients
Median daysNHS England
Statistics
Unify2 data
collection
Median RFF waiting time for
neurology / neurosurgery
outpatients
Unify2 data collection
The median is the 50th percentile or the mid-point of the RTT waiting times distribution. It is the
time that 50% of patients waited less than, e.g. the waiting time of the middle patient if you lined
them up from shortest wait to longest wait.
Median waiting times are calculated from aggregate data, rather than patients level data, and
therefore are only estimates of the position on average waits. Median waiting times are not
calculated when there are less than 50 pathways in the month.
Comorbities for neurological
conditions
A count of the primary
diagnosis conditions for
patients with a secondary
diagnosis of a neurological
condition
CountSecondary Uses
Service (SUS)
Secondary Uses
Service (SUS)
Count of primary diagnosis
conditions where patient
had a secondary diagnosis
of a neurological condition;
CCG responsible population
Secondary Uses Service (SUS)
Count of primary
diagnosis conditions
where patients had a
secondary diagnosis of a
specific neurological
condition
The Secondary Uses Service (SUS) data used is unpublished data and has not been aggregated or
cleaned as Hospital Episodes Statistics (HES) data is. Data may not therefore be entirely accurate or
complete.