London CCG Neurology Profile · CNS infections 2,898 3,696 -798 p.6 Outpatients Outpatient...

NHS Brent CCG

London CCG Neurology Profile

November 2014

Summary

LondonDifference

from LondonDetails

Admissions

Neurology admissions per 100,000 population 1,853 1,904 -51 p.1

Emergency admissions per 100,000 population 1,176 1,258 -83 p.1

Proportion of emergency admissions 65% 64% 2% p.2

Condition with highest emerg. admission rate per 100,000 pop.

Epilepsy 55 50 5 p.3

Bed days

Emergency bed days per 100,000 population 999 1572 -573 p.4

Condition with highest number of emergency bed days

Epilepsy 157 164 -7 p.4

Cost

Spend per neurology inpatient (£) 990 1,033 -43 p.6

Spend per emergency inpatient (£) 2,213 1,067 1,146 p.6

Condition with highest spend per inpatient (£)

CNS infections 2,898 3,696 -798 p.6

Outpatients

Outpatient appointments attended 74% 72% 2% p.7

Spend per 1,000 outpatients (£) 7,673 6,741 932 p.5

NHS Brent CCG

The proportion of neurology admissions that are emergencies is above

average, and patients with epilepsy, CNS infections, migraine headache

and nervous system tumours have particularly high proportions of

emergency admissions. This may indicate that better management of

neurology admissions is needed. However, positively, trends show that

the proportion of emergency admissions has been decreasing while

elective admissions are on the rise.

Comments

Positively, use of emergency bed days by neurology patients is low

compared to the London average, and length of stay has been declining.

Brent CCG has a low neurology budget compared to other CCGs in

London, and spends two thirds of the budget in secondary care. Spend

per neurology patient is lower than the London average, particularly for

emergency admissions and admissions for epilepsy, CNS infections and

Parkinson’s disease. Less money is spent on neurology patients

compared to other budget categories such as circulation, cancer,

respiratory problems or gastro-intestinal problems.

11% of neurology outpatients did not attend their appointment in 2012-

13, which is significantly higher than other CCGs in London as well as

higher than non-attendance rates for other specialisms. While 99% of

neurology outpatients are treated within 18 weeks of referral, both

neurology and neurosurgery outpatients wait longer for treatment than

the London average.

How many patients with neurological conditions are being admitted to hospital?

Primary diagnosis Primary diagnosis

Number of admissions 2,358 Number of emergency admissions 1,106

Number of admissions per 100,000 people 683 Number of emergency admissions per 100,000 people 320

London value 721 London value 316

Mention* Mention*

Number of admissions 6,638 Number of emergency admissions 4,022

Number of admissions per 100,000 people 1,922 Number of emergency admissions per 100,000 people 1,165

London value 2,025 London value 1,230

Payment by Results Programme Budget Category** Payment by Results Programme Budget Category**

Number of admissions 6,397 Number of admissions 4,169

Number of admissions per 100,000 people 1,853 Number of admissions per 100,000 people 1,176

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 1,853

Emergency admissions 1,176

Elective admissions 626

Emergency proportion

CCG 65%

London 64%

Elective proportion

CCG 34%

London 35%

How have admission trends for specific neurological conditions been changing?

NHS Brent CCG London

08/09 09/10 10/11 11/12 12/13

Epilepsy 69 76 64 73 80

CNS infections 16 9 24 12 20

Migraine headache 16 17 18 22 27

Parkinson's disease 13 16 11 13 8

Multiple sclerosis 27 58 63 82 75

Neuropathies 66 81 77 82 94

2

1,749

1,207

522

2011-12

1,805

2009-10

1,691

2010-11

1,127

32%

544

67%

65%

32%

33%

Number of admissions per 100,000 population in NHS Brent CCG

35%32%

Note that admissions for multiple sclerosis have increased throughout London due to an increase in

disease-modifying therapy.

69%

66%

30%

1,209

576

67%

64%

0

10

20

30

40

50

60

70

80

90

100

08/09 09/10 10/11 11/12 12/13

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

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 187 15% 7% 30%

CNS infections 29 17% 6% 36%

Migraine headache 83 23% 6% 48%

Nervous system tumours 92 5% 0% 16%

Parkinson's disease 30 26% 10% 45%

Multiple sclerosis 243 17% 10% 35%

Neuropathies 306 6% 2% 12%

3

17%

10%

Admissions

per 100,000

people

62

8

29

27

9

73

90

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

11%

14%

24%

4%

5

4

7%

5%

33%

Range for proportion of consultant managed admissions

Number of patients

managed by a

neurology consultant

21

4

20

4

10

41

31

Range for emergency admission rate per 100,000 peopleEmergency admissions

per 100,000 people

55

7

17

11

3

Proportion of

admissions that are

emergencies

88%

85%

61%

42%

37%

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 539 563 457 713

Percentage of patients drug treatment and seizure free 58% 61% 52% 71%

Proportion of patients with a seizure frequency record 95% 95% 94% 97%

Under 75 mortality from epilepsy (2009-11)1 1.14 1.20 0.18 2.53

Admission rate for primary diagnosis of epilepsy1 62 60 31 89

Emergency admission rate for primary diagnosis of epilepsy1 55 50 24 76

Emergency admission rate for children with epilepsy (2011/12)2 61.22 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)

46

2009-

10

2010-

11

2011-

12

2012-

136%

CCG value 10.1 9.5 9 7.3 12%

London value 11.2 10.2 10 10.2 11%

4

Number of

emergency

bed days

3451

541

205

45

99

126

107

Proportion of bed

days that are

emergencies

70%

83%

69%

48%

* 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 Brent CCG

Readmissions for neurological conditions in NHS Brent CCG*

Readmissions for all conditions in London

Range

70%

52%

50%

Emergency bed days

per 100,000 people

999

157

59

13

29

36

31

6

7

8

9

10

11

12

2009-10 2010-11 2011-12 2012-13

NHS Brent 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 15% 10,575 7,404 14,968

Inpatient (Elective and Day Case) 17% 10,937 6,715 16,046

Inpatient (Non-elective) 40% 24,589 8,323 51,446

Outpatient 12% 6,741 564 12,864

Other secondary care 6% 5,746 778 15,364

Ambulance 3% 1,935 1,492 3,033

A&E 1% 878 511 2,372

Community care 2% 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 75% 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

2,693,000

3,082,000

7,459,000

2,205,000

1,136,000

271,832

344,000

Spend per

1,000 people

(£)

0

0

9,372

10,725

0

0

559,000

1,197

0

2,565

48,309

64,334

25,957

0

737,000

13,882,000

18,486,832

946

Care setting Range for spend per 1,000 people

7,673

3,953

1,945

Total spend (£)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Primaryprescribing

Inpatient(Elective and

Day Case)

Inpatient (Non-elective)

Outpatient Othersecondary care

Ambulance A&E Communitycare

Other setting Nonhealth/social

care

NHS Brent CCG London average

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000


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 Brent CCG 1037

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 1088 1063 990

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 64,334 1,648

Circulation 139,495 4,740

Cancers 100,005 2,609

Musculoskeletal problems 94,221 2,658

Genito-urinary problems 112,654 1,613

Gastro-intestinal problems 93,437 1,946

Respiratory problems 96,776 2,947

Trauma and injuries 62,905 3,008

6

830

London

value

1,033

1,067

1,846

821

Range for spend per patientSpend per

patient

990

4,267,430

202,882

1,0471,032

51,685

211,861

1,391

3,696

713

Total spend

6,330,021

65,961

1,936,625

337,942

2,213

896

1,224

3,859

6,245

8,508

4,852

2,419

10,541,000

18,290,000

13,997,000

4,67527,075,111

32,372,011

26,849,776

12,425,000

10,075,000

16,555,000

14,298,000

7,277,000

5,365

6,39718,486,832

40,084,861

28,737,000

Total spend on

inpatient care

Number of

inpatient

admissions

2,668

336,524

910

2,898

709

Total spend

(all care

settings)

Spend per 1,000 people Spend per inpatient

27,809,406

18,076,062

800

900

1,000

1,100

1,200

1,300

1,400

1,500

2009-10 2010-11 2011-12 2012-13

NHS Brent 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%

London average

85%

153

99%

98%

Neurosurgery

141

87%

82%

Neurology

7% 3%

1%

2.8 9.0

9.2

Outpatients not treated within 18 wks 2 18

% of outpatients treated within 18 wks

Neurology

2.2

Neurosurgery

8.7

Value

74%

11%

7%

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%


Target

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%


Target

0

1

2

3

4

5

6

7

NHS Brent CCG London average0

2

4

6

8

10

12

14

16

18


0% 2% 4% 6% 8% 10% 12% 14%

Neurology

All specialisms

NHS Brent 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


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




20th March 2014


alogue/PUB13776

Count of admissions

for neurological

conditions; secondary

diagnosis; 18+ years;

CCG responsible

population

Hospital Episode


Compendium of

Neurology data


2014


/catalogue/PUB13776

Emergency admission

data divided by admission

data






completeness.

Neurological condition

emergency admission rates

(epilepsy, CNS infections,

migraine headache, nervous

system tumours, Parkinson's

disease, multiple sclerosis,

neuropathies)

The number of emergency


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




20th March 2014


alogue/PUB13776

All age CCG registered

population

Quality Outcomes

Framework HSCIC,


/catalogue/PUB12262

Emergency admission

data divided by CCG

registered population,

result multiplied by

100,000 for rate






completeness.

Trend in admissions for

neurological conditions

(epilepsy, CNS infections,

migraine headache, Parkinson's


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


Crude rate per 100,000 NHS Comparators

Secondary Uses

Service Payment by

Results (SUS PbR)

Count of admissions for


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



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



taken from NHS Comparators


population based on


population

NHS Comparators

Admission data divided

by PCT registered

population, result


rate








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).




20th March 2014


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


Compendium of

Neurology data


2014


/catalogue/PUB13776

Indicator derived from

HSCIC supplementary

information files

'Neurology data for

Intelligence Network'






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.


(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


epilepsy, CNS infection,



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


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.



All age CCG registered

population

Quality Outcomes

Framework HSCIC,


/catalogue/PUB12262

Emergency bed days

divided by CCG registered

population, result


rate








Mean length of stay for

patients with long term


2009/10 - 2012/13.

The length of all completed

hospital spells for

neurological averaged over

the number of spells for


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.



Count of completed

inpatient spells with a

primary diagnosis of a

long term neurological

condition; PCT

responsible

population; 2009/10 -

2012/13.


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.








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.


Health & Social

Care Information

Centre (HSCIC).

NHS Quality and

Outcomes

Framework (QOF)





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)





register seizure free in the

last 12-months

Quality Outcomes Framework

HSCIC,


alogue/PUB12262

The number of people


receiving drug

treatment for epilepsy


register including

exceptions.

Quality Outcomes

Framework HSCIC,


/catalogue/PUB12262

Divide the number

seizure free by the total

number on the CCG

register.



Proportion of patients with a

seizure frequency record

Proportion of individuals


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)





register who have a seizure

frequency record

Quality Outcomes Framework

HSCIC,


alogue/PUB12262

The number of people


receiving drug

treatment for epilepsy


register including

exceptions.

Quality Outcomes

Framework HSCIC,


/catalogue/PUB12262

Divide the number with a

seizure frequency record

by the total number on

the CCG register



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


(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,



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



Admissions for

neurology programme

budget category

conditions; PCT




PbR)

PbR tariff divided by

number of admissions

Spend of neurology programme

budget per 1,000 population



1,000 population


Secondary Uses

Service Payment by

Results (SUS PbR)


neurology programme


PCT responsible population




population based on


population

NHS ComparatorsPbR tariff divided by

population

Trend in spend of neurology


inpatient, 2009/10 - 2012/13



inpatient, 2009/10 -

2012/13

Crude rate £ NHS Comparators

Secondary Uses

Service Payment by

Results (SUS PbR)


neurology programme


PCT responsible population;

2009/10 - 2012/13



Admissions for

neurology programme

budget category

conditions; PCT




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


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


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


Count of admissions

(elective, day case, non-

elective) for the

respective programme

budget category

NHS Comparators;



PbR)

PCT expenditure on

inpatient care divided by

inpatient admissions


PbR and remains subject to local prices.








PCT expenditure of

neurology programme

category budget across 12

care settings

2012/13 Programme


2012/13 weighted

population using

weighted capitation

formula (calculated by

the Department of

Health)








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)


programme budget for each

care setting per 100,000

weighted population


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




20th March 2014


alogue/PUB13776

Total number of

outpatient

appointments for

Neurology (400)

Hospital Episode


Compendium of

Neurology data


2014


/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


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


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


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.

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