London CCG Neurology Profile

Transcription

1 CCG Neurology Profile November 214

2 Summary NHS Hammersmith And Fulham CCG Difference from Details Comments Admissions Neurology admissions per 1, 2,13 1, p.1 Emergency admissions per 1, 1,661 1, p.1 Proportion of emergency admissions 72% 64% 9% p.2 Condition with highest emerg. admission rate per 1, pop. Epilepsy p.3 While the proportion of neurology admissions that are emergencies is similar to the average, trends show there to be no improvement in decreasing this proportion over the past 4 years. Patients with epilepsy, CNS infections, migraine headache and neuropathies all have particularly high emergency admission rates. This may indicate that better management of neurology admissions is needed. Bed days Emergency bed days per 1, p.4 Condition with highest number of emergency bed days Epilepsy p.4 Positively, the mean length of stay for neurology patients has been dropping rapidly and is much lower than the average. However, patients with CNS infections and migraine headache who enter hospital on an emergency basis have more bed days than expected. While epilepsy prevalence is lower than the average, admissions and emergency admissions for epilepsy exceed the benchmark. Cost Spend per neurology inpatient ( ) 969 1,33-64 p.6 Spend per emergency inpatient ( ) 74 1, p.6 Condition with highest spend per inpatient ( ) CNS infections 2,832 3, p.6 Hammersmith and Fulham CCG s neurology budget is just below the average and most of the budget (76%) is spent on secondary care. Despite this, spend per neurology patients is low for almost all neurological conditions and particularly for emergency admissions. Less money is spent on neurology patients compared to other budget categories such as circulation, cancer, respiratory problems or gastrointestinal problems. Outpatients Outpatient appointments attended 64% 72% -8% p.7 Spend per 1, outpatients ( ) 8,815 6,741 2,74 p.5 13% of neurology outpatients did not attend their appointment in , which is higher than other CCGs in as well as higher than nonattendance rates for other specialisms. While a high proportion of neurology and neurosurgery outpatients are being treated within 18 weeks of referral, outpatients wait a longer time than average.

3 How many patients with neurological conditions are being admitted to hospital? All neurology admissions Emergency neurology admissions Primary diagnosis Primary diagnosis Number of admissions 1,49 Number of emergency admissions 613 Number of admissions per 1, people 692 Number of emergency admissions per 1, people 31 value 721 value 316 1,2 5 1, Mention* Mention* Number of admissions 3,739 Number of emergency admissions 2,381 Number of admissions per 1, people 1,837 Number of emergency admissions per 1, people 1,17 value 2,25 value 1,23 3, 2, 2,5 1,5 2, 1,5 1, 1, 5 5 Payment by Results Programme Budget Category** Payment by Results Programme Budget Category** Number of admissions 4,337 Number of admissions 3,143 Number of admissions per 1, people 2,13 Number of admissions per 1, people 1,661 value 1,94 value 1,258 3, 2, 2,5 1,5 2, 1,5 1, 1, 5 5 *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 see Appendix 1. ** 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. 1

4 How have neurology admission trends been changing? Per 1, Number of neurology admissions per 1, 3, Proportion of elective and emergency neurology 8% All admissions 2,229 2,612 2,218 2,13 Emergency admissions 1,543 1,881 1,546 1,661 Elective admissions Emergency proportion 2,5 2, 7% 6% 5% CCG 69% 72% 7% 72% 1,5 4% 65% 66% 64% 64% Elective proportion CCG 3% 27% 3% 27% 33% 32% 35% 35% 1, 5 3% 2% 1% 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 All admissions Emergency admissions Elective admissions % CCG Emergency CCG Elective emergency elective How have admission trends for specific neurological conditions been changing? Number of admissions per 1, in NHS Hammersmith And Fulham CCG 8/9 9/1 1/11 11/12 12/ Epilepsy CNS infections Migraine headache Parkinson's disease Multiple sclerosis Neuropathies Epilepsy CNS infections Migraine headache Parkinson's disease Multiple sclerosis Neuropathies 8/9 9/1 1/11 11/12 12/13 8/9 9/1 1/11 11/12 12/13 Note that admissions for multiple sclerosis have increased throughout due to an increase in disease-modifying therapy. 2

5 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 (212-13) Admissions per 1, people Emergency admissions per 1, people Proportion of admissions that are emergencies emergency lowest admissions value rate Range for emergency admission rate per 1, people highest value Epilepsy % CNS infections % Migraine headache % Nervous system tumours % Parkinson's disease 7 % Multiple sclerosis % 5 8 Neuropathies 69 % 5 9 Are your neurology patients being managed in the right way? Proportion of patients admitted with a primary neurology diagnosis that are managed by a consultant neurologist (212-13) 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 Number of patients managed by a neurology consultant Number of admissions lowest proportion value Range for proportion of consultant managed admissions highest value Epilepsy 9% % 7% 3% CNS infections 15% % 6% 36% Migraine headache 14% % 6% 48% Nervous system tumours 8% % % 16% Parkinson's disease 21% % 1% 45% Multiple sclerosis 18% % 1% 35% Neuropathies 12% % 2% 12% 3

6 Use of bed days following emergency admissions (212-13) Number of emergency bed days Emergency bed days per 1, people Proportion of bed days that are emergencies lowest value value Range for emergency bed days per 1, people highest value Neurology % Epilepsy % CNS infections % Migraine headache % Parkinson's disease % Multiple sclerosis % Neuropathies % How well are patients with epilepsy being managed? Value lowest value value Range highest value Prevalence of epilepsy 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 (29-11) Admission rate for primary diagnosis of epilepsy Emergency admission rate for primary diagnosis of epilepsy Emergency admission rate for children with epilepsy (211/12) per 1, 2 per 1, aged -17 Mean length of stay (days) for patients with long term neurological conditions Emergency 28 day readmissions for neurological conditions (212-13) 13 Number of emergency readmissions in Readmissions for neurological conditions in * 6% CCG value Readmissions for all conditions in 1 NHS Hammersmith And Fulham 12% CCG 9 value Readmissions for all conditions in England 11% * As a percentage of all emergency admissions Note: the above data for readmissions for neurological conditions is based on Service (SUS) data which is not published and therefore there may be data quality issues. 4

7 How is money being spent on neurology admissions in your area? Payment by Results (PbR) Neurology Programme Budget (212-13) Care setting Total spend ( ) Spend per 1, people ( ) Proportion of total spend lowest per 1, value ( ) people ( ) Range for spend per 1, people highest value ( ) Prevention % Primary care % Primary prescribing 1,87, 1,621 16% 1,575 7,44 14,968 Inpatient (Elective and Day Case) 1,428, 8,11 12% 1,937 6,715 16,46 Inpatient (Non-elective) 5,88, 28,897 42% 24,589 8,323 51,446 Outpatient 1,552, 8,815 13% 6, ,864 Other secondary care 1,48, 5,952 9% 5, ,364 Ambulance 368, 2,9 3% 1,935 1,492 3,33 A&E 112, % ,372 Community care % 1,395 59,415 Other setting % 87 1,716 Non health/social care 591, 3,357 5% 3, ,896 Total secondary care 9,116, 51,775 76% 48,13 33,556 7,111 Total 12,57,143 68,479-75,951 54, ,936 CCG spend on the Neurology Programme Budget Category per 1, people Proportion of neurology budget spent in different care settings 14, 12, 1, 8, 6, 4, 2, average 45% 4% 35% 3% 25% 2% 15% 1% 5% % Primary prescribing Inpatient Inpatient (Nonelective) (Elective and Day Case) % % average 14% 14% 32% 9% 8% 3% 1% 14% 1% 4% 63% Outpatient Other secondary care Ambulance A&E Community care Other setting Non health/social care 5

8 How much is being spent on neurology patients? Admission type Total spend Spend per patient value lowest value Range for spend per patient highest value Trend in spend per patient All admissions 4,2, , , Emergency admissio 3,84, , ,375 NHS Hammersm 144 Elective admissions 1,25, ,63 neurolo 198 Epilepsy 232,978 1,273 1,391 1,138 1,75 all cond 149 CNS infections 121,795 2,832 3,696 2,11 6, Migraine headache 65, Parkinson's disease 35,937 1,562 2,668 1,562 3, Multiple sclerosis 176, , Neuropathies 12, , ,261 1,5 1,4 1,3 1,2 1,1 1, neurology all conditions How much money is spent on neurological conditions compared to other budget categories? (212-13) Programme Budget Category Total spend (all care settings) Total spend on inpatient care Number of inpatient admissions Spend per 1, people Spend per inpatient Neurology 12,57,143 6,516, 4,337 68,479 1,52 Circulation 19,59,299 8,95, 1,953 11,84 4,145 Cancers 17,464, 6,913, 2,858 99,187 2,419 Musculoskeletal problems 13,36,146 4,623, 1,789 74,39 2,584 Genito-urinary problems 2,611,816 4,971, 2, ,66 1,761 Gastro-intestinal problems 14,486,582 9,271, 5,67 82,277 1,83 Respiratory problems 16,65,771 8,177, 3,134 94,313 2,69 Trauma and injuries 12,332,82 5,11, 1,928 7,45 2,65 6

9 How well are neurology outpatients being managed? What percentage of neurology outpatient appointments are attended? (212-13) Percentage of outpatient appointments not attended Value value lowest value highest value CCG England Neurology Attended 64% 72% 59% 84% 13% 1% 7% Not attended 13% 1% 6% 15% 9% 7% Cancelled by patient 11% 8% 1% 13% All specialisms Cancelled by hospital 12% 1% 3% 2% Neurology Range % 2% 4% 6% 8% 1% 12% 14% All specialisms England *CCG level data for outpatients not attended for all specialisms is not available What proportion of neurology outpatients are treated within 18 weeks? (213/14) Neurology Neurosurgery Total number of outpatients Outpatients not treated within 18 wks % of outpatients treated within 18 wks 99% 95% average 98% 82% 1% 95% 9% 85% 8% 75% 7% 65% Percentage of neurology outpatients treated within 18 wks 1% Percentage of neurosurgery outpatients treated within 18 wks 95% 9% 85% 8% 75% 7% 65% CCG average for all specialties 91% 6% 55% 6% 55% 5% average Target 5% average Target What is the median waiting time for neurology outpatients? (213/14) Neurology Neurosurgery 7 Median waiting time (weeks) for neurology outpatients Median waiting time (weeks) for neurosurgery outpatients 18 Median waiting time for outpatients (weeks) average CCG average for all specialties average average 7

10 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 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.

11 Appendix 2: Neurology Profiles Metadata Indicator Definition Value type Unit Data source Indicator Source Definition of numerator Source of numerator Definition of denominator Source of denominator Methodology Caveats Primary diagnosis of a neurological condition: proportion of admissions that are emergencies Secondary diagnosis of a neurological condition: proportion of admissions that are emergencies Neurological condition emergency admission rates (epilepsy, CNS infections, migraine headache, nervous system tumours, Parkinson's disease, multiple sclerosis, neuropathies) The proportion of admissions to hospital with a primary neurology diagnosis that were on an emergency basis Proportion % The proportion of admissions to hospital with a secondary neurology diagnosis (i.e. patient was Proportion % admitted to hospital with a different primary diagnosis) that were on an emergency basis The number of emergency admissions to hospital with a primary diagnosis of a specific neurological condition, expressed as a crude rate per 1, (CCG responsible ) Crude rate per 1, Inpatient Hospital Episode Statistics (HES) Inpatient Hospital Episode Statistics (HES) Inpatient Hospital Episode Statistics (HES) Count of emergency admissions for neurological conditions; primary diagnosis; CCG responsible Count of emergency admissions for neurological conditions; secondary diagnosis; CCG responsible Count of emergency admissions for specific neurological conditions; primary diagnosis; CCG responsible Hospital Episode Statistics taken from Compendium of Neurology data published 2th March alogue/pub13776 Hospital Episode Statistics taken from Compendium of Neurology data published 2th March alogue/pub13776 Hospital Episode Statistics taken from Compendium of Neurology data published 2th March alogue/pub13776 Count of admissions for neurological conditions; primary diagnosis; 18+ years; CCG responsible Count of admissions for neurological conditions; secondary diagnosis; 18+ years; CCG responsible All age CCG registered Hospital Episode Statistics taken from Compendium of Neurology data published 2th March /catalogue/pub13776 Hospital Episode Statistics taken from Compendium of Neurology data published 2th March /catalogue/pub13776 Emergency admission data divided by admission data Emergency admission data divided by admission data Emergency admission Quality Outcomes data divided by CCG Framework HSCIC, registered, result multiplied by /catalogue/pub , for rate HES inpatient data and ONS 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. HES inpatient data and ONS 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. HES inpatient data and ONS 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 The number of admissions neurological conditions to hospital due to specific (epilepsy, CNS infections, neurological conditions, migraine headache, Parkinson's expressed as a crude rate disease, multiple sclerosis, per 1, (CCG neuropathies), 28/9 - responsible ) 212/13 Crude rate per 1, NHS Comparators Service Payment by Results (SUS PbR) Count of admissions for specific neurological conditions covered under the Neurology Programme Budget Category; PCT responsible ; 28/9-212/13 Service Payment by Results (SUS PbR) taken from NHS Comparators All age PCT registered based on GP practice registered NHS Comparators Admission data divided by PCT registered, result multiplied by 1, for rate 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 211. Trend in proportion of neurology admissions that are emergencies, 29/1-212/13 The number of admissions and emergency admissions to hospital due to a neurological condition, expressed as a crude rate per 1, (CCG responsible ) Crude rate per 1, NHS Comparators Service Payment by Results (SUS PbR) Count of admissions and emergency for neurological conditions covered under the Neurology Programme Budget Category; CCG responsible ; 28/9-212/13 Service Payment by Results (SUS PbR) taken from NHS Comparators All age PCT registered based on GP practice registered NHS Comparators Admission data divided by PCT registered, result multiplied by 1, for rate 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 211. Proportion of patients admitted with a primary neurology diagnosis that are managed by a consultant neurologist Emergency readmittances within 28 days In patient admissions where the specialist code was recorded as consultant neurologist. The main specialty code for Neurology is 4. Percentage rates were calculated with respect to the total episode counts pertaining to neurological conditions. Percentage of primary diagnosis neurology emergency readmissions within 28 days of all primary diagnosis neurology emergency admissions Proportion % Proportion % Service (SUS) Inpatient Hospital Episode Statistics (HES) Service (SUS) Percentage of Finished Admission Episodes with primary diagnosis for specified neurological conditions managed by consultant neurologist by CCG of residence and diagnosis for Specialist code was recorded as consultant neurologist (4). Hospital Episode Statistics taken from Compendium of Neurology data published 2th March alogue/pub13776 Count of primary diagnosis neurology emergency admissions that occurred within 28 days of the Service (SUS) patient having a previous primary neurology admission; CCG responsible. Number of finished admitted episodes for a primary diagnosis of specified neurological condition by CCG of residence and diagnosis for Count of primary diagnosis neurology emergency admissions; CCG responsible. Hospital Episode Statistics taken from Compendium of Neurology data published 2th March /catalogue/pub13776 Service (SUS) Indicator derived from HSCIC supplementary information files 'Neurology data for Intelligence Network' Emergency readmissions divided by all emergency admissions HES inpatient data and ONS 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. The 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.

12 Use of emergency bed days The sum of individual following admissions for a hospital lengths of stay neurological condition (all following an emergency neurological conditions, admission where the epilepsy, CNS infection, primary diagnosis was for migraine headache, Parkinson's neurological conditions per disease, multiple sclerosis, 1, neuropathies) Mean length of stay for patients with long term neurological conditions, 29/1-212/13. Epilepsy pathway indicators Prevalence of epilepsy The length of all completed hospital spells for neurological averaged over the number of spells for neurological conditions, indirectly standardised by age and sex Crude rate per 1, NHS Comparators Service Payment by Results (SUS PbR) Indirectly standardised rate Days NHS Comparators Service Payment by Results (SUS PbR) 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 1, NHS Quality and Outcomes Framework (QOF) 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. Service All age CCG registered Payment by Results (SUS PbR) Sum of PbR length of stay for spells with a primary diagnosis for a long term neurological condition Service (note: where length of stay Payment by Results (SUS PbR) is in excess of 9 days then this is trimmed to 9 days); PCT responsible ; 29/1-212/13. The number of people aged 18 years and over receiving drug treatment for epilepsy recorded on practice register. Count of completed inpatient spells with a primary diagnosis of a long term neurological condition; PCT responsible ; 29/1-212/13. Prevalence table for number of patients with epilepsy at 18+ years CCG CCG level, Quality and registered Outcomes Framework, HSCIC Quality Outcomes Framework HSCIC, /catalogue/pub12262 Service Payment by Results (SUS PbR) Prevalence table for number of patients with epilepsy at CCG level, Quality and Outcomes Framework, HSCIC Emergency bed days divided by CCG registered, result multiplied by 1, for rate 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. Number on register for divided by 18+ registered in CCG 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 211. 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 211. 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 individuals aged 18 years and over Percentage of patients with receiving drug treatment for epilepsy on drug treatment and epilepsy recorded on Crude rate % seizure free practice register who have been seizure free in the last 12-months 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, alogue/pub12262 The number of people aged 18 years and over Quality Outcomes receiving drug Framework HSCIC, treatment for epilepsy recorded on practice /catalogue/pub12262 register including exceptions. 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 Under 75 mortality from epilepsy Emergency admission rate for children with epilepsy Proportion of individuals aged 18 years and over receiving drug treatment for Proportion % epilepsy who have a record of seizure frequency in the previous 15 months Mortality from epilepsy for people aged under 75, per 1, Emergency admission rate for children with epilepsy per aged -17 years Directly agestandardised rate per 1, (DSR) Spend and Outcome Tool (SPOT) Indirectly standardised rate per 1, Hospital Episode Statistics (HES) NHS Quality and Outcomes Framework (QOF) Commissioning for Value data Commissioning for Value data The number of people aged 18 years and over receiving drug treatment for epilepsy recorded on practice register who have a seizure frequency record Deaths from epilepsy per CCG First finished episodes for 29/1-211/12 for all persons aged -17 years with primary diagnosis ICD codes G4 and G41 and with an emergency admission method Quality Outcomes Framework HSCIC, alogue/pub12262 Spend and Outcome Tool (SPOT) Hospital Episode Statistics (HES) The number of people aged 18 years and over Quality Outcomes receiving drug Framework HSCIC, treatment for epilepsy recorded on practice /catalogue/pub12262 register including exceptions. ONS for Mid year GP relevant estimates by PCT, aged -17 years. ONS mid-year estimates ONS mid-year estimates Divide the number with a seizure frequency record by the total number on the CCG register The age-specific rates of the subject are applied to the age structure of the standard. This gives the overall rate that would have occurred in the subject if it had the standard age profile Emergency admissions for persons aged -17 divided by for each year 29/1, 21/11 and 211/12. Data was individually indirectly standardised for each year and the counts and expected counts then pooled over the three year period. QOF statistics are generally considered to be complete and robust. However, there may be a question regarding the quality of external cause coding.

13 Budget 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 there were non-mandatory tariffs for neurology and neurosurgery outpatient attendances, and also for high cost drugs and diagnostic imaging. Payment by Results Neurology Programme Budget (212-13) Spend per neurology patient (elective, non-elective, Spend of the neurology epilepsy, CNS infections, programme budget per migraine headache, Parkinson's inpatient disease, multiple sclerosis, neuropathies) Spend of neurology programme budget per 1, Trend in spend of neurology programme budget per inpatient, 29/1-212/13 Spend of the neurology programme budget per 1, Spend of the neurology programme budget per inpatient, 29/1-212/13 Spend of programme budget categories (Neurology, Circulation, Cancers, Musculoskeletal Spend of programme budget problems, Genito-urinary categories per 1, problems, Gastro-intestinal problems, Respiratory problems, and Trauma and injuries) per 1, Spend of programme budget categories per inpatient Spend of the neurology programme budget for each Crude rate per 1, care setting per 1, weighted 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 NHS Comparators Crude rate per 1, NHS Comparators Crude rate NHS Comparators Crude rate per 1, Crude rate 212/13 Programme Budgeting Benchmarking Tool 212/13 Programme Budgeting Benchmarking Tool Payment by Results 212/13 Programme Budget Sum of PbR tariff for neurology programme Service Service Payment by budget category conditions; Payment by Results (SUS PbR) Results (SUS PbR) PCT responsible Admissions for neurology programme budget category conditions; PCT responsible Sum of PbR tariff for All age PCT registered neurology programme Service based on Service Payment by budget category conditions; Payment by Results (SUS PbR) GP practice registered Results (SUS PbR) PCT responsible Sum of PbR tariff for neurology programme Service Service Payment by budget category conditions; Payment by Results (SUS PbR) Results (SUS PbR) PCT responsible ; 29/1-212/13 Payment by Results 212/13 Programme Budget PCT expenditure of neurology programme category budget across 12 care settings PCT total programme category budgets expenditure 212/13 PCT programme category Payment by Results Programme budgets expenditure on 212/13 Budgeting inpatient settings (elective, Programme Budget Benchmarking Tool day case, non-elective) 212/13 weighted using 212/13 Programme weighted capitation Budgeting Benchmarking Tool formula (calculated by the Department of Health) Admissions for neurology programme budget category conditions; PCT responsible 212/13 weighted using 212/13 Programme weighted capitation Budgeting Benchmarking Tool formula (calculated by the Department of Health) 212/13 Programme Budgeting Benchmarking Tool Service Payment by Results (SUS PbR) NHS Comparators Service Payment by Results (SUS PbR) 212/13 Programme Budgeting Benchmarking Tool Count of admissions NHS Comparators; (elective, day case, nonelective) for the 212/13 Programme Service Budgeting Benchmarking Tool Payment by Results (SUS respective programme PbR) budget category PCT expenditure divided by the weighted, result multiplied by 1, PbR tariff divided by number of admissions PbR tariff divided by PbR tariff divided by number of admissions PCT expenditure divided by the weighted, result multiplied by 1, PCT expenditure on inpatient care divided by inpatient admissions 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). 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 211. 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. Payment by Results tariffs do not include non-mandatory prices and some activity is excluded from PbR and remains subject to local prices. 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 211.

14 Outpatients indicators Percentage of neurology outpatient appointments attended Percentage of neurology outpatient appointments attended, not attended, cancelled by patient, and cancelled by hospital Proportion % Outpatient Hospital Episode Statistics (HES) Number of outpatient appointments for Neurology (4) attended, not attended, cancelled by patient, and cancelled by hospital; CCG responsible Hospital Episode Statistics taken from Compendium of Neurology data published 2th March alogue/pub13776 Total number of outpatient appointments for Neurology (4) Hospital Episode Statistics taken from Number of outpatient Compendium of appointments attended, Neurology data not attended or cancelled published 2th March divided by total number 214 of outpatient appointments /catalogue/pub13776 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 (4) outpatient referral to treatment waiting times that are less than 18 weeks Unify2 data collection (on an adjusted basis where clock pauses are discounted from the total wait) Count of neurology (4) 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 days NHS England Statistics Unify2 data collection Median RFF waiting time for neurology / neurosurgery Unify2 data collection outpatients The median is the 5th percentile or the mid-point of the RTT waiting times distribution. It is the time that 5% 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 5 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 Count Service (SUS) Service (SUS) Count of primary diagnosis conditions where patient had a secondary diagnosis Service (SUS) of a neurological condition; CCG responsible Count of primary diagnosis conditions where patients had a secondary diagnosis of a specific neurological condition The 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.