Using data to support service improvement

Sue Thomas, Chief Executive of NCS Sue’s background is in nursing, with extensive experience in Primary Care and commissioning. Sue is a Florence Nightingale Scholar, a Winston Churchill Fellow and has published over 150 papers and 20 book chapters. She regularly speaks at national and international conferences. E: sue.thomas@csupport.org.uk, T: 0207 581 8419 W: www.ncssupport.co.uk / Twitter: @NeuroCSupport

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Neurological Commissioning Support (NCS) is a unique voluntary sector organisation developed by three leading neurology charities; Parkinson’s UK, MS Society and Motor Neurone Disease Association. NCS provides expert neurology advice to health and social care to help improve the quality of services while driving down costs. Epilepsy Society became an affiliate partner in 2011.

From a relatively modest start in commissioning support, business has increased significantly in the last twelve months and NCS has worked with eight strategic clinical networks (SCNs) and a range of clinical commissioning groups (CCGs). Provider trusts like the Royal Free London NHS Foundation Trust and University College Hospital London Partners have also benefited from our expertise.

Much of NCS activity has focused around providing baseline neurology information and data in the areas we have worked, for example Hospital Episodic Statistics (HES)
data on numbers of elective and non-elective admissions, length of stay, costs etc. This enables the area to assess its performance and look for ways it can improve. Developing information from this data for specific conditions can be very revealing. For example, data analysed on Parkinson’s in 2012-13, for the BBC 2 current affairs programme, Newsnight, showed that people living with Parkinson’s are much more likely to end up in hospital as an emergency.

Of the more than 92,000 people with Parkinson’s aged over 65 in England, 39% went into hospital as an emergency admission that year. That’s two and a half times more than over 65s who don’t have Parkinson’s. In addition, almost half of the Parkinson’s patients had more than one admission. Once in hospital, those Parkinson’s patients each spent three and a half days longer there than over 65s who don’t have Parkinson’s. If planned admissions are included, it became five more days in hospital (Parkinson’s UK).

Knowledge like this enables us to make suggestions for service models that might support service improvement. NHS Vale of York CCG is one area where NCS carried out a ‘Quality Neurology’ audit of services with patients, carers and professionals.

We are about to do a similar audit in Bristol. The strategy is an action plan of short, medium and long-term service changes that will support service change including more self-management programmes for patients to help prevent avoidable admissions.

We identified that the most common causes for emergency admission in neurology were issues like falls, urinary tract and chest infections and what we needed was GPs and patients to understand how these problems could be prevented. We are now working with the CCG towards a strategy to reduce costly preventable admissions from occurring by developing integrated care pathways for four neurological conditions. These will highlight a more proactive approach to managing patient in the community rather than them using the hospital as their first port of call. There is a greater need for patients to recognise early signs of infection and seek help at that point to prevent acute deterioration.

We have worked to try and increase service efficiency alongside improved patient outcomes and satisfaction with services. For example, development of a first seizure clinic in epilepsy to prevent long waits to see a Neurologist for diagnosis and use of community pharmacy to undertake medicines usage reviews in Parkinson’s so that patients were taking medication appropriately.

A huge priority for the NHS is saving money but NCS strives to create efficiency to enable investment in services rather than cuts.

A significant amount of work this year will be on working at a locality level to address service transformation, creating models of service provision and integrating care. For example, we are working with East of England SCN on developing an integrated care pathway for people with epilepsy. This means making systems more joined up and dealing with problems proactively before the onset of a crisis.

NCS is also actively supporting commissioning leadership activities with Neurologists, Elderly Care Physicians and Specialist Nurses to ensure they understand how they can engage in commissioning for the benefit of their services.

Neurology has always been low profile in the NHS and current policy is bringing new opportunities for clinicians and commissioners to address service improvements.