NHS RightCare Commissioning For Value Focus Pack

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NHS RightCareCommissioning for ValueFocus PackNeurologicalNeurologicalAprilApril 20162016NHS Hastings and Rother CCGOFFICIALGateway ref: 04939

NHS Hastings and Rother CCGContents Gateway ref: 049392Introduction: Welcome to your focus packNHS RightCareWhy act?Commissioning for ValueYour most similar CCGsYour data Pathways on a page Spend and activity Opportunities Further analysis Next steps and actionsFurther support and informationUseful linksAnnexesNHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

NHS RightCare CFV Neurological focus packIntroduction: Welcome to your focus pack3Welcome to your focus pack on neurology. The information contained in this pack is personalised for yourCCG and should be used to help support local discussions and inform a more in-depth analysis aroundneurological pathways. There is a page of useful links at the end and there is a video guide to the pack too.Each of these focus packs provides detailed information on the opportunities to improve in the highestspending programmes previously covered by Commissioning for Value packs. They include a wider range ofoutcome measures and information on the most common procedures and diagnoses for the condition inquestion.By using this information, together with local intelligence and reports such as your Joint Strategic NeedsAssessment, your CCG will be able to ensure its plans focus on those opportunities which have the potentialto provide the biggest improvements in health outcomes, resource allocation and reducing inequalities.One of the main focuses for the Commissioning for Value series has always been reducing unwarrantedvariation in outcomes. NHS England, Public Health England and CCGs have legal duties under the Healthand Social Care Act 2012 with regard to reducing health inequalities. Commissioners should continue to usethese packs and supporting tools to drive local action to reduce inequalities in access to services and in thehealth outcomes achieved.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

NHS RightCare CFV Neurological focus packNHS RightCare4The primary objective for NHS RightCare is to maximise value: The value that the patient derives from their own care and treatment The value the whole population derives from the investment in their healthcareThe approach has been tested and proven successful in recent years in a number of different healtheconomies. The programme focusses on improving population value including improving outcomes,quality, and releasing capacity and resources for future investment.To build on the success and value of the RightCare programme, NHS England and Public HealthEngland are taking forward the RightCare approach to ensure it becomes embedded in the newcommissioning and public health agendas for the NHS. It is now referenced in the Mandate to NHSEngland, the NHS Planning Guidance and the CCG Improvement and Assessment Framework.The RightCare programme includes the Commissioning for Value packs and tools, the NHS Atlas seriesand a number of casebooks. NHS England has committed significant funding to rolling out the RightCareapproach to all CCGs over the next two years. Wave 1 has 65 CCGs and these are now receiving earlysupport from one of ten RightCare Delivery Partners. The remainder of CCGs are in Wave 2 and willreceive support from an expanded team of Delivery Partners later in 2016.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

NHS RightCare CFV Neurological focus packWhy act?5“What Commissioning for Value does is shine an honest light on what we are doing. The RightCare approachthen gives us a methodology for quality improvement, led by clinicians. It not only improves quality but alsomakes best use of the taxpayers’ pound ensuring the NHS continues to be one of the best value health and caresystems in the world.”Professor Sir Bruce KeoghNational Medical Director, NHS England“The data and evidence available through tools such as Commissioning for Value will help commissioners makethe most important decisions in delivering concrete and sustainable clinical and financial benefits across theNHS. We expect that the roll-out of the RightCare programme will drive up the quality of care while contributingsignificantly to meeting the efficiency challenge set out in the Five Year Forward View.”Paul BaumannChief Financial Officer, NHS England“Clear local care pathways for patients with common neurology conditions have often been neglected, resultingin fragmented, inefficient and ineffective care. Data on CCG spending for emergency care for these commonconditions shows considerable opportunities to improve care at lower cost. The CFV neurological packs providethis information at a local level in a clearly accessible and informative way, which will help CCGs commissionbetter care pathways.”David Bateman MD FRCPConsultant Neurologist, City Hospitals Sunderland NHS Foundation TrustNHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

NHS RightCare CFV Neurological focus packCommissioning for Value6Commissioning for Value is apartnership between NHS England andPublic Health England. The Where toLook packs produced in January 2016support the first phase of the NHSRightCare approach.The Where to Look packs begin with areview of indicative data to highlight thetop priorities or opportunities fortransformation and improvement foryour CCG.These focus packs help CCGs to beginwork on phase two What to Change byusing indicative data along a pathwayto identify improvement opportunities.Where to Look packsFocus packsNHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

NHS RightCare CFV Neurological focus packYour most similar CCGs7Your CCG is compared to the 10 most demographically similar CCGs. This is used to identify realisticopportunities to improve health and healthcare for your population. The analysis in this pack is based ona comparison with your most similar CCGs which are: West NorfolkGreat Yarmouth and WaveneySouth Kent CoastIsle of WightScarborough and Ryedale Lincolnshire EastHerefordshireNorthumberlandEastbourne, Hailsham and SeafordEast Riding of YorkshireTo help you understand more about how your most similar 10 CCGs are calculated, the Similar10 Explorer Tool is available on the NHS England website. This tool allows you to view similarity across allthe individual demographics used to calculate your most similar 10 CCGs. You can also customise yoursimilar 10 cluster group by weighting towards a desired demographic factor.In addition to the similar 10, there are CCG cluster groups which have been constructed using the samevariables (eg deprivation) as the similar 10. This larger cluster group is used in the opportunity tables,represented by a green triangle. Your CCG is in the following cluster group: Smaller CCGs with older populations and more rural areasNHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

NHS RightCare CFV Neurological focus packYour data8This focus pack presents analysis of a wide range of indicators focussing on spend, activity, quality andoutcomes. The indicators have been chosen with advice from national clinical leads and other keystakeholders including the National Mental Health Dementia and Neurology Intelligence Network.The data in this pack are the latest available*. The charts identify the metadata for each indicator and thefull metadata set will be available on the Commissioning for Value pages of the NHS England websiteshortly. Data quality has been assessed and only indicators which are sufficiently robust have beenincluded in the pack.The data are presented as an exploration, starting with the pathways on a page, then moving to electiveand non-elective spend, admissions, prescribing and procedures.Should you have any queries about the indicators or the data, please refer to the contact details on the‘further information and support’ page at the end of this pack.*As the spend indicators have been updated since the publication of the 2016 refreshed ‘Where to look’ packs, figuresfor spend rates and potential opportunities may differ slightly from those packs.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Pathways on a page9The intention of this pathway is not to provide a definitive view on priorities but to help commissionersexplore potential opportunities. It helps commissioners to understand how performance in one part of thepathway may affect outcomes further along the pathway. Each indicator is shown as the percentagedifference from the average of your 10 most similar CCGs.The indicators are colour coded to help you see if your CCG has ‘better’ (green) or ‘worse’ (red) valuesthan your peers. This is not always clear-cut, so (blue) is used where it is not possible to make thisjudgement. For example low prevalence may reflect that a CCG truly does have fewer patients with acertain condition, but it may reflect that other CCGs have better processes in place to identify and recordprevalence in primary care. Blue indicators could show significant opportunities for improvement.Even where an indicator is green there may still be an opportunity to improve. The programmeopportunity tables, starting on page 35, identify the opportunities that exist for your CCG to improve to alevel which matches the average of the best five of your similar 10 CCG group.Please note: The variation from the average of the similar 10 CCGs is statistically significant for thoseindicators where the confidence intervals do not cross the 0% axis.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Epilepsy Pathway10BetterWorseNeeds local interpretation80%% difference from Similar 10 CCGs60%40%20%0%-20%-40%Prevalence ofEpilepsy, 18 Prescribingspend escribingProportionProportion Emergency bed- Average length Mention ofspend - Sodiumspend spend spend - Otheradmitted toadmitted todays following of stay after anepilepsy ValproateLeviteracetam Carbamazepine drugs excluding hospital withhospital with admissions foremergencyadmissions perPregabalin Epilepsy primaryEpilepsyepilepsyadmission for100,000diagnosismentionepilepsyEpilepsy Proportionadmissionsmanaged byneurologistElective spend - Non-Elective Epilepsy seizureEpilepsyEpilepsyspend - Epilepsy free 12-month mortality rateperiodNICE ww.nice.org.uk/guidance/qs26NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Spend and activity11The intention of the following pages is to provide a more in-depth view of the spend and activity for the clinicalareas included in this pack compared to your 10 most similar CCGs. The charts show the rate for your CCG(yellow bar) and best five comparator (blue bar) and also the absolute difference (The ‘how different are we?’column).They should be used to explore key lines of enquiry to identify potential opportunities for improvement. Forexample a CCG with a high rate of spend on emergency admissions for epilepsy patients may want to look at theQOF indicator on those who have been seizure free in the last 12 months.The opportunity tables, starting on page 35, identify the best CCG in your similar 10, who you may want to contact– either directly or through your Delivery Partner.Prescribing and procedures groups and single interventions have been chosen to reflect highest spend. NationalClinical Directors and other expert stakeholders have advised on the chemical groupings of drugs used to treatcertain conditions within a pathway. Similarly they have advised on procedure grouping. Annex A gives details ofthose groupings.For some indicators, the difference between the value for your CCG and the Best 5 is marked as Not StatisticallySignificant (NSS). This means that we cannot say with confidence (statistically defined as 95% confidence) thatany difference between your CCG and the Best 5 is not simply due to chance. Values for these cases have beenincluded in order to provide detailed information for use in considering whether to explore an area further.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Neurological - Neurological (Other 7X) - SpendHastings and Rother12Best 5How different are we? 13,660Total Spend 438k 11,758 4,470 258kElective Spend 3,181 9,331Non-elective Spend 220k 8,421 0 2,000 4,000 6,000 8,000 10,000 12,000per 1,000 age-sex weighted population 14,000 16,00095% confidence intervalsThe Neurological programme budgeting category (PBC) comprises 'Chronic Pain’ (7A) and 'Neurological Other’ (7X).Subsequently this pack refers to 'Neurological' which is ‘Neurological Other’ (7X), 'Tumours of the Nervous System' (included within the ‘Cancerand Tumours’ PBC) and 'Traumatic Brain and Spine injuries' (include within the ‘Trauma and Injuries’ PBC).NHS RightCare CFV Neurological focus packNSSNot statistically significantNHS Hastings and Rother CCG

Neurological - Chronic Pain (07A) - Spend13Hastings and RotherBest 5How different are we? 12,007 530kTotal spend 9,419 3,689 73kElective spend 3,340 8,324 554kNon-elective spend 5,598 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000per 1,000 age-sex weighted population95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Spend on Elective Admissions14Condition GroupHastings and RotherBest 5How different are we? 510Epilepsy 55k 181 514Tumours of the Nervous System 801 10 22MND and Spinal Muscular Atrophy 256MS and Inflammatory Disorders 386 197Parkinsonism 22k 94 306Neuromuscular Diseases 52k 34 2 6Functional Disorders 0 16Traumatic Brain and Spine injuries 215 153Migraines and Headaches 0 100 12k 200 300 400 500 600 700 800 900per 1,000 age-sex weighted population95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Spend on Elective Admissions15Primary DiagnosisHastings and RotherBest 5How different are we? 223 2k (NSS)Syncope and collapse 215 1,048Carpal Tunnel Syndrome 132k 443 0 200 400 600 800per 1,000 age-sex weighted population 1,000 1,20095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Spend on Non-Elective Admissions16Condition GroupHastings and RotherBest 5How different are we? 1,384Epilepsy 54k 1,120 1,155Tumours of the Nervous System 131k 560 46 50MND and Spinal Muscular Atrophy 254 180MS and Inflammatory Disorders 15k (NSS) 294 306Parkinsonism 41 26Neuromuscular Diseases 3k (NSS) 50 113Traumatic Brain and Spine injuries 978Migraines and Headaches 69k 605 0 200 400 600 800 1,000 1,200per 1,000 age-sex weighted population 1,400 1,60095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Spend on Non-Elective Admissions17Primary DiagnosisHastings and RotherBest 5How different are we? 1,552Tendency to fall (Notelsewhere classified) 117k 1,132 964 75kSyncope and collapse 662 601 36kDisorientation (unspecified) 467 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800per 1,000 age-sex weighted population95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Chronic Pain - Spend on Elective AdmissionsHastings and Rother18Best 5How different are we? 298Chest 24k 187 375 358Abdomen 3k (NSS) 919Back 79k 549 838Joint 59k 557 119 138Limb 765Nervous system 25k 646 87 79Neck 2k (NSS) 184 180Not elsewhere classified 0 1k (NSS) 200 400 600 800per 1,000 age-sex weighted population 1,00095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Chronic Pain - Spend on Non-Elective AdmissionsHastings and RotherBest 519How different are we? 173k 2,206Chest 1,395 157k 3,130Abdomen 2,276BackJoint 629 359 58k 663 82k 340LimbNervous systemNeckNot elsewhere classified 0 255 120 30k 374 252 26k 99 37 14k 156 84 14k 500 1,000 1,500 2,000 2,500per 1,000 age-sex weighted population 3,000 3,50095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Admissions - Headaches and Migraine20per 100,000 age-sex weighted populationHastings and RotherHow different are we?Best 523.7Day case admissions per100,000 population20 adms.13.405101520250.0Average Elective LOS(not including day cases)Indicator not available due to insufficient numbers / data quality0.01.1Average Emergency LOS1.200.20.40.60.811.21.41.695% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Admissions - Epilepsy21per 100,000 age-sex weighted populationHastings and RotherHow different are we?Best 514.4Day case admissions per100,000 population14 adms.5.9Number of emergencyadmissions by children per100,000 children172.018 adms.124.00501001502006.9Average Elective LOS(not including day cases)94 Bed days3.0102 Bed days2.4Average Emergency LOS(for children)0.8012345678Mean length of stay (days)95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Admissions - Tumours of the Nervous System22per 100,000 age-sex weighted populationHastings and RotherHow different are we?Best 53.8Day case admissions per100,000 population11.3024681012144.4Average Elective LOS(not including day cases)6.89.7Average Emergency LOS124 Bed days (NSS)6.6024681012Mean length of stay (days)95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Admissions - Multiple Sclerosis and InflammatoryDisorders23per 100,000 age-sex weighted populationHastings and RotherHow different are we?Best 544.4Day case admissions per100,000 population62.801020Average Elective LOS(not including day cases)3040506070Indicator not available due to insufficient numbers / data quality6.2Average Emergency LOS8.2012345678910Mean length of stay (days)95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Admissions - Parkinsonism and other Extrapyramidaldisorders24per 100,000 age-sex weighted populationHastings and RotherHow different are we?Best 56.4Day case admissions per100,000 population6.9012Average Elective LOS(not including day cases)345678Indicator not available due to insufficient numbers / data quality14.8Average Emergency LOS105 Bed days10.3024681012141618Mean length of stay (days)95% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Admissions - Neuromuscular diseases25per 100,000 age-sex weighted populationHastings and RotherHow different are we?Best 532.9Day case admissions per100,000 population49 adms.7.70Average Elective LOS(not including day cases)5101520253035Indicator not available due to insufficient numbers / data quality4.2Average Emergency LOS7.695% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Primary Care Prescribing Spend26Condition drug groupsHastings and RotherBest 5How different are we? 3,034 153kAnti-epileptic drugs 2,342 2,260 125kAnti-Parkinsons disease drugs 1,696 521Drugs for narcolepsy 12k 467 1,925Migraine drugs 43k 1,728 0 500 1,000 1,500 2,000 2,500 3,000 3,500per 1,000 ASTRO-PU weighted populationMedicines Optimisation Dashboard: vation Scorecard: vation-scorecard/NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Neurological - Primary Care Prescribing Spend27Individual drugsHastings and RotherBest 5How different are we? 178 15kRizatriptan 112 524 56kSumatriptan Succinate 268 53SelegilineHydrochloride 9k 12 124Rasagiline Mesilate 136 0 100 200 300 400per 1,000 ASTRO-PU weighted population 500 60095% confidence intervalsSumatriptan Succinate and Rizatriptan are the two highest spend drugs within ‘Migraine drugs’ group.Selegiline is considered to be better value for money than Rasagiline (both Anti-Parkinsons drugs) with similar outcomes.NHS RightCare CFV Neurological focus packNSSNot statistically significantNHS Hastings and Rother CCG

Chronic Pain - Primary Care Prescribing SpendHastings and RotherBest 528How different are we? 1,719Buprenorphine 237k 646 139k 1,440Fentanyl 811 468Gabapentin 537 4,471Pregabalin 68k 4,163 653Morphine 11k 605 135Dihydrocodeine Tartrate 159 0 1,000 2,000 3,000 4,000per 1,000 ASTRO-PU weighted population 5,00095% confidence intervalsMedicines Optimisation Dashboard: vation Scorecard: vation-scorecard/NHS RightCare CFV Neurological focus packNSSNot statistically significantNHS Hastings and Rother CCG

Neurological - Procedures29Hastings and RotherBest 5How different are we? 3,791CT - Head155 procs. 2,686 973Carpal tunnel release120 procs. 423 384MRI - Head 46412 procs. (NSS) 552Diagnostic spinal puncture (unspecified) 435 393CT - Not elsewhere classified12 procs. 257 183Immunomodulating drugs Band 1 314 92Transthoracic ECG 104 0 500 1,000 1,500 2,000 2,500 3,000 3,500per 1,000 age-sex weighted population 4,000 4,50095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Neurological - Procedures continued30Hastings and RotherBest 5How different are we? 323Rehab - other disorders1 procs. (NSS) 303 356MRI - Not elsewhere classified7 procs. (NSS) 266 130Implantation - ECG loop recorder 152 217Bladder catheterisation4 procs. (NSS) 126 371EEG telemetry20 procs. 81 102Torsion dystonias and other drugs Band 19 procs. 62 0 50 100 150 200 250 300 350per 1,000 age-sex weighted population 40095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Chronic Pain - Procedures31Hastings and RotherBest 5How different are we?54 procs. 676CT - Not elsewhereclassified 45887 procs. 608CT - Head 297 78Injection - spinal facet 136Coronary arteriographytwo catheters 43139 procs. 96 395Immunoglobulins Band 1106 procs. 107Injection of therapeuticsubstancejointDiagnosticspinal puncture(unspecified) 105 125 173 1426 procs. (NSS) 181Angiocardiography- left heart16 procs. 53Injection of therapeuticsubstance spinalnerve rootMRI Not elsewhere classified 31 69 74 135 0 100 200 300 400 500 600per 1,000 age-sex weighted population 700 80095% confidence intervalsNSSNHS RightCare CFV Neurological focus packNot statistically significantNHS Hastings and Rother CCG

Scatter Plot Analysis32The Commissioning for Value Explorer Tool allows the comparison of two indicators, the diagram below is an example. This is aninvaluable tool to enable users to assess how one indicator relates to another. The similar 10 can be highlighted too. It is important toremember that correlations do not imply causation but the relationships can help target where to look. The explorer tool is available -for-ccgs/comm-for-value/CCG ValuesSimilar 10Hastings and RotherLinear (CCG Values) 3,000Epilepsy - Non-elective spend ( per 1,000 pop.)y -22.918x 2737.9R² 0.2533 2,500 2,000 1,500 1,000 500 04045505560657075808590Epilepsy seizure free 12-month period (%)NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Opportunity table: Methodology33The opportunity tables present all focus pack indicators for five aspects of the pathway. Risk Prevalence and detection Service and quality Spend OutcomesThe width of the spine chart shows the England range. Your CCG is benchmarked against its similar 10group. The shaded area of the spine chart within the table shows the range for the similar 10 group.Where the CCG is highest or lowest compared with its similar 10 group it is shown as outside that grouprange. This has been done to clearly show where the CCG is in relation to the similar 10 and theEngland worst/highest and best/lowest values.Opportunities have been calculated for all indicators apart from those that relate to recorded prevalenceand some risk factors. Where an indicator can be clearly interpreted as worse or better the spine chartsshow the position of the CCG, the best five average, and the wider cluster best CCG. The opportunity isquantified where the CCG is worse in relation to the Best 5 average.Where an indicator needs to be locally interpreted (for example elective spend) and the CCG is higherthan the average of the 5 CCGs with the lowest values, the opportunity table shows the potentialopportunity. By calculating the potential opportunity it is possible to answer the question “Is it worthinvestigating this further?” The Best 5 average and the cluster best are not shown on the spine chart forthese indicators.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Opportunity table: InterpretationEngland WorstorEngland HighestYour CCG(for indicators that require LocalInterpretation)Best 5 CCGaverage34Wider cluster groupbest CCG‡England BestorEngland Lowest(for indicators that require LocalInterpretation)WorseAny Town CCGp.30Not Stat SigAny Town CCGp.31Not Stat SigAny Town CCGp.32BetterAny Town CCGp.33No DataAny Town CCGp.34Locally InterpretThe shaded area is the range for your similar 10 group. YourCCG is the yellow circle and, as it is not part of the similar10, it could appear anywhere from England worst/highest tothe England best/lowestThe darker green shading shows the worst quintile in thesimilar 10.Red Statistically significantly worse than best 5 & quantified CCG opportunityAmber & ‘amount (NSS)’ Not statistically significant – worse than best 5Amber & ‘blank’ Not statistically significant – better than best 5Blue Indicator is to be locally interpreted and requires contextual information.Potential opportunities are only shown where the CCG is higher than the best 5. Nopotential opportunities are calculated for prevalence and some risk factors.Green Statistically significantly better than best 5‡ The wider cluster group best CCG is not always in the similar 10. It is included to indicate a'stretch' target. Your wider CCG cluster group is identified onpage 7.NHS RightCare CFV Neurological focus packNHS Hastings and Rother CCG

Neurological Conditions - Opportunity table - Risk*per 1,000 age/sex weighted population** per 100,000 age/sex weighted population*** per 1,000 ASTRO-PU weighted populationIndicatorEngland Worst orCCG Value HighestNHS Hastings and Rother CCGEngland Best Best/Lowest 5or Lowest Opportunity25.8NA*0.2NA*GP registered population aged 75 years (%)11.4NA*Injuries due to falls people 65 (**)2265NA*Population with LLTI or disability (%)22.8NA*9.0NA*Overall index of multiple deprivationIncome Deprivation Affecting Older People IndexPrevalence of depression (%)* No opportunity is calculated for risk and reported prevalence indicatorsSimilar 10 BestPlease refer to slide 34 for full guidance on interpretation of this table of opportunities35Page

Neurological Conditions - Opportunity table - Prevalence and detection*per 1,000 age/sex weighted population** per 100,000 age/sex weighted population*** per 1,000 ASTRO-PU weighted populationIndicatorPrevalence of Epilepsy, 18 (**)CCG Value0.9%* No opportunity is calculated for risk and reported prevalence indicatorsEngland Worst orHighestNHS Hastings and Rother CCGEngland Best Best/Lowest 5or LowestOpportunitySimilar 10 BestNA*Please refer to slide 34 for full guidance on interpretation of this table of opportunities36Page

Neurological Conditions - Opportunity table - Activity and quality*per 1,000 age/sex weighted population** per 100,000 age/sex weighted population*** per 1,000 ASTRO-PU weighted populationIndicatorCCG ValueEngland Worst orHighestNHS Hastings and Rother CCGEngland Bestor LowestBest/Lowest 5OpportunityHeadaches and migraine - Day case admissions (**)23.7Headaches and migraines - Average length of stay - emergency (bed days)1.1Proportion admitted to hospital - Epilepsy primary diagnosis (**)72.026 Adms.Proportion admitted to hospital with Epilepsy mention (**)326.067 Adms.Mention of epilepsy - number of admissions (**)432.4179 Adms.Epilepsy - Day case admissions (**)14.414 Adms.Epilepsy - Average length of stay - elective (bed days)6.994 Bed daysEpilepsy - average length of stay - emergency (bed days)1.1Emergency bed-days following admissions for epilepsy(**)275.069 Bed daysEpilepsy - Average length of stay - children - emergency (bed days)2.4102 Bed daysEpilepsy - Proportion admissions managed by neurologist (%)13.3Tumours of Nervous System - Day case admissions (**)3.8Tumours of Nervous System -Average length of stay - elective (bed days)4.4Tumours of Nervous System - Average length of stay-emergency (bed days)9.7MS and Inflammatory Disorders - Day case admissions (**)44.4Multiple Sclerosis - Average length of stay - emergency (bed days)6.2Parkinsonism - Day case admissions (**)6.4Parkinsonism - Average length of stay - emergency (bed days)14.8105 Bed days (NSS)Neuromuscular diseases - Day case admissions (**)32.949 Adms.Neuromuscular diseases - Average length of stay - emergency (bed days)4.2Similar 10 Best37Page20 Adms.Isle of Wightp.46East Riding of Yorkshirep.47124 Bed days (NSS)Please refer to slide 34 for full guidance on interpretation of this table of opportunities

Neurological Condit

It is now referenced in the Mandate to NHS England, the NHS Planning Guidance and the CCG Improvement and Assessment Framework. The RightCare programme includes the Commissioning for Value packs and tools, the NHS Atlas series and a number of casebooks. NHS England has committed significant funding to rolling out the RightCare

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