Research into the management of brain injury, stroke and neurological conditions by Clinical Commissioning Groups (CCGs) reveals a widespread lack of knowledge about the neuro-rehab pathways they are influencing.
Our study, involving Freedom of Information requests to every CCG in the country, also highlights inconsistencies in the way neuro- rehab care is commissioned.
Less than 16% of CCGs were able to say how many patients with brain injury, stroke or neurological conditions were allocated neuro-rehab care in 2015/16.
Even fewer had a breakdown of whether those patients accessed their care through an inpatient facility – or what proportion involved independent providers.
Of the 18 CCGs with this data, eight said they used only NHS neuro-rehab facilities, while four were 100% reliant on independent providers.
Only a handful had a relatively even split between the two.
Almost every CCG could identify the number of patients admitted to acute services with symptoms that ultimately led to a stroke or brain injury diagnosis. Yet, once those patients progressed through the system, data collection by the CCG appears to have dried up in many cases.
The responses also showed notable differences in the way funding for referrals to independent neuro-rehab facilities is approved and allocated.
In the majority of CCGs, panels of some description are involved in the decision to approve or reject funding applications for private neuro-rehab care.
At some CCGs, the final decision appears to land on the desk of a single senior professional, however.
While most CCGs have clear steps to follow for funding applications, certain CCGs said no formal process exists, with the approvals process changing on a case-by-case basis.
In other examples, the CCG said it has no involvement in the application process and no information about how inpatients access neuro-rehab.
Instead they pointed to the role of healthcare trusts in the process.
The pace of decision-making also appears to vary. In one instance decisions are made by a board which meets every two weeks.
In another example, daily ‘white board meetings’ attended by ward sta help to progress applications towards conclusion.
Generally funding for neuro-rehab is agreed for 12 weeks, with reviews taking place a er anything from six to 10 weeks.
Some CCGs put their lack of clear data on the treatment of people with brain injury, stroke and neurological conditions down to the way they classify cases.
“We are unable to differentiate between neurological rehabilitation and other types of rehabilitation,” was a common response.
Perhaps the current drive to improve the way the NHS harnesses data will give CCGs a clearer picture of neuro-rehab provision in future.
In the government’s 2015 spending review, £4.2bn was committed to fund the digitisation of the NHS.
The National Information Board, which oversees the ‘big picture’ of IT in the NHS, has since set out its key areas of focus.
Among 10 so-called ‘delivery domains’ is ‘data outcomes for research and oversight’.