Title: Cost-efficient service provision in neurorehabilitation: defining needs, costs and outcomes for people with long term neurological conditions
Funder: Department of Health (England)

Abstract: Aims This major national programme builds on our current applied health services research (HSR) programmes to understand the diverse rehabilitation needs of patients with long term neurological conditions (LTNC). Learning from established international models, it will provide the essential research to underpin development of casemix, patient-level costing and funding models to inform tariff costs under Payment by Results (PbR). It will lead to the development of a nationally co-ordinated approach to person-centred commissioning and provision of effective and cost-efficient neurorehabilitation services. Background LTNC cause significant disability for >1 million people in the UK, and present a substantial burden of care to family members and services who support them. Although rehabilitation services help to keep people out of acute hospitals and support them in the community, current NHS coding systems provide almost no data to measure or cost rehabilitation activity. This proposal addresses key priorities in the NHS Improvement Plan and the National Service Framework (NSF) for LTNC, as well as supporting delivery of PbR - a key milestone towards cost-effective service provision in the NHS. Research plan The 5 parts of the research programme will run concurrently. • Parts 1 and 2 will develop, test and validate a standardised set of tools for measuring rehabilitation needs in people with LTNC, defining casemix and the complexity of caseload in different services, and recording the resources (in terms of medical, nursing and therapy time) that are currently provided to meet these needs. • Parts 3 and 4 explore different funding models and patient-level costing methods, and then develop a standardised costing protocol that will subsequently be used to determine the treatment costs associated with different caseload complexity. • Part 5 will establish a national database to gather systematic case-episode data from specialist neurorehabilitation services. The dataset will include data identified in parts 1-4 on needs, inputs, costs and person-centred outcomes, and will be used to address the following questions: a) What are the costs of providing neurorehabilitation for patients with different levels of rehabilitation need in different settings? b) What patient characteristics determine the type of rehabilitation services they require? c) Which models of care offer best value for money in different settings? Dissemination through guidance and policy development will support implementation. Research team The multidisciplinary research team combines the UK’s leading clinical academics in rehabilitation [LTS, BB, DW] who have between them >40 years of experience in applied HSR; >300 published papers; and >£4 million grant income since 2001. Their research has influenced national UK policy, practice standards and service models in rehabilitation. KE and CW are senior HSR leaders with direct experience in establishment and analysis of large healthcare databases. The research will be undertaken in close collaboration with the DH Information Centre for Health and Social Care [VJ]; and includes experts in casemix [SS], and patient-level costing of NHS services from the perspectives of health economics [PM], and NHS accountancy [RD]; also NHS commissioning [BH], rehabilitation service management [SW] and health services evaluation[JG]. British Society of Rehabilitation Medicine backing will ensure UK wide engagement of rehabilitation physicians. Research environment The host institution, NWLHT, also hosts the Local Comprehensive Network for R&D. It has a strong reputation for HSR with well-embedded R&D infrastructure. The principal academic base for this research programme is King’s College London (KCL), through an interdepartmental collaboration between the Department of Palliative Care, Policy and Rehabilitation [LTS, DW], the Institute of Psychiatry HSR Department [PM], and the KCL Division of HSR [CW]. Outputs It will develop a set of practical validated tools to measure the needs for rehabilitation, and interventions provided, which will inform the need for staffing levels in relation to case-load, and thus assist in cost-effective service planning, across a wide range of rehabilitation services and long term care programmes in the UK. A standard framework for patient-level costing will deliver accurate costing data to inform development of commissioning currencies and tariff costs under PbR by 2011/12. The national centralised database will yield practice-based evidence regarding high quality and cost-efficient person-centred service models to inform future planning of neurorehabilitation services by 2012/13. Public involvement User and carer involvement is integral to the planning and execution of the programme, through both national voluntary organisations (eg Neurological Alliance, Headway, MS Society) and our locally established patient groups and public involvement forum. ??


Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS
Health categories: NEUROLOGICAL