The NHS has almost no data to measure or cost the rehabilitation activity it provides to more than 1 million people in the UK living with long-term neurological conditions such as multiple sclerosis, Parkinson’s disease, and stroke. This matters because current NHS coding systems cannot capture what rehabilitation patients actually need, what staff time and resources those needs consume, or whether different services deliver value for money. Without that information, the health service cannot design fair funding models or commission services efficiently. This research programme will develop and validate standardised tools to measure patient needs, define casemix complexity, and record the medical, nursing, and therapy time provided. It will then create a patient-level costing protocol and build a national database linking needs, inputs, costs, and outcomes. The goal is to determine which models of care offer best value in different settings and to inform tariff costs under Payment by Results. If successful, the work could transform how neurorehabilitation is commissioned and funded across the UK, shifting from opaque block contracts to transparent, person-centred payment systems that match resources to patient need.
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AimsThis 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.BackgroundLTNC 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 planThe 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 teamThe 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 environmentThe 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].OutputsIt will develop a set of practical validat
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