Provision of Neurological Rehabilitation in North West London

The Neurorehabilitation Provider Collaborative (NRPC) aims to improve the quality of care delivered to people living with life-limiting/changing neurological conditions within North West London. They are eager to address known variations in care provision across NW London and wanted to understand how we can use data to better understand population level Neuro Rehabilitation (NR) needs. 

ICHP worked with the NRPC, part of North West London Integrated Care Board, to analyse neuro rehabilitation needs across NW London using population level data via the Discover-NOW dataset. 

NW London  has a registered population of 2.7 million people, within 8 boroughs.  There are 10 acute hospitals, (6 key ones accepting neuro patients), four level 2 neuro rehab units, one level 1 unit, and 6 community teams (run by 4 providers). 

ICHP was approached to support the NRPC, using the Discover-NOW dataset, to: 

• Identify the prevalence and incidence of people with specified acquired and progressive neurological conditions (using ICD 10 codes), stratified by demographics across each borough within NW London.
• To bring people together as part of an in-person event to map the services that they provide, discuss the gaps and how provision differs across service and borough, and to work together to identify what constitutes good service. 

Discover data was extracted and analysed to identify prevalence and incidence of specified neuro conditions including patient demographics, providing a good overview of the current landscape. This was particularly effective for acute services, however there were limitations identified for community services. To address this, in collaboration with the NRPC an in-person event was planned and hosted to bring together the community teams to map service pathways and explore what good service should look like.

Using hospital acute data, we were able to gain a clear picture of the prevalence, incidence, hospital length of stay, and demographics of people living with neurological conditions in NW London. Key findings included: 

• Brent, Harrow and Hounslow have a high proportion of patients with undiagnosed neuro symptoms
• Prevalence is highest at the low and high ends of the deprivation index scale
• The 3 most prevalent condition groups in NW London are: 
  • SaH, Stroke & Occlusion & Stenosis 
  • Parkinsonism and other extrapyramidal disorders 
  • Undiagnosed neurological symptoms 

• 6% more males being seen with a stroke.
• Females are twice as likely to have MS or inflammatory disorders
• Parkinsonism, SaH, stroke & occlusion & stenosis become more common with increasing age. 

The findings of this report have been shared with the Neuro Rehab Steering group, the NRPC and Neuro Rehab services across NW London. The data from this analysis will also be used to map services against the prevalence and incidence data to show inequalities. 

To address limitations with data, the following next steps have also been advised:

• Pending IG approval, the CSDS dataset will be added into Discover-Now which will allow for more robust analysis of community healthcare activity 
• We are investigating the potential to use SNOMED codes to identify neurological activity in primary care and link it to the secondary care analysis produced for this study. 
• We will share data quality issues identified as part of this project with relevant organisations to facilitate more accurate and reliable data recording and reporting in the future