The neurology postcode lottery

New figures released in August 2015 have revealed for the first time the extent of variation in access to neurology services across England.

The new statistical release draws on hospital outpatient data for 2012-13 to provide the first ever figures on the number and location of neurology appointments in England.

The new figures are set out in a new briefing from the Neurology Intelligence Network, which can be found here

A summary of the new data is available here

The new figures show that access to neurology services within hospitals varies significantly depending on geographical location, with some parts of the country offering no access at all to consultant neurologists or nurses, resulting in people often having to travel long distances to access necessary care, or not receiving it all.

Arlene Wilkie, Chief Executive of the Neurological Alliance, said: “The postcode lottery in neurology must come to an end. Timely diagnosis and treatment is essential to the effective management of these complex conditions, and this requires access to the appropriate specialist neurological expertise.

We welcome the publication of this data which sheds new light on the issues affecting neurology services. It is crucial that commissioners engage with these findings and take steps to ensure good access to care and support for patients in all parts of the country.”

Headline findings:

Rates of outpatient consultant appointments
  • Local rates of new consultant adult neurology outpatient appointments vary hugely by clinical commissioning group (CCG) area, from 2,531 per 100,000 resident population in Camden to as low as 165 per 100,000 population in Doncaster.
  • In total, there are 83 CCGs in which the number of new consultant adult neurology outpatient appointments is ‘significantly below’ the national average of 913 per 100,000 population.
  • The regions that have the highest proportion of CCGs with low rates of access to a neurology consultant are the South West, Wessex, East Midlands and Northern England.

Shortage of neurology facilities

  • 45 CCGs (22%) offer no local consultant neurology services whatsoever.
  • Only 37% of CCGs provide more than 80% of appointments within the local CCG area.
  • Many of these CCGs sit in the North West of England and the East Midlands. Large parts of these regions offer no local neurology provision at all
  • By contrast, the largest concentration of specialised neurology centres is in London, which also contains 19 of the 24 CCGs with the highest rates of new consultant appointments.
  • The findings reflect those of the Neurological Alliance’s 2015 report, The Invisible Patients

Out-of-area appointments

  • In Swale, Wokingham and South East Kent CCGs, only 1% of new appointments were provided locally.
  • By contrast, Liverpool CCG (which is served by the Walton Centre) provided 99.3% of new appointments locally.
  • There are clear regional disparities in the availability of local appointments, which are relatively well provided in the South, East, and West Midlands regions of England, but are almost entirely unavailable across the East Midlands and North West regions.
    Follow-up appointments and nursing appointments
  • The rate of follow-up consultant appointments provided locally ranges from 1% in Scarborough and Ryedale CCG to 99% in Liverpool CCG. The national average is 47%.
  • Nursing neurology outpatient appointments were provided in 188 CCGs, but only 70 (34%) provided appointments locally.
  • There is little or no local provision of nursing services for neurology in 50% of CCGs (112).

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