For each recommendation, the committee considered the additional pressures that additional referrals could place on neurological services. To give the committee a reference point for what impact the recommendations could have, it was presented with the annual total number of neurological referrals along with the total cost to the NHS. The following outpatient attendance numbers were taken from the Hospital Episode Statistics (HES) for England 2014/15.²²¹

The HES show the number of first-time outpatient attendances split by age group. It was felt that this number would capture all of the attendances that arise from referral for a neurological symptom.

For children and young people under 17 years of age, the HES showed data for individuals attending neurological services and paediatric neurological services separately. These data are shown in Table 4 below. For young people and adults above 16 years of age, the data showed the number attending 55 paediatric neurological services (336) was <0.1% of total appointments and is therefore not shown below.

Overall, the data show that in 2014/15 there were:

• 24,696 first-time outpatient visits for a neurological-related problem for children under the age of 17
• 493,110 first-time outpatient visits for a neurological-related problem for young people and adults over the age of 16.

NHS references costs (2015/16) show that a consultant-led neurological outpatient attendance costs £178.94. A consultant-led paediatric neurological outpatient visit costs £380.16.¹⁵⁴

If we apply the NHS reference costs to all neurological outpatient visits for those under 16, the total cost to the NHS is between £7,944,183 and £9,388,337. The range of costs depends on the cost of neurological services for children who do not see a paediatric neurologist, which the data below suggest occurs in 29% of people under 17 years of age.

If we apply the cost of an average neurological outpatient visit to all neurological outpatient attendances to those over 16 years of age, the cost to the NHS is £88,303,003.

Therefore, if first-time neurological attendances for children were to be increased by 10%, this would cost the NHS approximately £1,000,000. If first-time neurological attendances for adults increase by 1%, this would cost the NHS approximately £900,000.

The committee was presented with these data and used them to make judgements about the potential health economic impact of recommendations within this guideline.