PurposeA key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models.Key messages(i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services.Conclusion(i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.

Purpose -This article aims to cover the experience of working with the new framework/criteria for specialist neuro-rehabilitation services to meet the needs of patients with rare or complex conditions to achieve eligibility for a level 1 status.Design/methodology/approach -Royal Leamington Spa Rehabilitation Hospital is currently collecting the full UK Rehabilitation Outcomes Collaborative (UKROC) dataset for all in-patient episodes. A number of tools for measuring rehabilitation needs were gathered by the multi-disciplinary team (i.e. costing of the service including staffing, building, equipments, etc.), and a range of clinical measures including needs: (the rehabilitation complexity scale); inputs: the Northwick Park nursing and therapy dependency scales (NPDS, NPTDA); and outcomes: the UK functional assessment measure (UK FIM þ FAM) which are collated on the national UKROC database.Findings -These measures have been used to assess the level of a patient's complex needs and to help formulate bandings, which are being used to inform national tariffs. A number of advantages and disadvantages have been acknowledged from the introduction of the new criteria and have been addressed in this viewpoint. As the current trend for services is to be paid (payment by results) depending on activity and outcome, it is essential to provide good outcome data to monitor performance and justify the units' effectiveness.Originality/value -This paper outlines the authors' journey to achieve specialist commissioning and highlights the importance of monitoring and measuring the units' performance to reflect the continuous needs of the NHS and patients.