Cranial Neurosurgery

Around 75,000 patients annually receive cranial neurosurgery on the NHS. Medical and technological advances in the last few decades have significantly improved the capacity to treat these serious and life-changing conditions. Brain cancer survival rates, for example, have doubled in the UK over the past 40 years.

Cranial neurosurgery caseloads are often a mix of medical emergencies (such as traumatic brain injuries), through to urgent non-emergencies (such as removal of malignant tumours). Other procedures, such as treatments for chronic pain conditions, can be planned as elective care .

The GIRFT national report made recommendations to help save lives and transform patient care and outcomes by reducing the risks associated with long waiting times, leveraging the expertise of the most experienced surgeons, and freeing up operating theatres and beds for new patients.

Nick Phillips

Clinical lead for cranial neurosurgery

Consultant neurosurgeon at Leeds Teaching Hospitals NHS Trust

Nick is a consultant neurosurgeon at Leeds Teaching Hospitals NHS Trust. He has worked in Leeds since 1997 and was clinical director for seven years.

His clinical interests are in endoscopic skull base surgery and radiosurgery, and he has contributed to national policy in radiosurgery. He is interested in quality improvement and outcomes, and the reporting of outcomes, and has published in this field.

A council member of the Royal College of Surgeons and the Society of British Neurosurgeons, Nick is also the lead for the National Neurosurgical Audit Programme and a member of the Invited Review Mechanism of the Royal College of Surgeons. He is the Expert Working Group (EWG) member for the Neurosurgery Casemix service of NHS Digital and Neurosurgery Advisor to HRG Development.

Nick studied Neurochemistry and Molecular Biology at the University of London before gaining a MBChB from the University of Edinburgh. He has the old style FRCS and the intercollegiate exam in Surgical Neurology (FRCS(SN)).

Paul May

Former clinical lead for paediatric neurosurgery

Director of Clinical Academic Development at University of Liverpool

Mr May was appointed as Merseyside’s Children Neurosurgeon in 1991 and was responsible for the establishing the paediatric neurosurgical service at Alder Hey Hospital, one of the country’s busiest services. In 1997, he led a successful bid to the Department of Health for the establishment of a supra regional craniofacial service at Alder Hey – one of only four services in the country.

In 2013 he was appointed chair of the Trauma Programme of Care Board for NHS England & NHS Improvement, and is a member of the Clinical Leaders Group, responsible for service specifications, service reviews, policy development and service delivery for complex orthopaedics, major trauma, burns, complex ear and eye surgery, neurosurgery, rehabilitation, complex spinal surgery and prosthetic surgery.

In 2012, Mr May was appointed vice-president of the Society of British Neurological Surgeons (SBNS) and later became president of SBNS from 2016-2018.

Mr May stepped down from his GIRFT role in March 2023.

Useful information

What is cranial neurosurgery?
Cranial neurosurgery is a term covering a wide range of surgical procedures carried out on the brain, or on nerves located in the skull.
Some of these procedures are emergencies and extremely time-sensitive, such as to remove a blood clot on/in the brain. In such instances, any delay can increase the risk of brain damage or loss of life. Cranial neurosurgery may also remove tumours and carry out procedures to address debilitating pain caused by nerve damage.

What is the purpose of the cranial neurosurgery report?
The report seeks to identify how cranial neurosurgery providers, and national bodies and programmes, could work together to deliver a better service to patients. The emphasis is on treating patients more promptly and to higher standards. These changes have the potential to free up hospital beds, operating theatres, and surgeon time, and in doing so, increase the number of procedures it conducts within the existing resources available.

What data sources were used for the cranial neurosurgery report?
The core sources used to analyse cranial neurosurgery are the National Neurosurgical Audit Programme (NNAP), established by the Society of British Neurological Surgeons (SBNS) in 2013, and Hospital Episode Statistics (HES).
Further sources used include the Intensive Care National Audit and Research Centre (ICNARC) and the Specialised Commissioning Quality Dashboard Programme for data relating to the use of critical care, trust reference costs and NHS Resolution data.
In a number of areas, the GIRFT team have had to rely on data for neurosurgery as a whole, because there is no separate data for cranial neurosurgery; there are very few widely-used outcome measures for cranial neurosurgery in England but as the programme develops it is intended to develop more informative and actionable metrics.

Review of cranial neurosurgery identifies opportunities to reduce length of hospital stay

Smarter procurement, avoiding unnecessary admissions and using critical care only when clinically required offer substantial opportunities to improve patient experience and outcomes finds an NHS report into cranial neurosurgery.

The Getting It Right First Time (GIRFT) programme has published a national report which identifies a number of data and clinically-led initiatives which could support a streamlined admissions-to-surgery process. This also has the added benefit of reducing the average length of stay in critical care wards for cranial trauma patients.

The report also highlights University Hospital Southampton’s policy of managing glioma tumour surgery which helped the trust achieve an average length of stay for these procedures of just two days – surpassing the national average of 6.4 days.