There are two versions of the Northwick Park Dependency Score (NPDS) for completion by staff:
There are also self-report versions that can be completed by the patient or their carer:
Northwick Park Dependency Score (original community version)
The Northwick Park Dependency Score (NPDS) is an ordinal score (total score range 0-100). It comprises three sections:
- Basic Care Needs (BCN) section - 12 items of activities for daily living and safety awareness, behavioural management, and communication (score range 0-65).
- Special Nursing Needs (SNN) section – seven dichotomous items (score range 0-35).
- Care Needs Assessment – additional five items required for translation to the Northwick Park Care Needs Assessment computerised algorithm.
Northwick Park Dependency Score - H (hospital version)
The Northwick Park Dependency Score – Hospital (NPDS-H) version is designed for hospital or residential care settings. It contains an extended version of the In-patient Nursing Needs containing eight dichotomous Yes/No items and eight ordinal items.
The total score for both NPDS and NPDS-H is 0-100.
NPDS AND NPDS-H scores may broadly be divided into three levels of dependency
| Score | Level of dependency | Help required |
|---|
|
0-10
|
Low dependency
|
Self-caring but may need incidental help
|
|
11-24
|
Medium dependency
|
Requires help from one person for most activities
|
|
25-100
|
High dependency
|
Requires help from two people for activities
|
Northwick Park Care Needs Assessment
- Once the NPDS/NPDS-H scores have been entered into the designated UK ROC software, an in-built computerised algorithm calculates the estimated care hours & care costs and produces a suggested care package to meet the needs identified.
- Graphs and tables provide a visual representation and are available within the software.
Completion of the NPDS-H/NPCNA
- The NPDS/NPDS-H is designed to be completed by any nurse or carer who is familiar with the patient's care needs.
- Within the UK ROC dataset collection of NPDS/NPDS-H/NCNA is mandated for all Level 1 & 2 specialist rehabilitation units in England. At minimum, scores should be completed on admission and discharge.
Development of the original NPDS (community version)
- The NPDS/NPCNA was developed during the 1990s using an iterative process to produce an ordinal scoring system and estimation of care needs/cost that would provide a seamless service into the community.
- The care costs were developed following extensive liaison with community care providers to establish hourly costs and live-in care costs. Care costs were updated in 2023 to reflect the care provider 12-hour shift patterns and associated costs.
Source references:
- Turner-Stokes L, Tonge P, Nyein K et al. The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation. Clinical Rehabilitation 1998; 12: 304-318. doi: 10.1191/026921598669173600.
- Turner-Stokes L, Nyein K. The Northwick Park Care Needs Assessment (NPCNA): a directly costable outcome measure in rehabilitation. Clinical Rehabilitation 1999; 13: 253-267. doi: 10.1191/026921599677787870.
- Nyein K, Turner-Stokes L. The Northwick Park Care Needs Assessment (NPCNA): a measure of community needs: sensitivity to change during rehabilitation. Clinical Rehabilitation 1999; 13: 482-491. doi: 10.1191/026921599674590637.
- Siegert RJ, Jackson D, Tennant A, Turner-Stokes L. A psychometric evaluation of the Northwick Park Dependency Scale (NPDS). Journal of Rehabilitation Medicine 2010; 42: 36-943. doi: 10.2340/16501977-0602.
Development of the NPDS-H
- The NPDS-H was further developed through an iterative process with nursing staff of all grades to further enhance the tool for use in an in-patient setting.
- The NPDS-H uses the same computerised algorithm as the NPDS to translate to the NPCNA.
Source reference:
- Williams H, Harris R, Turner-Stokes L. Northwick Park Care Needs Assessment: adaptation for in-patient neurological rehabilitation settings. Journal of Advanced Nursing 2007, 59 (6): 612-622. doi: 10.1111/j.1365-2648.2007.04344.x.
Validation of the postal version of the NPDS
Source reference:
- Siegert RJ, JacksonDM, PlayfordED, FlemingerS, Turner-Stokes L.A Longitudinal, Multi-Centre, Cohort Study of Community Rehabilitation Service Delivery in Long-Term Neurological Conditions.BMJ Open. 2014 Feb 28;4(2):e004231. doi: 10.1136/bmjopen-2013-004231.
The NPCNA does not necessarily represent the recommended care package for a given individual as this may vary with circumstances, but it provides an objective standard assessment which is not subject to bias.
Care is costed at standard rates regardless of whether it is provided by formal or informal carers, but basic care and skilled care (requiring a qualified nurse or specially trained carer) are separated. The output may then be interpreted in the light of individual circumstances.
Because the NPCNA is generic, it only provides an approximate estimate in the individual case, but offers the advantage of being able to predict care needs in relation to dependency, if this were to change over time or with rehabilitation
Licensing and accreditation
- The NPDS is designed to be intuitive and does not require formal training or accreditation.
- It is free to use and does not incur any licencing fee.
Guidelines
Further information about the NPDS/NPCNA tool and completion are also available as hard copies.
Self-Learning
Please use these three self-learning slide decks to assist with tool completion:
Training
For those who want further training in the use of the NPDS/NPCNA, sessions are provided annually through the UK Rehabilitation Outcomes Collaborative (UK ROC) as part of its Outcome Measures Training Course.
For further information and the date of the next course, please contact the UK ROC team LNWH-tr.ukroc@nhs.net
Additional references
Additional NPDS references (PURE).
Using the NPDS/NPCNA to demonstrate cost efficiency of rehabilitation
- The NPDS/NPCNA has been used extensively to demonstrate that rehabilitation provides value for money.
- A primary aim of rehabilitation is to improve independence for self-care. Recorded on admission and discharge from the programme, the NPDS/NPCNA is used to quantify any reduction in care needs and the associated savings in the weekly cost of ongoing care in the community.
- Within the UK ROC database, cost efficiency of rehabilitation is calculated in terms of the time taken these weekly savings to offset the cost of the original rehabilitation programme.
- Annual savings thereafter, extrapolated over the individual’s expected remaining years of life, may be used to estimate anticipated life-time savings in the cost of care. These calculations are now embedded in the UK ROC database for prospective patient-level reporting.
Key publications:
- Turner-Stokes L, Paul, S, Williams H. Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injury.
Journal of Neurology, Neurosurgery and Psychiatry. 2006; 77: 634-639. doi: 10.1136/jnnp.2005.073411.
- Turner-Stokes L. Cost efficiency of longer-stay rehabilitation programmes: Can they provide value for money? Brain Injury 2007; 21 (10): 1015-1021. doi: 10.1080/02699050701591445.
- Turner-Stokes L, Williams H, Bill A, Bassett P, Sephton K. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: A multicentre cohort analysis of a national clinical dataset BMJ Open 2016 Feb 24;6(2). doi: 10.1136/bmjopen-2015-010238.
- Turner-Stokes L, Bavikatte G, Williams H, Bill A, Sephton K. Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis. BMJ Open. 2016 Sep 8;6(9). doi: 10.1136/bmjopen-2016-012112.
- Turner-Stokes L, Dzingina M, Shavelle R, Bill A, Williams H, Sephton K. Estimated life-time savings in the cost of on-going care following specialist rehabilitation for severe traumatic brain injury in the UK. Journal of Head Trauma Rehabilitation. 2019 Jul/Aug;34(4):205-214. doi: 10.1097/HTR.0000000000000473.
- Turner-Stokes L, Harding R, Peihan Y, Dzingina M, Wei G Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of a national clinical dataset. Multiple Sclerosis Journal – Experimental, Translational and Clinical. 2020 Mar 16;6(1). doi: 10.1177/2055217320912789.
- Turner-Stokes l, LeFeuillee G, Francis R, Nayar M, Nair A. Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: A multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UK ROC). Disability and Rehabilitation. J 2021 Jul 20:1-9. doi: 10.1080/09638288.
The UK ROC software also includes an algorithm for automatic derivation of the Barthel Index from the NPDS assessments:
- Turner-Stokes L, Williams H, Howley D, Jackson D. Can the Northwick Park Dependency Scale be translated to a Barthel Index?
Clinical Rehabilitation 2010, 12:1112-1120. doi: 10.1177/0269215510371432.
Whilst the NPDS-H/NPCNA tool was designed for use within UK Specialist Neurorehabilitation Settings, it has also been used in alternative settings in the UK and overseas.
Requests for the NPDS/NPCNA have been received from many other countries including, Australia, New Zealand, Canada, Portugal, Italy and Ireland and to our knowledge translated into Swedish and Italian.
Working with centres in Melbourne and Perth we have adapted the costing algorithm within the Northwick Park Dependency and Care Needs Assessment for use in the Australia healthcare system using standardised national costs.
A first analysis of data from the Alfred Brain Injury Rehabilitation service in Melbourne has demonstrated that the system is transferable and a first abstract was presented at the RMANZ conference in Adelaide in October 2019. A second dataset has been initiated in with the Brightwater centre in Perth.
Based on these pilots, the Australasian Rehabilitation Outcomes Centre (AROC) is currently exploring inclusion of the NPDS/NPCNA within their national dataset.