Priority areas for care quality improvement are underrepresented – and sometimes completely left out – of the proposed accountability regime for clinical commissioners.

The finding is from analysis by the consultancy MHP Health Mandate, which has been shared with HSJ.

From April 2013, clinical commissioning groups will be monitored on performance against indicators in the NHS commissioning outcomes framework.

A National Institute for Health and Clinical Excellence consultation on more than 100 potential measures closed on 29 February.

Health Mandate analysed the indicators and found that many disease areas had relatively few indicators despite accounting for a large proportion of NHS spending.

There are no proposed indicators for neurological conditions, even though dementia has been highlighted as a top priority by the government. According to NHS budgeting data, neurological conditions account for £4.3bn, more than 4 per cent, of spending.

Around £3bn is spent on diabetes and other nutritional and metabolic disorders, but this area has more than 10 indicators in the framework proposals.

There are no indicators linked to trauma and injuries. Cancer and musculoskeletal services also appear to lose out when  compared with the amount which is spent on them.

The Health Mandate analysis, published today, shows that 56 per cent of the indicators in the framework are based on NICE quality standards. Most of the rest have been taken from the NHS outcomes and operating frameworks. The analysis shows that, as a result, conditions which already have NICE quality standards are over-represented in the framework.

The analysis also highlights the problem revealed by HSJ this month that NICE is behind schedule on producing quality standards. It says this could mean the framework continues to be unfairly balanced. The report estimates that if NICE was on course to publish 150 indicators by July 2015, as planned by the Department of Health, it should by now have issued 48. In fact it has only published 14.

Health Mandate managing director Mike Birtwistle said having an “imbalance” in measures could mean CCGs prioritised the wrong issues. He said: “The importance of NICE quality standards is becoming increasingly clear, yet many of the quality standards will not be ready in time to influence the early years of the commissioning outcomes framework.

“There is a danger that the imbalance in prioritisation seen [in the current GP pay for performance framework] will be replicated in the commissioning outcomes framework and this may lock in a distortion of priorities to the performance management of the next generation of commissioners.”

Responding to the analysis, a NICE spokeswoman said: “NICE has recently held its first consultation for the 2013-14 COF. The purpose of the consultation was to gather feedback on this draft indicator set for the independent COF Advisory Committee to consider, together with results of indicator testing, at its next meeting in May 2012.

“A final set of indicators has not yet been decided and it is too early to predict exactly which indicators will be included in NICE’s final recommendations for the NHS Commissioning Board. The [board] will ultimately decide which of NICE’s proposed recommendations will be used within the COF.

“Of the 120 indicators in the consultation, 33 are based on NICE Quality Standards, which is roughly a third… Developing indicators from existing NICE Quality Standards ensures that the indicators are robust and based on the best available evidence and data. The potential indicators for the first year of the COF are restricted to those where data is available in current systems. It requires longer term work to develop new data fields and data sources. Future indicators on different topic areas will be prioritised as the programme continues.”

NICE also denies that its work on quality standards has been delayed. The spokeswoman said: “NICE is on track to develop 150 quality standards by 2015. Fourteen quality standards have been published so far, with a further 32 currently in development/shortly due to start. In addition, NICE has recently received 10 new quality standard topic referrals from the Department of Health.”

Steve Ford, chair of the Neurological Alliance and Parkinson’s UK chief executive, said: “There are two million people in the UK living with neurological conditions and yet, they continue to be sidelined by the government.

“The billions of pounds being spent on neurology every year should deliver good value and quality services for patients. However, the recent National Audit Office report exposed how simply throwing money at a problem does not solve it. Health Mandate’s research only serves to underline this. The government must avoid the mistakes of the past and implement real monitoring through quality standards to ensure they fulfil their promise to improve patient outcomes.”