4. Benefits for people of all ages with epilepsy, the health service and the whole system

• Improving health and quality of life through having prompt access to specialist expertise in order to obtain a correct diagnosis and begin treatment


• Avoiding delayed or incorrect diagnosis, keeping misdiagnosis to a minimum. Misdiagnosis is currently thought to be happening in a quarter of all cases


• Reducing costs of misdiagnosis to the NHS, including the cost of inappropriate prescribing of anti-epileptic drugs and medico-legal costs arising from claims and complaints


• Reducing the risk of premature death by ensuring a correct diagnosis is made and treatment optimised


• Reducing emergency admissions to secondary care by preventing seizures and seizure related incidents


• Reducing social and financial deprivation, firstly through getting the diagnosis right, secondly by getting the drug regimens right, so that people can pursue an independent, normal lifestyle and gain employment, thereby taking people off benefits


• Reducing the risk of congenital malformation by giving appropriate information, advice and anti-epileptic drugs


• Reducing health inequalities by improving access to specialist services and support, including surgery where appropriate


• Enhancing patient choice, empowerment and self management through the use of regularly reviewed care plans


• Achieving better value for money by improving the service specification in line with NICE guidelines

5. Twenty Questions: A quick check list for commissioners

• 1. Are you implementing the NICE guidelines?


• 2. If not, why not? What are the barriers?


• 3. Do you have epilepsy trained specialist staff with expertise?


• 4. If so, at what level and how many?


• 5. How many people of all ages with epilepsy are there in your locality?


• 6. Have you calculated the demand for diagnostic investigations and ongoing support and review?


• 7. What services and resources are currently provided? Include support from the voluntary sector, primary and community services, secondary, tertiary or quaternary services


• 8. How well are your local services performing?


• 9. How well are the referral systems for all levels performing?


• 10. What are the waiting times like for first referral, for diagnosis, for referral on to the next level (step up or step down)?


• 11. Do you have clear care pathways for all age groups?


• 12. Is every patient offered a care plan and if so, what are the take up rates?


• 13. How regularly are care plans reviewed?


• 14. Does everyone should have access to high quality information and advice


• 15. Is there easy access, where required, to multi disciplinary services such as psychology and speech and language therapy


• 16. When did you last do a review or an audit of your epilepsy service?


• 17. What criticisms and recommendations were made then?


• 18. Have they been acted upon?


• 19. How is current provision seen by service users and their families?


• 20. What further improvements could be made?