The National Institute for Health and Clinical Excellence (NICE) on the 28 February 2013 issued an updated guide for commissioners to support the integrated commissioning of high-quality, evidence-based services for the diagnosis and management of the epilepsies in adults, children and young people. The guide focuses on improving the diagnosis of epilepsy and ensuring that diagnosis and treatment are both confirmed and reviewed as necessary.
The guide also focuses on tailoring treatment to individual circumstances and the needs of people with epilepsy so that they are offered the most suitable treatment. The guide, according to a release, will help commissioners towards achieving the outcomes set out in the NHS, Public Health and Adult Social Care Outcomes Frameworks, as well as achieving improvement areas in the Clinical Commissioning Group outcomes indicator set.
Illustrated throughout with service model example from across the spectrum of epilepsy services, the guide highlights the benefits of adhering to the NICE quality standards for the epilepsies in adults and the epilepsies in children and young people in terms of appropriate and urgent referral for people with suspected epilepsy, prompt access to diagnostic investigations, including the use of magnetic resonance imaging (MRI), and the importance of review and re-access to appropriate care for people with epilepsy.
The guide recommends that commissioners should consider commissioning services for the diagnosis and management of the epilepsies in adults, children and young people in several different ways, working with a range of partners and stakeholders, including clinical commissioning groups, health and wellbeing boards, social care organisations and regional epilepsy networks to ensure strategic and integrated service planning. Commissioners will also need to work with primary, secondary and tertiary care, ambulance trusts, third sector organisations and employment agencies, as well as service-users and carers, when planning services for people with epilepsy. This will ensure that people receive the recommended level of high-quality care and relevant information to reduce misdiagnosis rates, epilepsy-related deaths and avoidable emergency hospital admissions.
The guide also includes two commissioning and budgeting tools to help users determine the level of service that might be needed locally and to help calculate the cost of commissioning care for adults and children and young people with epilepsy using indicative benchmarks and/or their own local data.
J Helen Cross, The Prince of Wales’s chair of Childhood Epilepsy and honorary consultant in Paediatric Neurology, UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London and Young Epilepsy, UK, said: “This guide for commissioners recognises the importance of placing people with epilepsy, their family and carers firmly at the centre of care. In doing so the guide focuses on areas of real concern to people with epilepsy such as accurate and timely diagnosis, appropriate communication, the need for regular and structured reviews and transition from children’s services to adult services. It highlights the need for commissioners to ensure that a structured, multi-dimensional, multi-agency care pathway is in place to provide optimal management of all individuals with a suspected or confirmed diagnosis of epilepsy.”
While the guide for commissioners draws on existing NICE recommendations and the NICE quality standards on the epilepsies in adults and the epilepsies in children and young people, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning.
In addition to the guide for commissioners, NICE has also published summarised support for commissioners to accompany the NICE quality standards on the epilepsies in adults and the epilepsies in children and young people which have also been published.