Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, pursuant to the Answer of 19 April 2016 to Question 33552, if he will make an assessment of the extent of regional variation in premature death from epilepsy.

The Epilepsy Society paper presents the findings of the National General Practice Study of Epilepsy (NGPSE), a 25-year cohort analysis of 558 people having recurring unprovoked seizures, and also considers more widely the issue of premature mortality and death in epilepsy. The NGPSE study found that 189 (34%) of the cohort died during the 25 year follow-up period, and six people in this group (3%) had died directly due to their epilepsy. The NGPSE also found a frequent link between co-morbidity in epilepsy and death.

Increasing numbers of people have multiple long term conditions (LTCs), not just single diseases, and that the management of comorbidity and multimorbidity presents a significant challenge to the National Health Service. It is an issue highlighted in the Five Year Forward View and defined as a central task of the NHS. Improving the support and choice provided to people with LTCs and enabling them to live healthy independent lives remains a key ambition for this Government. NHS England is responding with specific actions to improve the delivery of personalised care planning, self-management support and personal health budgets, as well as helping to support the development of new service models that deliver care that is more proactive and less reactive in the management of patients with LTCs. More information can be found in NHS England’s Business Plan for 2016-17, available at the following link:

www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf

Guidance from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of epilepsy covers the issue of comorbidity, including polypharmacy. However, in recognition of this increasing problem, NICE is also working to produce a new clinical guideline on the management of multimorbidity in a range of common conditions which is scheduled for publication in September 2016.

Regarding the matter of variation in epilepsy mortality, the Neurology Intelligence Network (NIN), a partnership programme between Public Health England (PHE) and NHS England, has produced a detailed epilepsy profile presenting data at clinical commissioning group (CGG) level against 20 separate indicators, including mortality. CGGs should consider mortality rates alongside other indicators such as prevalence and unplanned admission rates, and in the wider socioeconomic context of their local area to understand the challenges and consider what improvement activity may be appropriate. NHS England is also taking specific action to target unwarranted variation in treatment and outcomes across range of conditions, including epilepsy, through the Rightcare Programme, which is being rolled out to all CCGs in 2016-17. The NIN profiles can be found at the following link:

http://fingertips.phe.org.uk/profile-group/mental-health/profile/neurology

Finally, as previously set out, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme on behalf of NHS England, Wales and other devolved administration. There are no specific plans for an audit to cover all cases of avoidable deaths from epilepsy at this time.