Dara Calleary (Mayo, Fianna Fail)
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249. To ask the Minister for Health the details of the national epilepsy service; his views on whether a seven-day service would be more appropriate than the current service; the supports and services that are available to epilepsy sufferers outside of Dublin; and if he will make a statement on the matter. [5025/17]

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Epilepsy is a neurological condition that is associated with seizures. While many causes are unknown, it may be the result of a brain injury, stroke, infection, malignancy or genetic conditions. It is diagnosed using a variety of tests including an EEG, brain scans and blood tests. These diagnostic tests are available in hospitals. It can be managed by anticonvulsant medication which are widely available in primary care and acute hospital settings. Surgery may be required for less common forms of epilepsy.

The HSE's National Clinical Programme for Epilepsy has advised my Department of improvements in epilepsy services with the development of epilepsy centres, 16.5 whole time equivalent Advanced Nurse Practitioners for Epilepsy in post, an Electronic Patient Record in use across the country (more than 6,500 patients are now registered on the Electronic Patient Record) and the development of additional specialised centres.

Prior to the establishment of the National Clinical Programme for Epilepsy, there were two beds available nationally for Epilepsy Monitoring based at Beaumont Hospital. Four beds are now available at Beaumont Hospital. In addition, a second Epilepsy Monitoring Unit has been opened in Cork University Hospital which has 2 beds. This has made an impact on services available to those with severe Epilepsy

In Ireland, composite data from the Hospital In-Patient Enquiry system (HIPE) revealed that in 2008 - before the programme was established - there were 6,982 discharges from acute Irish hospitals with a principal diagnosis of epilepsy. The total number of bed days used was 31,532 with an average (mean) length of stay (LOS) of 4.5 days (median 3.3 days) per discharge. The creation of a new Model of Care in Ireland using a seizure care pathway with early follow-up and prioritised diagnostics shows average length of stay has been reduced to 3.4 days in 2015. The number of patients being admitted to hospital has also seen a decrease to 6,009 – a release of thousands of bed days into the acute hospital setting. This has been due in a large part to the development of a wide breadth of nurse led services including:

- Nurse led OPD clinics;

- Nurse led rapid access clinics;

- Regional Outreach services;

- Group OPD clinics;

- Ambulatory phone and email service; and

- Educational programmes to both nurses and other health & social care professionals.

Another contributing factor to the reduction in admissions has been the development and implementation in 2 sites of the Acute Seizure Integrated Care Pathway. An audit of the use of the integrated care pathway in one hospital demonstrated a reduction in admission rate from 45.9% (when the pathway wasn’t used) to 28.7% where the pathway was followed. A significant drop in patient readmissions with seizure was also noted when the pathway was used i.e. 7.41% of patients were readmitted to hospital with seizure when the pathway was not used versus 0.8% readmission rate when the pathway was used.

The HSE National Clinical Programme for Epilepsy has a vision for the transformation of epilepsy care in Ireland. The core of the plan to deliver these objectives is to address each aspect of care with a specified care pathway delivered by experts:

1. Local level: This includes the patient’s GP, Primary Care HSCPs and nurses, Community Rehabilitation Teams, the nearest Acute General Hospital and support provided by Epilepsy Ireland, the national advocacy service for people with epilepsy.

2. Group Epilepsy/Neurology Services: The hospitals with an epilepsy service (existing or proposed) collaborate to function as a Group Neurology Service, operating as a Clinical Network in each of the six Hospital Groups. These group neurology services will support hospitals within their hospital group and Primary Care professionals in the management of patients with epilepsy in a planned and coordinated way.

3. National Tertiary Centres: In addition to the two neuroscience centres, Beaumont Hospital and Cork University Hospital, tertiary centres can be further developed across the service. Tertiary centres will generally have teams with sub specialism in some of the low volume / high complexity conditions within epilepsy.