What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Figures suggest that epilepsy in Dorset is over-diagnosed by non-specialists, but specialists see less than 40% of those diagnosed. Correctly identifying cause would allow us to pivot existing resources to provide more appropriate interventions, and may help reduce comorbidities such as depression and falls/fractures which are more common in those with poorly controlled epilepsy; also to reduce inappropriate treatment being given for new episodes of care based on a prior erroneous diagnosis.

We want to ensure the Dorset system is working collaboratively with primary care, community and acute care to better meet the needs of heavy users of the system. For example, less than 160 people in Dorset (1.6% of the population with epilepsy) account for:

•26% of emergency activity

•21% of emergency admissions

•4.5% of outpatient activity with more than double the DNA rate

•20% of the prescribing cost

•9% of the total cost for Epilepsy provision in Dorset

What does your project aim to achieve?

Present clinicians with real-time data for the individual they are scheduled to see. This will include information such as deprivation index and indicators of factors such as social isolation and safeguarding. This will focus attention on potential inequalities and unexpected variations in therapeutic response.  Interventions such as community-delivered clinics, psychology support and health-justice partnerships will be developed using existing resources, targeted to those at greatest need. This is intended to develop a blueprint for how other services and areas can use similar approaches to drive improvements in care and reduction in health inequalities.

We plan to target high users of emergency care who have epilepsy, as data shows that they are less likely to attend specialty clinic appointments. We aim to reduce unwarranted variations in health outcomes, and we will directly ask the affected patients what matters to them and what help they need. This would provide better personalised care.

How will the project be delivered?

Adult neurology is provided by University Hospitals Dorset (UHD) for the whole Dorset County therefore we are in a good position from the start. This data work would be done in conjunction with the Dorset Intelligence and Insight Service (DIIS). Dr Rupert Page (Consultant Neurologist) and the Epilepsy Specialist Nurses will provide clinical support and act as clinical stakeholders in the project.

We will:

·        Cleanse data

·        Liaise with clinicians

·        Build dataflows between UHD and the DiiS to support the specification

·        Build dashboards

At the same time, we would use existing patient identifiable data to identify the volume users, engage primary care and community colleagues, and have a conversation with these patients to strengthen our understanding of what they need. We would also seek to build partnerships with third sector organisations to deliver support areas of need identified through this project that may not be being met by existing services.

How is your project going to share learning?

Although this is a subspecialty of Neurology, the learning can then be applied across the whole Specialty and the wider Dorset ICS, to try and generate momentum towards a Learning Health System. This approach is extensible beyond Neurology as the thematic challenges seen in epilepsy are replicated in other long-term conditions.

For Dorset and the wider health system, the legacy will include:

·        How to improve the maturity of data / data quality and how this could be applied to other data sets

·        How to create dashboards that are meaningful to clinicians

·        How clinicians can better use data in real time and what works

We will provide a blueprint for this work in other services and areas, including a Data Model (not populated) which can have Power BI attached to it. We would seek to publish on the Q blog and within a journal within 12 months of the project starting.