Ministers routinely meet the system leaders to discuss a broad range of issues concerning population health, including long term health problems. The Department works closely with NHS England and Public Health England (PHE) to support delivery of the Mandate and system objectives.
The PHE report, Deaths associated with neurological conditions in England 2001 to 2014, was developed by PHE’s Neurology Intelligence Network (NIN), and published on 27 February 2018. The report found that a greater proportion of epilepsy related deaths occur in areas of higher levels of deprivation. The rate of deaths associated with epilepsy in areas ranked as the most deprived in England is almost three times larger than in the least deprived; 13 deaths per 100,000 population compared to 5 deaths per 100,000 population. A copy of the report can be found at the following link:
Wider research has shown that epilepsy prevalence varies with social deprivation, but this is not well understood, and it is not clear whether this inequality in mortality is the consequence of the increased prevalence seen in deprived areas, of poor care, or both. However, deprivation is a well-known determinant of poor general health, and although there is insufficient evidence to describe the relationship as causal, it underlines the health inequalities link in relation to epilepsy related deaths.
The Government is acting broadly to reduce health inequalities by addressing the social causes of ill health, promoting healthier lifestyles for all and tackling differences in outcomes of NHS services, all underpinned by legal duties. Through the Mandate the Government has asked NHS England to ensure service commissioning focuses on measurable reductions in inequalities in access to health services, in people’s experience of the health system, and across a specified range of health outcomes which contribute to reducing inequalities in life expectancy and healthy life expectancy. National and local outcomes frameworks feature indicators to measure improvements across a range of areas, including inequalities, and the Mandate asks NHS England to do more in increasing the transparency on services and outcomes that these frameworks provide.
At a national level, NHS England is the organisation responsible for securing and supporting high quality outcomes for people with epilepsy, and the vast majority of services for people with the condition are planned and commissioned by local clinical commissioning groups. Action is led locally to ensure the solutions put in place reflect the needs of individual communities.
NHS England’s RightCare programme provides practical support to local commissioners to tackle unwarranted variation, including in services for neurological conditions like epilepsy. NHS England is also working with the Neurological Alliance to support the Neurology Advisory Group, led by Professor Adrian Williams, to align work across the system to improve neurological care. In addition to developing the neurology mortality report, PHE’s NIN provides a broad range of data on disease, services and outcomes, including for epilepsy, to support local commissioners to benchmark services and drive improvement. The neurology mortality report will provide further focus for commissioners in considering whether there are any changes they need to make in terms of service planning and provision, including around the inequality issues identified.