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An economic assessment of the paediatric epilepsy nurse service within a district general hospital

Natalie Baines, Roald Dahl Sapphire Epilepsy Nurse Specialist, Royal Surrey County Hospital NHS Foundation Trust

Natalie's case study was undertaken in 2017 and reflects 2017 prices

Approximately 50 million people worldwide (WHO, 2016), and about 600,000 in the UK are effected by epilepsy (Epilepsy Action, 2016). Epilepsies are a common childhood neurological disorder giving rise to recurrent seizures. Three in 1000 children with a diagnosis of epilepsy, aged 17 years or younger, take anti-epileptic medication to control their seizures (NICE, 2012). Managing seizures improves health outcomes and can help to minimise any detrimental impact on social, educational and employment activity (NICE, 2012). However epilepsy is not a static condition and children and families can struggle with the high level of uncertainty and unpredictability regarding 'when the next seizure' is going to occur. This also created a challenge for Natalie, when demonstrating the value of her CNS-led service.

Natalie, a Roald Dahl Sapphire Epilepsy Nurse Specialist at Royal Surrey County Hospital NHS Foundation Trust, identified approximately 170 children and young people on her caseload. To better understand her workload at any one time, she developed a patient classification system which she validated though peer review. This allowed her to stratify her caseload into three categories of dependency levels which reflected the level of input required from her service. Acknowledging that the dependency of any one child can change on a regular basis and a child may transition between the various levels of dependency throughout their time within the service, Natalie selected a 'typical' case within each category to illustrate the impact of her service.

In her high dependency group, for example, Natalie illustrated how working intensively with a family over a three-month period, she helped stabilise a child's epilepsy through effective medication management, supported parents in managing their anxieties and enabled school staff to accept the child back into school. At the same time, it was argued that these interventions avoided the use of other primary and secondary care services. By using a sensitivity analysis, Natalie argued that her service, providing timely intervention with patient and families when their need is greatest may avoid the healthcare system costs of between £26,320 and £78,960 per annum. She also acknowledged that these figures did not take into account other costs avoided as a consequence of her intervention such as lost parental work time, rearranging childcare for siblings, extra hospital costs including parking and hospital food for parents.

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Case study
One page summary