National Clinical Audits for psychosis and epilepsy

The National Clinical Audit of Psychosis (NCAP) has published its findings for the 2019/20 audits in England and Wales.

The report for England describes the quality of care from a case note audit of 10,560 people aged 14 – 65 who had been on the caseload of 155 teams for 6 months and whose cases were still current, together with data from 2,374 service users in 56 trusts.

Treatment was initiated within 2 weeks in 74% of patients. The intervention was cognitive behavioural therapy in 49% and family intervention in 21%; clozapine was offered to 52% of patients. Supported employment and education programmes were taken up by 31% and 58% were referred to, or took up, carer-focused education and support programmes. Three-quarters of patients received all recommended physical health interventions, the most frequent being support for smoking cessation and alcohol and substance misuse.

Responses from users suggest that outcomes were favourable for the majority. Most (83%) felt their intervention team had listened to them and 89% believed their mental health had improved. Seventy-eight per cent felt they had been involved in medication decisions and 72% felt they had been given written or online information. One-third had a job and 84% had no problems with housing or benefits, whereas 7% did have problems and were not receiving help. Further, 23% felt they were not as healthy as they wanted to be and were not getting help.

The report concludes that timely access to intervention has generally improved since previous audits but more could be done to meet NICE quality standards and to increase provision of family intervention. There is variation in performance between trusts, suggesting scope for improvement, and there were too few under-18s to reliably assess services for young people.

A separate report for Wales shows that targets for intervention were achieved in a lower proportion of patients than in England – notably for smoking cessation, alcohol use and physical health measures. However, user satisfaction was comparable or better.

The Royal College of Paediatrics and Child Health’s National Clinical Audit of Seizures and Epilepsies for Children and Young People (Epilepsy12) for England and Wales evaluated the organisation of paediatric epilepsy services for children and young people and the clinical care of newly diagnosed children in 2019. It found that almost half of children with suspected epilepsy waited more than the NICE standard of four weeks for their first EEG. Two-thirds of those who met the criteria for an MRI had a scan in the first year and the same proportion of those with convulsive seizures had a 12-lead ECG in the same period. Fewer than expected children were diagnosed with a mental health condition, suggesting a lack of integrated mental health care. The report notes increasing involvement of epilepsy specialist nurses and of paediatric neurologists, though early access was still below the NICE standard of two weeks. Too few trusts were developing dedicated paediatric clinics and some children with surgically treatable epilepsies were not being assessed for surgery. Rates of misdiagnosis and inappropriate medication appear to be falling but there is inter-regional variation in both the socioeconomic distribution of epilepsy and the portion of children who had an ECG in whom epilepsy was subsequently diagnosed.

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