Calls for funding to save pilot service for homeless patients with epilepsy.

Image of Advanced Nurse Practitioner Cara Synott alongside St. James's Hospital logo

This week is National Advanced Practice Week, a week in which the importance of Advanced Nurse Practitioners is highlighted.

Epilepsy Advanced Nurse Practitioners play a vital role in epilepsy services in Ireland and have an in-depth knowledge of the medical management and complexities of epilepsy.

Epilepsy Ireland work closely with Epilepsy Nurse Specialists across Ireland and their importance to supporting people with epilepsy and their families cannot be understated. This is why we are proud to support the Neurological Alliance of Ireland’s campaign- ‘Patients Deserve Better’ – which not only aims to address the shortfall in Epilepsy Nurse Specialist numbers but address the number of nurse specialists required for other neurological conditions as well.

Unfortunately, based on the numbers of those living with neurological conditions across Ireland and to meet best practices, Ireland urgently needs 100 extra neurology nurses. If you’d like to support this campaign, please visit www.patientsdeservebetter.ie.

To mark Advanced Practice Week, Epilepsy Ireland recently spoke with Cara Synott, Registered Advanced Nurse Practitioner in Epilepsy, who is based in St. James’s Hospital, Dublin.

While we discussed the importance of the Advanced Nurse Practitioner Role, our discussion moved to the impending suspension of a pilot service which Cara is leading.  This service is a specialist outreach service to homeless people with epilepsy and those with intellectual disabilities with epilepsy.

EI: Why is there a specific project targeted at homeless people with epilepsy?

CS: Let me give some background. I work in St. James’s which is the busiest Emergency Department in the country with over 50,000 attendances and 12,500 admissions a year. The hospital serves the inner city of Dublin, and this area is associated with high level of poverty, drug and alcohol abuse. This area has the highest deprivation index in the country. For the catchment area of St. James’s, the homeless population represents approximately 0.4% of this entire population and in the hospital itself, 10% of all emergency department attendances and inpatient stays are associated with those who are homeless. This provides context to our project which aims to reduce visits to the emergency department by homeless persons with epilepsy by 30% and to provide an epilepsy outreach service in the community to these patients.

EI: Is there an association between epilepsy and homelessness?

CS: Yes. The reason the project focusses specifically on those with epilepsy is because the rate of epilepsy amongst the homeless community is 8 times greater than those in the settled population. Because of a person’s living circumstances, the associated morbidity is higher due to the lack of integrated care, ability to adhere to treatment, substance abuse and poor social circumstances. Therefore, these factors contribute to a homeless person’s epilepsy being associated with a much higher risk.

EI: How has the project aimed to reach this community of people with epilepsy?

CS: As mentioned, the aim is to reduce emergency department presentations from this community. Seizures are one of the most common causes for admissions within this population. Through the development of our outreach project, we have created a new care pathway and developed bespoke tools for primary care providers and for physicians working in the emergency department to enable them to assess and manage patients as they present, as well as provide access to remote epilepsy specialist support.

EI: What has been the impact of the project?

CS: First and foremost, we have hit one of our headline targets with a 30% reduction in inpatient stays amongst the homeless community with epilepsy, which obviously reduces pressure on hospital services and through the outreach service, we are able to engage directly with these patients and help them better manage their condition.

EI: Tell us more about how the project supports people with epilepsy and intellectual disability

CS: Our project also reaches out to those with intellectual disability and epilepsy. Almost 22% of those living with an intellectual disability will develop epilepsy and furthermore, over 70% will have refractory epilepsy. Because of the nature of their condition, they are regular users of the emergency department. Much like the aspect of our project which focussed on the homeless community, our project also provided outreach services to this specific cohort of patients. Again, we hit our target here– reducing visits to the out-patient department by over 60% amongst this cohort of patients.

These headline figures have been the key impact of the project so far but we’ve also improved communications between the epilepsy services and primary care providers in order to better serve the needs of this cohort of patients and we have seen first-hand how the development of remote service can make a positive impact in treating this cohort of patients.

EI: Given the undeniable impact of the project, why is funding coming to an end?

CS: Our project was funded under the Sláintecare Integration Fund and this funding is set to expire at the end of the year. It is now up to the HSE to decide whether they will provide further funding to continue this service. All the team involved in the project are in no doubt that the project has made a huge impact and we want it to continue to help support some of the most vulnerable patients with epilepsy. We hope that the HSE and the Government will recognise the real impact this project has had and ensure that funding is continued for 2022 and beyond.

Epilepsy Ireland also hope that this project is continued given the significant impact that has been reported. We would like to thank Cara for speaking to us for providing further details on the project and if you would like to learn more about this project and its impact, you can read an evaluation of the project which was recently featured in the British Medical Journal.

**We're delighted to report that shortly after the publication of this article, the HSE confirmed funding has been secured to continue this service in 2022. Well done to all involved.**