The Department of Clinical Neurosciences, Western General Hospital The term 'neuroscience' refers to a group of specialist disciplines. The two main specialties are neurology (medical) and neurosurgery (surgical). Along with a range of other specialists, neurologists and neurosurgeons treat people with disorders of the nervous system. These include problems affecting the brain and spinal cord and the nerves and muscles in the rest of the body, such as multiple sclerosis, Parkinson’s disease, or brain injuries. Disorders of the nervous system are quite common. Not all are serious and many can be dealt with locally by your GP and in the community. Some people will need to be referred to a secondary care facility, like a local hospital. Some people, who need more specialist care, will have to go to a neuroscience centre. The neuroscience centre here in Edinburgh is not only for the people of Lothian, it is where patients from the Borders, Dumfries & Galloway, Forth Valley and Fife are transferred for specialist care. It covers a population of 1.6 million across these areas, while for some specialist services it covers the 2.8 million people living on the east side of Scotland. NHS Lothian’s Department of Clinical Neuroscience is currently located at the Western General Hospital in North West Edinburgh. The department has three wards (49 beds and 7 high dependency beds), 2 operating theatres, diagnostic services (e.g. scans) and an outpatients department. The department also provides a 6 patient day case area for programmed investigations (PIU) and all elective patients are pre-admitted through the pre-assessment service. An outpatient service is also provided at St John’s Hospital in Livingston, The Conan Doyle GP Practice, Edinburgh, Roodlands Hospital, Haddington Hospital and the Royal Infirmary of Edinburgh. The service for children is provided in the Royal Hospital for Sick Children in Edinburgh. Surgical Directory The department has seven neurosurgeons. They are:Mr Patrick Statham Mr Michael Fitzpatrick (Clinical Director) Mr Anant Kamat (Locum) Mr Ioannis Fouyas Miss Lynn Myles Mr Jerard Ross Mr Jegajothy Kandasamy All surgeons carry out cranial and spinal surgery but have developed specialist interests: Mr Patrick Statham in pituitary/skull base and complex spinal surgery; Mr Michael Fitzpatrick in trigeminal neuralgia; Mr Jerard Ross in paediatric neurosurgery and epilepsy surgery; Mr Ioannis Fouyas in vascular and skull surgery; Mr Jothy Kanadsamy in paediatric surgery and Miss Lynn Myles in peripheral nerve surgery. The surgeons also have clinical responsibility for the patients who have been admitted and treated for a sub-arachnoid haemorrhage (SAH). Close links with Interventional Neuroradiology, Medical Neurology and Oncology have been established with neuro-oncological and neurointerventional multidisciplinary teams coordinating the management of patients with cerebrovascular pathologies and brain tumours. Patients from the entire East of Scotland, needing endovascular treatment are transferred to Edinburgh. Historical links with otolaryngologists, plastic surgeons, orthopaedic spinal surgeons and maxillofacial surgeons have been established, and combined procedures are frequently performed in patients with either complex pathologies or acute trauma. Team working with medical epileptologists is also pursued for the treatment of patients with intractable epilepsy. The service provides an elective service for surgery and also provides a 24 hour emergency receiving service as it is a tertiary receiving centre. Some facts about our service All emergencies are referred via the referral process from their local emergency departments/hospitals. It is aimed to admit these referrals to the department within 48 hours of referral. The average length of stay is 3-10 days. All patients who require a follow-up should have an out-patient appointment in 4 months from surgery. Brain tumour patients are followed up by the Edinburgh Centre for Neuro-oncology (ECNO). The SAH patients are followed up by Clinical Nurse Specialist in 3 months from discharge. Rehabilitation Patients are assessed as in-patients to assess if further input is required e.g. rehabilitation or discharge home with support. This assessment is carried out by members of the multidisciplinary team (MDT). The department has close working links with external services that provide this assistance in rehabilitation and also with the hospital-based social work team if the support is required in the community. The main services used are:Service Name Astley Ainslie Hospital Lead/Referral Process Dr Smith/Dr Fitzgerald Falkirk Community Hospital Dr Premphie Edinburgh Community Physiotherapy CRABIS (community rehabilitation and brain injury service) National Spinal Unit Via social service referral/occupational therapist. Refer via on call Consultant/Registrar. Medicine of the Elderly (Lothian) Local District Hospitals Referred through NHS Lothian referral policy. Refer to on call medical Consultant/Registrar. Contact Information 133 Grange Loan, Edinburgh, EH9 2HL. 0131 535 9000 Unit 1, Falkirk Community Hospital FK1 5QE. 01324 624 000 Slateford Physiotherapy Clinic, Slateford Medical Practice, Edinburgh, EH14 1NQ. 0131 442 8700 www.westlothianchcp.org.uk The Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF. 0141 201 2555 Various sites across Lothian Various sites The department has links with support services/organisations that are available to patients. The departments Clinical Nurse Practitioners (CNP) work close with patients/relatives/carers in making sure the care provided is fully holistic and access these services if required. The main organisations are:- Support Service/Organisation ECNO (Edinburgh Centre for NeuroOncology) British Brain Tumor Society Headway Brain & Spine foundation Clic Sargent Contact information Shanne McNamara, Specialist Nurse in Neuro-Oncology. www.braintumour.org.uk (Based local). www.headway.org.uk Headway House, Astley Ainslie Hospital, Cannan Lane, Edinburgh, EH9 2HL. 0131 446 9681 www.brainandspine.org.uk www.clicsargent.org.uk The future of Clinical Neuroscience in Lothian The Department of Clinical Neuroscience at the Western General Hospital building was purpose-built in the 1960s, but it is no longer flexible enough to accommodate everything we would want to do. It is too small for the number of patients we see and treat and cannot be adapted to accommodate the specialist procedures and technologies in use today. NHS Lothian looks forward to providing accommodation that will support these specialties in staying at the forefront of neuroscience patient care. The Department only sees adult patients, but some of its highly specialist staff work in the children’s service as well, currently on a different hospital site. However, a new Royal Hospital for Sick Children, beside the Royal Infirmary of Edinburgh at Little France, is being planned for 2017. NHS Lothian would like to take this opportunity to improve how we efficiently we treat patients by delivering adult and children’s neuroscience services on the same site. Joint working between the Department and the University of Edinburgh to provide clinical care, state-of-the-art equipment, teaching and research, benefits both patients and staff and contributes to the Department’s status as a leader in its field. The University plans to expand its research interests with the building of an Institute of Neurosciences at Little France. Being nearby would ensure continuing benefits to patients. Many of the reasons for change suggest that clinical neurosciences should be located alongside the Royal Infirmary of Edinburgh’s Emergency Department and the Royal Hospital for Sick Children. The process to review all options for the site of the Department of Clinical Neuroscience in future has been carried out in partnership with all groups who have an interest, including patient and public representatives. To address the challenges above NHS Lothian have recommended that the future home of clinical neurosciences be at Little France.