Select Committee on Health Minutes of Evidence



  With a background in social work, I have 19 years experience of working with brain injured individuals and their families at all stages of recovery. I have been employed as a local authority social worker in Sheffield and as an NHS case manager in Southern Derbyshire and currently in a community brain injury service in Sheffield. I currently also have a private practice as a head injury case manager.

  I hold the position of Chair in the Brain Injury Social Work Group (an informal national group providing support and education for specialist and non specialist workers). In 2000 I was elected onto the executive committee of UKABIF.

  I have a particular interest in the development of services to meet family need after brain injury. The National Traumatic Brain Injury Study (1992-97) funded the introduction of a specialist head injury social work team in Sheffield, for which I was able to design the family focussed service model.


  This submission is based on the evidence from my own case practice in Sheffield and Derby, and reported information from a wide geographical area via members of the Brain Injury Social Work Group.

  I have focussed my information and recommendations on the key areas of Family Services and Local Authority provision.


1.   Family Impact

  Well documented in research literature

  Few service developments addressing family need

  1.1  Extensive research literature indicates that impact on family members following acquired brain injury is profound and potentially damaging.

  Ref: Neil Brooks The Head Injured Family Journal of Clinical and Experimental Neuro Psychology 1991 Vol 13 No 1 pp155-188

    "These data suggested that the impact of a head injury was at least as great for family members as for the patient, and often family members were far more distressed than the injured person"

  1.2  Specialist services targeted to brain injury family need are under developed in the UK.

  1.3  Services set up within the National Traumatic Brain Injury Study (1992-1997) (eg the Head Injury Social Work Team in Sheffield) are notable exceptions—remit and service models differ.

  1.4  Existing family focussed services have yet to be fully evaluated.

  1.5  Impact on children in brain injury families is particularly damaging but this is rarely addressed, even by family specialist services.

  1.6  Geographical location determines the likelihood of brain injury families receiving appropriate and well-timed interventions.

2.   Local Authority Services

  Given the identified need for lifetime support after brain injury, demand will be placed on Local Authority services following NHS discharge.

  2.1  The number of brain injured individuals in any Local Authority area is unlikely to be precisely quantified due to poor incidence recording—accurate service planning is therefore difficult.

  2.2  Brain injury may not be identified as a distinct client group in the Community Care Plan and development of specialist community services is rare.

  2.3  Brain injury has historically been located in physical disability services—this is not appropriate—predominant psycho social difficulties require a different service delivery model.

  2.4  Community social work and care management teams may lack specialised skills for assessment of need, design and monitoring of brain injury care packages.

  2.5  Best value initiative directs local authorities towards contracting with non-specialist care agencies often lacking brain injury skills or knowledgeable management.

  2.6  There is serious risk that rehabilitation gains will be threatened by inadequate or inappropriate community provision.

  2.7  Many families report great difficulty accessing appropriate services following NHS discharge.

  2.8  Family care burden may be exacerbated by lack of appropriate services.

3.   Recommendations

  3.1  Broader remit

  Services should be planned for people who have sustained traumatic and non-traumatic brain injury. The current distinction is inequitable and clinically unhelpful.

  3.2  Equity of Service Provision

  To develop a national quality standard for Local Authority assessment and service delivery to brain injured individuals and their families.

  3.3  Integrated Care Pathways

  To be formulated jointly by each Health and Social Services District, with particular attention to developing protocols for the health and social service interface and joint funding mechanisms.

  3.4  Addressing Family Need

  To evaluate existing family specialist service models.

  To develop provision of specialist family services accessible to parents, spouses, children and siblings of brain injured individuals.

  3.5  Specialist training

  To initiative development of post qualification training in brain injury for social work staff, establishing core competencies.

  3.6  Specialist Support Workers

  To develop quality standards for brain injury support worker services in the public and private sector.

  3.7  Recognition of Lifetime Need

  To establish health and social service provision accessible on a recurrent basis to meet changing family and individual needs.

  The key question to pose is "Would you be happy to use the brain injury service in your area for yourself or a relative?" With appropriate service development and quality standards in place the answer can be affirmative.

19 February 2001

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