Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Director Brain Injury Rehabilitation Trust (H6)

  1.  The Brain Injury Rehabilitation Trust is a "Not for Profit" organisation; a division of The Disabilities Trust which developed its first community based rehabilitation service in Milton Keynes in 1992, having to date developed a continuum of service offering varying levels of rehabilitation, care and support in post-acute community based settings for people who have suffered a traumatic/acquired brain injury. The Trust at present offers services to over 250 clients and employs in excess of 500 people. The Trust's services are offered in settings as far south as Devon, and as far north as Northumberland.

  2.  There are a number of obstacles to social awareness, community re-integration and acceptance for those who have suffered from a traumatic or acquired brain injury. The obstacles are often based on the individual's behaviours and the lack of ability to control impulsive and disinhibited behaviours, often showing poor judgement, impulsiveness and a lack of social warmth that leads to difficulties in many relationships in personal and professional life.

  3.  The Trust would emphasise the global or holistic nature of the rehabilitation undertaken on behalf of each client. Having established a network of links and partnerships with organisations ranging from Housing Associations, Health Authorities and other care providing voluntary groups, the Trust looks at the broader issues with regard to community re-integration such as the social role and role of the individual within the family, independence skills (in the home and in the community) emphasising physical ability, cognitive ability, executive skills and behavioural self-control.

  4.  The Trust also looks at vocational prospects for individuals and the structured use of leisure time. Essentially, rather than looking at clients as a collection of clinical specialisms, the Trust adopts an inter-disciplinary approach within this neuro-psychology led service looking at the individual's whole life, future needs and aspirations.

  5.  In 1999, under the guidance of its Clinical Director Dr R Ll Wood, the Brain Injury Rehabilitation Trust published an outcome study, entitled "Clinical and Cost Effectiveness of Post-Acute Neuro-behavioural Rehabilitation". This followed research carried out over a number of years, which clearly outlines the correlation between early intervention, offering community based post-acute rehabilitation and much later intervention when often families, carers and the individuals concerned, are in crisis. The study looked at a number of areas, but in particular the cost effectiveness of early post-acute rehabilitation. This was achieved by looking at three very distinct groups of people:

      Group 1    0-2 years post-injury

      Group 2    2-5 years post-injury

      Group 3    more than five years post injury.

  6.  The research also identified the costs per day at pre-admission, discharge and follow-up.

  7.  Group 1 shows the greatest reduction in care costs over the period of this study. The calculations indicate that following an average of 14 months rehabilitation, the notional reduction in care costs per client amounted to £21,821. This amounts to 30.6 per cent of the cost of rehabilitation for one year. At follow-up the average amount saved per client increased to £131,623. A notional lifetime saving on care costs for each member of this group would be in the region of £1,980,023.

  8.  The calculations for Group 2 show a less dramatic reduction in care costs, but the amounts are still significant. Over the average period of rehabilitation £11,359 is saved, whilst between the period of admission and the average follow-up times (47 months) the saving in care hours amounts to £70,313 with a nominal lifetime saving of £586,559.

  9.  For Group 3 the saving in care costs over the period of rehabilitation is modest—£5,344, but by the time of follow-up, the savings per client were in the region of £48,580 with a lifetime saving of £405,262. (R Ll Wood et al 1998).

  10.  The Brain Injury Rehabilitation Trust continues to experience a number of difficulties, particularly in respect of funding and understanding of the benefits of rehabilitation by some Health Authorities and Social Services departments. These statutory bodies often appear to be cash strapped and financially led rather than identifying the most appropriate treatments and care for individuals who may have suffered a head injury. A lack of understanding of the nature of neuro-behavioural rehabilitation is often evident and the lack of co-operation between some Health Authorities and Social Service departments is often a problem when attempting to identify care pathways for individual clients. This does lead to individuals being inappropriately placed and not receiving appropriate care, treatment and rehabilitation.

February 2001

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