Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Jos Kerkvliet (H49)

  1.  I am a Consultant Clinical Psychologist and Manager of the Community Brain Injury Team, which covers the Medway Swale area in the North of Kent (population: 325,000). My other responsibilities include working with patients with adjustment difficulties in relation to chronic physical disabilities, like MS. I have management responsibility for other Psychology staff who work with Chronic Pain, and with amputations.

  2.  The Community Brain Injury Team has been in existence since April 1996. It was purchased in response to increases in the ECR budget of the Health Authority. The aim was to prevent as many out-of-area referrals as possible, estimated to be about seven every year. The ECR's were mostly people with severe head injuries.

  3.  The team is small, the budget is about £150K per year. Most staff are part-time. We have a neuro-physiotherapist, an occupational therapist, a speech and language therapist, clinical neuro-psychologist, an assistant and a secretary. We have input from a doctor and the Consultant in Rehabilitation Medicine.

  4.  The team accepts referrals of patients between the ages of 16 and 65 with head injuries, strokes and other non-degenerative brain damage, like treated and stable tumours or people with anoxic or toxic brain injury. Every year we deal with about 50 appropriate referrals. Most of our patients are between 40 and 65, and have had a stroke. Our most complicated and time consuming patients are young people with traumatic brain injuries, mostly under the age of 40. The latter also require an intensive collaboration with Social Services Care Managers. Our involvement with the traumatic brain injury patients often stretches into years.

  5.  We have often been able to support our Health Authority in monitoring patients who have needed out of area treatment in specialist centres. With our expertise we have been able to advise them on appropriate length of stay and available resources on return back to our local community. We have been funded by the Health Authority to provide some treatment, but mostly teaching to staff in local Nursing Homes, which look after patients with severe head injuries. These people are often considered to be in a Vegetative State, although we believe Low Awareness state is a more appropriate term to use.

  6.  From our experiences we draw some of the following conclusions about our own service.

  Strengths: (a)  We provide a local service, easily accessible for patients and their families, also after entitial discharge we can become re-involved when needed.

    (b)  The team sees a variety of patients, which keeps the work interesting and burn out for staff low.

    (c)  Our involvement with patients with traumatic head injuries can be very long term allowing us to progress with them to new levels of independence and accommodate life changes in their families.

    (d)  Personality changes take a long time to adjust to, particularly for relatives (partners and children) and our long-term commitment has helped to keep families together.

  Weaknesses: (a)  We do not see children.

    (b)  Eldery people with head injures are not seen by us.

    (c)  Other neurological conditions, which would benefit from the same multidisciplinary goal setting approach, are relatively neglected. A model of good practice in one area does not automatically lead to good practice in a closely related other area.

    (d)  There are no day facilities in our area.

  7.  We would like to make the following recommendations:

  A.  People with head injuries rely heavily upon good working relationships between Health and Social Services. They often need carers from Care Agencies. Our experience is that we keep training carers in the specific needs of this client group, but the turn over of staff in these agencies is enormous. We would benefit from an opportunity to tie carers to this client group and have less wastage of training efforts. Despite excellent relationships with our Care Manager colleagues, we have not managed to find our way through the rules and regulations surrounding the employment of Carers through Care Agencies.

  B.  Similarly, our efforts in training nursing staff in Nursing Homes are often lost through staff turn over. The problem here seems to be more that Nursing Homes are sometimes very business orientated, and staff get disheartened by the lack of resources available for this patient group. Registration of Nursing Homes is powerless to change the conditions in the homes in a fundamental way. In our opinion they need more and more powerful tools to intervene in these homes.

  C.  People with head injuries often experience crisis in their personal lives, early on, in the first two years, of their rehabilitation. They may not require Residential or Nursing Home care, because socially they can be appropriate with relative strangers and they do not require physical care. In their intimate relationships, however they may be impulsive and perseverative, leading to enormous stress and the risk of marital break up. We would like to see initiatives to enable the creation of Foster Families, where people with these personality changes can have a period of refuge and the family of origin can have a breathing space. Social Services and the Voluntary sector could be actively encouraged to explore this option. A team like ours could provide the training for the Foster Families to be and help with selection.

February 2001

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 3 April 2001