Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Liz Grice (H 73)

  My name is Liz Grice, and I am a Clinical Psychologist. I qualified in 1993, and I have been working with people with brain injuries since 1994, when I began sessional work at Headway East Dorset as part of my work with Dorset HealthCare Trust. I have also worked with carers, including carers groups both at East Dorset Headway and Headway Southampton. I am currently the Manager of Headway Southampton, which provides day care/rehabilitation and support for those with brain injuries and their carers.

  There are a number of points that I want to raise from my experiences both as a Clinical Psychologist working with brain injury and as the Manager of Headway Southampton.

1.   Older adults

  When brain injured adults reach the age of 65, even though their problems are related to brain injury not ageing, Social Services remove them from their day provision and place them in older adults day centres, which are not appropriate. One of our clients, Mr S, suffered just such a fate, but he and his wife were not happy with this, so he stopped using day provision until they found out about us from neighbouring Headway Winchester.

  We also have a problem when it comes to funding for older adults because older adults day centres cost half of what we do. We have several people over 65 who became brain injured when they were older, one fell from his bicycle and one was run over by a fork lift truck. These people are not suitable for older adults day centres as their problems are related to their brain injuries. In fact, Mr B, the man run over by the fork lift truck, was 75 when he was injured and although he looks well, he is our most difficult client because of the behaviour problems he has as a result of his brain injury.

2.   Physical disability services

  Social Services class brain injury in the same category as physical disability. This means that they tend to look towards physical disability day centres for their day provision. Unfortunately, many brain injured people do not have an obvious physical disability and find it distressing to be placed somewhere where some people have many physical problems. Conversely those who are physically disabled but cognitively intact do not understand why these brain injured people behave the way they do. The staff in the physical disability day centres do not feel able to handle some of these brain injured adults because they do not know enough about brain injury or how to handle challenging behaviours. I recently conducted a training session with a local physical disability day centre that they requested because of precisely these problems.

  I have discovered that Social Services managers also do not understand why brain injured people are not best placed in physical disability and do not understand the difference. This was in a discussion about funding with Hampshire Social Services. There is a clear need for brain injury to be a category separate from physical disability.

3.   Social Services charging

  The policy of making a charge to those receiving care from Social Services, depending on their means, is unfortunately not universal when it comes to brain injury. Hampshire have this policy, Southampton City do not. This means that we have people attending the day centre who pay a contribution towards their attendance and some who do not. This is seen as unfair by those who have to pay.

4.   Lack of understanding by professionals

  I am still being told by both those who have a brain injury and their carers, that medical staff have told them that if someone is not knocked unconscious then they are not considered to have a brain injury. Neuropsychological assessment makes it perfectly plain that this is not the case. Some people may have an apparently minor injury but still suffer problems as a result. A lady I saw recently fell and banged the back of her head on the stair rail. She was told she would be fine in two weeks. Three months later she is still suffering from extreme head pain, visual disturbance and fatigue, all of which is preventing her from working. The problem is now that this is tending to be viewed as psychological, which I can say with certainty, it is not.

5.   Carers' comments regarding having to fight for everything

  I have now run four carers groups and spoken to numerous carers since 1994, all of whom make the same kind of comments about the person they care for not being seen as having a problem and having to fight with both Social Services and Health to get the level of care and support needed. This is in addition to the Benefits Agency and in particular the DLA, which is focused on physical disability, with no allowance for the disability caused by cognitive problems. I have personally conducted a number of neuropsychological assessments to provide evidence for a DLA tribunal. I have also attended a tribunal in order to explain the nature of the neuropsychological difficulties being experienced by one of my clients. Mr E can walk and talk, but is so distractible that he joins in with conversations of passers by. His memory is so bad that he does not recall anything that happened the previous day or even the previous hour. His family have had to have an extension built with a sound-proofed quiet room, because he cannot cope with the normal sounds from four boisterous children aged from 6 to 16. He will never work again and cannot be left alone because he forgets what he is doing and does not see danger (for example trying to remove grass from the blades of a lawnmower whilst it was still running). Even with all these problems, it was still necessary to appeal to a tribunal because his level of difficulty was not appreciated from the forms and from the cursory examination given to him by the doctor who examined him for the DLA.

6.   Social Services handling of clients

  I have had a dispute with a local social services area office. They attempted to persuade two of our clients to say that they no longer wished to attend. They did this with no advocate present and did so quite clearly in an attempt to save money. Apart from the questions it raises about social services practice, I also discovered that social services do not seem to be aware that those with brain injuries in some cases need advocates in the same way as those with learning difficulties because they forget, they are suggestible and make poor judgements. They may also have given a relative their power of attorney because they cannot handle their own affairs.


  These are some of the issues which have arisen with clients that I have personally dealt with. There are other issues which I do not have time to address here. My opinion is that brain injury is poorly understood by medical professionals, social services, the benefits agency and the public at large. The classifying of brain injury as a separate category is essential for the effective delivery of services and as a basis for educating others about the problems of brain injury.

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