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
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
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
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
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.