Over 250 delegates gathered at London’s Royal Society of Medicine, with improving the approach to the UK brain injury challenge high on the agenda.
Many of the issues raised reflected the findings of the landmark 2018 paper by acquired brain injury (ABI) all party parliamentary group (APPG), Time for Change.
Diane Playford, professor of neurological rehabilitation at the University of Warwick and consultant in rehabilitation medicine at South Warwickshire Foundation Trust, alongside Ines Kander, PhD student at Warwick University, highlighted the ongoing need to change the community rehabilitation system which is, at best “ineffective”, and at worst “unavailable”.
Professor Playford said: “Commissioning services for neuro-rehab is complex with level 1 commissioned by NHS England, level 2 by the Clinical Commissioning Groups and no clear pathway for level 3. Health professionals work in silos and consequently individuals with ABI fall down the cracks.”
She reiterated the lack of rehabilitation medicine consultants and multidisciplinary team members, as well as poor information provision and inadequate long-term funding.
“We constantly underestimate the number of individuals requiring neuro-rehab in the community, and their inability to navigate the system. People need access to multiple services [in] neuro-rehab for a longer time period and a linkworker to facilitate progress through the pathway. We need to do it smarter and differently,” said Professor Playford.
Professor David Menon, head of the division of anaesthesia at the University of Cambridge, and honorary consultant at the Neurosciences Critical Care Unit at Addenbrooke’s Hospital in Cambridge, also highlighted the issue of resource shortages.
“Neurotrauma is, and will remain, the biggest cause of neurodisability, but it continues to be under-resourced and presents many challenges for societal care.
“Being alive following a brain injury is not enough – we need to know the extent of the injury and the predictable outcomes,” he said.
He explained that there is a burden of mortality over a 10-12 year period post-injury due to the chronic sequelae, and also infection susceptibility which results from immune response modulation.
This burden reinforces the need for long-term care, he said. Discussing the key issues in the Time for Change report, Professor Menon said: “UKABIF and the APPG on ABI have made a huge impact in raising awareness of ABI and driving change.
“We need to continue to ensure individuals with life-long disability receive the long-term care and support they require.”
The focus on change was repeated by Trevor Sterling (pictured above), partner at Moore Batch, regarding injury cost recovery. He warned that there
has been no review of cost recovery since Major Trauma Centres were introduced, and the extent of the shortfall in injury costs to the NHS is unknown.
Current legislation is outdated and the NHS is underfunded as a consequence, he continued.
“We urgently need new legislation, and as a minimum, a review of the existing legislation which could facilitate increased funding for neuro-rehab,” he said.
Dr Mike Dilley, consultant neuropsychiatrist in neurorehabilitation, brain and mind, addressed the fact that mental health and neuro-rehab are traditionally segregated, but said: “Mental health needs to be integrated in to neurosciences and neuro-rehab”.
He explained that neurological conditions and psychological problems are inextricably linked, and studies have shown that there is an increased mortality after brain injury and mental health problems worsen life expectancy.
Accessing mental services as part of a continuous chain of rehabilitation can be extremely challenging and early access is an essential part of recovery, he warned.
“The system urgently needs to be integrated,” he added.
The importance of supporting young people with an ABI in the education system was highlighted by Drs Emily Bennett and Emily Talbot, consultant clinical psychologists in paediatric neuropsychology at Nottingham Children’s Hospital.
They outlined the need for communication, education, monitoring and adapting in order to support children and young people with
Education is one of the work streams in the Time for Change report, with emphasis on the need to train teaching professionals about ABI and facilitate change for children and young people with ABI.
Meanwhile, a head-on collision in France left Dr Raymond Lynch with debilitating head and spinal injuries. He spoke at the conference of how through determination and the help of a neuropsychologist, he turned his life around.
Now, with the support of his employer Proctor and Gamble (P&G), he consults with the UK government and London-area hospitals on brain injury.
Dr Lynch discussed the ‘return to work toolkit’ he has developed for P&G employees worldwide with brain injury, as well as their managers, peers and families.
In a further experience-based presentation, the Silverlining Brain Injury Charity, founded in 2006, shared the experiences of 23 of
its members when they recently went to Namibia in Africa.
The film of the group’s experience wasa powerful reminder of the need and importance to invigorate, motivate, nurture and enable individuals with brain injury.
Dr Andrew Bateman, chair of UKABIF, discussed the aspirations of the ABI APPG and highlighted the work being done as a direct result of UKABIF and APPG engagement.
He also encouraged attendees to communicate with their local politician on brain injury issues.
Also the conference, two new UKABIF Chair’s Merit Awards were presented to Susan Pattinson, physiotherapist at STP Therapy Services and Hannah Farrell, clinical specialist physiotherapist in neuro-traumatology at Queen Elizabeth Hospital Birmingham, in recognition for their work in making change happen in neuro-rehab.
Other awards, sponsored by Cygnet Healthcare, were also presented, including the Stephen McAleese Award for Inspiration, which went to Dr Melanie George, consultant clinical neuropsychologist at Kent and Medway NHS and Social Care Partnership Trust.
The award recognised her work in raising awareness of the frontal lobe paradox and educating social workers.
The new Mike Barnes Innovation Award, run in collaboration with the National Institute for Health Research, was awarded to the team behind Goal Manager.
The rehabilitation goal-setting tool is made by clinicians, for clinicians. It combines goal-setting processes, such as the ICF, Goal Attainment Scaling, and the SMART framework, into one streamlined system.
Utilising cloud-based software, members of multi-disciplinary teams (MDTs) can log into it from remote locations, and update clients’ goals.
A report of goal outcome data can be produced, summarising goal progress and coordinating team discussions.
Goal Manager was developed by Dr Penny Trayner, a paediatric clinical neuropsychologist, who runs an independent neurorehabilitation service in Manchester.
She found that much of the time she wanted to spend working with clients was actually spent setting clinical goals within the MDT, as each of the main processes of goal setting take so long to complete.
By streamlining and automating a lot of the administrative work behind goal setting, she reduced time spent on goals but increased their effectiveness.
Since using the system herself, other clinicians and services have registered their interested, and so Goal Manager was born.