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Neuro-rehab bed numbers must triple in the UK, report warns

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The UK’s shortfall of neuro-rehab beds was laid bare recently, as a landmark report on the state of the national approach to brain injury was published.

To truly meet demand, the country needs more than triple the current number of neuro- rehab beds, according to the report from the All-Party Parliamentary Group on Acquired Brain Injury (ABI).

It estimates that 14,600 neuro-rehab, in- patient beds are needed to meet the annual caseload of around 300,000 ABI admissions. Currently there are just 4,600.

This is made up of 1,400 non-dedicated rehab beds and 1,800 dedicated ones in the independent sector. Just 1,400 neuro-rehab, in-patient beds exist within the NHS.

Since 2013, the number of private sector beds has risen by 700, against a fall of 100 in the NHS. The report states: “Investment in neurorehabilitation, in-patient neurorehabilitation beds and service provision are all inadequate and hugely variable across the UK.”

The report also underlines regional disparities in brain injury care provision. Parts of the North, East and South West are shown to have no access to neuro-rehab services, or to be served only by a very sparse network of providers.

Other major concerns, according to the APPG, include a shortage of neuro-rehab personnel and a general lack of understanding of neuro- rehab’s vital role within healthcare.

Poor delivery of the rehab prescription (RP) system is also scrutinised. That these documents are not made available to all individuals with an ABI is a major concern within neuro-rehab circles – as is the fact  that GPs rarely receive a copy and therefore cannot facilitate access to neuro-rehab services after discharge. The report’s neuro- rehab recommendations are to:

  • Make RPs available to all individuals with ABI on discharge from acute care. To have them held by the individual and copies made available to GPs
  • Conduct a national review of neuro-rehab to ensure provision is adequate and consistent across the UK
  • Have the government to collate reliable statistics for the number of individuals presenting at A&E with ABI, recording the numbers of people requiring and receiving neuro-rehab care
  • Significantly increase neuro-rehab beds and professionals so that every trauma centre has a consultant in rehab medicine and individuals with ABI have access to neuro- rehab
  • Have cooperation between government departments such as health and work and pensions to review funding for in-patient and community neuro-rehab services.

The paper also makes an excellent case for more funds for neuro-rehab services.

“Neurorehabilitation is one of the most cost-effective interventions available to the NHS… Although individuals with complex needs may require a longer hospital stay, the front-loaded cost of providing early, specialist neurorehabilitation for these individuals is rapidly offset by longer-term savings in the cost of community care, making this a highly cost-efficient intervention.”

The quoted figures should make compelling reading for controllers of NHS purse strings. Savings made possible through neuro-rehab are estimated at £500 per week per patient, or over £5bn per year for the 300,000 individuals who need such services each year.

The publication was well timed, having been circulated throughout Whitehall just a few weeks before the Chancellor announced news of an NHS funding boost in his autumn Budget.

Policymakers charged with allocating the £20.5bn, five-year NHS windfall set out by Phillip Hammond could certainly see healthy returns from investment in neuro-rehab services. Within the brain injury field, the APPG report served as a rallying cry for more action in better handling the nation’s head injury epidemic.

Claire Mills, public affairs manager for Headway, said: “We’re calling on all MPs to look at the report and use their influence to bring about much needed change to availability of rehabilitation, disability benefits, and in so many other areas, for the benefit of their constituents and the country as a whole.”

Richard McKenzie, CEO of private neuro- rehab provider Christchurch Group, said of the report: “In an area that has been neglected for too long, it’s promising to see that the All-Party Parliamentary Group will be proactively looking to seek improvements in support for those affected by ABI. Early access to neurorehabilitation is essential and key to being able to provide patients with a quality care pathway. Early rehabilitation in a multi- disciplinary environment has many benefits for both the patients’ outcomes and for providing a more cost effective healthcare solution.

“We would wholly support a funding review into investment for in-patient neurorehabilitation beds and service provision across the UK. People that suffer tragedy deserve to be able to maximise their potential and to have as normal a life as possible.”

Care provider Elysium Neurological was similarly eager for the report to make a tangible difference, saying in a company statement: “There should be a significant increase in neurorehabilitation beds and neurorehabilitation professionals, to ensure that individuals with an ABI have access to high quality efficient and effective neurorehabilitation to enable them to reach and if possible exceed their personal goals.”

As well as focusing specifically on neuro- rehab provision, the report set out key changes needed in relation to education, criminal justice, the welfare benefits system and concussion in sport. Among several education recommendations, there was a call for all professionals to have a minimum level of awareness of ABI and how it impacts on young learners. An ABI card for under-18s, promoted in schools, hospitals and local education authorities, was also urged.

On criminal justice, the report highlighted the stark statistic that every three minutes someone is admitted to an emergency department with a head injury.

If just one in 100 of these victims ends up in prison, this equates to 1,750 people entering the prison system every year, it said. Brain injury screening for people of any age entering the “secure estate” was one of several suggested measures.

Instilling brain injury expertise and awareness into the benefits assessment process was a key thread in the report’s welfare section meanwhile.

On sports-related concussion, the report calls for:

  • The government to ensure that there is collaborative research to evaluate and improve practical assessment tools, develop objective diagnostic markers and gain a deeper understanding of the recovery process and long term risks of sports-related concussion
  • An enhanced education campaign to be implemented in schools to improve awareness and understanding of sports- related concussion with the support of government departments (such as the departments for Education and Health and Social Care)
  • Sport, government, and professional clinical bodies to work collaboratively to improve health professionals’ knowledge of concussion management
  • The NHS to develop better pipelines for the diagnosis and care of sports-related concussion

The Rugby Football Union’s medical services director Dr Simon Kemp (pictured), who contributed to the report, told NR Times: “While there is a lot we are already doing in rugby around concussion awareness, education, research and prevention, in order to make significant further progress in the key areas outlined for concussion in sport then a co-ordinated approach involving non sporting bodies is critical.

“We are fully committed to achieving this and look forward to working collaboratively with government and the professional clinical bodies on concussion.”

It remains to be seen what impact the APPG report has on the UK’s approach to brain injuries. At the very least, neuro-rehab professionals now have an all-encompassing document setting out the many challenges ahead and reaffirming the value of adequate post-brain injury care provision.

As it also reminds readers, its recommendations must not be ignored or forgotten as has happened previously.

It warns: “In 2001 the parliamentary Health Select Committee published a report ‘Head injury: rehabilitation’ containing over 20 recommendations.

“The Committee examined the availability, organisation and resourcing of rehabilitation services for head-injured adults following medical stabilisation.

“It also considered rehabilitation services in the hospital and in the community, and looked at the extent to which agencies in the statutory and non- statutory sectors collaborate to provide seamless care.

“Whilst many of the recommendations relating to acute care have been implemented to some extent, the last 17 years have not seen any of the recommendations regarding neurorehabilitation achieve substantial implementation.”

Hopefully this time, the relevant influencers are listening and changes are afoot. Chris Bryant, the MP chairing the APPG on ABI, certainly seems committed.

He said: “ABI is a hidden epidemic affecting many hundreds of thousands of people. It impacts on so many government departments including the Department of Health and Social Care, Department for Work and Pensions, Department for Education and the Ministry of Justice that the government has to work in a co-ordinated and consistent way. The government should bring together a taskforce to address all the issues and recommendations as a matter of urgency.”


 

Legal view By Neil Whiteley
Partner / National Head of Serious Injury at Irwin Mitchell LLP

The All-Party Parliamentary Group (APPG) report on acquired brain injury and neuro-rehabilitation, A Time for Change, represents one of those, sadly rare, landmark moments on the long drive for a fully co-ordinated and well- funded approach to supporting people with ABI. Within the past 10 years, we have seen trauma care in the UK make considerable and life-changing strides, and whilst rehab services have developed, NHS and other statutory services have come under considerable strain.

As a legal professional who has represented many individual clients with the ability to access private funding after road collisions and other legal actions, I often hear frustrations from colleagues in the NHS and rehabilitation sector about the contrast in opportunities that are available to those with a claim, compared to those without.

Whilst completely closing that gap may be too much of an ask in reality, it is very much the organisation and funding of statutory services that accounts for this gap, not the dedication and skill shown by rehab professionals and support workers delivering care at the sharp end.

The excellent APPG report offers a chance for decision makers and politicians to be presented with the reality of what needs to be done, and so hopefully galvanise the debate and focus around some of the key recommendations.

For some, the report may not go far enough, there is always more that can be said and each stakeholder group will hope to see their experience and viewpoint reflected – this can be difficult to achieve with limited time and the need to find priorities.

However I believe that this is a moment for the sector to come together and focus on the key points that might make a difference when big decisions come to be made in the future about priorities and resources in the public sector.

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Flu vaccinations to become compulsory for care staff?

Plans to introduce mandatory flu jabs could be “one step too far” for an already under-pressure sector, leaders warn

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The introduction of compulsory flu vaccinations for care home staff could be “one step too far” for a sector already battling a recruitment crisis amidst the ongoing impact of COVID-19, leading professionals in the industry have told NR Times. 

The Government is currently consulting with key bodies in health and social care over whether to introduce a statutory requirement for vaccination against flu as a condition of employment for frontline workers. 

This follows the move to make COVID-19 double vaccination compulsory, which some forecasters predict could see up to 30 per cent of social care workers leave their roles in a sector already struggling to meet the soaring demand for its services, with an existing and growing shortfall of at least 80,000 staff nationally.

The consultation, which concludes next week, is likely to be met with “fury and outrage” by care operators, many of whom have battled to stay afloat over the past 18 months with mounting staffing and financial challenges. 

SAGE has advised that the combination of flu and COVID-19 could make this winter more of a threat than ever before to the most vulnerable people, particularly those in specialist care environments, and that vaccination is a tool in preventing the transmission of both.

In its consultation paper, titled ‘Making vaccination a condition of deployment in the health and wider social care sector’, the Department of Health and Social care says that flu vaccine uptake among social care workers in care homes was around 33 per cent last year – including 48 per cent for those directly employed and 36 per cent for those employed through an agency – which is significantly lower than uptake of the COVID-19 vaccine.

But for operators already under pressure to meet the needs of their residents while losing staff over the COVID-19 vaccination issue, the worry is that more leaving the profession over the compulsory flu jab may tip the balance. 

One senior figure in a care operator, who wished to remain anonymous, told NR Times: “This is one step too far, particularly so soon after we’ve been forced to lose good people because of the COVID vaccination. 

“Smaller operators are struggling to stay afloat. We’re doing all we can but these are very difficult times. People say we’re through the worst, and in some ways that is true, but the staffing situation is getting worse. By forcing more people out of the sector, the future is very worrying.” 

Paul TM Smith – consultant to Renal Health Ltd and a leading name in specialist care, who is also part of the Royal College of Nursing’s older people’s forum – confirmed to NR Times that the RCN was invited to be part of the consultation. 

“The recent report from MPs (Coronavirus: lessons learned to date) highlighted many failures in the Government’s handling of COVID, but also showed the success of the vaccination programme. There is absolute terror at the prospect of a fourth or fifth wave of COVID, particularly as we come into flu season,” he says. 

“So, given that, I can understand where this approach by the Government comes from – but the situation with the COVID vaccinations has been rushed through and care homes now risk being hit again. And I can’t see it being a one-off for this year, as COVID isn’t going away. 

“I think there will be fury when this becomes known, there will be outrage from many. I worry this could be one vaccination too far and I’d be hesitant to say I’m 100 per cent convinced a policy around compulsory flu vaccinations for staff would be a good thing.

“We’ve seen that clinical advice and political action can be poles apart, and the Government aren’t bound to take that advice. The implications for the sector need to be fully considered.”

While many social care workers will qualify for free flu jabs, not all will, and a lack of clarity also exists over who would have to fund compulsory vaccinations. 

“If it starts costing people to be vaccinated, people who are on low pay working in very challenging conditions, then it becomes a levy. And if this falls to operators, up to 85 per cent of whom are very small operations, this will be a very significant expense for them at a time when they can’t afford any more financial pressures,” says Paul. 

The care home operator adds: “For any care staff in our homes who didn’t qualify for a free flu vaccination, I couldn’t possibly allow them to pay; but then that’s yet another outlay for us. I would hope there may be some Government support there, and that they appreciate how under pressure we really are.”

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Long COVID symptoms ‘typically last up to six months’

Research shows more than half of people with COVID-19 will go on to experience long-term Long COVID symptoms

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More than half of the 236million people who have been diagnosed with COVID-19 worldwide since December 2019 will experience Long COVID symptoms up to six months after the initial virus, new research has revealed. 

During their illnesses, many patients with COVID-19 experience symptoms such as tiredness, difficulty breathing, chest pain, sore joints and loss of taste or smell.

But its impacts, both mentally and physically, can extend into a range of further debilitating issues which can last for months – which the research team at Penn State College of Medicine saying their study findings should leave governments, healthcare organisations and public health professionals in no doubt over the scale of COVID-19 survivors who will need care for a variety of psychological and physical symptoms.

Until recently, few studies have evaluated patients’ health after recovering from the Coronavirus. To better understand the short- and long-term health effects of the virus, the researchers examined worldwide studies involving unvaccinated patients who recovered from COVID-19.

According to the findings, adults, as well as children, can experience several adverse health issues for six months or longer after recovering from COVID-19.

The researchers conducted a systematic review of 57 reports that included data from 250,351 unvaccinated adults and children who were diagnosed with COVID-19 from December 2019 through to March 2021. 

The researchers analyzed patients’ health post-COVID during three intervals at one month (short-term), two to five months (intermediate-term) and six or more months (long-term).

According to the findings, survivors experienced an array of residual health issues associated with COVID-19. Generally, these complications affected a patient’s general wellbeing, mobility or organ systems. 

Overall, one in two survivors experienced long-term COVID manifestations and the rates remained largely constant from one month through to six or more months after their initial illness.

Issues with general wellbeing, mobility, neurological impacts and mental health disorders all featured heavily in the long-term symptoms. 

“These findings confirm what many health care workers and COVID-19 survivors have been claiming, namely, that adverse health effects from COVID-19 can linger,” said co-lead investigator Vernon Chinchilli, chair of the Department of Public Health Sciences. 

“Although previous studies have examined the prevalence of Long COVID symptoms among patients, this study examined a larger population, including people in high-, middle- and low-income countries, and examined many more symptoms. Therefore, we believe our findings are quite robust given the available data.”

“The burden of poor health in COVID-19 survivors is overwhelming,” said co-lead investigator Dr. Paddy Ssentongo, assistant professor at the Penn State Center for Neural Engineering. 

“Among these are the mental health disorders. One’s battle with COVID doesn’t end with recovery from the acute infection. Vaccination is our best ally to prevent getting sick from COVID-19 and to reduce the chance of Long COVID even in the presence of a breakthrough infection.”

The mechanisms by which COVID-19 causes lingering symptoms in survivors are not fully understood. These symptoms could result from immune-system overdrive triggered by the virus, lingering infection, reinfection or an increased production of autoantibodies. 

According to the researchers, early intervention will be critical for improving the quality of life for many COVID-19 survivors. They said that in the years ahead, healthcare providers will likely see an influx of patients with psychiatric and cognitive problems, such as depression, anxiety or post-traumatic stress disorder, who were otherwise healthy before their COVID-19 infection. 

Based on these findings, healthcare providers should plan and allocate resources accordingly in order to effectively monitor and treat these conditions, the team said. 

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A Chance for Life extends neurorehab in the North

The move will extend the range of patient services in the area and improves patient journeys

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Neurological physiotherapy provider Neurocare Physiotherapy now falls under the umbrella of complex case management and rehabilitation specialist A Chance for Life. 

The move extends the range of patient services in the North and improves patient journeys, too.

There is an inevitable challenge for any organisation delivering neuro rehab. With such a wide range of conditions to treat, it can be difficult for any organisation to build a pool of expertise large and diverse enough to service them all.

But Louise Chance, founder of A Chance for Life Ltd, the specialist in rehabilitation support work, case management, physiotherapy, occupational therapy and medico-legal reporting, has found a solution to that challenge.

Louise has combined her team’s capabilities with those of Lancashire-based Neurocare Physiotherapy. 

For almost two decades, Neurocare Physiotherapy has treated patients across the North West of England for neurological conditions such as stroke, multiple sclerosis (MS), Parkinson’s, foot drop, head injury and other disorders.

For much of that time, A Chance for Life has worked in a similar space from its base in Penrith, providing support for clients who often have a variety of social, physical, mental and vocational needs.

Louise saw an opportunity to bring the two organisations together: “We saw that what we do and where we do it dovetails nicely.

“Being able to expand the range of care we offer across the North of England and Southern Scotland is so important, because it means our clients can access more of the support they need from a single source.”

Get in touch to find out more on 01768 891709.

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