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.