There continues to be a major concern relating to rehabilitation and support services in the community, which will need to be long-term – often life-long – for a significant proportion of those sustaining a brain injury. They should ideally be part of an integrated system with Social Services.
Community rehabilitation services
Although there are some very good services available, provision varies markedly across London. It is effectively a ‘post code lottery’. This should be a priority for CCGs.
Without effective, specialist services available to all who need them, the whole care pathway will continue to be compromised, as well of course as the effects on survivors and their families/carers. And this also does not take into account the costs to society, which could be reduced with the right rehabilitation and support at the right time.
Community brain injury rehabilitation services need to be specialist and interdisciplinary in nature – they need to include:
- specialist physiotherapy, occupational therapy (OT), speech & language therapy (SLT) and neuropsychology;
- support from rehabilitation consultants; and
- input as necessary from neuropsychiatry, neurology and endocrinology
They should ideally be part of an integrated system with Social Services. Such services could be specific brain injury rehabilitation services or within broader neurorehabilitation services (with a specific brain injury element). People should be able to be re-referred seamlessly to such services when their circumstances change.
There is also a need for greater attention and resources to be devoted to the support of the family members/carers providing ongoing care and support to the survivor. They will need initial and follow up education and training, as well as respite, and ongoing support from the relevant healthcare specialists involved in community rehabilitation.
Commissioning arrangements will need to address such matters as the specialisms needed and the capacity of the services in terms of number of staff in relation to the population they serve.
Support through Local Authority Social Services
There also needs to be follow-on support through Social Services to enable the maintenance and consolidation of gains made through community rehabilitation. This will typically involve the use of trained support workers through Direct Payments/Personal Budgets.
It is important that the assessment process involves people with an understanding of the often subtle and hidden effects of brain injury, including importantly a lack of insight on the part of the person as to how their injury has affected them. This will in many cases require the support of an advocate – for example, family member or Headway representative – during the assessment process.
In this overall context, useful tools have been produced:
– the Brain Injury Needs Indicator (BINI) –has been developed by the Brain Injury Rehabilitation Trust – see http://www.thedtgroup.org/brain-injury/information-for-professionals/the-brain-injury-needs-indicator-(bini).aspx and http://www.thedtgroup.org/media/427268/BIRT%20-%20Brain%20Injury%20Needs%20Indicator%20-%20BINI.pdf
Practice Guidance for Social Workers working with people where there may be an Acquired Brain Injury – developed by the Brain Injury Social work group – http://www.biswg.co.uk/files/3814/6676/7620/ABI_Practice_Guidance_BISWG.pdf