To achieve the best level of recovery, people will – as appropriate – need specialist rehabilitation and support services across the whole care pathway – that is, starting at the acute stage, then as an inpatient, and later in the community.
Where people after a brain injury have complex needs, they will require specialised inpatient neurological rehabilitation, often followed by day- patient or community rehabilitation, in order to achieve maximum levels of recovery. For these gains to be maintained, they will also need knowledgeable/specialist support in the community. This will often be long term, sometimes life-long, and, as identified in the NSF for Long Term (Neurological) Conditions, will require integrated working between Health and Social Services with involvement from other agencies as appropriate.
With the right interventions – and, importantly, long-term follow-up and support and encouragement – the person can be helped to be as independent as possible, and to have a good quality of life.
Currently there are shortages of provision – in terms of expertise and capacity – in rehabilitation at all levels, and a lack of recognition that impairments following brain injury often require long-term support.
Without appropriate rehabilitation and follow-up support services, people will continue to “fall through the gaps” in service, and are at risk of relationship breakdown, homelessness, alcohol and drug dependency, or finding themselves in the criminal justice system.
The right rehabilitation at the right time saves money
Published studies clearly show that by providing the right rehabilitation at the right time, the savings made offset the costs, even when rehabilitation is not carried out immediately after injury. Over what is often a normal lifetime, optimal recovery results in significant savings to healthcare and also very significant reductions in other costs.
Providing the right rehabilitation and support at the right time can result in substantial cost savings – but this often means spending money in one area to provide greater savings in another! Two obvious examples are:
- if people who have had a mild-to-moderate brain injury can be helped to retain their existing job or return to paid work in some other way, the savings to the exchequer will by far outweigh the cost of the interventions.
- If people who would otherwise find themselves in, or would return to, the criminal justice system can receive the necessary rehabilitation and be supported to live in the community, the cost savings will be substantial.
Other situations are, of course, more complex, and thus it is less straightforward to demonstrate cost savings, but there is a strong evidence base that if the right interventions are made at the right time, then the cost savings can be substantial – and the quality of life optimised for survivors and their family and carers. However, this needs joined-up thinking and working to achieve the necessary outcomes – as outlined in the NSF.
Some relevant publications are:
Life After Brain Injury. A Way Forward. Manifesto for Acquired Brain Injury. The United Kingdom Acquired Brain In jury Forum (UKABIF). 2012.
Turner-Stokes L. Cost-efficiency of longer-stay rehabilitation programmes: Can they provide value for money? Brain Injury. 2007; 21 (10): 1015-1021.
Turner-Stokes L. Evidence for the effectiveness of multidisciplinary rehabilitation following acquired brain injury: A synthesis of two systematic approaches. Journal of Rehabilitation Medicine 2008; 40 (9): 691-701.
Turner-Stokes L, Paul S and Williams H. Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injuries. Journal of Neurology, Neurosurgery & Psychiatry 2006; 77:634-639.
Wood R L, McCrea J D, Wood, L. M et al. Clinical and cost effectiveness of post-acute neurobehavioural rehabilitation. Brain Injury 1999; 13 (2): 69-88.
Worthington A D, Matthews S, Melia Y et al. Cost-benefits associated with social outcome from neurobehavioural rehabilitation. Brain Injury 2006; 20 (9): 947-957.
Michael Oddy, & Sara da Silva Ramos. The clinical and cost-benefits of investing in neurobehavioural rehabilitation: A multi-centre study. Brain Injury, 2013; 27 (13–14): 1500–1507.
Feeney, T; Ylvisaker, M; Rosen, B H; Greene, P. Community Supports for Individuals with Challenging Behavior after Brain Injury: An Analysis of the New York State Behavioral Resource Project. Journal of Head Trauma Rehabilitation: 2001; 16 (1); 61-75