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Neurorehabilitation Services Continue To Be Inadequate : Evidence Mounts But Still No Action

MPs at today’s Westminster debate on Acquired Brain Injury (ABI), heard Chris Bryant MP, Chair of the All-Party Parliamentary Group (APPG) on ABI highlight the poor state of UK neurorehabilitation services, with only 40% of individuals in Major Trauma Centres receiving specialist in-patient neurorehabilitation, a shortfall of 330 beds, and a lack of health professionals including consultants in rehabilitation medicine.

In September 2018 the APPG on ABI published a report ‘Acquired Brain Injury and Neurorehabilitation – Time for Change’ which called for immediate action to address the issues surrounding neurorehabilitation for children, young people and adults with ABI in the UK.

Neurorehabilitation is one of the most cost-effective interventions available to the National Health Service (NHS). The report ‘Specialist Rehabilitation following Major Injury (NCASRI)’ published in April this year found that in a group of 1381 individuals assessed as requiring specialist rehabilitation, only 40% received it. Those who did receive specialist rehabilitation did well, with 94% becoming more independent in their activities of daily living, which in turn reduced the costs of on-going care by an average of £536 per week.  Extrapolated over their lifetime, the average net life-time savings from neurorehabilitation amounted to just over £500,000 per patient, meaning that the total savings generated from this study group was £582 million.

The cost of meeting the shortfall of 330 rehabilitation beds was estimated at just
£53 million per year, which would still generate net savings in excess of £500 million per year in longer-term care costs.  It is no longer a question of whether the government can afford to meet this shortfall in trauma rehabilitation beds – but whether it can afford not to.

Commenting on behalf of the British Society of Rehabilitation Medicine (BSRM), and as Director of the UK Rehabilitation Outcomes Collaborative (UKROC), Professor Lynne Turner-Stokes said: “There is now substantial and robust evidence to support the clinical and cost-effectiveness of neurorehabilitation.  Although individuals with complex needs following ABI may need a longer stay in hospital, the front-loaded cost of providing early specialist rehabilitation is rapidly offset by the longer-term savings in the cost of community care, making specialist rehabilitation for these individuals one of the most cost-efficient interventions in healthcare.  Moreover the benefits for patients and their families are immeasurable.  The NHS can no longer ignore the mounting evidence, and the BSRM is demanding improved in-patient and community service provision.”

Dr Andrew Bateman, Chair of the United Kingdom Acquired Brain Injury Forum (UKABIF) said: “The excellent advances in emergency and acute medicine mean that individuals now survive with an ABI, but many require early and continued access to rehabilitation to optimise their recovery and maximise their long-term potential.  The services and expertise are just not available which is extremely short-sighted on the part of the NHS, and hugely detrimental long-term for individuals with ABI.”

Notes:
Specialist Rehabilitation following Major Injury (NCASRI) Final Audit Report April 2019

https://www.kcl.ac.uk/cicelysaunders/about/rehabilitation/National-Clinical-Audit-

www.kcl.ac.uk
The National Clinical Audit of Specialist Rehabilitation for Patients with Complex Need following Major Injury is a major national clinical audit.. It has been commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and is funded by NHS England and the Welsh Government.

 

The NCASRI audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England, ran from 2015-18 and was led by Professor Lynne Turner-Stokes at Northwick Park Hospital, London.  The audit was implemented because it was acknowledged that:

  • Rehabilitation had been overlooked in the initial planning and development of the major trauma networks
  • There was a lack of information on the extent of current service provision and how specialist rehabilitation units integrated with the acute trauma services
  • Existing service capacity was insufficient to meet demand, but very little information was available about the rehabilitation needs of severely injured patients or how well these needs were being met

Acquired Brain Injury and Neurorehabilitation – Time for Change

https://www.ukabif.org.uk/campaigns/appg-report/

The report, published in October 2018 by the APPG on ABI, was the result of a series of meetings with experts about the issues surrounding the provision of neurorehabilitation services for children, young people and adults with ABI in the UK, focussing on education, criminal justice, sport-related concussion and the welfare benefits system.

The key neurorehabilitation recommendations were:

www.ukabif.org.uk
UKABIF is a registered charity number 1128284 and a company limited by guarantee registered in England and Wales Company Number: 6520608. Address of the Company’s Registered Office: 40 Holborn Viaduct, London, EC1N 2PZ.
  1. Rehabilitation Prescriptions should be available to all individuals with an ABI on discharge from acute care, held by the individual with copies made available to the general practitioner
  2. A national review of neurorehabilitation is required to ensure service provision is adequate and consistent throughout the UK
  3. The Government should collate reliable statistics for the number of individuals presenting at Accident and Emergency Departments with ABI, and record the numbers that require and receive neurorehabilitation.
  4. There should be a significant increase in neurorehabilitation beds and neurorehabilitation professionals so that every trauma centre has a consultant in rehabilitation medicine, and individuals with an ABI have access to neurorehabilitation
  5. Cooperation between key government departments (i.e. the Department of Health and Social Care and the Department for Work and Pensions) is required to review funding for in-patient and community neurorehabilitation services

APPG on ABI

Formed in 2017 to raise awareness of ABI, the APPG on ABI is a voice for those who are not always heard in Westminster and beyond, raising key issues across health, social care and welfare and seeking improvements in support and services for people directly affected by ABI, and for their families and carers.