SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS
(i) We have managed to look at some key
issues, but we believe that this is an area which would benefit
from a wider inquiry (paragraph 2).
(ii) We recommend that the DoH finds
ways of improving the methods of data collection on incidence,
prevalence and severity of head injury and subsequent disability,
as a matter of urgency. In particular, we recommend that all health
authorities are required to collect data on head injury and that
an estimate of the incidence and prevalence of head-injury informs
planning (paragraph 12).
(iii) We recommend that the statutory
services re-evaluate their procedures to ensure greater involvement
of the families of head-injured people in the person's recovery
and rehabilitation, and the provision of support systems for the
families independently of the treatment of the head-injured person
(paragraph 22).
(iv) It is imperative that people with
a suspected brain injury are assessed by specialist staff and
nursed in a location appropriate to their needs (paragraph 24).
We recommend that guidance should be issued to all acute trusts
to ensure that head-injured people are treated, as soon as possible
after medical stabilisation, in appropriately resourced rehabilitation
beds where specialist rehabilitation staff can care for them and
begin their rehabilitation interventions. This may require extra
resources, but we believe this course of action will yield long
term savings, as well as benefits to patients (paragraph 25).
(v) We recommend that all health authorities
and trusts plan care pathways for head-injured people so that
they can move through the system as quickly as is appropriate,
thus releasing acute beds for other patients and increasing their
own potential to improve. It may also be necessary to increase
capacity of specialised staff. To do these things health authorities
and trusts must improve their data on the incidence and prevalence
of head injury in their catchment area, by better collation and
maintenance of data (paragraph 26).
(vi) We recommend that the Government
requires the statutory services to improve their supply of information
on head injury to head-injured people and their families; such
information should be given to these people in written and verbal
form during their stay in hospital, should be available to GPs
and should include the literature produced by Headway-the Brain
Injury Association (paragraph 28).
(vii) We recommend that the acute sector
takes responsibility for planning the onward care journey of a
head-injured person on discharge from the hospital, and issues
care plans to patients and families of patients which make clear
where they should go next (paragraph 29).
(viii) The lack of community support
and care networks to provide ongoing rehabilitative care is the
problem area that has emerged most strongly in the written evidence
(paragraph 30).
(ix) We recommend that health authorities
and trusts plan care pathways for seriously head-injured people
and locate tertiary facilities which they can be sent to if need
be, without delay. These facilities must be well-regulated to
ensure standards of care are high and appropriate for head-injured
people. Patients should only be referred on to such facilities
after skilled assessment by specialised rehabilitation staff with
expertise in brain injury, in the hospital (paragraph 31).
(x) Mental health services, including
medication, should be offered to head-injured people when, and
only when, appropriate, and such intervention should be directed
by a neuropsychiatrist (paragraph 32).
(xi) We recommend that the DoH allocates
more of the R&D budget to research into traumatic brain injury
rehabilitation (paragraph 41).
(xii) There is very little vocational
rehabilitation available in the UK (paragraph 45). We recommend
that the Government learns from the work that has already been
done on helping people with complex neurological disorders back
into work, and formulates vocational rehabilitation services with
sufficient flexibility to be of real help to these people as well
as those with physical disabilities (paragraph 46).
(xiii) We recommend that those assessing
brain-injured people for disability living allowance have specialist
skills which enable them to understand the complex combination
of physical, cognitive and behavioural impairments characteristic
of this type of neurological disability; and that the assessment
process is adjusted to allow the input of a patient's advocate,
be it a carer, relative or case manager (paragraph 48).
(xiv) We recommend that health authorities
are required to provide rehabilitation in the community which
includes the needs of neurologically disabled people who have
a combination of physical and cognitive impairments. We further
recommend that DoH takes responsibility for the long term rehabilitation
of head-injured people and consults with members of the professional
rehabilitation community on the best shape of such services (paragraph
50).
(xv) Most GPs have a very limited understanding
of the realities of head injury and its consequences, and so may
not pick up on the needs of head-injured people. We recommend
that GPs are made aware of the nature of head injury and of the
services which are available to cater for head-injured people,
and that these services are made accessible through primary care
not just through emergency acute care(paragraph 51).
(xvi) We recommend that every head-injured
person admitted to hospital should leave hospital with a clear
care plan mapped out for him or her. The trust will need to be
able to access the services of a manager with a remit to co-ordinate
brain injury services in order to plan services in this way (paragraph
51).
(xvii) We recommend that social services
departments use an additional classification of user group, to
plan services, which explicitly includes complex neurological
problems such as those resulting from head injury. We believe
that the Community Care Plan should have a section within which
these problems are explicitly considered (paragraph 55).
(xviii) We recommend that health authorities,
trusts and local authorities are required to put in place a case
management or equivalent system which gives head-injured patients
and carers an identifiable guide and advocate through the whole
care pathway (paragraph 59).
(xix) We recommend that every NHS trust
should be required to identify a named manager with responsibility
for rehabilitation services for head-injured people. He or she
should liaise with services, case managers and patients to help
coordinate the service with the need (paragraph 60).
(xx) We recommend that the statutory
services recognise the contribution in this field of the independent
sector, and that they collaborate actively with them to provide
the best possible service for the patient (paragraph 67).
(xxi) We recommend that the DoH should
help charitable organisations, where they are providing core services,
to develop these services further (paragraph 69).
(xxii) We recommend that responsibilities
to provide different kinds of rehabilitation are defined between
health and social services, and that named managers are identified
within both health and social services departments. We further
recommend that health and social services departments collaborate
locally to map out care pathways for head-injured people with
clearly allocated responsibility at each level of care. These
care pathways should include agreements with services out of the
catchment area if the service is not provided within the catchment
area of the health authority (paragraph 73).
(xxiii) We recommend that the Government
subsidises a publication of all resources available to head-injured
people and circulates this to health authorities (paragraph 75).
(xxiv) We recommend that Health Improvement
Plans and Community Care Plans have a section for planning services
which will include the rehabilitative services needed by those
with complex neurological conditions such as head injury (paragraph
76).
(xxv) We recommend that the Government
makes explicit the level at which responsibility for planning
different levels of rehabilitation for head injury should be located
(paragraph 78).
(xxvi) While we can appreciate that the
scoping of the NSF for long term conditions is yet in its early
stages, we would ask Ministers to clarify whether or not it will
include rehabilitation for head-injured people. As the NICE guidelines
do not appear to be relevant to long term rehabilitation, some
assurance is necessary that consideration of this area will enter
into some policy work as a matter of urgency (paragraph 84).
(xxvii) We recommend that the Government
spells out clearly what steps it will take to improve the situation
in the provision of rehabilitation services for head-injured people,
and that it instigates plans for action which will come into place
long before 2005 (paragraph 85).
(xxviii) We believe that the Government
cannot rely on intermediate care to provide comprehensive rehabilitation
services to head-injured people. Given the problems surrounding
the NICE guidelines, the NSF on long term conditions, and intermediate
care, we recommend that the Government with urgency formulates
policy which does cater for the long term rehabilitation of head-injured
people (paragraph 87).
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