Select Committee on Health Third Report


  (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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