Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Headway Bristol (H27)


  1.  Lack of funding for the Private Finance Initiative Brain Injury Rehabilitation Unit

  2.  Lack of consultation by Avon Health or North Bristol NHS Trust with local Headway Group who had the knowledge and experience to help when setting up new units

  3.  Lack of experienced staff at rehabilitation units

  4.  No seamless service

  5.  No Clinical Psychologist available

  6.  Non acceptance of strategic plan for brain injury by Avon Health

  7.  Difficulty of funding from Social Services


  1.  More funding for brain injury rehabilitation

  2.  A further brain injury rehabilitation in-patient unit be set up in addition to the PFI

  3.  Appointment of a Rehabilitation Consultant to present the seamless service

  4.  Urgent appointment of a Clinical Psychologist

  5.  Urgent action by Avon Health on the strategic plan already presented

  6.  A greater liaison between Health and Social Services

  7.  Consultation with Headway who have a great deal of knowledge and experience


  1.  The first Private Finance Initiative, Frenchay Brain Injury Unit, was set up at Frenchay Hospital. Since opening it has been almost empty most of the time because Avon Health has, until recently, only funded four out of the 27 beds. However, because of pressure, this has now been increased to eight. Lack of funding is the biggest problem with this unit.

  2.  There are now at least six patients on the waiting list and it has to be said that there is little appropriate rehabilitation outside this unit. Why are more beds not purchased by Avon Health Authority—is it lack of resources or commitment on their part? Maybe there should be a separate rehabilitation inpatient service post acute care set up in Avon for brain injured survivors.

  3.  The Medical Director, appointed when the unit opened, resigned a short time after and staff have been continuously leaving. Why are they leaving, we are never told but those leaving tell us it is bad management? We feel it is a mixture of the way the unit was set up, lack of number of patients, lack of training for staff to understand the brain injured, the original criteria of admission and the poor management.

  4.  The unit was set up for behaviour difficulties because this service had cost Avon Health a great deal of money using specialised units in Northampton. Had Headway been consulted it could have advised that the number of patients with behavioural difficulties were getting less and less. In fact over the past four years we know of only four head injured who have had severe behavioural difficulties.

  5.  Whilst the criteria for admission to the unit has now changed it is felt so much has been lost, such as time, patients not having good rehabilitation, families coping with the fact there is no room for their loved ones because of funding plus, the loss of good therapists. Therefore, it is felt that the unit was set up and has been used inappropriately.

  6.  There was a lack of consultation with Bristol Headway at the setting up stage and since, even though they had the knowledge and experience to help.

  7.  At Headway House, where we undertake social rehabilitation and stimulation we have had very little bad behaviour because the patients are treated as normal, are loved and wanted. Like everyone else, if this happens they are usually not unreasonable. Added to this professional rehabilitation is necessary. It can and does work and Headway can provide many examples of good recovery with this menu. The NHS should be able to provide the rehabilitation.

  8.  The Leonard Cheshire Home, in the grounds of a small local hospital, has NHS patients but has social problems; the patients are lonely because having lived in active wards they are now in their own rooms, with little company. Headway House takes three patients from this unit for the Sensory Day so we have feedback from those able to communicate and from relatives.

  9.  This unit was again set up without consultation with Headway who had the expertise and knowledge of how head injured patients would react to circumstances and surroundings. The patients are many years out of their accidents and have bad contractures and speech problems. Most have had no physiotherapy and certainly no speech therapy for many years. The families, as well as the patients are becoming despondent. Maybe it is too late for these patients but Headway is providing as much as they possibly can. Please bear in mind the feelings of these families when their loved ones have been passed over and are still being passed over for any rehabilitation at all. The Cheshire Home provides good care and tries very hard but these young people suffer from lack of understanding and lack of trained staff have added to difficulties.

  10.  We talk of a seamless service when in the Avon Health area it is fragmented with no one who seems able to bring it all together. We have good services but they are not working with each other. It is understood that they are considering employing a person for a Pathway of Care for Brain Injured patients, this should improve the situation.

  11.  Previously I have talked about severe to moderate head injury but I have omitted, as do most Health Authorities, mild head injury. The small bump on the head, which can result in a family man finding it difficult to cope with his job, unable to cope with his children and any noise they make and a wife trying to live with what is now a different husband. I would refer to two research articles Thornhill et al, (2000) Disability in young people and adults one year after head injury: prospective cohort study, BMJ: 320: 1631-5, Shoumitro (1999) ICD—ten codes detect only a proportion of all head injury admissions, Brain Injury: vol 13, no 5, 369-373). My own personal experience confirms the findings.

  12.  There is the Head Injury Therapy Unit, a day unit for rehabilitation, where again it is difficult to be accepted. The number of patients dealt with at this unit is very small and it takes from such a wide area. It is run by a trained Clinical Psychologist who spends little time at that job because she manages the unit and is responsible for 12 part time staff, which is not providing the appropriate care to its patients.

  13.  At Frenchay Hospital, apart from the Clinical Psychologists at the Brain Injury Unit and the Head Injury Therapy Unit, we have no general Clinical Psychologist. It is left to Headway to assist families who beg for someone to counsel their loved ones who find life difficult. 15 years ago we had a Clinical Psychologist who, when he left, was never replaced. A Clinical Psychologist is a necessity with the brain injured and their cognitive problems.

  14.  For all that has been provided and put in place the majority of brain injured and their families are worse off than they were 15 years ago.

  15.  Provision made with good intentions by the Department of Health and the North Bristol NHS Trust over the past ten years are:

  Good Neurosurgery

  Good Intensive Care Unit

  Head Injury Therapy Unit—Day Patient

  Brain Injury Rehabilitation Unit—Private Finance Initiative

  Barbara Russell Children's Unit—in patient

  Cheshire Home—Cossham Gardens—Home for life

  It sounds a good service and many Headway Groups are envious of the services we have but the fragmentation makes a seamless service almost an impossibility.

  16.  The Neurosciece Department at Frenchay Hospital prepared and researched a strategic plan for brain injury and presented it to Avon Health almost a year ago, it has not been implemented. No one seems prepared to tell the families why. Those at Frenchay dealing with brain injuries are becoming despondent as well as the families.

  17.  Headway Houses are providing social rehabilitation and stimulation for the brain injured in a structured and happy environment. However, Health and Social Services are still not working together, as they should. It is becoming a battle to get a small contribution from Social Services in a lot of cases and when several unitary authorities are involved the position is even worse. We have no difficulty with Bristol City and North Somerset but a great deal of difficulty with South Gloucestershire.

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Prepared 3 April 2001