Memorandum by Jos Kerkvliet (H49)
1. I am a Consultant Clinical Psychologist
and Manager of the Community Brain Injury Team, which covers the
Medway Swale area in the North of Kent (population: 325,000).
My other responsibilities include working with patients with adjustment
difficulties in relation to chronic physical disabilities, like
MS. I have management responsibility for other Psychology staff
who work with Chronic Pain, and with amputations.
2. The Community Brain Injury Team has been
in existence since April 1996. It was purchased in response to
increases in the ECR budget of the Health Authority. The aim was
to prevent as many out-of-area referrals as possible, estimated
to be about seven every year. The ECR's were mostly people with
severe head injuries.
3. The team is small, the budget is about
£150K per year. Most staff are part-time. We have a neuro-physiotherapist,
an occupational therapist, a speech and language therapist, clinical
neuro-psychologist, an assistant and a secretary. We have input
from a doctor and the Consultant in Rehabilitation Medicine.
4. The team accepts referrals of patients
between the ages of 16 and 65 with head injuries, strokes and
other non-degenerative brain damage, like treated and stable tumours
or people with anoxic or toxic brain injury. Every year we deal
with about 50 appropriate referrals. Most of our patients are
between 40 and 65, and have had a stroke. Our most complicated
and time consuming patients are young people with traumatic brain
injuries, mostly under the age of 40. The latter also require
an intensive collaboration with Social Services Care Managers.
Our involvement with the traumatic brain injury patients often
stretches into years.
5. We have often been able to support our
Health Authority in monitoring patients who have needed out of
area treatment in specialist centres. With our expertise we have
been able to advise them on appropriate length of stay and available
resources on return back to our local community. We have been
funded by the Health Authority to provide some treatment, but
mostly teaching to staff in local Nursing Homes, which look after
patients with severe head injuries. These people are often considered
to be in a Vegetative State, although we believe Low Awareness
state is a more appropriate term to use.
6. From our experiences we draw some of
the following conclusions about our own service.
Strengths: (a) We provide a local service,
easily accessible for patients and their families, also after
entitial discharge we can become re-involved when needed.
(b) The team sees a variety of patients,
which keeps the work interesting and burn out for staff low.
(c) Our involvement with patients with traumatic
head injuries can be very long term allowing us to progress with
them to new levels of independence and accommodate life changes
in their families.
(d) Personality changes take a long time
to adjust to, particularly for relatives (partners and children)
and our long-term commitment has helped to keep families together.
Weaknesses: (a) We do not see children.
(b) Eldery people with head injures are not
seen by us.
(c) Other neurological conditions, which
would benefit from the same multidisciplinary goal setting approach,
are relatively neglected. A model of good practice in one area
does not automatically lead to good practice in a closely related
(d) There are no day facilities in our area.
7. We would like to make the following recommendations:
A. People with head injuries rely heavily
upon good working relationships between Health and Social Services.
They often need carers from Care Agencies. Our experience is that
we keep training carers in the specific needs of this client group,
but the turn over of staff in these agencies is enormous. We would
benefit from an opportunity to tie carers to this client group
and have less wastage of training efforts. Despite excellent relationships
with our Care Manager colleagues, we have not managed to find
our way through the rules and regulations surrounding the employment
of Carers through Care Agencies.
B. Similarly, our efforts in training nursing
staff in Nursing Homes are often lost through staff turn over.
The problem here seems to be more that Nursing Homes are sometimes
very business orientated, and staff get disheartened by the lack
of resources available for this patient group. Registration of
Nursing Homes is powerless to change the conditions in the homes
in a fundamental way. In our opinion they need more and more powerful
tools to intervene in these homes.
C. People with head injuries often experience
crisis in their personal lives, early on, in the first two years,
of their rehabilitation. They may not require Residential or Nursing
Home care, because socially they can be appropriate with relative
strangers and they do not require physical care. In their intimate
relationships, however they may be impulsive and perseverative,
leading to enormous stress and the risk of marital break up. We
would like to see initiatives to enable the creation of Foster
Families, where people with these personality changes can have
a period of refuge and the family of origin can have a breathing
space. Social Services and the Voluntary sector could be actively
encouraged to explore this option. A team like ours could provide
the training for the Foster Families to be and help with selection.